From obstacles to outcomes: Transforming breast cancer care in Rwanda
Women in Rwanda with breast cancer frequently face starkly different realities than their counterparts in higher-income countries. Diagnoses are often made at advanced stages of the disease, awareness of breast cancer screening is low, and numerous barriers — including geographic, socioeconomic, and cultural factors — stand in the way of timely care.
These photos capture the challenges women in Rwanda face throughout their health care journey and how innovative partnerships are working to break down barriers to care, while strengthening health systems across the country.
When Bernadette Narame, 66, from the rural village of Butaro in Rwanda’s Northern Province, first discovered a lump in her breast, she didn’t know what it meant.
“Cancer was not talked about at that time,” she said. “Despite the symptoms, I didn’t know it was breast cancer because [the lump] didn’t cause any pain.”
Over time, however, the lump began to cause discomfort and made it difficult for Bernadette to work on the farm. Encouraged by her friend and daughter, she visited the local health clinic, beginning a treatment journey that spanned from surgery at a nearby hospital to specialized radiotherapy at Kanombe Hospital in Kigali, more than 110 kilometers away.
Navigating complex barriers
In Rwanda, primary health care centers have traditionally focused on maternal and child health and infectious diseases, while chronic conditions such as cancer are managed by tertiary hospitals.
For patients like Bernadette, this means traveling long distances for specialized care. Financial constraints, limited transportation, and a lack of nearby accommodations can delay diagnoses and disrupt treatments.
These challenges contribute to breast cancer’s high mortality rate across the region. Despite lower incidence compared to higher-income countries, five-year survival rates in some sub-Saharan African nations are as low as 41% — a stark contrast to more than 90% in higher-income countries.
Addressing access gaps in rural settings
After seeing women with curable diseases struggle to access quality screening, diagnostic, and treatment services, Partners In Health, or PIH — known in Rwanda as Inshuti Mu Buzima — opened the Butaro Cancer Center of Excellence in 2012. As the first cancer center in rural Rwanda, it served as a “proof of concept” for showing what’s possible in improving cancer outcomes in rural settings.
Today, the hospital treats over 1,700 patients a year, drawing people from all 30 districts of Rwanda and even neighboring countries to access comprehensive services for breast cancer and other types of cancers.
In 2024, The Pfizer Foundation partnered with PIH through its Action & Impact: A Cancer Care Initiative to help expand the Butaro center’s reach and help improve patient outcomes.
In just one year, the collaboration has raised awareness about breast cancer, helped improve access to timely diagnostics, and strengthened referral pathways and follow-up care. The partnership has also introduced endocrine therapy and breast cancer surveillance programs at district hospitals, reducing the need for patients to travel long distances for high-quality services.
From community to clinic: Breaking down barriers to care
Community health care workers play an essential role in the breast cancer care journey, especially in rural villages. PIH selects trusted community members and trains them in breast health awareness, screening, and patient support.
Because they are embedded in the community, these workers build trusted relationships with patients — helping mobilize women to visit health facilities, encouraging patients to adhere to medication, and teaching breast self-examination techniques.
Their emotional support is equally important. After a diagnosis, community health care workers often counsel women, helping reduce their anxiety, and accompany them to health facilities throughout treatment.
Jean Damascene Senzira, a 54-year-old community health care worker from Gahunge village in Butaro, serves 21 households. In his 22-year career, he has witnessed many barriers to timely diagnosis, including misconceptions about breast cancer, limited knowledge of symptoms, reliance on traditional medicine, and cultural norms that can make it difficult for women to confide in male health care workers.
Building trust is central to his work.
“The important thing is that I have been keeping confidentiality with our community members,” Jean Damascene said. “Women trust me and are able to tell me everything concerning their lives. They are always with me as a community health care worker … from the community to the health facilities where they take treatment. Even when they have another health-related issue, they come to me and I advise them.”
Jeannette Mukashyaka, a 48-year-old woman from Nyagatare district in Rwanda’s Eastern Province, is living with advanced breast cancer, which has worsened since her diagnosis in November 2023. After completing her chemotherapy at the Butaro center, she has been receiving radiotherapy at Rwanda Military Hospital, where long wait times are common due to the limited equipment.
Bernadette and Jeannette are just two of the many breast cancer patients supported by PIH. Throughout their care, PIH has covered medical expenses, arranged transport to and from hospitals, secured nearby accommodation during radiotherapy, and provided patient navigators to guide them through hospital procedures.
“I had no financial support throughout the entire journey except from PIH. They assigned navigators to help us at the hospital. This enabled us to receive our treatment without any delays or being lost.”
“PIH’s support reaches not only me but also numerous other individuals. When I meet them, they say that PIH is like a friend to them.”
Strengthening health systems in Rwanda
A core part of PIH’s work with The Pfizer Foundation focuses on training health care providers and community health care workers, such as Jean Damascene, and expanding access to care for patients such as Bernadette and Jeannette.
Rather than waiting for formal training, the program equips nurses and general practitioners in district hospitals to detect and manage breast cancer on-site — a model now being adopted nationally.
Hands-on mentorship has further enabled non-oncologists to provide safe, quality care across different levels of complexity. Many of those mentored are now training their peers in other hospitals, helping build lasting capacity within Rwanda’s health system.
“From the beginning of our work, people did not know about the symptoms of breast cancer. Now, after the training we received [from the Ministry of Health and PIH], people are coming from the community to the health facility to seek care. It is important that our community members know about breast cancer, and this will improve as we are continuing to increase the number of nurses, doctors, and specialists in breast cancer.”
“We hope for the future that breast cancer will no longer kill women. Because this disease is now known and is now treated in our catchment area.”
Renewed focus: Closing the disparity gap
Despite its success, the Butaro center still faces challenges. Gaps in patient navigation and understaffing mean some patients are lost in the system without proper follow-up. No hospital in Rwanda currently offers the full spectrum of cancer treatment, so patients are often referred between facilities — where delays can compromise the timing and quality of their care.
As they enter the next phase of their partnership, PIH and The Pfizer Foundation aim to address these remaining barriers, improve clinical outcomes, and increase breast cancer survival rates in Rwanda by 8%.
Today, the three-year survival rate for early-stage breast cancer in Rwanda is around 90.9%. For advanced stages, however, it drops to 44.8% — underscoring the importance of screening, early diagnosis, and advanced treatment options.
“One of the incredible aspects of PIH is their rigorous approach to document and share best practices in Rwanda and beyond. This partnership lays the groundwork for strengthening Rwanda’s cancer care system and creating models that can be adapted across the region.”
Looking ahead, PIH is working with the Rwandan government to scale up cancer care through a five-year National Cancer Control Plan, a road map aimed at reducing disparities and expanding health care access nationwide.
“Health care is a human right, it is not a luxury. You cannot segregate people. There is nothing like ‘malaria is urgent, cancer is not.’ They are all mothers from a family, so treating a cancer patient doesn’t mean [only saving] one life; you are actually saving society.”
“Before my cancer diagnosis, many people believed that the disease was incurable. First and foremost, when you have it, you must have hope. Maintaining hope plays a crucial role in managing cancer. You live with it and you carry it with you on your journey.”
“While undergoing medication, I had to endure side effects, such as hair loss, my nails changed, it was even difficult to eat. But now I am able to feed myself, I can wash things, and cook for myself. This is how I manage my life now. I am hopeful about my life.”
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All images courtesy of Partners In Health
The Pfizer Foundation is a charitable organization established by Pfizer Inc. It is a separate legal entity from Pfizer Inc. with distinct legal restrictions.
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