Eur J Cancer Care 2017; 26: e12658; wileyonlinelibrary.com/journal/ecc | 1 of 4 DOI: 10.1111/ecc.12658 © 2017 John Wiley & Sons Ltd Accepted: 5 December 2016 DOI: 10.1111/ecc.12658 FEATURE AND REVIEW PAPER Development of mult-disciplinary breast cancer care in Southern Malawi E.R.S. Brown MBChB, PhD, Consultant 1 | J. Bartlet PhD, Director Transformatve Pathology 2 | K. Chalulu MBBS, Consultant 3 | L. Gadama MBBS, Consultant 3 | D. Gorman MBChB, FFPH, Consultant 4 | L. Hayward MBChB, PhD, Consultant 1 | Y. Jere DipClinMed, Clinical Ofcer 3 | M. Mpinganjira BN, Breast Care Nurse 3 | P. Noah MBBS, Consultant 5 | M. Raphael RGN, Clinical Nurse Specialist 1 | F. Taylor RGN, BSc, Senior Charge Nurse 1 | L. Masamba MBBS, Consultant 3 1 | INTRODUCTION Malawi is a low-income country with a Gross Natonal Income (GNI) per capita of 250 US dollars and approximately 50% of the pop- ulaton are estmated to live below the poverty line (less than 1.25 US dollars per day)(The World Bank 2016). Communicable diseases including HIV, TB and Malaria are the major causes of morbidity and mortality in Malawi (WHO 2016), although it is now becoming clear that non-communicable diseases including cancer are becoming major healthcare issues (United Natons 2011). The Malawi Ministry of Health Strategic Plan 2011 acknowledged the absence of efectve cancer services in Malawi and included cancer in its Essental Health Package. Subsequently the Natonal Acton Plan for Preventon and Management of Non-Communicable Diseases in Malawi 2012–2016 placed increasing emphasis on cancer educaton, preventon and treat- ment including the development of specialist cancer centres (Ministry of Health 2013) and the Malawi Ministry of Health has now included a cancer secton for the frst tme in the Malawi Standard Treatment Guidelines (Ministry of Health 2015). In Malawi, in common with other East African sub Saharan natons, breast cancer forms the fourth or ffh commonest cancer in women, behind Kaposi’s sarcoma, cervical cancer, oesophageal 1 Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK 2 Ontario Insttute for Cancer Research, Toronto, ON, Canada 3 Queen Elizabeth Central Hospital, Blantyre, Malawi 4 Department of Public Health, NHS Lothian, Edinburgh, UK 5 Department of Surgery, University of Malawi College of Medicine, Blantyre, Southern Region, Malawi Correspondence Ewan R.S. Brown, Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK. Email: ewan.brown@luht.scot.nhs.uk Funding informaton This project was supported by funding from the Scotsh Government Malawi Development Programme 2015-2018 (M/15/H/001). The Edinburgh Malawi Breast Cancer Project, a collaboratve partnership project be- tween the Queen Elizabeth Central Hospital (QECH) Oncology Unit, Blantyre, Malawi and the Edinburgh Cancer Centre, UK, was established in 2015. The principal objectve of the project is to help to develop high quality mult-disciplinary breast cancer care in Malawi. A needs assessment identfed three priority areas for further improvement of breast cancer services: mult-disciplinary working, development of oestrogen receptor (ER) testng and management of clinical data. A 3-year project plan was implemented which has been conducted through a series of reciprocal training visits. Key achieve- ments to date have been: (1) Development of a new specialist breast care nursing role; (2) Development of mult-disciplinary meetngs; (3) Completon of a programme of on- cology nursing educaton; (4) Development of a clinical database that enables prospec- tve collecton of data of all new patents with breast cancer; (5) Training of local staf in molecular and conventonal approaches to ER testng. The Edinburgh Malawi Breast Cancer Project is supportng nursing educaton, data use and cross-specialty collabora- ton that we are confdent will improve cancer care in Malawi. Future work will include the development of a breast cancer diagnostc clinic and a breast cancer registry. KEYWORDS Breast Cancer, Mult-disciplinary care