Breast cancer is one of the most common cancers affecting women in Nigeria. The Globocan 2020 report showed that breast cancer is the leading cause of deaths in the country, currently representing 23 per cent of all cancer cases and approximately 18 per cent of deaths.
Medical experts say late presentation for diagnosis and treatment account for the high mortality rate from breast cancer and other cancers in the country.
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They say timely intervention is critical to improving survival and reducing morbidity and mortality from cancers.
Ifeoma Okoye, a Professor of Radiation Medicine, College of Medicine, University of Nigeria Nsukka, said early detection still remained the best way to control breast cancer.
She said if detected early, with adequate diagnosis and treatment, there was a good chance of being cured.
Findings by Daily Trust on Sunday revealed that the development of a technological innovation called Bridge Application is helping to reduce delays in accessing breast cancer diagnosis and improving outcomes for women in rural areas.
The application was piloted through a study called the Feasibility and Acceptability of an M-Health Intervention to Improve Breast Cancer, called Bridge Study of the Institute of Human Virology (IHVN), Nigeria.
According to Dr Elima Jedy-Agba, the coordinator of the International Research Centre of Excellence (IRCE) of IHVN Nigeria, the Bridge App is a simple, innovative, clinic-based m-health patient referral service used by trained Community Health Workers (CHWs) in rural settings to promote early detection and reduce delays to the diagnosis of breast cancer in the country.
Dr Jedy-Agba, who is also the Principal Investigator of the Bridge study, said it was geared towards building the capacity of first contact health care workers, that is community health care workers on breast cancer, and to improve the referral process and shorten delays to diagnosis in Nigeria.
“If that period of delay is shortened, the women will present at an earlier stage that they are more likely to survive from breast cancer,” she said.
The Bridge app was developed in collaboration with the Seam Health group in Nigeria and the Department of Global Health Informatics at the Mount Sinai Hospital in New York, USA.
It was piloted at six Primary Health Care Centres (PHCs) in the Gwagwalada Area Council of the Federal Capital Territory (FCT).
It was funded by a grant from the CONQUER Cancer Foundation from the American Society of Clinical Oncology (ASCO).
She said as part of the funding for the study, they were able to buy Android-based smart-phones, which are being used by community health workers.
She said, “There are patient delays and the health system delays in accessing cancer care. The patient delay is from when a woman first recognises the symptoms to when she makes that first contact with the health care system.
“Then the provider delay or health care system delay is from when she makes that first contact with the health system till when she gets that first diagnosis of breast cancer.”
Explaining how the app works, she said it was actually targeted at provider delay.
“How soon will it take the woman to get the diagnosis after first contact with the health care system because the delay may be so long as women visit multiple providers like traditional healers and a lot of places?
“The app provides community health care workers with the symptoms and other things they need to look out for. There is also a video in the app that shows the community health worker how to conduct a clinical breast exam before the woman goes to the hospital. For example, if the woman comes with a breast lump or nipple discharge, they know that the woman needs to be seen at the referral hospital, which is the University of Abuja Teaching Hospital (UATH) within a month.
“At the PHC centres where they are not using the app, they may just send the women away without follow-up as to whether they go to the teaching hospital or not,” she said.
She added that with the app, once the health worker registers the patient, the nurse at the UATH automatically receives an alert on her coming and an appointment is immediately scheduled for her with the surgeon.
“Before we started using this app, we did a survey and found that community health workers had good knowledge of breast cancer but poor knowledge on how to conduct a clinical breast exam. So we developed the app and put in features that would be useful to them. So it helps women access care within the shortest possible time to reduce delay to diagnosis,” Dr Jedy-Agba said.
A patient, Dabit Luret Sylvanus, said the use of the app by health workers at the Gwako Primary Health Care Centre helped her to quickly access diagnosis for breast cancer.
