Time to A.C.T.: implementing strategies for breast cancer control in Africa
Breast cancer is the most common cancer in women in both high- and low-resource settings. Although widely recognized as a significant public health concern in developed nations, breast cancer is becoming an increasingly urgent health issue in low and middle-income countries (LMICs). Both incidence and mortality in LMICs continue to increase, and the majority of breast cancer deaths now occur in developing nations. Global disparities in breast cancer mortality persist due to inequities in access to early detection and curative treatment. This study was developed in response to the expressed desire of our in-country partners to address the growing burden of breast cancer in the communities in which we currently work to prevent cervical cancer. The Mwanza region of Tanzania is the ideal setting for this research because of the enormous momentum to build cancer control programs. The region’s Bugando Medical Center (BMC) is being developed as the nation’s second private cancer hospital, serving approximately 13 million people and yet there is currently no coordinated plan to engage the target population, shift the focus to early detection, and overcome barriers along the breast cancer control continuum. Thus, recognizing the importance of evidence to inform action, we propose research methods from the emerging field of implementation science to Assess (local context), Couple (strategies to context), and Test (implementation strategies) within a larger effort to scale-up breast cancer programs in Tanzania. The overarching goal of the multidisciplinary “Time to ACT” study is to improve the outlook for breast cancer by identifying, implementing, and evaluating evidence-based strategies for breast cancer control and care that take into account the local setting, perspectives of women and clinicians, and make the best use of available resources. Beyond the local impact in Tanzania, this study will have a global impact on breast cancer by producing a standardized way to link strategies to local context in order to identify programs that are feasible, sustainable, and can accommodate changing resources.