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Selmouni F, Bendahhou K, Sauvaget C, Abahssain H, Lucas E, Muwonge R, Mimouni H, Ismaili R, Bidar S, Benkaddour FZ, Abousselham L, Chami Khazraji Y, Belakhel L, Basu P. Impact of clinical breast examination-based screening program on care pathway, stage at diagnosis, nature of treatment, and overall survival among breast cancer patients in Morocco. Cancer 2024; 130:3353-3363. [PMID: 38837217 DOI: 10.1002/cncr.35419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND This study aimed to indirectly examine whether the implementation of clinical breast examination-based screening program in Morocco has been successful in downstaging and improving survival rates. Breast cancer patients detected through the screening pathway were compared with those detected through self-referral over the same period in terms of cancer stage at diagnosis, tumor characteristics, care delays, and survival. METHODS A prospective observational study was conducted between April 2019 and August 2020 at two major public oncology centers. RESULTS A total of 896 women with confirmed breast cancer were recruited (483 were program-referred and 413 were self-referred). The authors did not report any significant difference between the two groups in terms of stage at diagnosis, molecular profile, or histopathological grade. Early-stage cancer (stage I-II) was detected in 55.7% of self-referred participants compared to 55.5% of program-referred participants. Median intervals between symptom recognition, pathological diagnosis, and treatment initiation were not significantly different between the two groups. Similarly, survival after treatment showed no significant difference between patients screened by the program and self-referred patients. The 3-year survival rate after treatment was 94.5% for patients referred through the program and 88.6% for patients not referred through the program (p = .16). CONCLUSIONS This study highlights the importance of equitable and timely access to high-quality diagnosis and treatment facilities, leading to substantial downstaging and enhanced survival rates. Continued efforts to improve quality and expand coverage to include asymptomatic women will consolidate the health infrastructure gains achieved by the Moroccan breast cancer screening program.
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Affiliation(s)
- Farida Selmouni
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Karima Bendahhou
- Greater Casablanca Population-Based Cancer Registry, Casablanca, Morocco
| | - Catherine Sauvaget
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Halima Abahssain
- National Oncology Institute, University Hospital Centre-Rabat, Rabat, Morocco
| | - Eric Lucas
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Richard Muwonge
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Hind Mimouni
- National Oncology Institute, University Hospital Centre-Rabat, Rabat, Morocco
| | - Rachid Ismaili
- National Oncology Institute, University Hospital Centre-Rabat, Rabat, Morocco
| | - Soukaina Bidar
- Greater Casablanca Population-Based Cancer Registry, Casablanca, Morocco
| | | | - Loubna Abousselham
- Noncommunicable Diseases Unit, Epidemiology and Disease Control Department, Ministry of Health, Rabat, Morocco
| | | | - Latifa Belakhel
- Noncommunicable Diseases Unit, Epidemiology and Disease Control Department, Ministry of Health, Rabat, Morocco
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
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Budukh A, Dora T, Sancheti S, Singh V, Goel A, Bagal S, Kaur A, Manchanda I, Kaur G, Gulia A, Chaturvedi P, Badwe R. Outcome of early detection approach in control of breast, cervical, and oral cancer: Experience from a rural cancer center in India. Int J Cancer 2024; 155:894-904. [PMID: 38642029 DOI: 10.1002/ijc.34966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/22/2024]
Abstract
In low- and middle-income countries most of the cancer patients attend the hospital at a late stage and treatment completion of these cases is challenging. The early detection program (EDP), in rural areas of Punjab state, India was initiated to identify breast, cervical, and oral cancer at an early stage by raising awareness and providing easy access to diagnosis and treatment. A total of 361 health education programs and 99 early detection clinics were organized. The symptomatic and self-interested (non-symptomatic individuals who opted for screening) cases visited the detection clinic. They were screened for breast, cervical, and/or oral cancer. Further diagnosis and treatment of screen-positive cases were carried out at Homi Bhabha Cancer Hospital (HBCH), Sangrur. Community leaders and healthcare workers were involved in all the activities. The EDP, Sangrur removed barriers between cancer diagnosis and treatment with the help of project staff. From 2019 to 2023, a total of 221,317 populations were covered. Symptomatic and self-interested individuals attended the breast (1627), cervical (1601), and oral (1111) examinations. 46 breast (in situ-4.3%; localized-52.2%), 9 cervical (localized-77.8%), and 12 oral (localized-66.7%) cancer cases were detected, and treatment completion was 82.6%, 77.8%, and 50.0%, respectively. We compared cancer staging and treatment completion of cases detected through EDP with the cases attended HBCH from Sangrur district in 2018; the difference between two groups is statistically significant. Due to the early detection approach, there is disease down-staging and improvement in treatment completion. This approach is feasible and can be implemented to control these cancers in low- and middle-income countries.
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Affiliation(s)
- Atul Budukh
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Tapas Dora
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Sankalp Sancheti
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Vikram Singh
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Alok Goel
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Sonali Bagal
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
| | - Amandeep Kaur
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
| | - Ishan Manchanda
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
| | - Gurwinder Kaur
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
| | - Ashish Gulia
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Pankaj Chaturvedi
- Homi Bhabha National Institute, Mumbai, India
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Rajendra Badwe
- Homi Bhabha National Institute, Mumbai, India
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
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Katsika L, Boureka E, Kalogiannidis I, Tsakiridis I, Tirodimos I, Lallas K, Tsimtsiou Z, Dagklis T. Screening for Breast Cancer: A Comparative Review of Guidelines. Life (Basel) 2024; 14:777. [PMID: 38929759 PMCID: PMC11204612 DOI: 10.3390/life14060777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Breast cancer is the most common malignancy diagnosed in the female population worldwide and the leading cause of death among perimenopausal women. Screening is essential, since earlier detection in combination with improvements in breast cancer treatment can reduce the associated mortality. The aim of this study was to review and compare the recommendations from published guidelines on breast cancer screening. A total of 14 guidelines on breast cancer screening issued between 2014 and 2022 were identified. A descriptive review of relevant guidelines by the World Health Organization (WHO), the U.S. Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the National Comprehensive Cancer Network (NCCN), the American College of Obstetricians and Gynecologists (ACOG), the American Society of Breast Surgeons (ASBrS), the American College of Radiology (ACR), the Task Force on Preventive Health Care (CTFPHC), the European Commission Initiative on Breast Cancer (ECIBC), the European Society for Medical Oncology (ESMO), the Royal Australian College of General Practitioners (RACGP) and the Japanese Journal of Clinical Oncology (JJCO) for women both at average and high-risk was carried out. There is a consensus among all the reviewed guidelines that mammography is the gold standard screening modality for average-risk women. For this risk group, most of the guidelines suggest annual or biennial mammographic screening at 40-74 years, while screening should particularly focus at 50-69 years. Most of the guidelines suggest that the age limit to stop screening should be determined based on the women's health status and life expectancy. For women at high-risk, most guidelines recommend the use of annual mammography or magnetic resonance imaging, while the starting age should be earlier than the average-risk group, depending on the risk factor. There is discrepancy among the recommendations regarding the age at onset of screening in the various high-risk categories. The development of consistent international practice protocols for the most appropriate breast cancer screening programs seems of major importance to reduce mortality rates and safely guide everyday clinical practice.
