Article Type

Original Research

Publication Date





Breast cancer incidence and mortality are rapidly increasing in low- and middle-income countries like Uganda. Shifting the proportion of women presenting with late-stage breast cancer to early-stage breast cancer (downstaging) at the time of diagnosis would substantially improve survival and efficient use of available resources. Imaging The World (ITW) conducted a pilot study in Uganda where trained village health teams (VHTs) promoted breast cancer awareness in the Kamuli District (Uganda). As a result, 212 women with self-detected lumps presented to the community health center level III (Nawanyago HCIII) for a clinical breast examination (CBE). Patients with masses on CBE were examined with breast ultrasound by a certified sonographer trained in breast imaging. Women with ultrasound-detected masses were referred to a regional health center for further evaluation. Of the 212 women, 44 (21%) had a palpable mass by CBE, 11 (28%) examined by ultrasound were recommended for biopsy, and four breast cancers were diagnosed. Providing ultrasound scanning at Nawanyago HCIII reduced the number of women travelling to the referral hospital by 75%. As a result of breast cancer awareness and ultrasound studies, we were able to diagnose breast cancer at an earlier stage than would be otherwise possible. This pilot project supports locally available breast ultrasound as a resource-appropriate strategy to downstage breast cancer in a low-income country.


low- and middle-income countries (LMICs), breast cancer downstaging, breast ultrasound

Rights and Permissions

© 2016 the Author(s). This open access article is distributed under a Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/).

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.


This work was supported by the Stars in Global Health Grant from Grand Challenges Canada and the citizens of Canada. JRS is supported in part by the American Roentgen Ray Society Scholar award. The authors thank Ms. Catherine O’Donnell and Dr. Gaytri Scheel for their critical review of this manuscript.

Corresponding Author(s)

Current address: John R. Scheel, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G3-200, Seattle, WA 98109-1023; jrs4yg@uw.edu

fig001.jpg (63 kB)
Figure 1. Imaging The World breast cancer downstaging strategy

fig002.jpg (2327 kB)
Figure 2. Ugandan sonographer undergoing ultrasound training on a breast phantom

M1021_figure 3.tiff (1521 kB)
Figure 3. Ultrasound images of a mass from a woman presenting with a palpable lump to Nawanyago HCIII.