She said, “It really helped me. I went for checkup and they used it and gave me a date. I went back and they now sent me for scan and x-ray. I didn’t experience any delay or stress at all in the whole process before I was diagnosed.”
She said the app should be provided to more facilities in the country to enable early detection of breast cancer in women.
Sharing his experience with using the application, a health worker at Gwako Primary Health Care, Okorie Nwabueze Ezekiel, said the Bridge programme was quite innovative because it gave health workers the opportunity to use such an app to carry out breast cancer examination at the primary health care level, identify cases and refer to the UATH, a tertiary facility, for diagnosis and treatment.
He said the programme began in February 2020 and he and other colleagues, including nurses, were trained on clinical examination of patients and how to use the Bridge application.
“The way the app is structured, it enables us to schedule a client for referral, and the staff at the UATH also get the situation of the client that has been scheduled for a visit at their centre,” he said.
While saying the programme was very effective and helped health workers do early diagnosis of breast cancer, Ezekiel said it also helped them to enroll quite a number of women with breast issues.
“When we clinically examine and enroll them, we refer them to the UATH and they undergo further examination like lab tests and x-rays.
“Those found with abnormal growth were booked for surgery while others were placed on drugs.”
Ezekiel, however, said though the app was innovative, there’s a need for some improvement.
He said one of the challenges he encountered when using the app was difficulty sometimes in accessing the stored records on it when he wanted to update the records.
He said, “It is either you can’t find the records you entered previously, or when you find them, the button to make an update is not working.
“At a point, it was difficult to open the app itself, so I notified them and they said it was a hitch and worked on it, but we still had challenges in between.”
He said another challenge was poor power supply in PHCs, so health workers had to resort to buying fuel to power generators and charge their phones to access the app.
In such case, he said, “Sometimes I take it to my friend’s barbing salon to charge.”
He said he did not experience poor internet network while using the app.
The health worker said a total of 24 patients were enrolled in using the app in his PHC.
“In all, it was a good experience. It was the first time PHC practitioners were exposed to breast examination tools. We wish that the programme is sustained, improved on and extended to other PHCs in the country,” he said.
He said some patients from the rural areas also complained of transport fares to the facility they were referred to, especially when multiple visits for diagnosis were required.
Gomina Jimoh, a nurse at the UATH, Gwagwalada, said the Bridge study helped improve the knowledge of health workers on breast cancer, and also helped them to provide timely diagnosis for patients from rural areas.
He said that through the app, patients were referred from Dobi, Gwako and Dukpa PHCs in Gwagwalada Area Council of the Federal Capital Territory (FCT) to their facility.
He said the study also helped PHCs provide enlightenment campaign about breast cancer diagnosis, prevention and treatment for rural dwellers.
“The PHCs register patients and refer them to our hospital. Then we book them to see the specialists and receive treatment without having to face the complications that come with delay.”
“The app has large storage and stores some very vital documents. It made it very easy for people to overcome delays in accessing care.
“The network was very fast, and we didn’t have any issues with the internet using the app. The phone was water-resistant and also has a good and clear camera for view,” he further said.
He, however, said when there was power outage and they were charging the mobile phone, they often had to put it off, and so, won’t use the app.
“It will be good to extend it to other area councils, and even outside Abuja. This is because people still have poor knowledge and access to diagnosis and care for breast cancer,” he added.
Dr Jedy-Agba said some of the key findings of the study were that the Bridge app actually worked and was useful in reducing delay.
She said previous studies showed that women spent about five to eight months roaming about from one place to another, but with the app, the period has really shortened.
She said, “Within one to three months at most, these women are able to see a surgeon at the UATH, and they are then given an appointment to get a biopsy and other care.
“Community health workers are also excited about the app because it is user-friendly.
“We are hoping to apply for funding to extend the research to other parts of the country.”
She said that while power supply was a challenge in rural areas, it had not disturbed work with the application.
This piece is with support from the Solutions Journalism Network and Nigeria Health Watch.