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Affiliation(s)
- Laskarina Katsika
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (L.K.); (I.T.); (Z.T.)
| | - Eirini Boureka
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.B.); (I.K.); (T.D.)
| | - Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.B.); (I.K.); (T.D.)
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.B.); (I.K.); (T.D.)
| | - Ilias Tirodimos
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (L.K.); (I.T.); (Z.T.)
| | - Konstantinos Lallas
- Department of Medical Oncology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Zoi Tsimtsiou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (L.K.); (I.T.); (Z.T.)
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.B.); (I.K.); (T.D.)
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Sathishkumar K, Sankarapillai J, Mathew A, Nair RA, Gangane N, Khuraijam S, Barmon D, Pandya S, Majumdar G, Deshmane V, Zomawia E, Bhutia TW, Jerang K, George PS, Maliye S, Laishram R, Das G, Shah A, Debbarma S, Koyande S, Pachuau L, Sherpa A, Jongkey G, Chaturvedi M, Das P, Santhappan S, Mathur P. Breast cancer survival in India across 11 geographic areas under the National Cancer Registry Programme. Cancer 2024; 130:1816-1825. [PMID: 38183671 DOI: 10.1002/cncr.35188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Population-based cancer survival is a key indicator for assessing the effectiveness of cancer control by a health care system in a specific geographic area. Breast cancer is the most common cancer among women in India, accounting for over one quarter of all female cancers. The objective of this study was to estimate the 5-year survival of female patients who were diagnosed with breast cancer between 2012 and 2015 from the existing Population-Based Cancer Registries (PBCRs) in India. METHODS In total, 17,331 patients who had breast cancer diagnosed between 2012 and 2015 from 11 PBCRs were followed until June 30, 2021. Active methods were used to track the vital status of registered breast cancer cases. The study conducted survival analysis by calculating the difference between the date of first diagnosis and the date of death or censoring to estimate observed survival and relative survival using the actuarial survival approach and the Ederer-II approach, respectively. RESULTS The 5-year age-standardized relative survival (95% confidence interval [CI]) of patients with breast cancer was 66.4% (95% CI, 65.5%-67.3%). Mizoram (74.9%; 95% CI, 68.1%-80.8%), Ahmedabad urban (72.7%; 95% CI, 70.3%-74.9%), Kollam (71.5%; 95% CI, 69.2%-73.6%), and Thiruvananthapuram (69.1%; 95% CI, 67.0%-71.2%) had higher survival rates than the national average. Conversely, Pasighat had the lowest survival rate (41.9%; 95% CI, 14.7%-68.6%). The 5-year observed survival rates for localized, regional, and distant metastasis in the pooled PBCRs were 81.0%, 65.5%, and 18.3%, respectively. CONCLUSIONS The overall disparity in survival rates was observed across 11 PBCRs, with lower survival rates reported in Manipur, Tripura, and Pasighat. Therefore, it is imperative to implement comprehensive cancer control strategies widely throughout the country.
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Affiliation(s)
- Krishnan Sathishkumar
- National Center for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
| | - Jayasankar Sankarapillai
- National Center for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
| | | | - Rekha A Nair
- Regional Cancer Center, Thiruvananthapuram, Kerala, India
| | - Nitin Gangane
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| | | | | | - Shashank Pandya
- The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | | | | | - Eric Zomawia
- National Health Mission, Health and Family Welfare, Government of Mizoram, Aizawl, Mizoram, India
| | | | - Kaling Jerang
- Bakin Pertin General Hospital, East Siang District, Arunachal Pradesh, India
| | | | - Swapna Maliye
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| | - Rajesh Laishram
- Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Gaurav Das
- Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Anand Shah
- The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | | | | | - Lalawmpuii Pachuau
- National Health Mission, Health and Family Welfare, Government of Mizoram, Aizawl, Mizoram, India
| | | | - Gegong Jongkey
- Bakin Pertin General Hospital, East Siang District, Arunachal Pradesh, India
| | - Meesha Chaturvedi
- National Center for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
| | - Priyanka Das
- National Center for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
| | - Stephen Santhappan
- National Center for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
| | - Prashant Mathur
- National Center for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
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Abdul Rehman M, Tahir E, Ghulam Hussain H, Khalid A, Taqi SM, Meenai EA. Awareness regarding breast cancer amongst women in Pakistan: A systematic review and meta-analysis. PLoS One 2024; 19:e0298275. [PMID: 38452109 PMCID: PMC10919669 DOI: 10.1371/journal.pone.0298275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/18/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Breast cancer (BCa) is the most common cause of cancer death in Pakistan. In 2019, Pakistan saw the highest global BCa-associated death rate. But do Pakistani women know about the various aspects of BCa? And how prevalent are BCa screening methods amongst Pakistani females? These questions formed the basis for our study. METHODS We conducted this review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. On September 1, 2023, we searched PubMed, Embase, Scopus, and Google Scholar, and performed a citation search to search for eligible studies published in 2010 or after, using the following terms: "breast cancer" and "Pakistan". Observational studies that evaluated BCa awareness and/or practice amongst Pakistani females who were not associated with medicine were eligible. We used the National Institutes of Health quality assessment tool to assess the risk of bias. We conducted a proportion meta-analysis to calculate pooled prevalences for variables. RESULTS Responses from 9766 Pakistani women across 18 included studies showed alarmingly low levels of BCa knowledge: risk factors, 42.7% (95% CI: 34.1%-51.4%); symptoms, 41.8% (95% CI: 26.2%-57.5%); diagnostic modalities, 36.3% (95% CI: 23.1%-49.4%); treatments, 46.6% (95% CI: 13.5%-79.8%). Prevalence of breast self-examination (BSE) and ever having undergone a clinical breast exam (CBE) was 28.7% (95% CI: 17.9%-39.6%) and 15.3% (95 CI: 11.2%-19.4%), respectively. BCa knowledge was significantly associated with better educational status, age, and socioeconomic status. CONCLUSION On average, only two in five Pakistani women are aware of one or more risk factors, symptoms, or diagnostic modalities. Approximately one in two women know about possible BCa treatment. Less than one in three women practice regular BSE, and less than one in five women have ever undergone a CBE.
