Our Research > Portfolio of Projects >Early Detection
WHAT DO WE ALREADY KNOW?
As a general rule, if a tumor is smaller and good treatment is given, the chances of cure are better. First results from this study concern the effects of surgical oophorectomy and tamoxifen treatment on bone mineral density and risk for fractures. A comprehensive scientific report of these results has been prepared and submitted to a scientific journal for publication. When these results are published they will also be presented on this website. Further results about the effects of this treatment in patients with Her-2neu positive and negative tumors are expected soon and should be published in the next 6 months and similarly presented here. Finally the main results of this study are expected in April 2013 and will be promptly submitted for scientific journal publication. Again when published these will be presented in detail on this website.
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
This activity and the Amader Gram Breast Care Center is generously supported by a grant from the Susan B. Komen for the Cure® Foundation.
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 partnered with Amader Gram ("Our Village") a non-governmental organization in Bangladesh, and developed a system wherein at an Amader Gram 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, the Amader Gram Breast Care Center, providing access (regardless of ability to pay) to centralised and coordinated care in a paperless system. Care would be based on evidenced-based, clinical practice guidelines and international (U.S.-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, for this center, 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.
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| 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, (PDF) 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 full-time chief medical officer, coordinator/nurse, and business manager staff.
8. Envisioned a revenue generation and social business model for the center. A patient user fee system has been 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.
| (Left to Right) Moshahida Sultana, consultant economist; Rumana Dowla, Amader Gram palliative care consultant; Reza Salim, Director, Amader Gram |  |
Why is this research important?
We are testing here a practical health system “fix” for the problem of diagnosis and treatment of breast cancers when they are advanced.
Our Research Team
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Dr. Syed Mozammel Hossain Associate Professor of Obstetrics and Gynecology Khulna Medical College Khulna, Bangladesh |
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Dr. James Woods, M.D. American Board of Surgery Fellow, American College of Surgeons |
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Dr. Rahela Munim Dipi, MBBS, FCPS, M.D. Assistant Professor, Radiology & Imaging Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh |
To learn more: Write to Dr. Jim Woods at jharwoods@aol.com
Click here to see how you can help
Early detection Study 2: Case-finding and mobile-health reporting by primary health workers
This research is generously supported by a Susan B. Komen for the Cure® Foundation-supported project.
In low and middle income countries, one of the major challenges in improving health for specific diseases like breast cancer is to build and strengthen and not weaken, primary health care systems. This project attempts to do this. Secondly, in high income countries the operating philosophy is that it is individuals’ responsibilities to seek care for obvious health problems like a growing breast mass. The focus then is on “awareness”. In low and middle income countries however, where there are many structural societal barriers (poverty, gender and cultural discrimination) which keep women from acting on their own observations of a breast lump, (in our interviews with women in Bangladesh they are fully aware) developing some kind of societal “fix” seems an appropriate and socially just approach.
Our Research Team
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Dr. Syed Mozammel Hossain Associate Professor of Obstetrics and Gynecology Khulna Medical College Khulna, Bangladesh |
To learn more: Write to Dr. Richard Love at richardibcrf@gmail.com
A brief report of the interesting initial results of this research has been prepared and submitted to a scientific journal for publication. When these results are published they will also be presented on this website.
