Empowering healthcare workers

As the incidence of cancer increases, the Breast Course for Nurses (BCN) aims to provide healthcare workers with the knowledge, skills and confidence to educate and screen women and men in their communities, and to know when to refer patients for further management. Therefore increasing early detection and treatment of patients with breast cancer.

What is the BCN? 

The BCN is a public benefit organisation that equips healthcare workers with the skills to manage patients with breast problems.

In many places in Africa, the first contact with a health professional for women with breast complaints is a nurse in a primary clinic. Over the last decades, there has been little formal breast training for nurses as the emphasis has been on the management of infectious diseases. However, as the management of infectious diseases improves, the World Health Organisation (WHO) predicts that the mortality due to non-communicable diseases in the developing world will increase by 17% in the next 10 years.

This will have a major impact on an already overburdened health system1. Similarly, The Lancet Oncology (2013) has predicted that the prevalence of cancer in developing countries could rise by 90% by 2030.

Healthcare services in South Africa are a mixture of those seen in low- and high-income countries. Access to the healthcare services is also problematic and often relatively expensive. As a result of that, more than 65% of women with breast cancer present with locally advanced disease.

Consequently, the programmes used for breast screening in high-income countries are not appropriate or feasible for the majority of low-income countries.

Screening, using mammography, is not an option in many African countries as there is minimal access to mammography equipment, and it is very expensive. In Southern Africa, a different model of breast screening is necessary to improve the general well-being of the majority of women.

Clinical breast examination has been studied as a modality of screening but without much success.  However, the only study to look at its application in Africa is encouraging. In Sudan, nurses and volunteers were trained to perform breast examinations on all women over the age of 18 in the screened population. The incidence and stage of breast cancer were compared to that in an unscreened population. They showed clinical screening resulted in women being diagnosed with earlier breast cancer2.

The BCN is based on the Breast Care book3 which is part of the Bettercare series. The BCN combines distance education with a residential course. The course puts the theory into practice. Volunteers, care workers, enrolled nurses and registered nurses form the majority of the students, although it has been extended to include doctors and oncology nurses.

The emphasis is on learning rather than teaching, with most of the faculty being local healthcare providers. Therefore, although the core content of the course remains the same wherever the course is taught, the information becomes applicable for the available resources.

It can also be adapted depending on the type of health care workers being trained.

Since 2012, the BCN has been taught on numerous occasions in South Africa (Cape Town, Johannesburg, Durban and Port Elizabeth), Malawi (Lilongwe), Zimbabwe (Harare and Bulawayo) and Namibia (Windhoek and Ongwediva), and just over 600 healthcare providers have successfully completed the course.

NEXT COURSE: Healthcare providers are encouraged to join us at the Chris Hani Baragwanath Hospital in March 2017 at our next course. If you wish to attend, please email Lieske Wegelin at [email protected]. You can also stay up-to-date with our activities by visiting our Facebook page: Breast Course 4 Nurses.

Written by  Dr Jenny Edge, Sr L Wedeln and Prof Dave Woods.


1. http://www.who.int/nmh/publications/ncd_report_full_en.pdf (accessed 13/10/16)

2. Lancet Oncology 2013

3. http://bettercare.co.za/learning-programmes/breast-care/) which forms part of the PEP series (http://pepcourse.co.za/).

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