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Affiliation(s)
- Muhammad Abdul Rehman
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Erfa Tahir
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Huzaifa Ghulam Hussain
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ayesha Khalid
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Mohammad Taqi
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Eilaf Ahmed Meenai
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Goel N, Lubarsky M, Hernandez AE, Benck K, Lee E, Kesmodel S, Knaul F, Kobetz E, Anderson BO. Unmet Social Needs and Breast Cancer Screening Utilization and Stage at Presentation. JAMA Netw Open 2024; 7:e2355301. [PMID: 38353954 PMCID: PMC10867685 DOI: 10.1001/jamanetworkopen.2023.55301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024] Open
Abstract
Importance Unmet social needs in local populations may hinder the development of targeted cancer control interventions aimed at improving screening utilization and early-stage breast cancer diagnosis to ultimately improve breast cancer survival disparities. Objective To evaluate if (1) city-funded screening mammography is associated with utilization of screening mammography, (2) unmet social needs are associated with utilization of screening mammography, and (3) unmet social needs are associated with later-stage disease at diagnosis. Design, Setting, and Participants This cohort study included patients with stages I-IV invasive ductal or lobular carcinoma treated at an academic medical center (including both an underserved safety-net hospital [SNH] and a National Cancer Institute-designated academic cancer center [ACC]) from 2020 to 2023. Eligible patients were aged 18 years or older and able to consent. Data were analyzed between July 2023 and September 2023. Exposure The Health Leads Social Needs Screening Toolkit, a screening tool that gathers information on the most common social need domains affecting patient health. Main Outcomes and Measures Univariable and multivariable logistic regression was utilized to evaluate the following primary outcomes: (1) routine screening mammography and (2) American Joint Committee on Cancer 8th edition clinical stage at presentation. Results Of the 322 women who completed the Health Leads Social Needs Screening Toolkit, 201 (62%) self-identified as Hispanic, 63 (19%) as non-Hispanic Black, and 63 (19%) as non-Hispanic White. Two hundred fifty-five (76%) patients with access to city-funded screening mammography completed a screening mammogram. Patients who presented to the SNH were more likely to present with late-stage disease compared with early-stage disease (15 of 48 [31%] vs 50 of 274 [18%]; P = .04). On multivariable logistic regression, not completing a screening mammography was associated with having an increasing number of unmet social needs (OR, 0.74; 95% CI, 0.55-0.99; P = .047) and an increasing age at diagnosis (OR, 0.92; 95% CI, 0.89-0.96; P < .001). Moreover, increasing unmet social needs was significantly associated with late-stage diagnosis above and beyond screening mammography (OR, 1.38; 95% CI, 1.01-1.89; P = .04). Conclusions and Relevance In this cohort study, access to screening mammography did not translate to utilization of screening mammography, increasing unmet social needs were significantly associated with lower rates of screening mammography, and those with increasing unmet social needs were more likely to present with late-stage disease. This association transcended recruitment site (SNH vs ACC), indicating that patients in either hospital setting may benefit from unmet social needs screening to overcome access to care barriers associated with late-stage disease at diagnosis.
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Affiliation(s)
- Neha Goel
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, Florida
- University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- University of Miami Miller School of Medicine, Miami, Florida
- World Health Organization, Geneva, Switzerland
| | - Maya Lubarsky
- University of Miami Miller School of Medicine, Miami, Florida
| | - Alexandra E. Hernandez
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, Florida
| | - Kelley Benck
- University of Miami Miller School of Medicine, Miami, Florida
| | - Emma Lee
- University of Miami Miller School of Medicine, Miami, Florida
| | - Susan Kesmodel
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, Florida
- University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida
- University of Miami Miller School of Medicine, Miami, Florida
| | - Felicia Knaul
- University of Miami Institute for Advanced Study of the Americas, Coral Gables, Florida
| | - Erin Kobetz
- University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida
- University of Miami Miller School of Medicine, Miami, Florida
- Department of Public Health Sciences, University of Miami, Miami, Florida
- Department of Medicine, Division of Internal Medicine, University of Miami, Miami, Florida
| | - Benjamin O. Anderson
- Department of Surgery, University of Washington, Seattle
- World Health Organization, Geneva, Switzerland
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Bhardwaj PV, Dulala R, Rajappa S, Loke C. Breast Cancer in India: Screening, Detection, and Management. Hematol Oncol Clin North Am 2024; 38:123-135. [PMID: 37330342 DOI: 10.1016/j.hoc.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Breast cancer is the most common cancer in urban Indian women and the second most common cancer in all Indian women. The epidemiology as well as biology of this cancer seems to be different in the Indian subcontinent when compared with the West. The lack of population-based breast cancer screening programs and delay in seeking a medical consult due to financial and social reasons, including lack of awareness and fear related to a cancer diagnosis, results in delayed diagnosis.
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Affiliation(s)
- Prarthna V Bhardwaj
- Division of Hematology-Oncology, University of Massachusetts Chan Medical School - Baystate, 759 Chestnut Street, Springfield, MA 01199, USA
| | - Renuka Dulala
- Division of Hematology-Oncology, Holyoke Medical Center, 575 Beech Street, Holyoke, MA 01040, USA
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Road no. 10, Banjara Hills, Hyderabad, Telangana 500034, India
| | - Chandravathi Loke
- Division of Hematology-Oncology, University of Massachusetts Chan Medical School - Baystate, 759 Chestnut Street, Springfield, MA 01199, USA.
