Interventions for Breast cancer

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Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Encourage exclusive breastfeeding in first 6 months and breastfeeding for a minimum of 1				Social Marketing campaigns instituted towards generating empathy and promotion social inclusion of those who have completed a treatment cycle Promotion of manufacturing of prosthetics, post-Surgical treatment
Primary Care
				Provision of Clinical Psychology services as part of Primary Care for clients who have completed treatment cycles	Set up publicly run hospices to collaborate with Primary Care Centers
Referral Facility: General
			Institute Specialist teams to offer a combination of Surgery, Chemotherapy and Radiotherapy depending on the stage of the condition Ductal Carcinoma-In-Situ (DCIS) – Surgery and Radiotherapy		Set up publicly owned-and-run hospices Promote private sector participation in setting up hospices and palliative care centers
Referral Facility: Specialist
			Physical and clinical examination supportive managemnet including: pain relieve Nutritionla support Admission where necessary managemnet of opportunitsic infections Management of any underlying conditions Monitoring and managemnet of any complications Blood transfusions if indicated Oxygen therapy Chemotherapy Surgical interventions Radiotherapy Hormonal therapy INtensive care unit services Follow up invclidng counselling for compliance with treatmnent INVESTIGATIONS /diagnostics Mamograms Blood tests Biopsy Other tests eg to check for metastasis x-rays eg chest r-ray CT scan MRI Ultra-sound PET scan Mammmography Gene testing -BRCA testing for women with high risk of breast cancer		psychosocial support for atient and family Spiritual support Counsellng services

Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Health and Wellness education on diet management, regular exercise, weight management, reduced exposure to radiation, reducing alcohol intake and avoiding exposure to tobacco smoke Pursue intersectoral collaborations, with Ministry of Agriculture and its agencies, that make nutritious food sources available and affordable Pursue intersectoral collaborations with Ministry of Environment, that reduce exposure to sources of radiation Parents education on need for breastfeeding (exclusive for 6 months and breastfeeding at least upto 2 years	Health Education on Breast Cancer–symptoms, risk factors, available treatment, need for prevention, early detection and early reporting for management			Social Marketing campaigns instituted towards generating empathy and promotion social inclusion of those who have completed a treatment cycle Promotion of manufacturing of prosthetics, post-Surgical treatment	Set up publicly owned-and-run hospices Promote private sector participation in setting up hospices and palliative care centers
Primary Care
				Provision of Clinical Psychology services as part of Primary Care for clients who have completed treatment cycles	Set up publicly run hospices to collaborate with Primary Care Centers
Referral Facility: General
			Institute Specialist teams to offer a combination of Surgery, Chemotherapy and Radiotherapy depending on the stage of the condition Ductal Carcinoma-In-Situ (DCIS) – Surgery and Radiotherapy
Referral Facility: Specialist
			Physical examination supportive therapy relive pain Nutritional support managemnet of any opportunistc infections Investigations Biopsy Ultrasoud MRI N/B Often when children have tumors in their breast tissue, the tumors aren’t cancerous but mainly fibroadenomas. (Benign in nature) Surgery to remove the tumour Radiotherapy follow up

Age Cohort: 5 - 11 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Health and Wellness education on diet management, regular exercise, weight management, reduced exposure to radiation, reducing alcohol intake and avoiding exposure to tobacco smoke Pursue intersectoral collaborations, with Ministry of Agriculture and its agencies, that make nutritious food sources available and affordable Pursue intersectoral collaborations with Ministry of Environment, that reduce exposure to sources of radiation	Health Education on Breast Cancer–symptoms, risk factors, available treatment, need for prevention, early detection and early reporting for management			Social Marketing campaigns instituted towards generating empathy and promotion social inclusion of those who have completed a treatment cycle Promotion of manufacturing of prosthetics, post-Surgical treatment	Set up publicly owned-and-run hospices Promote private sector participation in setting up hospices and palliative care centres
Primary Care
				Provision of Clinical Psychology services as part of Primary Care for clients who have completed treatment cycles	Set up publicly run hospices to collaborate with Primary Care Centers
Referral Facility: General
			Institute Specialist teams to offer a combination of Surgery, Chemotherapy and Radiotherapy depending on the stage of the condition Ductal Carcinoma-In-Situ (DCIS) – Surgery and Radiotherapy
Referral Facility: Specialist
			Physical examination supportive therapy relive pain Nutritional support managemnet of any opportunistc infections Investigations Biopsy Ultrasoud MRI N/B Often when children have tumors in their breast tissue, the tumors aren’t cancerous but mainly fibroadenomas. (Benign in nature) Surgery to remove the tumour Radiotherapy follow up

