BRIDGEing the Gap: Impact of a Short Virtual Course on Delivering Global-Standard Breast Cancer Care in Low-Resource Settings.

Abstract

Access to guideline-concordant global-standard breast cancer care remains limited in many low- and middle-income countries (LMICs), where high-cost technologies for diagnostics, surgical diagnosis and treatment (such as radioisotope mapping, ICG fluorescence, and intraoperative margin assessment) are not widely available. The BRIDGE Course (Breast Surgery Resource Integration & Development for Global Excellence) was designed as a short, virtual educational program to educate and update surgeons with validated, low-cost techniques that ensure oncologic safety while addressing resource constraints. A 7-h online course was designed and conducted in September 2025 with participation from international and national faculty. Content emphasized pragmatic adaptations of global guidelines, including triple assessment, surgical decision-making for mastectomy versus breast conservation, sentinel lymph node biopsy (SLNB) using methylene blue and fluorescein torch, and low-cost oncoplastic approaches. Pre- and post-course surveys assessed baseline practice, perceived barriers, satisfaction, confidence, and intent to implement. Descriptive statistics were analyzed. Seventy-five participants completed the pre-course survey and 66 completed the post-course survey. At baseline, mastectomy was the most common primary operation (30.7%), whereas only 20% predominantly performed breast-conserving surgery; SLNB was mainly performed using methylene blue (68.5%). Reported barriers included lack of resources, training gaps, and patient mindset. Post-course, ≥ 85% of participants reported improved confidence across all domains: triple assessment (83% strongly agreed), mastectomy versus BCS decision-making (74%), SLNB with low-cost tracers (66%), and complication management (60%). Implementation intent was high, with nearly all (96%) planning to adopt at least one new technique and all intending to share knowledge with colleagues or trainees. The BRIDGE Course successfully enhanced knowledge and confidence in resource-adapted breast cancer surgery, with strong intent to implement and improve practices. Such short, focused virtual programs may serve as a scalable model for narrowing disparities in breast cancer care across LMICs.