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Sharma R, Abbastabar H, Abdulah DM, Abidi H, Abolhassani H, Abrehdari-Tafreshi Z, Absalan A, Ali HA, Abu-Gharbieh E, Acuna JM, Adib N, Sakilah Adnani QE, Aghaei A, Ahmad A, Ahmad S, Ahmadi A, Ahmadi S, Ahmed LA, Ajami M, Al Hamad H, Al Hasan SM, Alanezi FM, Saeed Al-Gheethi AA, Al-Hanawi MK, Ali A, Ali BA, Alimohamadi Y, Aljunid SM, Ali Al-Maweri SA, Alqahatni SA, AlQudah M, Al-Raddadi RM, Al-Tammemi AB, Ansari-Moghaddam A, Anwar SL, Anwer R, Aqeel M, Arabloo J, Arab-Zozani M, Ariffin H, Artaman A, Arulappan J, Ashraf T, Askari E, Athar M, Wahbi Atout MM, Azadnajafabad S, Badar M, Badiye AD, Baghcheghi N, Bagherieh S, Bai R, Bajbouj K, Baliga S, Bardhan M, Bashiri A, Baskaran P, Basu S, Belgaumi UI, Nazer C Bermudez A, Bhandari B, Bhardwaj N, Bhat AN, Bitaraf S, Boloor A, Hashemi MB, Butt ZA, Chadwick J, Kai Chan JS, Chattu VK, Chaturvedi P, Cho WC, Darwesh AM, Dash NR, Dehghan A, Dhali A, Dianatinasab M, Dibas M, Dixit A, Dixit SG, Dorostkar F, Dsouza HL, Elbarazi I, Elemam NM, El-Huneidi W, Elkord E, Abdou Elmeligy OA, Emamian MH, Erkhembayar R, Ezzeddini R, Fadoo Z, Faiz R, Fakhradiyev IR, Fallahzadeh A, Faris MEM, Farrokhpour H, Fatehizadeh A, Fattahi H, Fekadu G, Fukumoto T, Gaidhane AM, Galehdar N, Garg P, Ghadirian F, Ghafourifard M, Ghasemi M, Nour MG, Ghassemi F, Gholamalizadeh M, Gholamian A, Ghotbi E, Golechha M, Goleij P, Goyal S, Mohialdeen Gubari MI, Gunasekera DS, Gunawardane DA, Gupta S, Habibzadeh P, Haeri Boroojeni HS, Halboub ES, Hamadeh RR, Hamoudi R, Harorani M, Hasanian M, Hassan TS, Hay SI, Heidari M, Heidari-Foroozan M, Hessami K, Hezam K, Hiraike Y, Holla R, Hoseini M, Hossain MM, Hossain S, Hsieh VCR, Huang J, Hussein NR, Hwang BF, Iravanpour F, Ismail NE, Iwagami M, Merin J L, Jadidi-Niaragh F, Jafarinia M, Jahani MA, Jahrami H, Jaiswal A, Jakovljevic M, Jalili M, Jamshidi E, Jayarajah U, Jayaram S, Jha SS, Jokar M, Joseph N, Kabir A, Kabir MA, Kadir DH, Kakodkar PV, Kalankesh LR, Kalankesh LR, Kalhor R, Kaliyadan F, Kamal VK, Kamal Z, Kamath A, Kar SS, Karimi H, Kaur N, Keikavoosi-Arani L, Keykhaei M, Khader YS, Khajuria H, Khan EA, Khan MN, Khan M, Khan MA, Khan YH, Khanmohammadi S, Khatatbeh MM, Khateri S, Khayamzadeh M, Khayat Kashani HR, Kim MS, Kompani F, Koohestani HR, Koulmane Laxminarayana SL, Krishan K, Kumar N, Kumar N, Kutluk T, Kuttikkattu A, Ching Lai DT, Lal DK, Lami FH, Lasrado S, Lee SW, Lee SW, Lee YY, Lee YH, Leong E, Li MC, Liu J, Madadizadeh F, Mafi AR, Mahjoub S, Malekzadeh R, Malik AA, Malik I, Mallhi TH, Mansournia MA, Martini S, Mathews E, Mathur MR, Meena JK, Menezes RG, Mirfakhraie R, Mirinezhad SK, Mirza-Aghazadeh-Attari M, Mithra P, Mohamadkhani A, Mohammadi S, Mohammadzadeh M, Mohan S, Mokdad AH, Al Montasir A, Montazeri F, Moradi M, Sarabi MM, Moradpour F, Moradzadeh M, Moraga P, Mosapour A, Motaghinejad M, Mubarik S, Muhammad JS, Murray CJ, Nagarajan AJ, Naghavi M, Nargus S, Natto ZS, Nayak BP, Nejadghaderi SA, Nguyen PT, Niazi RK, Noroozi N, Okati-Aliabad H, Okekunle AP, Ong S, Oommen AM, Padubidri JR, Pandey A, Park EK, Park S, Pati S, Patil S, Paudel R, Paudel U, Pirestani M, Podder I, Pourali G, Pourjafar M, Pourshams A, Syed ZQ, Radhakrishnan RA, Radhakrishnan V, Rahman M, Rahmani S, Rahmanian V, Ramesh PS, Rana J, Rao IR, Rao SJ, Rashedi S, Rashidi MM, Rezaei N, Rezaei N, Rezaei N, Rezaei S, Rezaeian M, Roshandel G, Chandan S, Saber-Ayad MM, Sabour S, Sabzmakan L, Saddik B, Saeed U, Safi SZ, Sharif-Askari FS, Sahebkar A, Sahoo H, Sajedi SA, Sajid MR, Salehi MA, Farrokhi AS, Sarasmita MA, Sargazi S, Sarode GS, Sarode SC, Sathian B, Satpathy M, Semwal P, Senthilkumaran S, Sepanlou SG, Shafeghat M, Shahabi S, Shahbandi A, Shahraki-Sanavi F, Shaikh MA, Shannawaz M, Sheikhi RA, Shobeiri P, Shorofi SA, Shrestha S, Siabani S, Singh G, Singh P, Singh S, Sinha DN, Siwal SS, Sreeram S, Suleman M, Abdulkader RS, Sultan I, Sultana A, Tabish M, Tabuchi T, Taheri M, Talaat IM, Tehrani-Banihashemi A, Temsah MH, Thangaraju P, Thomas N, Thomas NK, Tiyuri A, Tobe-Gai R, Toghroli R, Tovani-Palone MR, Ullah S, Unnikrishnan B, Upadhyay E, Tahbaz SV, Valizadeh R, Varthya SB, Waheed Y, Wang S, Wickramasinghe DP, Wickramasinghe ND, Xiao H, Yonemoto N, Younis MZ, Yu C, Zahir M, Zaki N, Zamanian M, Zhang ZJ, Zhao H, Zitoun OA, Zoladl M. Temporal patterns of cancer burden in Asia, 1990-2019: a systematic examination for the Global Burden of Disease 2019 study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 21:100333. [PMID: 38361599 PMCID: PMC10866992 DOI: 10.1016/j.lansea.2023.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 02/17/2024]
Abstract
Background Cancers represent a challenging public health threat in Asia. This study examines the temporal patterns of incidence, mortality, disability and risk factors of 29 cancers in Asia in the last three decades. Methods The age, sex and year-wise estimates of incidence, mortality, and disability-adjusted life years (DALYs) of 29 cancers for 49 Asian countries from 1990 through 2019 were generated as a part of the Global Burden of Disease, Injuries and Risk Factors 2019 study. Besides incidence, mortality and DALYs, we also examined the cancer burden measured in terms of DALYs and deaths attributable to risk factors, which had evidence of causation with different cancers. The development status of countries was measured using the socio-demographic index. Decomposition analysis was performed to gauge the change in cancer incidence between 1990 and 2019 due to population growth, aging and age-specific incidence rates. Findings All cancers combined claimed an estimated 5.6 million [95% uncertainty interval, 5.1-6.0 million] lives in Asia with 9.4 million [8.6-10.2 million] incident cases and 144.7 million [132.7-156.5 million] DALYs in 2019. The age-standardized incidence rate (ASIR) of all cancers combined in Asia was 197.6/100,000 [181.0-214.4] in 2019, varying from 99.2/100,000 [76.1-126.0] in Bangladesh to 330.5/100,000 [298.5-365.8] in Cyprus. The age-standardized mortality rate (ASMR) was 120.6/100,000 [110.1-130.7] in 2019, varying 4-folds across countries from 71.0/100,000 [59.9-83.5] in Kuwait to 284.2/100,000 [229.2-352.3] in Mongolia. The age-standardized DALYs rate was 2970.5/100,000 [2722.6-3206.5] in 2019, varying from 1578.0/100,000 [1341.2-1847.0] in Kuwait to 6574.4/100,000 [5141.7-8333.0] in Mongolia. Between 1990 and 2019, deaths due to 17 of the 29 cancers either doubled or more, and 20 of the 29 cancers underwent an increase of 150% or more in terms of new cases. Tracheal, bronchus, and lung cancer (both sexes), breast cancer (among females), colon and rectum cancer (both sexes), stomach cancer (both sexes) and prostate cancer (among males) were among top-5 cancers in most Asian countries in terms of ASIR and ASMR in 2019 and cancers of liver, stomach, hodgkin lymphoma and esophageal cancer posted the most significant decreases in age-standardized rates between 1990 and 2019. Among the modifiable risk factors, smoking, alcohol use, ambient particulate matter (PM) pollution and unsafe sex remained the dominant risk factors between 1990 and 2019. Cancer DALYs due to ambient PM pollution, high body mass index and fasting plasma glucose has increased most notably between 1990 and 2019. Interpretation With growing incidence, cancer has become more significant public health threat in Asia, demanding urgent policy attention and guidance. Its heightened risk calls for increased cancer awareness, preventive measures, affordable early-stage detection, and cost-effective therapeutics in Asia. The current study can serve as a useful resource for policymakers and researchers in Asia for devising interventions for cancer management and control. Funding The GBD study is funded by the Bill and Melinda Gates Foundation.
