Implementing a National Cancer Control Plan

for early detection of breast cancer: Barriers and key lessons

Dr Mary Nyangasi, Head of the National Cancer Control Programme, Ministry of Health of Kenya described how the early diagnosis cancer action plan was elaborated and implemented in the country.

Dr Nyangasi gave background of the context in Kenya, which is similar to many LMICs, with nearly 70% of cancer cases diagnosed in advanced stages. In such contexts, structural barriers to screening include limited service availability, weak referral networks, human resource capacity, affordability of services and information management. Other barriers to access include sociocultural, personal and financial issues such as myths and misconceptions, poor linkages between health facilities and communities, poor health-seeking behavior, and high out-of-pocket expenditure due to lack of health insurance.

Kenya’s breast cancer screening and early diagnosis plan was issued in 2021 and recommends mammography as screening method alongside complementary methods (such as breast self-examination, CBE and ultrasound) as mammography is not widely available across the country. Magnetic resonance imaging is also recommended for selected high-risk groups. It is recommended that women in average risk groups are screened from ages 40-74 years, with women from 40-55 years screened every year and women from 56-74 years screened every two years.

Dr Nyangasi highlighted that controlling breast cancer is not only reliant on screening but requires a full spectrum of interventions from primary prevention to treatment.

Kenya’s Breast Screening and Early Diagnosis Cancer Action Plan

Key Highlights

Primary Prevention

Secondary Diagnosis

Diagnosis

Treatment

• Lifestyle modification

• High risk individuals: Chemoprevention, prophylactic surgery

• Clinical breast exam for early diagnosis

• Mammogram for screening

• Mammogram, ultrasound, biopsy

• Treatment (surgery, chemotherapy, radiotherapy)

Stage 1-4

• Supportive and palliative care as indicated

She also provided broader recommendations for implementing NCCPs including:

• Wider adoption of fiscal policies such as taxation on sugar-sweetened beverages, unhealthy foods and subsidies for healthy foods

• Sustained multisectoral coordination

• Sustained surveillance

• Prioritise strengthening of health systems for breast cancer screening, diagnosis and treatment

• Adoption of cost-effective interventions in the Universal Health Coverage (UHC) benefit package.

Table Discussion

What would it take to have early detection of breast cancer included in your country’s NCCP as well as a dedicated budget for this in the setting in which you operate?

With a majority of civil society organisations amongst the participants, table discussions focused on the importance of advocacy. The main actions identified in the order of importance were:

• Advocate to build political will. Patient advocates and civil society are recommended to work jointly to influence political will, and seek consensus with policymakers and medical societies to draft the NCCP together.

• Improve data collection for evidence-based advocacy. Need for data on the breast cancer burden in the country, an investment case demonstrating the effectiveness and a cost-benefit analysis of an early detection programme, and cancer registries to be able to better advocate for early detection.

• Build accountability around the NCCP, which includes strengthening its governance, the transparency of the NCCP (public access and understanding of what is funded), holding policy makers accountable, and putting the legislation in place to ensure that the NCCP will be implemented. Other points mentioned in the conversations related to the need to have screening and treatment integrated into UHC packages.