Early Detection of Breast Cancer through Community-Based Interventions in Rwanda: A Pre–Post Intervention Study

Breast cancer is the second most common cancer globally and the leading cause of cancer-related deaths among women in low- and middle-income countries (LMCs). Each year, approximately five million people die from cancer in these regions, representing 10% of total deaths. While once viewed as a disease of industrialized nations, more than half of global breast cancer deaths occur in less developed areas, where gender inequality, poverty, and weak health systems limit women's access to timely diagnosis and treatment. Studies conducted in Rwanda have revealed prolonged delays between symptom onset, initial presentation, and confirmed diagnosis, resulting in late-stage presentations and poor outcomes. Early detection remains one of the most effective strategies to reduce breast cancer mortality. This project therefore aims to integrate community-based early detection into Rwanda's existing health system through CHW and nurse training, public awareness, and strengthened referral mechanisms.

1. To train community health workers and health center nurses in early detection and timely referral of suspected breast cancer cases.

2. To establish a functional referral system linking community and health facilities for early diagnosis and management.

3. To evaluate the impact of training and referral interventions on early detection rates and diagnostic timelines.

This study introduces an innovative, cost-effective model leveraging Rwanda's established community health system. By integrating breast cancer early detection into existing CHW programs, the intervention can be sustained and scaled nationally. The approach addresses both patient-level and system-level delays while building local capacity among frontline health workers.

The study will use a pre–post intervention design conducted in randomly selected rural sectors. All CHWs and nurses in intervention areas will receive structured training based on Ministry of Health-approved curricula. CHWs will sensitize women to breast cancer signs and symptoms, while trained nurses will perform clinical breast exams and refer suspected cases for further evaluation. Data from community, health center, and hospital levels will be collected before and after intervention for comparative analysis. Regular mentorship and supervision will ensure quality and fidelity of implementation.

Data will be collected at CHW, health center, and hospital levels using standardized checklists. Key indicators include the number of women referred, diagnostic timelines, and cancer stage at diagnosis. Statistical analysis will be performed using paired t-tests and chi-square tests to assess changes between pre- and post-intervention periods. Data will be analyzed using STATA software, version 11. Success will be determined by a measurable increase in early-stage diagnoses and reduced diagnostic delay.

Potential challenges include limited financial resources, variable CHW education levels, and cultural barriers influencing women's willingness to participate. To mitigate these, training modules will be simplified and localized, community mobilization will precede data collection, and additional support will be sought from the Rwanda Biomedical Centre (RBC).

This intervention is inherently sustainable as it utilizes Rwanda's existing CHW infrastructure and referral system. Post-grant, early detection activities will be integrated into government health budgets and CHW training programs. The model's simplicity allows easy scale-up across districts and adaptation in other LMCs with similar community health frameworks.

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