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Deffieux X, Rousset-Jablonski C, Gantois A, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Gaucher L, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Pizzoferrato AC, Artzner F, Tavenet A, Le Ray C, Fauconnier A. [Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:297-330. [PMID: 37258002 DOI: 10.1016/j.gofs.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.
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Affiliation(s)
- Xavier Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Saclay, AP-HP, 92140 Clamart, France.
| | - Christine Rousset-Jablonski
- Département de chirurgie, Centre Léon Bérard, 28, rue Laënnec, 69008 Lyon, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Adrien Gantois
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | | | - Julia Maruani
- Cabinet médical, 6, rue Docteur-Albert-Schweitzer, 13006 Marseille, France
| | - Lorraine Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | | | - Laurent Gaucher
- Collège national des sages-femmes de France, CNSF, 75010 Paris, France; Public Health Unit, hospices civils de Lyon, 69500 Bron, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Genève, Suisse
| | - Yoann Athiel
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, université de Lille, 59000 Lille, France
| | - Alexandre Bailleul
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France; Unité Inserm 1312, université de Bordeaux, Bordeaux Institute of Oncology, 33000 Bordeaux, France
| | - Mathilde Bourdon
- Service de gynécologie-obstétrique II et médecine de la reproduction, université Paris cité, AP-HP, centre hospitalier universitaire (CHU) Cochin Port-Royal, 75014 Paris, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, 44000 Nantes, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance publique-Hôpitaux de Paris, 93140 Bondy, France; Institut de recherche interdisciplinaire sur les enjeux sociaux, UMR 8156-997, UFR SMBH, université Sorbonne Paris Nord, 93000 Bobigny, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU d'Angers, 49000 Angers, France
| | - Yohann Dabi
- Service de gynécologie-obstétrique et médecine de la reproduction, Sorbonne université-AP-HP-hôpital Tenon, 75020 Paris, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, faculté de médecine, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, 75005 Paris, France
| | - Anne Freyens
- Département universitaire de médecine générale (DUMG), université Paul-Sabatier, 31000 Toulouse, France
| | - Virginie Grouthier
- Service d'endocrinologie, diabétologie, nutrition et d'endocrinologie des gonades, Hôpital Haut Lévêque, Centre Hospitalo-universitaire régional de Bordeaux, 31000 Bordeaux, France; Université de Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | - Elisabeth Iraola
- Institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, conseil départemental du Val-de-Marne, 94000 Créteil, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France
| | - Nadege Lauchet
- Groupe médical François-Perrin, 9, rue François-Perrin, 87000 Limoges, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, 49000 Angers, France; UMR_S1085, université d'Angers, CHU d'Angers, université de Rennes, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, Inserm, LTSI - UMR 1099, 35000 Rennes, France; Département de gynécologie et obstétrique, CHU de Rennes, 35000 Rennes, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126, boulevard Saint-Germain, 75006 Paris, France
| | | | - Marine Masson
- Département de médecine générale, 86000 Poitiers, France
| | - Caroline Matteo
- Ecole de maïeutique, Aix Marseille Université, 13015 Marseille, France
| | - Anne Pinton
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne université, 75013 Paris, France
| | - Emmanuelle Sabbagh
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | - Camille Sallee
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - Thibault Thubert
- Service de gynecologie-obstétrique, CHU de Nantes, 44000 Nantes, France; EA 4334, laboratoire mouvement, interactions, performance (MIP), Nantes université, 44322 Nantes, France
| | - Isabelle Heron
- Service d'endocrinologie, université de Rouen, hôpital Charles-Nicolle, 76000 Rouen, France; Cabinet médical, Clinique Mathilde, 76100 Rouen, France
| | - Anne-Cécile Pizzoferrato
- Service de gynécologie-obstétrique, hôpital universitaire de La Miletrie, 86000 Poitiers, France; Inserm CIC 1402, université de Poitiers, 86000 Poitiers, France
| | - France Artzner
- Ciane, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101, rue Pierre-Corneille, 69003 Lyon, France
| | - Arounie Tavenet
- Endofrance, Association de lutte contre l'endométriose, 3, rue de la Gare, 70190 Tresilley, France
| | - Camille Le Ray
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Arnaud Fauconnier
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
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Sayed S, Ngugi AK, Nwosu N, Mutebi MC, Ochieng P, Mwenda AS, Salam RA. Training health workers in clinical breast examination for early detection of breast cancer in low- and middle-income countries. Cochrane Database Syst Rev 2023; 4:CD012515. [PMID: 37070783 PMCID: PMC10122521 DOI: 10.1002/14651858.cd012515.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Most women living in low- and middle-income countries (LMICs) present with advanced-stage breast cancer. Limitations of poor serviceable health systems, restricted access to treatment facilities, and lack of breast cancer screening programmes all likely contribute to the late presentation of women with breast cancer living in these countries. Women are diagnosed with advanced disease and frequently do not complete their care due to a number of factors, including financial reasons as health expenditure is largely out of pocket resulting in financial toxicity; health system failures, such as missing services or health worker lack of awareness on common signs and symptoms of cancer; and sociocultural barriers, such as stigma and use of alternative therapies. Clinical breast examination (CBE) is an inexpensive early detection technique for breast cancer in women with palpable breast masses. Training health workers from LMICs to conduct CBE has the potential to improve the quality of the technique and the ability of health workers to detect breast cancers early. OBJECTIVES To assess whether training in CBE affects the ability of health workers in LMICs to detect early breast cancer. SEARCH METHODS We searched the Cochrane Breast Cancer Specialised Registry, CENTRAL, MEDLINE, Embase, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, and ClinicalTrials.gov up to 17 July 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) (including individual and cluster-RCTs), quasi-experimental studies and controlled before-and-after studies if they fulfilled the eligibility criteria. