A focus on early detection and integrated care at Bermuda Cancer and Health Centre has provided breast cancer patients on the island with world-class support as they negotiate the path toward recovery.
Five years ago, the BCHC – in tandem with the Bermuda Hospitals Board – launched an integrated breast cancer care pathway of education, detection, diagnostics, treatment and recovery that is designed to improve efficiencies and the quality of care.
The BCHC’s goal for all patients is to reduce the time between abnormal imaging or biopsy, confirmed diagnosis, and initiation of treatment, to improve both the patient experience and the clinical outcome.
All BCHC breast cancer cases are presented to a multi-disciplinary team (MDT) that includes surgeons, clinical and medical oncologists, pathologists, radiologists, nurses and a dedicated cancer navigator, to ensure each patient benefits from collective clinical expertise across the island.
The MDT’s functions include:
- Case discussions. The team reviews all newly referred patients, including diagnostics (biopsies, scans), to determine the best treatment plan
- Evidence-based care. The MDT uses national guidelines to guide decisions, reducing variation in practice
- Clinical trials. The team discusses suitability for clinical trials
- Patient-centred approach. Although patients usually do not attend the meeting, their preferences and needs are represented by the nurses and doctors in the meeting
- Communication. After the meeting, the treatment plan is communicated to the patient via their oncologist or general practitioner.
The BCHC said the integrated pathway has resulted in patients being better informed about what should be happening next, how long it should take, and who they should be talking to.
The development of the pathway formed part of the BHB’s integration programme and was led by clinical oncologist Dr Chris Fosker, now the CEO and medical director of the BCHC, in collaboration with BHB executive sponsor Scott Pearman and physician lead Anna Neilson-Williams.
There are also specific MDTs, or in some cases clinical review meetings, for other cancers, as well as the multi-disciplinary Comprehensive Tumour Board, which also reviews cancer cases of all types.
Dr Fosker said: “The pathway work gave us visibility into where the system was creating delays and unnecessary stress for patients. Once those barriers were clearly mapped, we were able to make practical changes to improve co-ordination, reduce avoidable waiting, and create a better experience for patients at a very uncertain time.
“Cancer care is time-sensitive, but it is also emotionally charged. By structuring the pathway and reviewing cases through a multi-disciplinary team, we have been able to remove friction points in the system and ensure patients move from diagnosis to treatment in a co-ordinated, deliberate way.”
Promoting awareness
The integrated breast cancer care pathway starts with an emphasis on early detection.
Programme manager Azuree Williams is responsible for promoting breast health education, awareness and the importance of early detection, including public education campaigns and how women are encouraged to seek screening early.
BCHC’s Know Your Lemons presentation explains nine breast cancer risk factor categories, 12 symptoms, and six detection tools that can help with early detection.
Eight presentations in 2025 attracted a total of 5,000 attendees. Information was also presented at BCHC events such as the annual breast cancer walk and Relay for Life, reaching 7,230 attendees.
Ms Williams said: “Early detection truly can change someone’s story. When people understand what is normal for their own body and feel confident recognising changes, they are far more likely to seek help early. As an educator, I see every day how knowledge gives people the reassurance and clarity to act sooner and often that means treatment can be simpler and outcomes more positive.
“Breast health education isn’t about creating fear. It’s about building understanding and confidence. Through programmes like Know Your Lemons, we focus on practical, relatable information: what to look for, understanding risk factors, recognising symptoms, and knowing what screening tools are available.
“My hope is that everyone feels informed and supported enough to act early if something doesn’t feel right, because when they do, they will have more options and a stronger chance of a good prognosis.”
Breast specialist radiologist Paul Risk interprets imaging, performs image-guided biopsies and identifies suspicious findings that lead to diagnosis.
Dr Risk said: “My role within the pathway is to ensure that imaging and biopsy results are accurate, timely and clearly communicated. Breast imaging is often the first step in a patient’s cancer journey, and precision at this stage is critical.
“Through the weekly multi-disciplinary meetings, imaging findings are reviewed alongside pathology and clinical information. That collaborative review ensures that diagnoses are robust and that each patient’s case is considered from multiple expert perspectives before treatment decisions are made.”
Clinical oncologist Pat Murray leads systemic treatment planning and works closely with radiation oncology and surgical colleagues to deliver co-ordinated care.
Dr Murray said: “Treatment planning needs to be patient centred. Each patient’s tumour biology, stage of disease, overall health and personal circumstances must be considered carefully.
“The strength of the multi-disciplinary approach is that no single clinician is making decisions in isolation. We discuss each case collectively and agree on the most appropriate, evidence-based plan. From there, we tailor treatment to the individual, ensuring that care is both clinically sound and aligned with the patient’s needs and values.”
Michele Hypolite supports patients and general practitioners by answering questions and co-ordinating care after diagnosis, helping to ensure that the right appointments happen at the right time.
She said: “A cancer diagnosis can feel overwhelming. Patients are suddenly faced with new terminology, multiple appointments and difficult decisions, often all at once.”
In her role as a cancer navigator, she provides clinical, practical and emotional support to patients and their GPs throughout the diagnostic and treatment pathway. She helps interpret clinical information, co-ordinate investigations and appointments, address questions or concerns, and ensure that each step is clearly communicated and well organised.”
She said: “Patients and physicians consistently report that the integrated pathway offers greater clarity, smoother communication, and the reassurance that a dedicated clinical professional is actively guiding and supporting the process from start to finish.”
For information related to breast cancer, see https://www.cancer.bm/cancer-information/prevention–early-detection/breast-cancer-and-the-bermuda-pathway
