Article Text
Abstract
Background Breast cancer is the leading cause of female mortality in low-income and middle-income countries (LMICs). Early detection of breast cancer, either through screening or early diagnosis initiatives, led by community health workers (CHWs) has been proposed as a potential way to address the unjustly high mortality rates. We therefore document: (1) where and how CHWs are currently deployed in this role; (2) how CHWs are trained, including the content, duration and outcomes of training; and (3) the evidence on costs associated with deploying CHWs in breast cancer early detection.
Methods We conducted a systematic scoping review and searched eight major databases, as well as the grey literature. We included original studies focusing on the role of CHWs to assist in breast cancer early detection in a country defined as a LMIC according to the World Bank.
Findings 16 eligible studies were identified. Several roles were identified for CHWs including awareness raising and community education (n=13); history taking (n=7); performing clinical breast examination (n=9); making onward referrals (n=7); and assisting in patient navigation and follow-up (n=4). Details surrounding training programmes were poorly reported and no studies provided a formal cost analysis.
Conclusions Despite the relative paucity of studies addressing the role of CHWs in breast cancer early detection, as well as the heterogeneity of existing studies, evidence suggests that CHWs can play a number of important roles in breast cancer early detection initiatives in LMICs. However, if they are to realise their full potential, they must be appropriately supported within the wider health system.
- cancer
- health education and promotion
- screening
- systematic review
- epidemiology
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Footnotes
Handling editor Kerry Scott
Contributors Conceptualisation: JO and OG. Data curation: JO, AN, DV, CO and MCM. Formal analysis: JO, AN, CO and MCM. Funding acquisition: JO. Methodology: JO, DV and OG. Project administration: JO and AN. Supervision: JO and OG. Validation: JO, AN, CO and MCM. Visualisation: JO. Writing – original draft preparation: JO. Writing – review and editing: all authors. All authors agree to take public responsibility for the paper’s contents and have approved the final paper prior to submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval Ethical approval was not sought for this study, because this is a review of existing published literature and does not directly involve human subjects.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information. Data relevant to the design and execution of this study are included in entirety in this article or included in the supplementary material or on the Harvard dataverse: open access link: https://doi.org/10.7910/DVN/LDRYO2.