Breast Cancer Screening and Early Diagnosis Action Plan 2021-2025

Objectives

Kenya’s Breast Cancer Screening and Early Diagnosis Action Plan 2021-2025 seeks to ensure that breast cancer is diagnosed at an early stage and that eligible women obtain timely screening, diagnosis, referral, management and supportive care. It applies a country-specific, resource-stratified approach to a largely screen-naive population, responding to high levels of late presentation and advanced-stage diagnosis.[1][2][3][4]The plan aligns with the World Health Organization Global Breast Cancer Initiative pillars of health promotion, timely diagnosis, and comprehensive treatment including supportive care.[3]

• Increase clinical breast examination and mammography coverage among eligible women to at least 30% by 2025.[4]
• Ensure that at least 90% of symptomatic women are linked to further evaluation and management within 60 days of their first contact with a health worker.[1][4]
• Strengthen governance and policy, community awareness and demand creation, workforce development, service delivery, and monitoring, evaluation and research.[1][4]
• Reduce breast cancer risk through health promotion addressing alcohol and tobacco use, body weight, diet, physical activity and breastfeeding, while recognising that early detection and treatment remain essential because prevention cannot eliminate most breast cancers.[5][6]
• Promote breast self-awareness and breast-health education, while using clinical breast examination to identify suspicious lesions, triage women and support referral for diagnostic imaging and tissue sampling.[7][8]
• Provide age- and risk-appropriate screening, with mammography identified as the preferred method for average-risk populations where diagnostic and treatment capacity is available.[7][6]
• Improve down-staging, early diagnosis, treatment outcomes, patient navigation, psychosocial support and survivorship care through coordinated services across community, primary, county, regional and national referral levels.[7][9][10][11]
• Expand access by establishing Breast Cancer Centres of Excellence at three national referral hospitals, rapid diagnostic units at county referral hospitals, and mammography services across all 47 county referral facilities.[12][13]
• Integrate breast cancer prevention, screening and early diagnosis with cervical cancer screening, family planning, maternal and child health, HIV services and non-communicable disease management to reduce missed opportunities for care.[8][12][14]

Implementation

Implementation is phased by level of care and supported by national and county governance, standardised clinical pathways, workforce development, quality assurance, referral systems and routine data use.[15][4][16][17]The Ministry of Health leads overall implementation, while counties, the National Cancer Control Programme, the National Cancer Institute of Kenya, referral facilities, professional bodies, training institutions, communities, civil-society organisations, development partners and private providers contribute to delivery.[1][18][19][20][17]

• Deliver community awareness through Community Health Volunteers, cancer survivors, religious and community leaders, media, workplaces, local-language materials, health talks and outreach, with referral links from communities to facilities.[8][4][18][21]
• Provide health promotion, self-examination education, clinical breast examination and prompt referral at community and primary-care levels.[15][4]
• Provide clinical breast examination, ultrasound, mammography, fine-needle aspiration or core biopsy and rapid diagnostic services at secondary and county-level facilities, with ultrasound generally used for women under 35 years and mammography for women over 35 years.[15][16]
• Require triple assessment of suspicious lesions through clinical examination, imaging and tissue diagnosis, and use multidisciplinary review to reconcile biopsy, imaging and clinical findings before treatment.[22][15]
• Provide advanced imaging, surgery, treatment, palliative care, rehabilitation and survivorship services at tertiary and national referral facilities.[10][15]
• Strengthen pathology, hormonal testing and specimen referral through histopathology, immunohistochemistry, telepathology, accredited second-opinion links and national tissue referral networks.[12][20][11]
• Equip services with private examination space, mammography units, radiation protection, image storage and reporting systems, biopsy equipment, consumables and appropriately trained radiology, pathology, nursing, navigation, data and support staff.[23][24][20][11]
• Train community and facility health workers, imaging personnel, laboratory staff, health records officers and specialists; develop fellowships in breast imaging and onco-pathology; and integrate breast cancer content into undergraduate and postgraduate curricula.[4][19][25]
• Establish county breast cancer committees and national and county technical working groups, hold regular coordination meetings, provide technical assistance to counties, disseminate guidelines, and incorporate activities into annual work plans and County Integrated Development Plans.[26][27]
• Mobilise resources through government planning and budgeting processes, investment-case briefs, public-private partnerships and consideration of screening, diagnosis and management within Universal Health Coverage and insurance benefit packages. Monetary budgets, funding allocations and financing gaps are not specified in the supplied summaries.[27][12]
• Monitor implementation through process, outcome and impact indicators, monthly reporting through the Kenya Health Information Management System, facility assessments, screening databases, oncology electronic medical records, the Kenya National Cancer Registry and civil registration systems.[1][14][17]
• Track 2025 outcomes including 50% screening invitation coverage, 30% participation and screening coverage, 90% treatment initiation, 40% advanced-stage detection and breast cancer mortality of 17.1 per 100,000 women.[17]
• Conduct baseline, mid-term and end-term assessments, annual screening and quality-of-care audits, and priority research across the care continuum to refine delivery and improve service quality.[12][26][14][28]

Monitoring & Evaluation

The plan establishes a monitoring, evaluation and accountability system spanning programme inputs, service delivery, quality, outcomes and population impact. It combines an implementation matrix assigning activities, responsible entities and timeframes with national and county targets for 2021 to 2025.[1][29][4]The Ministry of Health leads overall implementation, county health committees measure and report indicators through the Kenya Health Information Management System, and the National Breast Cancer Technical Working Group continuously monitors and evaluates key performance indicators.[17]

