Original articleCancer early detection program based on awareness and clinical breast examination: Interim results from an urban community in Mumbai, India
Introduction
The estimated age-standardized incidence rate of breast cancer in India is around 36 per 100,000 women per year [1]. Although the incidence in India is much lower than that of Europe and North America (ranging from 92 to 112 per 100,000), the breast cancer mortality in India (12.7 per 100,000 women) is similar to that of the developed countries implying a higher mortality to incidence ratio [2]. There is no national organised population-based breast cancer screening programme in India. Women can receive screening mammography in the private sector. In the public sector, mammography is only performed for diagnosis, not screening. Indian women usually present with advanced tumours leading to poor survival [3], [4], [5], [6], [7]. In lower-middle income countries like India, although the 5-year survival for localised tumours exceeds 75%, survival of the larger tumours is as low as 15–32% [3], [4], [5]. Clinical down-staging by increasing breast awareness and access to early diagnosis followed by prompt and adequate treatment has been suggested for breast cancer control in low and middle income countries (LMICs) [8]. We implemented a breast awareness-based clinical down-staging program in a cohort of women receiving universal health care from an occupational healthcare scheme in Mumbai, India, in collaboration with the International Agency for Research in Cancer (IARC) Lyon, France. The program aims to improve breast cancer awareness and encourage symptomatic women to seek prompt medical attention and diagnostic investigations such as expert clinical breast examination (CBE), imaging and tissue sampling leading to early diagnosis and adequate multidisciplinary management of detected breast cancers. We report the interim results after three years of breast awareness efforts in this manuscript.
Section snippets
Study setting
This breast awareness program is undertaken in the context of the Universal Health Care (UHC) system for employees at Bhabha Atomic Research Centre (BARC), a facility of the Government of India. The occupational health scheme comprising of a two tiered network of primary health centres and a secondary care referral hospital (BARC Hospital), hereafter referred as the “central hospital”, offers a lifelong free health care to its employees and their dependent family members. An electronic medical
Results
Around 88,000 brochures containing breast awareness messages were sent during the 4 rounds of mailing. During the intervention period, a total 400 breast clinics were conducted and 2709 women attended the clinics seeking care. Of them, 427 women were referred to the central hospital for mammography and further evaluation. A total of 93 FNAC were performed, and 77 cancers were diagnosed.
The demographic characteristics of women diagnosed with breast cancers in the pre-intervention and
Discussion
Our interim results after four rounds of breast awareness efforts in a cohort of women in an occupational healthcare setting indicate early diagnosis of breast cancer cases and reduced two-year case fatality in the intervention period compared to the intervention period. The increase in the proportion of cancers in early (I-II) stages, and axillary node negative cancers is more likely to be the direct effect of the awareness intervention which may be further confirmed by a prolonged
Conflict of interest statement
Authors declare no conflict of interest.
Acknowledgements
Authors acknowledge the contributions of Mr. Prashant Bhandarkar, Mr. Ravi Kumar, Mr. Kale and Mr. Raina in compiling the mailing lists, printing and mailing the breast cancer brochures. We also acknowledge the clinical breast examination team comprising of primary healthcare doctors and nurses involved in performing clinical breast examination.
Institutional funding from the existing community health care facility of Bhabha Atomic Research Centre (BARC) and its printing and mailing sections was
References (21)
- et al.
Recommendations for screening and early detection of common cancers in India
Lancet Oncol
(2015) - et al.
Cancer survival in Africa, Asia, and Central America: a population-based study
Lancet Oncol
(2010) - et al.
Research on cancer prevention, detection and management in low- and medium-income countries
Ann Oncol
(2010) - et al.
Reducing by half the percentage of late-stage presentation for breast and cervix cancer over 4 years: a pilot study of clinical downstaging in Sarawak, Malaysia
Ann Oncol
(2007) National cancer registry programme, Indian Council of Medical Research. Three-year report of population based cancer registries 2009-2011
(2013)- et al.
How can we improve survival from breast cancer in developing countries?
Breast Cancer Manag
(2013) - et al.
Cancer survival in Africa, Asia, the Caribbean and Central America (SurvCan)
(2011) - et al.
Spectrum of breast cancer in Asian women
World J Surg
(2007) - et al.
Epidemiology and patterns of care for invasive breast carcinoma at a community hospital in Southern India
World J Surg Oncol
(2007) - et al.
Guideline implementation for breast healthcare in low-income and middle-income countries: overview of the Breast Health Global Initiative Global Summit 2007
Cancer
(2008)
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