Identifying and treating serious breast problems in rural Bangladesh

In Bangladesh women, particularly those living in remote areas, have limited options for diagnosis and treatment of breast cancer. Socio-cultural, health system and economic elements discourage women from seeking treatment, leading to greater presentation with late stage disease. Whereas the majority of women in developed countries survive breast cancer, the opposite is true in countries such as Bangladesh. In 2006 a low cost woman-run breast exam clinic was piloted to provide an easily accessible, discrete and cost-free option for women to be examined for breast disease. Four additional clinics were set up with local partners in following years. These village-based clinics are linked with a breast specialty center in Khulna city where women with potentially serious breast problems are referred. Over 2000 women have been examined, counseled, treated or referred through these clinics. Of women referred to the breast specialty center, approximately 19% are ultimately diagnosed with breast cancer. This percentage exceeds case finding through routine screening efforts seen in other developing countries, suggesting that this may be an effective, low cost model for identifying and treating women with serious breast problems from remote areas. Challenges related to implementing these clinics and referral networks, patient characteristics, and recommendations for improving breast cancer diagnoses and treatment options for women in Bangladesh will be presented.