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion, and extracted data, assessed risk of bias, and assessed the certainty of the evidence using the GRADE approach. We performed statistical analysis using Review Manager software and presented the main findings of the review in a summary of findings table. MAIN RESULTS We included four RCTs that screened a total population of 947,190 women for breast cancer, out of which 593 breast cancers were diagnosed. All included studies were cluster-RCTs; two were conducted in India, one in the Philippines, and one in Rwanda. Health workers trained to perform CBE in the included studies were primary health workers, nurses, midwives, and community health workers. Three of the four included studies reported on the primary outcome (breast cancer stage at the time of presentation). Amongst secondary outcomes, included studies reported CBE coverage, follow-up, accuracy of health worker-performed CBE, and breast cancer mortality. None of the included studies reported knowledge attitude practice (KAP) outcomes and cost-effectiveness. Three studies reported diagnosis of breast cancer at early stage (at stage 0+I+II), suggesting that training health workers in CBE may increase the number of women detected with breast cancer at an early stage compared to the non-training group (45% detected versus 31% detected; risk ratio (RR) 1.44, 95% confidence interval (CI) 1.01 to 2.06; three studies; 593 participants; I2 = 0%; low-certainty evidence). Three studies reported diagnosis at late stage (III+IV) suggesting that training health workers in CBE may slightly reduce the number of women detected with breast cancer at late stage compared to the non-training group (13% detected versus 42%, RR 0.58, 95% CI 0.36 to 0.94; three studies; 593 participants; I2 = 52%; low-certainty evidence). Regarding secondary outcomes, two studies reported breast cancer mortality, implying that the evidence is uncertain for the impact on breast cancer mortality (RR 0.88, 95% CI 0.24 to 3.26; two studies; 355 participants; I2 = 68%; very low-certainty evidence). Due to the study heterogeneity, we could not conduct meta-analysis for accuracy of health worker-performed CBE, CBE coverage, and completion of follow-up, and therefore reported narratively using the 'Synthesis without meta-analysis' (SWiM) guideline. Sensitivity of health worker-performed CBE was reported to be 53.2% and 51.7%; while specificity was reported to be 100% and 94.3% respectively in two included studies (very low-certainty evidence). One trial reported CBE coverage with a mean adherence of 67.07% for the first four screening rounds (low-certainty evidence). One trial reported follow-up suggesting that compliance rates for diagnostic confirmation following a positive CBE were 68.29%, 71.20%, 78.84% and 79.98% during the respective first four rounds of screening in the intervention group compared to 90.88%, 82.96%, 79.56% and 80.39% during the respective four rounds of screening in the control group. AUTHORS' CONCLUSIONS Our review findings suggest some benefit of training health workers from LMICs in CBE on early detection of breast cancer. However, the evidence regarding mortality, accuracy of health worker-performed CBE, and completion of follow up is uncertain and requires further evaluation.
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Affiliation(s)
- Shahin Sayed
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Anthony K Ngugi
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Nicole Nwosu
- Department of Medical Sciences, Western University, London, Canada
| | - Miriam C Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Powell Ochieng
- Department of Post Graduate Medical Education, Aga Khan University, Nairobi, Kenya
| | | | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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Ramadas K, Basu P, Mathew BS, Muwonge R, Venugopal M, Prakasan AM, Malu R, Lucas E, Augustine P, Mony RP, Thara S, Sankaranarayanan R. Effectiveness of triennial screening with clinical breast examination: 14-years follow-up outcomes of randomized clinical trial in Trivandrum, India. Cancer 2023; 129:272-282. [PMID: 36321193 PMCID: PMC10091935 DOI: 10.1002/cncr.34526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study presents the preliminary results of a randomized controlled trial (RCT) initiated in January 2006 in India to evaluate the effectiveness of clinical breast examination (CBE) in reducing breast cancer mortality as compared to a no-screening control group reported significant downstaging in the intervention group. The present manuscript reports long-term follow-up outcomes. METHODS Women 30-69 years old from 133 intervention clusters and 141 control clusters were invited to participate. Women in the intervention arm underwent three rounds of CBE every 3 years. CBE-positive women were reexamined by a physician, and triple-assessment was performed on those confirmed to have abnormalities. All participants were followed through home visits and linkage with population-based cancer registry. RESULTS Of the 55,843 eligible women in the intervention arm, 95.7% had CBE at least once and 11.5% were CBE-positive. Breast cancers were diagnosed in 335 participants in the intervention group and 273 in the control group (N = 59,447). Age-standardized incidence rate of early cancer was 30.4 of 100,000 in the intervention and 21.9 of 100,000 in the control group, with a rate ratio (RR) of 1.4 (95% confidence interval [CI], 1.1-1.8). The age-standardized breast cancer mortality rates were 11.3 and 11.1 per 100,000 in intervention and control arms, respectively (RR, 1.1; 95% CI, 0.8-1.5) after 15 years. Five-year breast cancer survival rates were 77.0% in the intervention and 71.2% in the control groups (overall p value = .043). CONCLUSIONS Triennial CBE screening failed to demonstrate any mortality benefit despite achieving a shift toward earlier stage at detection and improved survival in the intervention arm. CBE is a valuable tool for diagnosis of breast cancer in symptomatic women especially in areas where mammography and/or breast cancer screening programs are not widely available.
