Establishing a breast cancer center in Herat, Afghanistan: an implementation study

Objective

Breast cancer is the most common cancer in women, causing significant mortality in the world, which contributed 11.7% to the overall cancer-related mortality in Afghanistan. In 2018, 3 062 new breast cancer cases were reported accounting for 29.7% of all cancers in women in the country. However, a comprehensive diagnostic and therapeutic system is lacking in Afghanistan. In this paper, we reported the implementation of a project aiming to establish a comprehensive breast cancer center in Herat province of Afghanistan.

Methods

From July 2017, a two-year-program initiated at Kimia Hospital in Herat. This first free diagnostic and therapeutic breast cancer project planned by the Afghanistan Surgeons Society – West and the Verein für Afghanistan-Förderung e. V., as well supported by three international foundations. The target populations of this project were women presenting with breast problems at Kimia Hospital in Herat and healthcare staff involved in breast cancer diagnosis and management.

Results

A group of six medical personnel chosen to represent the breast cancer core team for breast cancer diagnosis and management were trained in India. These caregivers established the breast cancer service and tumor board. During a period of 20 months, a total of 632 women with breast problems presented to Kimia Hospital of whom 44 (7.0%) were diagnosed with breast cancer. Diagnosis was established by a physical examination, ultrasonography, mammography, biopsy and histopathology. Treatment included surgery, radiotherapy and chemotherapy. Twelve seminars for 512 healthcare workers, 1 000 brochures and a movie were prepared for awareness-raising actions. For continuation of this project, potential resource providers were identified. A database was developed to record project findings.

Conclusion

Implementation of this comprehensive breast cancer project resulted in significant achievements in healthcare staff capacity building, diagnosis and management of breast cancer patients in Herat province. Data obtained in this project offer Afghan government, public health authorities, and the community the opportunity of improving diagnosis and treatment of breast cancer in Afghanistan.