Training health workers in clinical breast examination for early detection of breast cancer in low- and middle-income countries

Purpose Breast cancer presents in advanced stages in low- and middle-income countries where screening mammography is not available. In Malaysia, almost 60% of women, particularly in those the low socioeconomic group, present with stage III and IV breast cancer. We evaluated the feasibility of a community-based early detection program using clinical breast examination (CBE) carried out by the Breast Cancer Welfare Association, a nongovernmental organization. Methods Using a mobile clinic that was equipped to carry out CBE, a team of six health professionals trained in CBE techniques reached out to urban poor communities on the outskirts of the city and the rural population at the invitation of community leaders. At these events, breast self-awareness was taught to the community, with particular regard to the signs and symptoms of breast cancer and to breast self-examination. CBE was carried out in those women who agreed to be examined. Women who were found to have breast lumps were referred to the nearest public hospital and were observed for compliance. Women with anxiety were counseled. Results In 2016 to 2017, CBE was performed for 7,503 women, and 295 (3.9%) were found to have a palpable breast lump. These women were referred to the nearest hospital for additional assessment. Of these women, 156 (52.9%) consulted the doctor and sought additional examination. A total of 153 patients had no malignant findings, whereas three were found to have breast cancer. The mean age for women found to have a palpable breast lump was younger than 40 years—35 years in 2016 and 33 years in 2017—whereas the median age among the 295 women was 33 years in 2016 and 31 years in 2017 (range, 17 to 67 years). Conclusion A community outreach program using CBE as a method of early detection is feasible in Malaysia. Additional study is required to determine why 47% of those who were found to have a breast lump did not seek additional assessment. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

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Knowledge, Attitude, and Practice Regarding Breast Cancer Early Detection Among Women in a Mountainous Area in Northern Vietnam

Cancer Control ◽

10.1177/1073274819863777 ◽

2019 ◽

Vol 26 (1) ◽

pp. 107327481986377

Author(s):

Do Thi Thanh Toan ◽

Dinh Thai Son ◽

Le Xuan Hung ◽

Luu Ngoc Minh ◽

Dinh Le Mai ◽

...

Keyword(s):

Breast Cancer ◽

Early Detection ◽

Clinical Breast Examination ◽

Breast Self Examination ◽

Cancer Early Detection ◽

Attitude And Practice ◽

Breast Examination ◽

Clinical Breast ◽

Self Examination ◽

Knowledge Attitude And Practice

Breast cancer is the most common cancer in women all over the world, also in Vietnam. In recent years, the incidence of breast cancer has been increasing in Vietnam, and most cases are diagnosed at late stages, making treatment more difficult. More and better early detection could help more women to survive. The aim of this study was to identify the current knowledge, attitude and practice about early detection of breast cancer as well as potential predictors of breast cancer screening among women aged 20 to 49 year in a mountainous commune in Thanh Hoa Province, Vietnam, in a largely ethnic Muong population. Women aged 20 to 49 years were selected by systematic random sampling to participate in a cross sectional study in October 2017. They were interviewed with a closed questionnaire about their knowledge of breast cancer, its risk factors, and warning signs. A checklist for performance of breast self-examination was also applied. Three hundred six women agreed to participate in the study. More than half had a low level of knowledge, and were weak in attitude and practice about breast self-examination, clinical breast examination, breast ultrasound, and mamography. Among women who had practiced at least 1 screening method, 17.0% mentioned clinical breast examination, and only 13.8% reported practicing breast self-examination. Factors associated with practice included knowledge about breast cancer early detection (BCED), ethnicity, income, the BCED information approach, and the BCED screening programs approach. The finding of a very low proportion of women in the mountainous setting with good awareness and practice on early detection of breast cancer is important evidence to inform the BCED intervention program developers about where and how to target which information, especially to reach more ethnic minority women.

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Original Paper: Contribution of clinical breast examination to mammography screening in the early detection of breast cancer

Journal of Medical Screening ◽

10.1258/096914103321610761 ◽

2003 ◽

Vol 10 (1) ◽

pp. 16-21 ◽

Cited By ~ 47

Author(s):

C Bancej ◽

K Decker ◽

A Chiarelli ◽

M Harrison ◽

D Turner ◽

...