Age Cohort: 12 - 24 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Health and Wellness education on diet management, regular exercise, weight management, reduced exposure to radiation, reducing alcohol intake and avoiding exposure to tobacco smoke Pursue intersectoral collaborations, with Ministry of Agriculture and its agencies, that make nutritious food sources available and affordable Pursue intersectoral collaborations with Ministry of Environment that reduce exposure to sources of radiation	Teach Self Breast Teach Self Breast Examinations at schools, community gatherings, religious gatherings and through the print and electronic media			Social Marketing campaigns instituted towards generating empathy and promotion social inclusion of those who have completed a treatment cycle Promotion of manufacturing of prosthetics, post-Surgical treatment	Set up publicly owned-and-run hospices Promote private sector participation in setting up hospices and palliative care centres
Primary Care
	Clinical Breast Examinations (CBE) offered during all Primary Care visits Breast Ultrasound scans for investigating pathologies picked up from Clinical Breast Examinations		Early Detection through annual mammography, CBE at every visit and Breast Ultrasonography to investigate pathologies picked up by mammography and CBE. Followed by prompt referral for Incisional biopsy by Specialist Surgical Teams at Hospital Level	Provision of Clinical Psychology services as part of Primary Care for clients who have completed treatment cycles	Set up publicly run hospices to collaborate with Primary Care Centers
Referral Facility: General
	Institute Specialist teams to offer a combination of Surgery, Chemotherapy and Radiotherapy depending on the stage of the condition; Ductal Carcinoma-In-Situ (DCIS) – Surgery and Radiotherapy Local Carcinoma-In-Situ (LCIS) (classic) – Surgical Excision only LCIS (pleomorphic) – Surgery and Chemotherapy * Early Stage Cancer (Stages I and II) – Pre-Operative Chemotherapy, Surgery and Radiotherapy Locally Advanced Cancer (Stage III) – Pre-Operative Chemotherapy, Surgery, Post -Operative Radiotherapy and Post-Operative Chemotherapy Metastatic Cancer (Stage IV) – Chemotherapy and Radiotherapy. Surgery is not recommended Paget’s Disease of the Nipple – Surgery only		Institute Specialist teams to offer a combination of Surgery, Chemotherapy and Radiotherapy depending on the stage of the condition Ductal Carcinoma-In-Situ (DCIS) – Surgery and Radiotherapy	Institute Specialist teams to offer reconstructive plastic surgery after mastectomies
Referral Facility: Specialist
	Guidance on Preventive measures which involves healthy habits such as: Eat healthy and nutritious food Avoidance of alcohol exercises Visit doctor for regular examination screening for Breast cancer eg through physical examination Guidance on self breast examination		Physical and clinical examination supportive managemnet including: pain relieve Nutritionla support Admission where necessary managemnet of opportunitsic infections Management of any underlying conditions Monitoring and managemnet of any complications Blood transfusions if indicated Oxygen therapy Chemotherapy Surgical interventions Radiotherapy Hormonal therapy INtensive care unit services Follow up invclidng counselling for compliance with treatmnent INVESTIGATIONS /diagnostics Mamograms Blood tests Biopsy Other tests eg to check for metastasis x-rays eg chest r-ray CT scan MRI Ultra-sound PET scan Mammmography Gene testing -BRCA testing for women with high risk of breast cancer	Physiotherapy/ exercises Reconstructive plastic surgery after mastectomies

Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community awareness on symptoms of breast cancer, importance of screening with regular breast exams and mammography Community engagement and empowerment on cancer awareness and avoiding harmful traditional practice for breast cancer treatment Community leaders and advocates engagement to address cancer stigma and identification of barriers to accessing care	Keep a healthy life style: healthy weight, physically active, no alcoholic drink or in moderation, no smoking, eat vegetables and fruits Breasts self-examination	Recognition of cancer signs and symptoms	Immediate transfer of suspected cases to a higher-level health care facility	Physical exercise Nutritional support	Home-based care with multi-disciplinary team with access to opiates and essential supportive medicines Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care
Primary Care
Health education on prevention and management of breast cancer	Keep a healthy life style: healthy weight, physically active, no alcoholic drink or in moderation, no smoking, eat vegetables and fruits and breast feed Guidance on self-observance and taking note of any unusual symptoms e.g., nipple discharge, skin change, pitting, breast mass	History Physical examination	Immediate transfer of suspected cases to a higher-level health care facility	Physical exercise Nutritional support	Multi-disciplinary team with access to opiates and essential supportive medicines Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care
Referral Facility: General
Health education on prevention and management of breast cancer	Regular screening with mammogram	History Physical examination Mammography Ultrasonography Full blood count	Immediate transfer of suspected cases to a higher-level health care facility	Physical exercise Nutritional support Cognitive behaviour therapy (CBT)	Multi-disciplinary team with access to opiates and essential supportive medicines Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care
Referral Facility: Specialist
Health education on prevention and management of breast cancer	Regular screening with mammogram	History Physical examination Staging X-ray Ultrasonography Mammography, Computed tomography (CT) Positron emission tomography (PET) scan Magnetic resonance imaging Cytology Haematology Histopathology Prognostic markers Immunochemistry	Chemotherapy Hormone therapy Lumpectomy Simple mastectomy Radical mastectomy Lymphadenectomy Radiotherapy	Physical exercise Nutritional support Cognitive behaviour therapy (CBT)	Multi-disciplinary team with access to opiates and essential supportive medicines Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care

Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community awareness on symptoms of breast cancer, importance of screening with regular breast exams and mammography Community engagement and empowerment on cancer awareness and avoiding harmful traditional practice for breast cancer treatment Community leaders and advocates engagement to address cancer stigma and identification of barriers to accessing care	Keep a healthy life style: healthy weight, physically active, no alcoholic drink or in moderation, no smoking, eat vegetables and fruits Breasts self-examination	Recognition of cancer signs and symptoms	Immediate transfer of suspected cases to a higher-level health care facility	Physical exercise Nutritional support	Non-opioid analgesia for effective control of mild to moderate pain Symptomatic non-pharmacological treatment Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care
Primary Care
Health education on prevention and management of breast cancer	Regular symptomatic screening for breast diseases	History Physical examination	Immediate transfer of suspected cases to a higher-level health care facility	Physical exercise Nutritional support	Opioid analgesia for effective control of moderate to severe pain Symptomatic non-pharmacological treatment Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care
Referral Facility: General
Health education on prevention and management of breast cancer	Regular screening with mammogram	History Physical examination Mammography Ultrasonography Full blood count	Immediate transfer of suspected cases to a higher-level health care facility	Physical exercise Nutritional support Cognitive behaviour therapy (CBT)	Opioid analgesia for effective control of moderate-to-severe pain Symptomatic non-pharmacological treatment Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care
Referral Facility: Specialist
Health education on prevention and management of breast cancer	Regular screening with mammogram	History Physical examination Staging X-ray Ultrasonography Mammography, Computed tomography (CT) Positron emission tomography (PET) scan Magnetic resonance imaging Cytology Haematology Histopathology Prognostic markers Immunochemistry	Chemotherapy Hormone therapy Lumpectomy Simple mastectomy Radical mastectomy Lymphadenectomy Radiotherapy	Physical exercise Nutritional support Cognitive behaviour therapy (CBT)	Opioid analgesia for effective control of moderate-to-severe pain Symptomatic non-pharmacological treatment Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care*