Breast Cancer Control Policy – 3. Access to Care

 

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KNOW YOUR RIGHTS: YOU ARE NOW ENTITLED TO ACCESS DEDICATED BREAST UNITS TO ENSURE EARLY DETECTION AND INTERVENTION TO SECURE IMPROVED SURVIVAL RATES AMONG BREAST CANCER PATIENTS.

“Limited resource settings with weak health systems where the majority of women are diagnosed in late stages should prioritise early diagnosis programmes based on awareness of early signs and symptoms and prompt referral to diagnosis and treatment.” – World Health Organisation (WHO)1

 

With resources and expertise variable across health facilities – so impacting the achievement of standard levels of care for all breast cancer patients – the new policy calls for Regional Breast Units (RBUs) to be set up at all regional hospitals. In addition, the most appropriate facilities must be identified for the establishment of Specialist Breast Units (SBUs) to create a network of care that combats treatment delays, while ensuring the best use of available resources.

The SBUs are the third link in the referral pathway chain – after primary healthcare clinics and district hospitals, and before Provincial Oncology Units (PCUs) at tertiary hospitals. The POUs are where multidisciplinary teams meet to secure rapid bidirectional referral of patient information, which is critical to prevent inappropriate appointments or delays. 2

 

REFERRAL CARE PATHWAYS

Referral Care Pathways
Referral Care Pathways
 

 

WHY ARE THESE BREAST UNITS SO IMPORTANT IN THE OVERALL BREAST CANCER CONTROL INITIATIVE?

Early detection and intervention is critical for improved survival rates amongst breast cancer patients, which makes it crucial to avoid any delays in assessing patients. This, in turn, means utilising what resources South Africa does have in the best way possible.

Timely access to care is Key Area 2 of the new policy, and stipulates that both RBUs and SBUs must meet the minimum requirements to accurately diagnose both benign and malignant breast cancer. For this, the policy says they must meet minimum staffing and equipment guidelines to ensure optimal treatment. 3

In short, the Breast Units will help ensure you get:

  • Timely diagnosis.
  • Appropriate and rapid intervention, whether you have benign or malignant breast cancer disease. This could include breast surgery, radiology or pathology.

Another very important aim is to improve overall breast care management by doing the following:

  • Improving skills at Primary Health Care and district hospital level.
  • Ensuring survivorship support for patients.
  • Co-ordinating care and providing palliative care where necessary.
  • Auditing and documenting your personal care pathway so there’s no chance you’ll get “lost” in the system. 4

The policy warns that patient care is jeopardised by the existing lengthy pathways in the continuum of cancer care. The new system secures the imperative timeous movement through the process, from screening and early detection, to treatment (radiotherapy, chemotherapy, surgery or palliative). If you present with advanced breast cancer disease, you will be referred directly to an SBU after passing through an RBU. 5

 

WHAT CARE CAN YOU EXPECT TO RECEIVE AT THESE BREAST UNITS?

Clear minimum packages for care are defined in the policy, and include:

  • Counselling.
  • Biopsy where necessary.
  • Relevant breast surgery.
  • Access to an oncologist.
  • Access to relevant radiation treatment.
  • Access to relevant chemotherapy.
 

WHAT IS THE DIFFERENCE BETWEEN RBUS AND SBUS?

  • RBUs must meet the minimum standards, with the required staffing and equipment, to accurately diagnose benign and malignant disease.
  • You must then be referred within 1 to 62 days to a specialist breast unit (SBU) for Specialist Breast Assessment (SBA) if applicable.

WHAT WILL YOUR ASSESSMENT INCLUDE?

  • All eligible patients are entitled to triple assessment. This includes:

– Clinical examination.

– Imaging.

– Histological confirmation.

  • Testing for HER2 is also recommended if you’re newly-diagnosed with an invasive breast cancer. This tests for your likely response to specific antibody and other systemic therapies.
  • If you’ve been diagnosed with breast cancer, you should also be screened for emotional distress.
  • You must be allocated a breast care nurse or counsellor, who will become the go-between linking you with your multi-disciplinary team of medical professionals working on your case.6

 

WHAT ARE THE BENEFITS OF A ONE-STOP BREAST CLINIC?

  • If you have malignant disease, you will be referred immediately to an oncologist.
  • You won’t have to make multiple visits to clinics for investigations and results.
  • You’ll save on transport costs and loss of income in the event you have to take time off work.
  • You will be evaluated more efficiently.
  • Shorter waiting times for diagnosis mean less anxiety.
  • You are more likely to attend your follow-up visits, especially if you have malignant disease, because the whole process is so much faster, and easier. 7
 
 

WHERE ARE THE PROPOSED RBUS BY PROVINCE?

PROVINCEPROPOSED REGIONAL BREAST UNITS
-- Pending Accreditation --
Eastern CapeNelson Mandela Academic Hospital
Cecilia Makiwane Hospital
Free StateBoitumelo Regional Hospital
Dihlabeng Provincial Hospital
Bongani Regional Hospital
Botshabelo District Hospital
Mofumahadi Manapo Mopeli Regional Hospital
GautengPholosong Hospital
Tambo Memorial Hospital
Sebokeng Hospital
Kalafong Hospital
Kwazulu-NatalAddington Hospital
Port Shepstone Regional Hospital
R.K. Khan Hospital
Ngwelezana Hospital
LimpopoMankweng Hospital
MpumulangaEmalahleni Hospital
Northern CapeKimberley Hospital
Upington Hospital
North WestKlerksdorp Tshepong Complex
Potchefstroom Hospital
Western CapeKarl Bremer Hospital
Khayelitsha Hospital
Mitchell's Plain District Hospital
Paarl Provincial Hospital
Somerset Hospital
Victoria Hospital
Worcester Hospital

WHAT IF THERE’S NO SBU IN THE PROVINCE IN WHICH YOU LIVE?

This is likely to remain problematic until the network of SBUs is fully established, but the policy says that if there isn’t one in your home province, you must be referred to the closest SBU in a neighbouring province.

In addition, the policy says that in areas currently without SBUs, the RBUs must be properly equipped to pick up the slack, conducting timely and accurate diagnosis of any patients with breast symptoms.8

WHAT ARE THE TIMELINES FOR YOUR CARE?

If you have a breast symptom, you must be examined and immediately referred to a designated RBU or SBU.

In cases of high or medium suspicion, you must have a specialist breast assessment (SBA) within 21 days.

That number is 62 days for women with low suspicion of breast cancer. 9

 

REFERENCES

  1. World Health Organisation (2018). Health topics: Cancer: Breast Cancer. Retrieved on September 30, 2018, from http://bit.ly/2Qlq2Ql
  2. National Department of Health (2017). Breast Cancer Control Policy. http://bit.ly/BreastPolicy2017 P.22
  3. National Department of Health (2018). Clinical Guidelines for Breast Cancer Control and Management. NDOH internal document – P.22
  4. National Department of Health, Stakeholder Briefing – Breast Cancer Control Policy (2018). Unpublished document – P.11
  5. National Department of Health (2018). Clinical Guidelines for Breast Cancer Control and Management. NDOH Internal Document – P.25
  6. National Department of Health, Stakeholder Briefing – Breast Cancer Control Policy (2018). Unpublished document – P.7-9
  7. National Department of Health (2018). Clinical Guidelines for Breast Cancer Control and Management. NDOH Internal Document – P.28
  8. National Department of Health (2018). Clinical Guidelines for Breast Cancer Control and Management. NDOH Internal Document – P.31
  9. National Department of Health (2018). Clinical Guidelines for Breast Cancer Control and Management. NDOH Internal Document – P.34

 

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