Keyword(s):

Breast Cancer ◽

Early Detection ◽

Breast Cancer Mortality ◽

Clinical Breast Examination ◽

Screening Mammography ◽

Detection Rates ◽

Breast Examination ◽

Mode Of Detection ◽

Clinical Breast ◽

Interim Measures

Objectives: As the benefit of clinical breast examination (CBE) over that of screening mammography alone in reducing breast cancer mortality is uncertain, it is informative to monitor its contribution to interim measures of effectiveness of a screening programme. Here, the contribution of CBE to screening mammography in the early detection of breast cancer was evaluated. Setting: Four Canadian organised breast cancer screening programmes. Methods: Women aged 50-69 receiving dual screening (CBE and mammography) (n=300,303) between 1996 and 1998 were followed up between screen and diagnosis. Outcomes assessed by mode of detection (CBE alone, mammography alone, or both CBE and mammography) included referral rate, positive predictive value, pathological features of tumours (size, nodal status, morphology), and cancer detection rates overall and for small cancers (≤10 mm or node-negative). Heterogeneity in findings across programmes was also assessed. Results: On first versus subsequent screen, CBE alone resulted in 28.5-36.7% of referrals, and 4.6-5.9% of cancers compared with 52.6-60.1% of referrals and 60.0-64.3% of cancers for mammography alone. Among cancers detected by CBE, 83.6-88.6% were also detected by mammography, whereas for mammographically detected cancers only 31.7-37.2% were also detected by CBE. On average, CBE increased the rate of detection of small invasive cancers by 2-6% over rates if mammography was the sole detection method. Without CBE, programmes would be missing three cancers for every 10,000 screens and 3-10 small invasive cancers in every 100,000 screens. Conclusions: Inclusion of CBE in an organised programme contributes minimally to early detection.

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Breast Cancer: A Review of Mammography and Clinical Breast Examination for Early Detection of Cancer

OALib ◽

10.4236/oalib.1106866 ◽

2020 ◽

Vol 07 (10) ◽

pp. 1-19

Author(s):

Gadafi Iddrisu Balali ◽

Denis Dekugmen Yar ◽

Vera Gobe Afua Dela ◽

Emmanuel Effah-Yeboah ◽

Philip Asumang ◽

...

Keyword(s):

Breast Cancer ◽

Early Detection ◽

Early Detection Of Cancer ◽

Clinical Breast Examination ◽

Breast Examination ◽

Clinical Breast

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Community health workers and early detection of breast cancer in low-income and middle-income countries: a systematic scoping review of the literature

BMJ Global Health ◽

10.1136/bmjgh-2020-002466 ◽

2020 ◽

Vol 5 (5) ◽

pp. e002466

Author(s):

James O'Donovan ◽

Ashley Newcomb ◽

MacKenzie Clark MacRae ◽

Dorice Vieira ◽

Chinelo Onyilofor ◽

...

Keyword(s):

Breast Cancer ◽

Early Detection ◽

Scoping Review ◽

Low Income ◽

Health Workers ◽

Middle Income ◽

Middle Income Countries ◽

Breast Cancer Early Detection ◽

Cancer Early Detection

BackgroundBreast cancer is the leading cause of female mortality in low-income and middle-income countries (LMICs). Early detection of breast cancer, either through screening or early diagnosis initiatives, led by community health workers (CHWs) has been proposed as a potential way to address the unjustly high mortality rates. We therefore document: (1) where and how CHWs are currently deployed in this role; (2) how CHWs are trained, including the content, duration and outcomes of training; and (3) the evidence on costs associated with deploying CHWs in breast cancer early detection.MethodsWe conducted a systematic scoping review and searched eight major databases, as well as the grey literature. We included original studies focusing on the role of CHWs to assist in breast cancer early detection in a country defined as a LMIC according to the World Bank.Findings16 eligible studies were identified. Several roles were identified for CHWs including awareness raising and community education (n=13); history taking (n=7); performing clinical breast examination (n=9); making onward referrals (n=7); and assisting in patient navigation and follow-up (n=4). Details surrounding training programmes were poorly reported and no studies provided a formal cost analysis.ConclusionsDespite the relative paucity of studies addressing the role of CHWs in breast cancer early detection, as well as the heterogeneity of existing studies, evidence suggests that CHWs can play a number of important roles in breast cancer early detection initiatives in LMICs. However, if they are to realise their full potential, they must be appropriately supported within the wider health system.

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