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Improving the breast health care system requires a systemic approach beginning with situational analysis to identify systematic gaps that prevent sustainable improvements in outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The authors performed a situational analysis of the breast health care system using methods developed by the Breast Health Global Initiative. Based on their findings, they developed a series of recommendations for strengthening the health system for the early diagnosis of breast cancer based on clinical detection, referral, tissue sampling, and diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Deficits in the recognition of breast cancer signs and symptoms, the underuse of clinical breast examination as a diagnostic and\/or screening tool, the centralization of diagnostic tests (radiology and pathology), reliance on excisional biopsies rather than needle biopsies, and a lack of trained professionals and knowledge of the referral system all contribute to significant health system delays.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>To strengthen referral networks and improve the early diagnosis of breast cancer in Uganda, national referral hospitals should provide educational programs to primary health care providers in community health centers (CHCs), at which the majority of women first present with symptoms. At secondary district\u2010level facilities in which imaging and tissue sampling can be performed, the capacity for diagnostic testing could be increased through task shifting of basic interpretation (abnormal vs normal) from specialists to nonspecialists using networking technology to facilitate remote oversight from specialists at the national referral hospitals.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.32890","type":"journal-article","created":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T16:37:27Z","timestamp":1588178247000},"page":"2469-2480","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Breast cancer early detection and diagnostic capacity in Uganda"],"prefix":"10.1002","volume":"126","author":[{"given":"John R.","family":"Scheel","sequence":"first","affiliation":[{"name":"Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle Washington"},{"name":"Department of Radiology University of Washington Seattle Cancer Care Alliance Seattle Washington"},{"name":"Department of Global Health University of Washington Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahbod J.","family":"Giglou","sequence":"additional","affiliation":[{"name":"Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Segel","sequence":"additional","affiliation":[{"name":"Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackson","family":"Orem","sequence":"additional","affiliation":[{"name":"Uganda Cancer Institute Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivien","family":"Tsu","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses","family":"Galukande","sequence":"additional","affiliation":[{"name":"Department of Surgery School of Medicine Makerere University Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy","family":"Okello","sequence":"additional","affiliation":[{"name":"Department of Radiology Mulago Hospital Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gertrude","family":"Nakigudde","sequence":"additional","affiliation":[{"name":"Uganda Women's Cancer Support Organization Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noleb","family":"Mugisha","sequence":"additional","affiliation":[{"name":"Uganda Cancer Institute Kampala Uganda"},{"name":"Community Prevention and Screening Ugandan Cancer Institute Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeridah","family":"Muyinda","sequence":"additional","affiliation":[{"name":"Department of Radiology Mulago Hospital Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin O.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle Washington"},{"name":"Department of Global Health University of Washington Seattle Washington"},{"name":"Department of Surgery University of Washington Seattle Cancer Care Alliance Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7369-4021","authenticated-orcid":false,"given":"Catherine","family":"Duggan","sequence":"additional","affiliation":[{"name":"Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,4,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6604435"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-015-0632-4"},{"key":"e_1_2_8_5_1","unstructured":"The Breast Health Global Initiative.2019."},{"key":"e_1_2_8_6_1","unstructured":"IlbawiA VargheseC LoringB GinsburgO CorbexM.Guide to cancer early diagnosis.2017."},{"key":"e_1_2_8_7_1","unstructured":"World Health Organization.Guide to cancer early diagnosis.2017."},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2018.0083"},{"key":"e_1_2_8_9_1","unstructured":"International Agency for Research on Cancer.Global cancer observatory: cancer tomorrow. 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