Regular breast checks by trained health workers linked to fewer breast cancer deaths in India

▴ Regular breast checks by trained health workers linked to fewer breast cancer deaths in India
Regular clinical breast examination should be considered in low and middle-income countries, say, researchers

A trial published by The BMJ recently shows that regular breast examination by trained female health workers in Mumbai led to earlier diagnosis and reduced deaths from breast cancer in women aged 50 and older.

The researchers say this type of examination (known as clinical breast examination or CBE) should be considered as an alternative to x-ray (mammography) screening in low and middle-income countries.

Breast cancer rates are rising across the world, but particularly so in low and middle-income countries.

Mammography is the established screening tool in developed countries, but its cost and complexity mean it might not be an appropriate approach in low and middle-income countries. What’s more, most women in low and middle-income countries are younger than 50, and mammography is less effective in this age group.

Although clinical breast examination is an alternative screening method, doctors are still not sure if it can reduce deaths from breast cancer.

So a research team based in Mumbai set out to test if screening by clinical breast examination could result in earlier diagnosis and reduced mortality from breast cancer when compared with no screening.

Their findings are based on 20 years of data from 151,538 women aged 35-64 with no history of breast cancer who were living in 20 geographically distinct clusters in Mumbai, India.

Women were randomly allocated to 10 screening and 10 control arms.

Women in the screening arm (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 (76,178) received one round of cancer awareness followed by eight rounds of active surveillance every two years.

Breast cancer was detected at an earlier age in the screening arm than in the control arm (55 v 57 years), with a significant reduction in the proportion of women with more advanced (stage III or IV) disease (37% v 47%) - known as downstaging.

Across all ages, clinical breast examination led to a non-significant reduction in breast cancer mortality in the screening arm versus the control arm (21 v 25 deaths per 100,000 person-years).

However, a significant reduction in breast cancer mortality of nearly 30% was seen in women aged 50 and older (25 v 35 deaths per 100,000 person-years). In women younger than 50, despite successful downstaging, no mortality reduction was seen. There was a 5% reduction in all-cause mortality in the screening arm compared with the control arm, but it was not statistically significant.

The researchers point out that some cancer staging data and cause of death information may have been missed, and that some residual uncertainty cannot be excluded.

However, this was a well-designed trial carried out by researchers with a full understanding of the realities that influence the conduct of complex, public health randomised trials in low and middle-income countries.

As such, they say: “Our study suggests that implementation of population screening by clinical breast examination in low and middle-income countries is feasible, provided that adequate training of screening providers, careful monitoring, and quality of performance are assured.”

And they conclude: “Clinical breast examination should be considered for breast cancer screening in low and middle-income countries.”

Tags : #BreastCancerinIndia #TheBMJ #LatestPharmaResearchonBreastCancer3rdMar #LatestPharmaNews3rdMar #MammographyBreastCancer #CancerDeathinIndia #CancerAwareness

About the Author


Team Medicircle

Related Stories

Loading Please wait...
-Advertisements-


Trending Now

It is important to adopt a non-judgmental attitude towards any teenage girl seeking contraceptive advise suggests Dr. Teena Trivedi, Obstetrician and GynecologistApril 16, 2021
80% of the diseases are psychosomatic which means they have roots in the mind and this is where homeopathy steps in - It resolves physical ailments by finding the cause in the mind – Dr. Sanket Dhuri, Consultant Homeopath April 14, 2021
A futuristic Vision of a Healthcare Entrepreneur: Shyatto Raha, CEO, and Founder of MyHealthcareApril 12, 2021
Saher Mehdi, Founder and Chief Scientist at wellOwise talks about aspects making healthcare more equitable and reachableApril 10, 2021
Wide variety of therapies to address autism in children explained by Dr. Shilpa Jasubhai, Clinical PsychologistApril 09, 2021
Allopathic and Homeopathic medicines should not be taken together says Dr. Sunil Mehra, Homeopath ConsultantApril 08, 2021
The charm of homeopathic medicine is that it can be taken with conventional medicines – Dr. Shruthi Shridhar, Consulting Homeopath April 08, 2021
Dissociative Identity Disorder and associated concepts explained by Dr. Vinod Kumar, Psychiatrist and Head of Mpower - The Centre (Bangalore) April 07, 2021
Dissociative Identity Disorder explained by Dr. Shilpa Jasubhai, Clinical PsychologistApril 05, 2021
Sehat Ki Baat, Karishma Ke Saath- Episode 6 Healthy Diet For Boosting Metabolism Which Can Help Thyroid Patients April 03, 2021
Significant Pointers on Kidney Health by Dr. Santosh Waigankar, Consultant Urooncologist and Robotic Surgeon at Kokilaben Dhirubhai Ambani HospitalApril 01, 2021
Dr. Vaishal Kenia, Ophthalmologist Talks About the Different Possibilities Available for the Treatment of Glaucoma Depending Upon Their Type and SeverityMarch 30, 2021
No Definitive Role of Diet in Treatment of Lymphedema but Intake of Calories, Salt and Long Chain Fatty Acids should be controlled says Dr. Ramani CVMarch 30, 2021
Dr. Kiran Chandra Patro, Senior Nephrologist Talks About Dialysis as the Temporary Process and Not a Permanent Cure for the Patients of Renal DysfunctionMarch 30, 2021
Two out of three new chronic kidney disease patients are found to have diabetes or hypertension informs Dr. Sreeharsha HarinathaMarch 30, 2021
Glaucoma Treatment: Medications or Surgery? A valuable piece of advice from Dr. Pranay Kapdia, Chairman and Medical Director of Kapadia Eye CareMarch 25, 2021
Dr. Shraddha Satav, Consultant Ophthalmologist Recommends that Everybody After 40, Should Go for the Complete Eye Checkup at Regular IntervalMarch 25, 2021
Childhood Obesity is not a Disease but a Condition which can be very well ManagedMarch 19, 2021
World Sleep Day - 19 th March 2021- Know More About Healthy Sleep As Per The Guidelines by The World Sleep Society March 19, 2021
Sipping Warm Water, the First Thing in the Morning is Good for DigestionMarch 18, 2021