In Peru’s northern La Libertad Region lies the bustling metropolis of Trujillo, a city known for its moderate climate, pre-Columbian archaeological sites, and lively culture. The surrounding rural areas are also well known for their exports of artichokes, asparagus, sugar cane, and a variety of agricultural products.
By many accounts, La Libertad is a diverse region poised for growth. And yet, like many low- and middle-income areas around the world, access to health care services remains vastly unequal for its people.
In the case of women’s cancers, the burden falls more heavily on the region’s poor, marginalized, and rural women because of access disparities to screening and treatment.
Addressing the scourge of women’s cancers
PATH, for the past 25 years, has been addressing women’s cancers by developing and advancing innovative solutions around the world that help reduce the disparity in health service access. This work is as varied as a vaccination campaign in schools to reach and protect girls against human papillomavirus (HPV, the virus that causes most cervical cancers), or developing an HPV test as a low-cost alternative to Pap smears which allows women to collect their own sample for screening.
An area of growing concern is breast cancer. Breast cancer rates are increasing worldwide, but they’re growing faster in low- and middle-income countries like Peru. While the number of new cancers will increase 30 percent globally in the next 10 years (from 1.7 million per year to 2.2 million), they will increase 40 percent in Peru.
One way we can win the fight is to provide tools and best practices that can empower everyone in the health system, from individual women and health care workers to community health clinics and providers.
Detection + diagnosis + treatment = survival
Since 2011, PATH has been involved with an innovative community-based breast health program. It’s a layered approach that brings early detection, treatment, and support services closer to women in their communities.
The work is part of a major cancer initiative, collaborating with the Peru National Cancer Institute (INEN), the Regional Cancer Institute (IREN-Norte), and the Ministry of Health (MINSA).
The goal is to introduce and evaluate a new model of care for women in low-resource areas, based on community education, screening by clinical breast exam, diagnostic triage by fine needle aspiration biopsy and ultrasound, and referral to a regional cancer hospital.
What a difference empowerment can make
To screen for breast cancer, community health workers encourage women 40 and older to get annual clinical breast examinations. These exams are performed by midwives who follow a standardized and validated training process as they check their patients’ breasts for lumps or other changes. The system screens women in clinics and other facilities that are nearest to them.
If providers find anything suspicious during a clinical breast exam, they refer their patient for appropriate evaluation at a local hospital by a doctor who’s been trained to perform an ultrasound exam and, if necessary, perform a fine needle aspiration biopsy. Biopsies are sent to a pathologist for evaluation. When needed, the woman may be referred to the cancer center for final diagnosis and treatment. Along the way, volunteer patient navigators serve as a resource for the patient, answering questions and anticipating health care needs.
We can make an impact
At each step, a woman’s care and treatment is customized depending on her needs and tailored to the available human, financial, and infrastructure resources.
We can provide care and treatment for more women this way. By providing new tools and strategies, we’re empowering women, community health workers, local doctors, and specialist providers with valuable resources that can reach more people. It’s a strategy that’s meeting with success and saving lives.
Programs are supported by Norwegian Cancer Society/Norwegian Breast Cancer Society, Susan G. Komen for the Cure®, and individual donors.
careHPV is a trademark of QIAGEN.
- Tracy Romoser is a communications officer and the blog editor at PATH.