Kimberly Badal1,2, Fidel Rampersad3,4, Wayne A Warner4, Adetunji T Toriola5, Hamish Mohammed6, Harold-Alexis Scheffel7, Rehanna Ali8,9, Murrie Moosoodeen10, Siva Konduru11, Adaila Russel9, Rajini Haraksingh8,9. 1. Caribbean Cancer Research Initiative, San Fernando, Trinidad and Tobago. kimberly@ccrinitiative.com. 2. Department of Life Science, Faculty of Science and Technology, The University of the West Indies, St. Augustine, Trinidad and Tobago. kimberly@ccrinitiative.com. 3. Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago. 4. Department of Cell Biology and Physiology, Medical Oncology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA. 5. Division of Public Health Sciences, Washington University School of Medicine, Saint Louis, MO, USA. 6. Department of HIV and STIs, National Infection Service, Public Health England, London, UK. 7. Department of Geography, York University, Toronto, Canada. 8. Caribbean Cancer Research Initiative, San Fernando, Trinidad and Tobago. 9. Department of Life Science, Faculty of Science and Technology, The University of the West Indies, St. Augustine, Trinidad and Tobago. 10. San Fernando General Hospital, San Fernando, Trinidad and Tobago. 11. Sangre Grande General Hospital, Sangre Grande, Trinidad and Tobago.
Abstract
PURPOSE: A situational analysis of breast cancer (BC) early detection services was carried out to investigate whether Trinidad and Tobago (T&T) has the framework for successful organized national screening. METHODS: An online survey was designed to assess the availability, accessibility, quality control and assurance (QC&A), and monitoring and evaluation (M&E) mechanisms for public and private BC early detection. A focus group with local radiologists (n = 3) was held to identify unaddressed challenges and make recommendations for improvement. RESULTS: Major public hospitals offer free detection services with wait times of 1-6 months for an appointment. Private institutions offer mammograms for TTD$240 (USD$37) at minimum with same day service. Both sectors report a lack of trained staff. Using 1.2 mammograms per 10,000 women ≥40 years as sufficient, the public sector's rate of 0.19 mammograms per 10,000 women ≥40 years for screening and diagnosis is inadequate. Program M&E mechanisms, QC&A guidelines for machinery use, delays in receipt of pathology reports, and unreliable drug access are further unaddressed challenges. CONCLUSION: T&T must first strengthen its human and physical resources, implement M&E and QC&A measures, strengthen cancer care, and address other impediments to BC early detection before investing in nationally organized BC screening.
PURPOSE: A situational analysis of breast cancer (BC) early detection services was carried out to investigate whether Trinidad and Tobago (T&T) has the framework for successful organized national screening. METHODS: An online survey was designed to assess the availability, accessibility, quality control and assurance (QC&A), and monitoring and evaluation (M&E) mechanisms for public and private BC early detection. A focus group with local radiologists (n = 3) was held to identify unaddressed challenges and make recommendations for improvement. RESULTS: Major public hospitals offer free detection services with wait times of 1-6 months for an appointment. Private institutions offer mammograms for TTD$240 (USD$37) at minimum with same day service. Both sectors report a lack of trained staff. Using 1.2 mammograms per 10,000 women ≥40 years as sufficient, the public sector's rate of 0.19 mammograms per 10,000 women ≥40 years for screening and diagnosis is inadequate. Program M&E mechanisms, QC&A guidelines for machinery use, delays in receipt of pathology reports, and unreliable drug access are further unaddressed challenges. CONCLUSION: T&T must first strengthen its human and physical resources, implement M&E and QC&A measures, strengthen cancer care, and address other impediments to BC early detection before investing in nationally organized BC screening.
Entities:
Keywords:
Breast cancer; Early detection; Health service evaluation; Primary prevention; Screening; Situational analysis; Trinidad and Tobago
Authors: Srikanth Umakanthan; Maryann Bukelo; Vijay Kumar Chattu; Ravi Maharaj; Nicole N Khan; Katherine Keane; Nick Khadoo; Aliyyah Khan; Amaara Khan; Ronny Kong; Selina Korkmaz; Anvesh Kovoor Journal: J Family Med Prim Care Date: 2021-12-27