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Affiliation(s)
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Richard Muwonge
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | | | - Rafi Malu
- Regional Cancer Centre, Trivandrum, India
| | - Eric Lucas
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Rengaswamy Sankaranarayanan
- Karkinos Healthcare, Kerala Operations, Ernakulam, India
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
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12
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Van Christ Manirakiza A, Pfaendler KS. Breast, Ovarian, Uterine, Vaginal, and Vulvar Cancer Care in Low- and Middle-Income Countries. Obstet Gynecol Clin North Am 2022; 49:783-793. [DOI: 10.1016/j.ogc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Boamah Mensah AB, Mensah KB, Aborigo RA, Bangalee V, Oosthuizen F, kugbey N, Clegg-Lamptey JN, Virnig B, Kulasingam S, Ncama BP. Breast cancer screening pathways in Ghana: applying an exploratory single case study methodology with cross-case analysis. Heliyon 2022; 8:e11413. [DOI: 10.1016/j.heliyon.2022.e11413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/24/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
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Subramanian MJ, Ravi RM. Phone-Based Breasts Self-Examination as an Intervention in Breast Cancer Control During the COVID-19 Pandemic. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022; 20:28. [PMID: 35702634 PMCID: PMC9186479 DOI: 10.1007/s40944-022-00628-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/04/2022] [Accepted: 05/16/2022] [Indexed: 12/24/2022]
Abstract
Importance Exploring methods to mitigate the effect of COVID-19 pandemic on routine cancer screening activities among women. Objective To investigate the effectiveness of telephone-based outreach as a substitute for physical screening for breast among screened women, during COVID-19 lockdown. Design/Setting/Subjects Asymptomatic women aged 30–59 years were screened for breast and cervix cancers in the Chennai region, between January 2017 and March 2020 and are due for screening follow-up. A database from the population-based cancer screening program organized by the Cancer Institute during the above period was used for the study. Outcome data were obtained through the period from October 2020 to March 2021. Intervention Phone-based breast self-examination awareness, inquiry about breast cancer symptoms, and guiding clinical management. Outcome Measure Compliance to BSE protocol after 8–16 weeks, presence of significant symptoms, and incidence of early breast cancer. Results Among 12,242 screened women, 6716 (56.8%) responded to a phone-based BSE intervention and 53 women had breast-related symptoms. Thirty-two (60.4%) women reported for further evaluation, and five invasive breast cancers were identified. Conclusion and Relevance In a low-resource setting where there are no existent screening programs, simple interventions like teaching breast self-examination of women through tele-counseling can result in early detection of breast cancers.
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Affiliation(s)
| | - Rathi Meena Ravi
- Department of Preventive Oncology, Cancer Institute (WIA), Chennai, India
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15
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Mahanani MR, Valkov M, Agaeva A, Kaucher S, Pikalova LV, Grishchenko MY, Zhuikova LD, Jaehn P, Winkler V. Comparison of female breast cancer between Russia and Germany: A population-based study on time trends and stage at diagnosis. Cancer Epidemiol 2022; 80:102214. [PMID: 35841762 DOI: 10.1016/j.canep.2022.102214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/14/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES While a mammography-screening program (MSP) is being offered systematically in Germany since 2009, the dispanserizatsiya has been implemented in Russia since 2013. This study examined trends of stage at breast cancer diagnosis in two Russian regions and compared the results with the development in Germany. In addition, we aimed to gain further insights into the early detection of breast cancer in Russia. METHODS Incidence data from two cancer registries in Russia and 12 population-based cancer registries in Germany were used to analyse breast cancer incidence rates among women above age 30 over time. Further, we calculated rate ratios to compare the age group-specific incidence rates after the implementation of MSP in Germany (2010-2014) with the period before implementation (2003-2005) separately for each tumour stage and all stages combined. RESULTS During the study period from 2003 to 2014, age-standardised rates for breast cancer were 54.6 and 116.7 per 100,000 for Russia and Germany, respectively. The proportion of the T1 stage at diagnosis among Russian women aged 50 + is half than that in Germany. Nevertheless, we observed an increasing trend of early-stage alongside the reduction of advanced-stage incidence rates of breast cancer in Russia. CONCLUSIONS The observed trend in Russia may reflect overall positive changes in early detection of breast cancer, with actual proportion of T1 stage still far behind Germany. Advances in breast cancer screening efforts through the dispanserizatsiya may help to further reduce the breast cancer burden.
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Affiliation(s)
- Melani R Mahanani
- Epidemiology of Transition, Heidelberg Institute of Global Health, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Mikhail Valkov
- Department of Radiology, Radiotherapy and Oncology, Northern State Medical University, Trotsky av. 51, Arkhangelsk, Russia
| | - Anna Agaeva
- Department of Radiology, Radiotherapy and Oncology, Northern State Medical University, Trotsky av. 51, Arkhangelsk, Russia
| | - Simone Kaucher
- Epidemiology of Transition, Heidelberg Institute of Global Health, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Lidia V Pikalova
- Population Cancer Register of the Tomsk Region, 634050 Tomsk, Russia
| | | | - Lilia D Zhuikova
- Cancer Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences (RAS), 634050 Tomsk, Russia
| | - Philipp Jaehn
- Brandenburg Medical School Theodor Fontane, Institute of Social Medicine and Epidemiology, 14770 Brandenburg an der Havel, Germany; Brandenburg Medical School Theodor Fontane, Faculty of Health Sciences Brandenburg, Karl-Liebknecht-Str. 24-25, 14467 Potsdam, Germany
| | - Volker Winkler
- Epidemiology of Transition, Heidelberg Institute of Global Health, University Hospital Heidelberg, 69120 Heidelberg, Germany.
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16
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Newman LA. Breast cancer screening in low and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2022; 83:15-23. [PMID: 35589536 DOI: 10.1016/j.bpobgyn.2022.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 12/09/2022]
Abstract
Breast cancer incidence rates are rising in low and middle-income countries (LMIC), and these populations have reduced access to advanced multidisciplinary treatment. Screening and early detection are therefore critical in these regions but must be affordable and sustainable. Mammography screening programs are well established in more affluent countries, but alternative strategies to reduce the breast cancer burden of LMIC (such as clinical breast examination, general breast health awareness, and addressing modifiable lifestyle factors including obesity) are likely to be more realistic at the present time.
