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. Late diagnosis vastly reduces women's chances of survival. And tragically, the women destined to die often lack access to palliative care, including medication that, for pennies, could relieve their suffering.
Addressing the scourge of women’s cancers
Community health care workers in Guatemala bring careHPV swab kits into homes, marketplaces, and factories—wherever they can find women who may need screening for cervical cancer. Photo: PATH/Xiomara Celeste Gonzalez.
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.
School girls in Peru who received their HPV vaccine. Photo: PATH/Jenny Winkler.
An area of growing concern is breast cancer, the leading cancer killer among women aged 20 to 59 years worldwide. 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.
Due to lack of services, poor access to the care that might exist, and scant information about breast health, women in poorer countries are far more likely to progress to advanced disease than women in the United States and Europe. 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
To better coordinate breast cancer screening efforts, providers along the whole continuum of care must understand the new methods being implemented. A pathologist in La Libertad learns how local midwives use clinical exams for breast cancer screening.
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.
“Showing women how to recognize potential danger signs and symptoms can really make a difference—when linked with access to treatment services and education about surviving breast cancer.”— Dr. Vivien Tsu, associate director, Reproductive Health Program at PATH.
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
Cancer survivors and their families are benefiting from the introduction of a new cancer health care model in Peru that is bringing services closer to women in their communities. Photo: PATH/Tara Hayes Constant.
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
The world is slowly waking up to the need to address noncommunicable diseases, including cancer, in low- and middle-income countries. The momentum is growing to tackle barriers to diagnosis and care, and there's broad recognition that the cost of inaction will be staggering.
PATH and others are pushing to identify low-cost approaches for early detection of cervical and breast cancer. 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. The key to success is integrating strategies and interventions into existing systems, developing strong partnerships within countries and across the world to find out what works, and, most important, ensuring that innovations are sustainable in local communities.
Programs are supported by Norwegian Cancer Society/Norwegian Breast Cancer Society, Susan G. Komen for the Cure®, and individual donors.
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