A Situational Analysis of Breast Cancer Early Detection Services in Trinidad and Tobago

October 9, 2017

Adetunji T. Toriola, MD, PhD, MPH is co-author of a paper investigating whether Trinidad and Tobago has the necessary framework for breast cancer screening. 

Scholars
Adetunji T. Toriola headshot
Assistant Professor, Division of Public Health Sciences, School of Medicine

Breast cancer is the most common cancer among women, as well as the leading cause of cancer-related deaths in women, with over half occurring in developing countries. Specifically, it is the leading cause of cancer-related deaths in women in Trinidad and Tobago (T&T). Not only does T&T have one of the highest breast cancer mortality rates, but also it has the highest mortality incidence ratio in the Americas.

The authors of this study conducted a situational analysis of breast cancer early detection services in order to assess whether T&T has the necessary infrastructure to successfully implement organized breast cancer screening throughout the country. The authors utilized an online survey to evaluate the availability, accessibility, quality control and assurance, and monitoring and evaluation mechanisms for both private and public early detection facilities. A focus group with local radiologists (n = 3) was held to identify unaddressed challenges and make recommendations for improvement.

Number of mammography units per 10,000 women 40 years and over in the Trinidad and Tobago public sector by Regional Health Authority. Hospitals with units are indicated.

The authors found that in both public and private screening settings in T&T, there is a need for standardized professional and technical quality control and assurance protocols as well as program evaluation mechanisms. T&T engages in opportunistic breast screening in both public and private domains which has increased early detection of breast cancer, however, these screenings prove to be less cost-effective and may lead to deceptive positive results and possible radiation-induced cancers.

Even more, the authors found that major public hospitals in T&T offer free detection services, but with wait times of 1- 6 months for a single appointment. Meanwhile, private institutions offer mammograms for what is equivalent to $37 USD at minimum with same day service.  Both divisions of care had a lack of trained staff.

As a result of this study, the authors conclude that T&T must strengthen its human and physical resources, implement more evaluation mechanisms, strengthen cancer care from diagnosis to treatment and follow-up, and address various other challenges to healthcare in early breast cancer screening before investing in nationally organized screening.

Summary of key challenges to breast cancer early detection services along the cancer care continuum from presentation to treatment and management in Trinidad and Tobago. The current early detection opportunistic program and health care system in which it operates also has critical challenges.

There must be the necessary health infrastructure and workforce providing equitable and timely service access. Most importantly, the entire cancer care continuum from diagnosis to treatment and follow-up care needs to be robust.

Therefore, this study conducted a situational analysis to determine whether the framework for successful administration of breast cancer early detection services exists in T&T. The study results found T&T must first strengthen its human and physical resources, implement monitoring and evaluation and quality control and assurance measures, strengthen cancer care, and address other impediments to breast cancer early detection before investing in nationally organized breast cancer screening.

Read the full study published on August 11, 2017 on SpringerLink.