Understanding Linkage to Biopsy and Treatment Services for Breast Cancer After a High-Risk Tele-Mammography Result in the Ministry of Health-Subsidized Population in Peru

Abstract

Paper 1 provides a thorough background of the situation of breast cancer in Peru and builds the hypothesis that women living in poverty in Peru face barriers to continue care after abnormal mammography results conducted through the Ministry of Health tele-mammography services. Paper 2 covers the research study conducted about such topic and is summarized as follows: Background: Low- and middle-income countries face difficulties in securing access to biopsy and treatment following an abnormal mammogram. Thus, we conducted a mixed-methods study to understand linkage to biopsy and treatment for breast cancer after a high-risk mammography result obtained through the national tele-mammography program of Peru. Methods: Data from all women who underwent tele-mammography between July 2017 and September 2018 and had a high-risk result (BIRADS 4-5) were collected. We determined completion rates (number of women who obtained a biopsy or initiated treatment, compared to the expected number for the same step) and delays (>45 days from a high-risk result to the biopsy and from the biopsy to treatment initiation; >90 days from high-risk result to treatment initiation). Also, 32 in-depth interviews were conducted with women receiving high-risk results, healthcare providers, program coordinators and policymakers to explore the factors explaining non-completion and delays. Results: Of 126 women with high-risk mammography results, 48.4% obtained a biopsy; of the confirmed 51 women with breast cancer, 86.37% initiated treatment. Among those who obtained a biopsy, 37.5% had a delay from the high-risk result to the biopsy; and among those who initiated treatment, 69.2% had a delay from the biopsy to treatment and 65.9% from the high-risk result to treatment. Having to travel to and stay in major cities to seek biopsy and treatment, patients' misconceptions of the disease, and administrative and operational factors, impeded continuing care for breast cancer. Conclusion: Breast cancer diagnostic and treatment capacity urges to be strengthened in Peru’s provinces. Better awareness of guidelines, standardized referral pathways, and robust tracking and information systems are required. Addressing these factors could help to improve the rate and time of linkage to diagnosis and treatment for breast cancer after high-risk tele-mammography results.