Elsevier

The Breast

Volume 31, February 2017, Pages 85-89
The Breast

Original article
Cancer early detection program based on awareness and clinical breast examination: Interim results from an urban community in Mumbai, India

https://doi.org/10.1016/j.breast.2016.10.025Get rights and content

Highlights

  • Women from LMIC are usually diagnosed with advanced breast cancer.

  • Breast awareness and access to diagnosis/treatment are key factors for cancer control.

  • A programme with breast cancer awareness and facilitated access to care is described.

  • More conserving surgery after the programme was reported.

Abstract

Indian women with breast cancer are usually diagnosed in advanced stages leading to poor survival. Improving breast awareness and increasing access to early diagnosis and adequate treatment has been advocated for breast cancer control. We implemented a program to increase awareness on breast cancer and access to its early detection in an occupational health care scheme in Mumbai, India. Breast awareness brochures were mailed annually between June 2013 and June 2016 to a cohort of 22,500 eligible women aged 30–69 years old receiving universal health care from an occupational health care scheme comprising of primary health centres and a referral secondary care hospital in Mumbai. Women with suspected breast cancers were provided with diagnostic investigations and treatment. Socio-demographic information and tumour characteristics were compared between the breast awareness pre-intervention period (Jan 2005–May 2013) and the breast awareness intervention period after four rounds of mailers (June 2013–June 2016). The proportion of women with early tumours and axillary lymph node negative cancers increased from 74% to 81% and 46% to 53% respectively, between the two periods. While the proportion of patients receiving breast conserving surgery increased from 39% to 51%, the proportion receiving chemotherapy decreased from 84% to 56%. Interim results following efforts to improve breast awareness and access to care in a cohort of women in an occupational health care scheme indicate early detection and more conservative treatment of breast cancers. Creating awareness and improving access to care may result in cancer down-staging.

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)

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