Community health workers and early detection of breast cancer in low-income and middle-income countries: a systematic scoping review of the literature

Abstract

BackgroundBreast 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.MethodsWe 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.Findings16 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.ConclusionsDespite 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.

Breast self-examination practice and its determinants among women in Ethiopia: A systematic review and meta-analysis

“…The so far promising achievement of health extension program in Ethiopia [ 130 , 131 ] should one of the mechanism through which awareness and knowledge disseminated about breast cancer. In low and middle income settings where there is shortage of health workers’ to provide early detection services, community health workers’ (CHWs), have been proposed in order to achieve universal health coverage [ 132 ].…”

Socioeconomic Determinants of Participation in Cancer Screening in Argentina: A Cross-Sectional Study

“…This will need action at the local level, since despite the existence of national strategies cancer screening, the Ministry of Health provides recommendations and the provinces are responsible of their implementation. Evidence suggests that community health workers can play a role in cancer screening ( 41 , 42 ). Further increase in cancer screening coverage can be achieved by developing population-based screening programs to recruit populations from different age groups and socioeconomic levels through, for example, linking cancer screening to services that are used by these populations and upscaling the introduction of approaches such as HPV self-sampling, mobile mammography, and colonoscopy services.…”

The global role, impact, and limitations of Community Health Workers (CHWs) in breast cancer screening: a scoping review and recommendations to promote health equity for all

“…CHWs have demonstrated their value by strengthening primary care services in complex health systems, working to combat both communicable diseases and non-communicable diseases (NCDs), including diabetes, hypertension, and tobacco cessation [ 16 ]. Their beneficial role in LMICs has been documented in the context of cervical and breast cancer screening, where CHW educators and coordinators improved screening [ 17 , 18 ]. It has also been documented in the US, where increased training and resources for CHWs improved mammography rates [ 19 ].…”

“…CHW effectiveness in these areas inspires the question of how CHW interventions can be leveraged in other contexts, such as that of breast cancer screening. Indeed, while reviews focused on CHWs within LMICs exist [ 18 ], there is a lack of literature that comprehensively reviews the role of CHWs in breast cancer screening across both HICs and LMICs. Viewed through the lens of global healthcare during the concurrent pandemics of systemic racism and COVID-19, this insight is particularly timely to better understand creative, community-driven approaches to address health disparities for under-served populations and populations with limited access to high quality care.…”