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

2003 ◽  
Vol 10 (1) ◽  
pp. 16-21 ◽  
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.

scholarly journals A Community-Based Clinical Breast Examination Program: Is it Feasible?

2018 ◽  
Vol 4 (Supplement 3) ◽  
pp. 36s-36s
Author(s):  
Ranjit K. Pritam Singh ◽  
Zainab Abdullah ◽  
Salimah Saleh
Keyword(s):  
Breast Cancer ◽  
Early Detection ◽  
Conflicts Of Interest ◽  
Clinical Breast Examination ◽  
Outreach Program ◽  
Breast Lump ◽  
Community Based ◽  
Breast Examination ◽  
Clinical Breast ◽  
Palpable Breast

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.

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

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.

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

OALib ◽  
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

Barriers to Early Detection of Breast Cancer Among Women Living in Poverty

2020 ◽  
Vol 7 ◽  
Author(s):  
Nihal Gördes Aydoğdu ◽  
Zuhal Bahar
Keyword(s):  
Breast Cancer ◽  
Early Detection ◽  
Health Care Services ◽  
Effective Means ◽  
Breast Cancer Mortality ◽  
Clinical Breast Examination ◽  
Healthcare Services ◽  
Absolute Poverty ◽  
Inhibiting Factors ◽  
Clinical Breast

Objective: Early detection and screening are the most effective means to reduce breast cancer mortality in all populations. In this study, the inhibiting factors in the applications of qualitative research methods used for early diagnosis of breast cancer among poor women were identified.Material and methods: Through focus group interviews, 40 women ranging between 20-60 years of age, meeting the absolute poverty criteria, without regular breast self-examination, clinical breast examination and mammography were recruited for the study. A conventional content analysis method was used in the data analysis. Interviews were recorded using a voice recorder, and the average duration of the interviews was 53 minutes.Results: Factors inhibiting women's behaviors regarding early detection of breast cancer were identified as, respectively; individual attitudes and beliefs, provision of healthcare services and, cultural factors.Conclusion: According to the data achieved, we concluded that, initiatives should be planned in order to reduce the inhibiting factors in the breast cancer screening behaviors of women living in poverty. In addition, health policies concerning provision of health care services should be revised.

scholarly journals Effect of screening by clinical breast examination on breast cancer incidence and mortality after 20 years: prospective, cluster randomised controlled trial in Mumbai

BMJ ◽  
2021 ◽  
pp. n256
Author(s):  
Indraneel Mittra ◽  
Gauravi A Mishra ◽  
Rajesh P Dikshit ◽  
Subhadra Gupta ◽  
Vasundhara Y Kulkarni ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Confidence Interval ◽  
Cancer Mortality ◽  
Health Workers ◽  
Controlled Trial ◽  
Breast Cancer Mortality ◽  
Clinical Breast Examination ◽  
Cancer Awareness ◽  
Breast Examination ◽  
Clinical Breast

Abstract Objective To test the efficacy of screening by clinical breast examination in downstaging breast cancer at diagnosis and in reducing mortality from the disease, when compared with no screening. Design Prospective, cluster randomised controlled trial. Setting 20 geographically distinct clusters located in Mumbai, India, randomly allocated to 10 screening and 10 control clusters; total trial duration was 20 years (recruitment began in May 1998; database locked in March 2019 for analysis). Participants 151 538 women aged 35-64 with no history of breast cancer. Interventions Women in the screening arm (n=75 360) received four screening rounds of clinical breast examination (conducted by trained female primary health workers) and cancer awareness every two years, followed by five rounds of active surveillance every two years. Women in the control arm (n=76 178) received one round of cancer awareness followed by eight rounds of active surveillance every two years. Main outcome measures Downstaging of breast cancer at diagnosis and reduction in mortality from breast cancer. Results Breast cancer was detected at an earlier age in the screening group than in the control group (age 55.18 (standard deviation 9.10) v 56.50 (9.10); P=0.01), with a significant reduction in the proportion of women with stage III or IV disease (37% (n=220) v 47% (n=271), P=0.001). A non-significant 15% reduction in breast cancer mortality was observed in the screening arm versus control arm in the overall study population (age 35-64; 20.82 deaths per 100 000 person years (95% confidence interval 18.25 to 23.97) v 24.62 (21.71 to 28.04); rate ratio 0.85 (95% confidence interval 0.71 to 1.01); P=0.07). However, a post hoc subset analysis showed nearly 30% relative reduction in breast cancer mortality in women aged 50 and older (24.62 (20.62 to 29.76) v 34.68 (27.54 to 44.37); 0.71 (0.54 to 0.94); P=0.02), but no significant reduction in women younger than 50 (19.53 (17.24 to 22.29) v 21.03 (18.97 to 23.44); 0.93 (0.79 to 1.09); P=0.37). A 5% reduction in all cause mortality was seen in the screening arm versus the control arm, but it was not statistically significant (rate ratio 0.95 (95% confidence interval 0.81 to 1.10); P=0.49). Conclusions These results indicate that clinical breast examination conducted every two years by primary health workers significantly downstaged breast cancer at diagnosis and led to a non-significant 15% reduction in breast cancer mortality overall (but a significant reduction of nearly 30% in mortality in women aged ≥50). No significant reduction in mortality was seen in women younger than 50 years. Clinical breast examination should be considered for breast cancer screening in low and middle income countries. Trial registration Clinical Trials Registry of India CTRI/2010/091/001205; ClinicalTrials.gov NCT00632047 .

scholarly journals Effectiveness of clinical breast examination as a ‘stand-alone’ screening modality: an overview of systematic reviews

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tran Thu Ngan ◽  
Nga T. Q. Nguyen ◽  
Hoang Van Minh ◽  
Michael Donnelly ◽  
Ciaran O’Neill
Keyword(s):  
Breast Cancer ◽  
Systematic Reviews ◽  
Breast Cancer Mortality ◽  
Indirect Evidence ◽  
Clinical Breast Examination ◽  
Asian Women ◽  
Lower Sensitivity ◽  
Breast Examination ◽  
Overview Of Systematic Reviews ◽  
Clinical Breast

Abstract Background There is uncertainty about the effectiveness of clinical breast examination (CBE) and conflicting recommendations regarding its usefulness as a screening tool for breast cancer. This paper provides an overview of systematic reviews that assessed the effectiveness of CBE as a ‘stand-alone’ screening modality for breast cancer compared to no screening and focused on its value in low- and middle-income countries (LMICs). Methods We searched MEDLINE, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews for systematic reviews reporting the effectiveness of CBE published prior to October 29, 2019. The main outcomes assessed were mortality and down staging. The AMSTAR 2 checklist was used to assess the methodological quality of the reviews including risk of bias. Results Eleven systematic reviews published between 1993 and 2019 were identified. There was no direct evidence that CBE reduced breast cancer mortality. Indirect evidence suggested that a well-performed CBE achieved the same effect as mammography regarding mortality despite its apparently lower sensitivity (40–69% for CBE vs 77–95% for mammography). Greater sensitivity was recorded among younger and Asian women. Moreover, CBE contributed between 17 and 47% of the shift from advanced to early stage cancer. Conclusions CBE merits attention from health system and service planners in LMICs where a national screening programme based on mammography would be prohibitively expensive. In particular, it is likely that considerable value would be gained from conducting implementation scientific research in countries with large numbers of Asian women and/or where younger women are at higher risk. Registration PROSPERO, registration number CRD42019126798.

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