Decentralizing breast biopsy procedures for early cancer diagnosis in rwanda - projects summary/abstract background: with 2.3 million new cases per year, breast cancer is among the most diagnosed…

The National Institutes of Health Fogarty International Center awarded the University of Global Health Equity $262,556 on September 16, 2025, under the International Research and Research Training program (CFDA 93.989) to evaluate the feasibility and implementation of decentralized breast biopsy services at district-level hospitals in Rwanda for early cancer diagnosis.

The award funds research to assess organizational capacity and readiness for decentralized breast biopsy at district hospitals, identify facilitators and barriers through qualitative methods, and evaluate implementation feasibility at five district hospitals using technology-enabled training and optimized diagnostic networks. The research addresses the diagnostic bottleneck affecting rural Rwandan patients with breast cancer, who currently face six-month delays to obtain biopsies centralized at tertiary facilities. The project collaborates with U.S. scientists from Duke University, University of North Carolina, and Brigham and Women's Hospital to leverage Rwanda's integrated national health system for rigorous, real-world longitudinal evaluation of implementation strategies transferable to rural U.S. health systems.

The award supports career development for a clinician researcher and faculty general surgeon at the Center for Equity in Global Surgery, University of Global Health Equity, transitioning to independence through structured training in advanced health services research, qualitative research, implementation research, and clinical epidemiology with process improvement.

Period of performance runs through July 31, 2030. Place of performance is Rwanda.

Decentralizing breast biopsy procedures for early cancer diagnosis in rwanda - projects summary/abstract background: with 2.3 million new cases per year, breast cancer is among the most diagnosed cancers in women globally and is the leading cause of cancer mortality in low-and middle-income countries (lmics), including rwanda. Breast cancer outcomes in lmics are far worse as 33-90% of women with breast cancer present with advanced-stage disease, due to delays in diagnosis exacerbated by the absence of decentralized biopsy services, forcing patients in rural areas to travel to tertiary centers for diagnosis. Centralization of breast biopsy creates bottlenecks and delays treatment initiation. The feasibility of implementing decentralized breast biopsy services at district (level II) hospitals to facilitate early cancer treatment, save lives, and create sustainable improvements in breast cancer care across rwanda has not yet been demonstrated. This research aligns with national cancer institute's focus on implementation science and health systems research, cross disciplinary capacity development in research methods for lmics, and technology for cancer control, in addition to fogarty's support for global health research, partnerships, and capacity building. Candidate: this emerging global leader (K43) award will transition the clinician researcher and faculty general surgeon at the center for equity in global surgery, university of global health equity to independence in strengthening breast cancer care in rwanda through rigorously researched, locally relevant interventions that increase access to early cancer biopsy, and timely, high-quality care. He will gain additional training in advanced health services research, qualitative research and implementation research, and clinical epidemiology with process improvement. This K43 will support his long-term career goals by offering structured training in critical areas, guidance from leading global experts, and applied research experience to accomplish his scientific objectives. Research: the researcher will evaluate the capacity, determinants, and feasibility of integrating decentralized breast biopsy services into district (level II) hospitals across rwanda through the following aims: 1- quantitatively evaluate the capacity and organizational readiness for decentralized breast biopsy services at district hospitals across rwanda; 2- qualitatively assess the facilitators and barriers to implementing decentralized breast biopsy services at district hospitals across rwanda; 3- to assess feasibility of implementation of decentralized breast biopsy services at five district hospitals. Innovation: defining optimal means to reduce reliance on centralized systems, using innovative technology-driven training tools including gamification, simulation, and extended reality to train, pioneering use of organizational readiness tools in the global breast biopsy space are innovative. Few global surgeons are in the cancer implementation science space. Deliverables and future directions: the researcher will publish 8 relevant manuscripts and submit an R01 proposal to test the impact of implementing decentralized models of care across the region.