Abstract 104: Barriers and Facilitators to Integrating Breast and Cervical Cancer Screening Programs in Outpatient Clinics in Western Kenya

Abstract

Abstract Purpose: Nearly 50% of Kenyan women with breast cancer present with advanced disease – owing partially to limited patient awareness of the importance of breast cancer screening and financial limitations of screening in low- and middle-income countries. With increasing access to nurse-led cervical cancer screening in government clinics in Kenya, we investigated provider-perceived barriers and facilitators to integrating breast cancer screening into ongoing cervical cancer screening programs in Kisumu County, Kenya. Methods: Providers offering cervical cancer screening within Ministry of Health Clinics in Kisumu County were recruited to participate in a two-phase, sequential, mixed methods study. Providers' knowledge of breast cancer screening guidelines was assessed with a questionnaire based on the 2018 Kenya National Cancer Guidelines. Providers with significant cervical and breast cancer screening experience were invited to complete a 1-on-1 interview to discuss barriers and facilitators to integration. Results: Sixty-nine nurses and clinical officers from 20 randomly selected facilities participated in the survey. Providers all agreed that breast cancer screening was very important. While 93% said they routinely offered clinical breast examinations, only 22% of these providers screened at least 8 of their last 10 patients. Forty-four percent correctly identified 4 or more of 5 signs and symptoms of breast cancer and 45% correctly identified the recommended screening frequency for women aged 40-55 years. While providers showed enthusiasm for integration, several barriers were identified and grouped into four themes: 1) fragmentation of services; 2) staffing shortage and inadequate on-job training; 3) limited space and referral system challenges; 4) limited patient awareness on need for cancer screening. Conclusion: Addressing providers' concerns by providing routine on-job clinical training, strengthening the diagnostic and treatment referral pathway, and increasing patient education are some of the first steps in facilitating integration of breast and cervical cancer screening services in primary care clinics in Kenya. Citation Format: Prisca Diala, Magdalene Randa, Jackline Odhiambo, Gregory Ganda, Craig Cohen, Chemtai Mungo. Barriers and Facilitators to Integrating Breast and Cervical Cancer Screening Programs in Outpatient Clinics in Western Kenya [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 104.