Improving Breast Cancer Control via the Use of Community Health Workers in South Africa: A Critical Review.


Breas1. Introduction
While breast cancer has long been recognized as a major public health burden in high-income countries, the majority of cases actually occur in low- and middle-income countries (LMCs), and it is expected that incidence rates will rise most rapidly in these locations [1]. The relative burden of mortality is also higher in less developed countries than in more developed countries, as indicated by higher mortality : incidence ratios (0.44 versus 0.29, resp.) [2]. Current global initiatives focus on developing and implementing resource-appropriate guidelines and strategies to improve breast health care and breast cancer outcomes in LMCs [35].
Common challenges cited for resource-poor countries include limited health care infrastructure [6], later stages at diagnosis, and competing health care priorities [7]. The purpose of this paper is to examine the potential for community health worker (CHW) programs to improve access to breast health resources in LMCs. To this end, we briefly review the effectiveness of CHW programs in LMCs and identify key components of a CHW-based breast health program. We focus on South Africa as an example country to assess the feasibility of such a program. South Africa represents a middle-income country, according to its World Bank classification [8], has a growing cancer control infrastructure including many of the cancer centers in Africa, with well-trained oncologists and radiologists [910], has historical experience with community-based health worker programs [1112], and has a higher breast cancer mortality : incidence ratio compared to the world standard (Table 1), indicating lower survival from breast cancer [213]. Importantly, it also enjoys advocacy from its First Lady, Her Excellency Madam Tobeka Stacie Madiba-Zuma, who serves as Vice Chairperson of the newly-formed Forum of African First Ladies Against Breast and Cervical Cancer [14]. Still, barriers to breast care persist. Many women do not have access to the information and screening necessary to prolong survival, as evidenced by the high mortality : incidence ratio in South Africa. These factors illustrate both the need and potential assets for a successful CHW breast health program.
Full Article with references available in the "Research Section."

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