In Côte d’Ivoire, >70% of women present with breast cancer at Stages III/IV. We designed an educational curriculum for primary healthcare providers (PCPs) to improve breast cancer early diagnosis.


Based on qualitative interviews with seventeen PCPs we designed the Breast Health Project curriculum for PCPs on recognizing signs/symptoms of breast cancer, referral pathways, and helping patients access financial assistance for diagnostic procedures. The curriculum was presented to 36 PCPs during a day-long educational session. All completed baseline and post-session questionnaires on demographics and management of breast health conditions. Changes in pre-/post data were analyzed using Fisher’s exact test. All p-values were two-sided.


Participants included 36 PCPs from five healthcare centers. 75% were female, with a mean age of 41.3 years (SD 7.2). Nine (28%) were physicians, 6 (17%) nurses, 18 (50%) midwives, with a median of 7 (range 3-32 years) work experience.

At baseline, eighteen (50%) providers felt qualified to evaluate patients with breast complaints; 10 (28%) did not, vs. 32 (89%) and 2 (6%) respectively at follow-up (χ2=8.75 p=0.003). 15 (42%) providers felt qualified to help patients overcome barriers to diagnosis, and eleven (31%) felt unqualified/neutral at baseline, vs. 31 (86%) and 4 (11%) respectively at follow-up (χ2=7.67, p=0.006)

There were no statistically significant differences between baseline-follow-up in feeling qualified to perform CBE (27 (75%) versus 32 (89%)) or ability to refer patients for diagnostic workup (29 (81%) versus 34 (94%)).


The educational curriculum was effective in improving confidence in evaluation of breast complaints and addressing barriers to cancer diagnosis. There were no differences in feeling qualified to perform CBE or ability to refer patients to diagnostic workup, which were high at baseline.

Future work includes expanding the reach of the Breast Health Program and evaluation of impact on time to receipt of diagnosis.