Contextualizing policy implementation, challenges, and plans for improving breast cancer early detection programs in Indonesia

Abstract Background Late-stage breast cancer (BC) is commonly diagnosed in limited-resource countries such as Indonesia. The lack of information for decision-making emphasizes the need for efforts to support evidence-informed practice for improving BC early detection in Indonesia. This study attempts to understand the local context evidence on policy implementation, challenges, and plans for enhancing BC early detection programs in Indonesia. The evidence gained from this study will help harness the power of scientific reasoning that shapes theories of how BC early detection intervention works and its operationalization in practice. Methods This study engaged three interrelated phases of qualitative methods. Phase I involved a document analysis in determining the predominant strategy and approach to the landscape of BC early detection programs. Phase II was an in-depth interview to clarify the operationalization of the technical aspect, eliciting stakeholder experiences and their perceptions about the factors supporting or hindering goal achievement. In phase III, two consecutive collaborative expert workshops and a collaborative learning process nested with the Indonesia Project ECHO team for Knowledge Summaries for Comprehensive Breast Cancer Control. Results Current BC early detection strategies to downstage women's symptomatic breast abnormalities are considered an essential preparatory step before starting a screening program at the enhanced or maximal level of resources. However, the absence of an integrated cancer registry system renders it impossible to measure the full effect of the program implementation as a public health policy. Emphasis on improving structural barriers during the follow-up of abnormalities, patient navigation for referrals, and a surveillance system to track the times from presentation to diagnosis and diagnosis to treatment is needed for Indonesia's early detection services continuum. Conclusion The local context presented in this research increased the usability and usefulness of relevant evidence for decision-makers, thus bridging the gap in translating research findings into healthcare practice for BC early detection in Indonesia. Importantly, attention to providing a clear national guideline, developing a highly interoperable screening registry system, and ensuring the sustainability of pilot sites on mammography screening is critical to the success of expected outcomes.