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Poster session 23

1724P - Improving access to breast cancer diagnosis and treatment through navigation: Evaluation of a one-year pilot project in Botswana


21 Oct 2023


Poster session 23


Fundamentals of Cancer Care Organisation;  Multi-Disciplinary and Multi-Professional Cancer Care;  Cancer Prevention;  Cancer Diagnostics

Tumour Site

Breast Cancer


Ariane Migeotte


Annals of Oncology (2023) 34 (suppl_2): S925-S953. 10.1016/S0923-7534(23)01945-2


A. Migeotte1, I.S. Soares de Pinho2, N. Ngwako3, T. Leselwa4, T. Lethloma5, T. Ralefala6, I. Setlhako6, N.C. Swart7, J. Khutjwe7, T. Gaolathe8, R. Lebelonyane9, K.M. Chalegwa10, P. Moanakwena11, R. Marlink12, K. Sharma13, P. Vuylsteke14

Author affiliations

  • 1 Oncology Department, Centre Hospitalier Jolimont-Lobbes, 7100 - Haine-Saint-Paul/BE
  • 2 Oncologia Médica, Faculdade de Medicina da Universidade de Lisboa, 1649-028 - Lisbon/PT
  • 3 Faculty Of Medicine, University of Botswana, Gaborone/BW
  • 4 Assistant Program Coordinator, Botswana Rutgers Partnership for Health, Gaborone/BW
  • 5 Princess Marina Hospital - Outpatient Clinic, Ministry of Health, Gaborone/BW
  • 6 Princess Marina Hospital - Oncology Department, Ministry of Health, Gaborone/BW
  • 7 School Of Nursing, University of Botswana, Gaborone/BW
  • 8 Senior Advisor, Botswana Rutgers Partnership for Health, Gaborone/BW
  • 9 Program Manager, Botswana Rutgers Partnership for Health, 08901 - New Brunswick/BW
  • 10 /, University of Botswana, Gaborone/BW
  • 11 Teaching And Learning Unit, University of Botswana, Gaborone/BW
  • 12 Global Health - Director, Rutgers Global Health Institute, New Brunswick/US
  • 13 Rutgers Global Health Institute, Rutgers Global Health Institute, New Brunswick/US
  • 14 Internal Medicine Dept., University of Botswana, Gaborone/BW


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Abstract 1724P


In Botswana, 65% of breast cancers present at an advanced stage due to multifactorial delays. The WHO Global Breast Cancer Initiative recommends a maximum of 60 days of lead time in diagnostic workup and strongly advocates for the use of patient Navigation. A Patient Navigation Project was created to improve the timely diagnosis and treatment of breast cancer patients around Gaborone, the capital.


A 2-day theoretical and practical course was delivered in March 2022 to 15 clinical navigators (nurses from 6 district Hospitals and from the Referral Hospital) and 7 non-clinical navigators (advocacy groups). A navigation coordinator served as the point of contact, reported on program outcomes and provided smartphone airtime. Different virtual communication groups were created with navigators to accelerate patient flow and facilitate problem solving.


Between April 2022 and July 2023, 75 patients were included in the navigation program: 21 were in early stages (stages I and II) (28%) and 53 in advanced stages (stages 3 and 4) (71%). From those patients, 46% received neoadjuvant chemotherapy, 17% adjuvant chemotherapy and 25% palliative therapy. Navigation enabled faster access to CT-scan staging, unveiling more stage IV disease (23%), thus avoiding inappropriate curative treatments.

Table: 1724P

Key navigation challenges and improvements

Key persistent challenges Key improvements
Delays in biopsy (needle shortages) Biopsies and staging done locally, avoiding referral delays for diagnostic workup
Delays in obtaining biopsy and IHC results (pathology backlogs, loss of sample, reagent shortages) Fast referral pathway for patients in need of urgent consultation
Patient transport issues Closer tracking of patients and tests results
Treatment delays: Stock-outs of drugs (hormone therapy, chemotherapy) and radiation therapy delays Facilitated access to counselling and transport services
Time constraints: Limited time allocated to navigation Increased multidisciplinary collaboration


The Botswana Breast Cancer Navigation project succeeded in implementing Cancer Navigation in accordance with international guidelines. It improved management of breast cancer patients through a smoother access to diagnosis and treatment, and it addressed barriers to care for specific situations. Many navigation sites referred patients with upfront biopsy diagnosis and minimal staging, and this reduced the time from first consultation in breast clinic to treatment (median delay 22 days). Dr Migeotte and Dr Soares de Pinho contributed equally to this work.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Botswana-Rutgers Partnership for Health.




All authors have declared no conflicts of interest.

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