As a general rule, if a tumor is smaller and good treatment is given, the chances of cure are better. In countries where the disease is frequent, in post menopausal women in particular, mammography done at one –two year intervals can detect very small cancers that are mostly curable.

THE BIG ISSUES

#1. IN YOUNGER WOMEN, AND WHEN THE DISEASE IS INFREQUENT, AS IT IS IN MOST LOW AND MIDDLE INCOME COUNTRIES, MAMMOGRAPHY IS IMPRACTICAL, VERY COSTLY AND PROBABLY INEFFECTIVE.

#2. THE CHALLENGES ARE TO FIND THE WOMEN WHO HAVE BREAST CANCERS WHEN THEY ARE SMALL AND GET THEM TREATED CORRECTLY AND PROMPTLY IN THESE CIRCUMSTANCES, AND NOT LATER.

Early Detection Study 1:
“One stop” diagnosis at first presentation

In Bangladesh it appears that about 25% of women at diagnosis have had a small tumor detected several months earlier but the treatment given then was incomplete because of various barriers. To by-pass these barriers we have developed a system wherein at a Multidisciplinary Breast Specialty Center, centrally located in the Khulna division of the country, at a first visit any woman with a suspected breast cancer has this tissue biopsied for pathological examination and the center takes responsibility for seeing that proper follow up treatment is given, based on the tissue laboratory examination results.

To these ends we have envisioned a “one stop” outpatient facility providing:

ACCESS, REGARDLESS OF ABILITY TO PAY to CENTRALISED AND COORDINATED CARE in a PAPERLESS SYSTEM with care based on EVIDENCED-BASED CLINICAL PRACTICE GUIDELINES and INTERNATIONAL (US-NATIONAL CANCER INSTITUTE) TELEMEDICINE CONSULTATIONS

This center will “outsource” for:

I. Diagnostic x ray, blood testing and pathology services.

II. Hospitalization for surgeries

III. Radiation therapy treatments

To date we have:

1. Leased space in a main road building in Khulna (the centrally located city in the division) with 8 rooms around a large two-section central open space.

2. Organized this space into waiting areas, a registration/intake room, an examination room with a US /IBCRF donated breast ultrasound diagnosis machine, a procedure room for biopsies (and system for appropriate care and transfer of tissues for surgical pathology examinations in Dhaka and electronic reporting), a discharge and follow up planning office, and a teaching/family conference room.

Dr. James Woods, IBCRF, installing the new GE Ultrasound machine in our Khulna Center, Bangladesh.	Doctors Woods, Mozammel and Ahki. The ultrasound machine allows immediate distinction of likely malignant and likely benign abnormalities and helps guide tissue diagnosis sampling.

3. Installed computer work stations and printers, with a local area network and wirless broadband access to the internet.

4. Developed a customized electronic medical record.

5. Planned with a diagnosis radiology and laboratory service provider a contract with test ordering and reporting electronically.

6. Written a 27-page set of Clinical Practice Guidelines, modeled on other such internationally-used materials, but specifically tailored to the Bangladeshi circumstances, as an “operations “ manual for center care. (Available for at agbreastcare.org and on this website)

7. Hired a full time patient care coordinator/nurse, and are in the process of hiring a chief medical officer and business manager.

8. Envisioned a revenue generation and social business model for the center. A patient user fee system is being developed by a Dhaka University health economist, Dr. Moshahida Sultana.

9. Secured major Bangladeshi, in-country philanthropic support to pay for indigent patient care for the next three years.

Pictured at right: (Left to Right) Moshahida Sultana, Lecturer of Economics; Rumana Douwla, Medical Director and Team Coordinator at Bangladesh Palliative and Supportive Care for Children and Adults; Reza Salim, Amader Gram