Strengthening national strategy to improve early detection of breast cancer in El Salvador

A project in El Salvador, funded through UICC’s Breast Cancer programme, and which aims to reduce breast cancer mortality rates in the country, has yielded encouraging results. In 2022, the Asociación Salvadore?a para la Prevención del Cáncer (ASAPRECAN) embarked on an ambitious initiative to improve early breast cancer diagnosis within the country’s public healthcare network.

The project, ‘Improving early diagnosis of breast cancer in a public healthcare network in El Salvador is overseen by Dr Lisseth Guadalupe Ruiz de Campos, President of the Association, and draws inspiration from a successful model in Peru.

Aligned with WHO's Global Breast Cancer Initiative, its primary goal is to increase the detection of breast cancer at earlier stages, when treatment is more effective and less invasive for patients.

ASAPRECAN has adopted a two-pronged approach, focusing on community education and professional training.

The association has reviewed two sets of training materials, consisting of a community promotion manual and a clinical examination manual, which had been previously developed and tested in Peru, and adapted them to the context in El Salvador.

The protocols, workflows and processes needed to provide timely breast cancer early diagnosis in the comprehensive health network of Santa Ana have also been reviewed and updated.

ASAPRECAN will be convening a committee of experts in radiology and interventional breast procedures (minimally invasive procedures for the diagnosis or treatment of breast conditions, such as breast biopsy, needle aspiration and image-guided procedures for diagnosis or treatment) before adapting the other two manuals planned in the project on screening with ultrasound and fine needle aspiration biopsy.

“The main challenge was adapting the care processes described in the original Manual to the health system of our country, as well as aligning these processes with current regulations. To solve this challenge, we formed a multidisciplinary and inter-institutional team to carry out this process. This ensured that the Manual for El Salvador did not violate any regulations and could be used by all institutions providing breast cancer care services. This process was successful; the new Manuals will form part of the Ministry of Health's regulatory documentation.” - Dr Lisseth Ruiz de Campos , President of ASAPRECAN

ASAPRECAN also trained 60 community health workers (promotores comunitarios de salud) on the early signs and symptoms of breast cancer, risk factors and the services offered at each facility, as well as 25 primary healthcare providers (general practitioners) and five gynaecologists on the early diagnosis of breast cancer (clinical breast exam, triage, breast US and FNA). A rigorous pre- and post-test was conducted to assess the training’s effectiveness.

To assess implementation of the improvements to service provision, the project is currently conducting an evaluation of the intervention, assessing feasibility, barriers and facilitators of implementing early diagnosis in a public healthcare network in El Salvador. The learnings of this preliminary study will be used to scale-up/out to additional regions.

Within the next few months, the project will assess the effectiveness in reducing the time between the appearance of symptoms and diagnosis, with the aim of achieving the goal of 50% reduction compared to prior years, and in reducing time between evaluation and diagnosis to less than 60 days, as per the target for the second pillar of WHO's Global Breast Cancer Initiative framework.

“One of the main objectives of this project was to implement a new care model that strengthens care networks, in order to promptly refer the woman, from the appearance of the first symptoms, to the corresponding Level II health service. This is how we should significantly reduce the time from the appearance of the first symptoms to the first medical evaluation.” - Dr Lisseth Ruiz de Campos, President of ASAPRECAN

The project benefits from and leverages the support of multiple stakeholders, including the Ministry of Health of El Salvador, the Pan American Health Organization, the Autonomous University of Santa Ana, and the National Alliance for the Prevention and Control of Cancer in El Salvador. This multi-agency collaboration has been vital in adapting training materials and securing high-level endorsements.

“Collaboration with multiple agencies has been fundamental in achieving the project's initial objectives. The contribution of each of these agencies added expertise and credibility to the process. We are in discussions with some of them to obtain support for scaling the project to a new phase.” - Dr Lisseth Ruiz de Campos, President of ASAPRECAN

While the initiative has faced challenges such as defining healthcare facilities for implementation and integrating teams at multiple healthcare levels, these issues have been resolved through focused stakeholder meetings.

The impact of this project has been significant, with 500 patients so far benefitting from improved screening and/or diagnosis. Furthermore, 95 professionals have been trained on the new care model, strengthening the healthcare system’s capability to address breast cancer.

UICC is delighted to have been able to support projects such as this one in El Salvador, through the UICC Breast Cancer programme and as a result of the support UICC has received from its partners. The programme aims to reduce mortality and improve the quality of life for breast cancer patients globally, through actions that strengthen and engage the breast cancer community (such as learning, knowledge sharing, funding and convening opportunites). The El Salvador project serves as a tangible example of how targeted interventions can make a meaningful difference in healthcare outcomes.