Open AccessDeveloping a Breast Fine Needle Aspiration Biopsy Service in Peru
Author(s) -
Diang,
Britt–Marie Ljung,
Ricardo H. Bardales,
Milagros Abad,
Manuel Cedano,
Tara Hayes Constant,
Jennifer L. Winkler,
Ronald Balassanian
Publication year - 2016
Publication title -
journal of global oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.002
H-Index - 17
ISSN - 2378-9506
DOI - 10.1200/jgo.2016.003897
Subject(s) - medicine , breast cancer , referral , fine needle aspiration , curriculum , cancer , biopsy , family medicine , radiology , psychology , pedagogy
6 Background: Breast cancer incidence is increasing in developing countries. In 2010, 57.8% of breast cancers in Peru were at least stage III at diagnosis. Federal and regional Peruvian institutions partnered with several organizations, including UCSF, to improve access and quality of breast cancer care in Peru. Phase 1 involved screening with clinical breast exam, creating a community-based referral system for women with masses, and promoting evaluation of lesions using fine needle aspiration biopsy (FNAB) by trained physicians, with treatment at the regional cancer institute. Curricula for each activity were developed and validated. During phase 1, in-country FNAB expertise was recognized as limited. For phase 2, the critical objective was to solidify local capacity for high-quality FNAB and integrate FNAB into standard of care for breast cancer.Methods: Three main activities were completed during phase 2. 1) Develop a Training of Trainers (ToT) curriculum for FNAB, and identify master trainers and trainees. 2) Facilitate endorsement of a national approach to training FNAB and undertake preliminary rollout in La Libertad region. 3) Strengthen interpretation and reporting of FNAB results.Results: A 5-day ToT pilot course occurred during October 19-23, 2014. Prior to the course, women with palpable masses were identified during a breast screening campaign and scheduled for FNAB. Regional, national and international clinical teams observed, procured and interpreted FNAB. Four new cases of cancer and eight cases of granulomatous mastitis were diagnosed. Slide quality before and after the training intervention will be compared. Following the course, a one-day validation meeting including physicians and national leaders took place at the national cancer center in Lima, Peru. FNAB was endorsed for early diagnosis and triage.Conclusions: To ensure sustainability of FNAB, cytology fellowships and training centers are needed. Strengthening partnerships will be critical for long-term capacity. An electronic reporting system will be developed to replace paper-based methods. Funding: Norwegian Cancer Society/Norwegian Breast Cancer Society (NCS/NBCS), Susan G. Komen for the Cure, The PATH Catalyst Fund.AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.