• Track screening coverage and timely referral against core targets: at least 30% of the eligible population screened by 2025, and at least 90% of symptomatic women linked to evaluation and management within 60 days of their first contact with a health worker.[4]
• Measure process indicators including health workers trained in clinical breast examination, radiographers and radiologists trained in breast imaging, county referral facilities providing histopathology, and facilities performing breast imaging. The 2025 targets are 25,000 trained health-care workers, 500 trained imaging personnel, 40 county referral facilities offering histopathology, and 15% of facilities performing breast imaging.[17]
• Monitor screening invitations, participation and coverage, positivity and biopsy rates, advanced-stage detection and treatment initiation. The stated 2025 targets are 50% invitation coverage, 30% participation, 30% screening coverage, 50 positive results per 1,000 women screened, a 25% biopsy rate at Centres of Excellence, 40% advanced-stage detection and 90% treatment initiation.[17]
• Assess impact through breast cancer mortality per 100,000 women, with a 2025 target of 17.1.[17]

Monitoring is intended to cover process, outcome and impact indicators, including screening and diagnostic capacity, patient navigation, referrals, treatment and follow-up.[1][14]Service-capacity measures include rapid diagnostic units, accredited imaging and pathology facilities, counties providing histopathology, turnaround times, workforce levels, equipment and consumable availability, and facilities reporting confirmed cases to the National Cancer Registry.[20]Delivery measures also include protocol use, trained imaging personnel, tele-radiology infrastructure, linked facilities, patients supported by navigators, maintained client databases, support groups, referral centres and commodity stockouts.[11]

• Conduct baseline, mid-term and end-term assessments using developed tools, trained evaluators, data collection, analysis and dissemination of results.[12][14]
• Strengthen information systems to calculate and track indicators across screening, diagnosis, treatment and follow-up, including piloting and rolling out an oncology electronic medical record to level 4 to level 6 facilities.[12][14]
• Submit breast cancer indicator reports monthly and promote their use by stakeholders, particularly county authorities.[12][28]
• Use data sources including facility assessments, the Kenya Health Information Management System, screening invitation databases, the Kenya National Bureau of Statistics, oncology electronic medical records, the Kenya National Cancer Registry, and civil registration and vital statistics.[17]

Quality assurance is embedded in active screening and diagnostic services. Measures include standardised Breast Imaging Reporting and Data System reporting for ultrasound and mammography, possible telereporting, multidisciplinary review of biopsy, imaging and clinical findings, and quality assurance for imaging and pathology.[15][26]A technical working group is expected to address laboratory and imaging quality assurance, turnaround time, test accuracy and accreditation.[13]Annual breast cancer screening and quality-of-care audits, audit tools, programme publications and county pathology quality-assurance teams provide further accountability mechanisms.[26]

Implementation monitoring also covers governance, demand creation and workforce development. Indicators include sensitisation meetings, county breast cancer committees established, quarterly technical working group minutes and completed actions, stakeholder databases, annual progress reports, technical-support activities, guideline dissemination and uptake, awareness materials, media outputs, outreach sessions, facility linkages, women accessing screening, training-needs assessments, supervision visits and health personnel trained.[26][27][18][30]

Pilot evidence provides operational learning measures: 80% of attendees were reached through awareness campaigns, 87% had never had a mammogram, 33% of mammogram reports were uncollected after six months, and 45% of clients with suspicious lesions had received biopsy and linkage to treatment by the campaign’s end.[31]Mammography uptake fell when the awareness campaign ended and follow-up transferred to the hospital, highlighting the need to monitor continuity and strengthen follow-up arrangements.[31]Surveillance and research are also expected to track screening rates and quality, identify research priorities and support research across the care continuum.[12][28]

Costing & Financing

The plan recognises that implementation requires resource mobilisation, integration into government planning and budgeting, partnerships and insurance coverage, but the supplied material provides no overall budget, costed workplan, expenditure allocation, funding gap or quantified economic assumption.[4][27]

• Mobilise resources by identifying essential programme inputs, incorporating breast cancer activities into national and county annual work plans and County Integrated Development Plans, preparing investment-case policy briefs, and pursuing inclusion of screening, diagnosis and management in Universal Health Coverage and other insurance benefit packages.[27]
• Secure funding, technical assistance, programme management and leadership, partnerships, equipment, commodities, infrastructure and human resources for screening and early diagnosis services.[12][23][24]
• Provide resources for workforce development, mammography and ultrasound, biopsy and histopathology, hormonal testing, patient navigation, tele-radiology and telepathology, information systems, quality assurance, referral networks and supportive care.[19][20][11]
• Address mammography access barriers, including client service costs, limited specialist capacity and low public awareness. Community-based awareness is characterised as a cost-effective approach, while clinical breast examination is described as lower cost and less technically demanding than mammography in resource-constrained settings.[22][31][32]

Financial and technical support from GE Healthcare and its agencies was acknowledged, and Nyeri County Government was recognised as a partner in the Breast Health Awareness Campaign pilot.[29]The source also identifies the National Research Fund and partners as potential actors for funding priority breast cancer research, without specifying funding amounts.[28]