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Affiliation(s)
- Lisa A Newman
- Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Weill Cornell Medicine, 420 East 70th Street, New York, 10021, USA
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17
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Afaya A, Seidu AA, Sang S, Yakong VN, Afaya RA, Shin J, Ahinkorah BO. Mapping evidence on knowledge of breast cancer screening and its uptake among women in Ghana: a scoping review. BMC Health Serv Res 2022; 22:526. [PMID: 35443647 PMCID: PMC9022278 DOI: 10.1186/s12913-022-07775-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/14/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Female breast cancer is currently the most commonly diagnosed cancer globally with an estimated 2.3 million new cases in 2020. Due to its rising frequency and high mortality rate in both high- and low-income countries, breast cancer has become a global public health issue. This review sought to map literature to present evidence on knowledge of breast cancer screening and its uptake among women in Ghana. METHODS Five databases (PubMed, CINAHL, PsycINFO, Web of Science, and EMBASE) were searched to identify relevant published studies between January 2012 and August 2021 on knowledge of breast cancer screening and its uptake among women. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and the six-stage model by Arksey and O'Malley were used to select and report findings. RESULTS Of the 65 articles retrieved, 14 records were included for synthesis. The review revealed varied knowledge levels and practices of breast cancer screening among women across a few regions in Ghana. The knowledge level of women on breast cancer screening was high, especially in breast cancer screening practice. Breast cancer screening practice among women was observed to be low and the most identified barriers were lack of technique to practice breast self-examination, having no breast problem, lack of awareness of breast cancer screening, and not having breast cancer risk. The results further showed that good knowledge of breast cancer screening, higher educational level, increasing age, physician recommendation, and household monthly income were enabling factors for breast cancer screening uptake. CONCLUSION This review showed varied discrepancies in breast cancer screening uptake across the regions in Ghana. Despite the benefits of breast cancer screening, the utilization of the screening methods across the regions is very low due to some varied barriers from the different regions. To increase the uptake of breast cancer screening, health workers could employ various strategies such as community education and sensitization on the importance of breast cancer screening.
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Affiliation(s)
- Agani Afaya
- College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Australia.
- Faculty of Built and Natural Environment, Department of Estate Management, Takoradi Technical University, Takoradi, Ghana.
- Centre for Gender and Advocacy, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana.
| | - Somin Sang
- College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Vida Nyagre Yakong
- Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Richard Adongo Afaya
- Department of Midwifery and Women's Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Jinhee Shin
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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18
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Kulkarni VY, Mishra GA, Pimple SA, Patil AS, Bajpai J, TS S. Determinants of Compliance for Breast and Cervical Cancers Screening among Female Police Personnel of Mumbai, India—A Cross-Sectional Study. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Women working in police force have unique and vital role to play in law enforcement. Although these women have established a secured place for themselves in the police force, they are exposed to several behavioral and health risks apart from job stress. All these can have potentially serious consequences on their well-being.
Objectives To determine the compliance to breast and uterine cervical cancers screening and identify predictors of participation in breast and cervical cancers screening among women police personnel.
Materials and Methods This is a cross-sectional study conducted among the Mumbai police personnel during the period 2019 to 2021. All women working for Mumbai police work force in 12 zones were invited to participate in the study. Temporary clinics for screening were set up in different police stations and eligible participants were enrolled after obtaining written informed consent. This was followed by sociodemographic and risk factor assessment, health education program, screening for common cancers conducted by trained primary health workers (breast by clinical breast examination and uterine cervix by visual inspection with 5% acetic acid). Screen positives were referred according to predefined referral criteria for further investigations and management.
Results A total of 3,017 police women were contacted, among them, 2,629 (87.14%) were eligible for screening, 2,609 (99.24%) participated in health education, and 1,839 (69.95%) complied for breast or cervical cancer screening. Further, compliance for screening of breast and uterine cervix were 1,837 (91.67%) and 1,297 (64.72%). A total of 256 (13.94%) and 217 (11.81%) police women were screen positives for breast and cervical cancers. According to multivariate logistic regression analysis, women younger than 50 years, those who were not married or were widowed or separated, postmenopausal women, and those who did not have shift duties had higher compliance for breast and cervix cancers screening.
Conclusion Good participation for breast and cervical cancers screening was seen among the women police personnel. This study has demonstrated that awareness and screening by simple low-cost methods for breast and cervical cancers screening is easily implementable and can be replicated among the women police force in different states of India.
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Affiliation(s)
- Vasundhara Y. Kulkarni
- Department of Preventive Oncology, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gauravi A. Mishra
- Department of Preventive Oncology, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sharmila A. Pimple
- Department of Preventive Oncology, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anil S. Patil
- Department of Preventive Oncology, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shylasree TS
- Department of Gynecology Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Martei YM, Dauda B, Vanderpuye V. Breast cancer screening in sub-Saharan Africa: a systematic review and ethical appraisal. BMC Cancer 2022; 22:203. [PMID: 35197002 PMCID: PMC8867875 DOI: 10.1186/s12885-022-09299-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The aim of this systematic review was to evaluate the evidence and clinical outcomes of screening interventions and implementation trials in sub-Saharan Africa (SSA) and also appraise some ethical issues related to screening in the region through quantitative and qualitative narrative synthesis of the literature. METHODS We searched Pubmed, OvidMEDLINE, Embase, and Web of Science to identify studies published on breast cancer screening interventions and outcomes in SSA. Descriptive statistics were used to summarize the frequency and proportions of extracted variables, and narrative syntheses was used to evaluate the clinical outcomes of the different screening modalities. The mixed methods appraisal tool was used to assess the quality of studies included in the review. RESULTS Fifteen studies were included, which consisted of 72,572 women in ten countries in SSA. 63% (8/15) of the included publications evaluated Clinical Breast Examination (CBE), 47% (7/15) evaluated mammography and 7% (1/15) evaluated ultrasound screening. The cancer detection rate was < 1/1000 to 3.3/1000 and 3.3/100 to 56/1000 for CBE and mammography screening respectively. There was a lot of heterogeneity in CBE methods, target age for screening and no clear documentation of screening interval. Cost-effective analyses showed that CBE screening linked to comprehensive cancer care is most cost effective. There was limited discussion of the ethics of screening, including the possible harms of screening in the absence of linkage to care. The gap between conducting good screening program and the appropriate follow-up with diagnosis and treatment remains one of the major challenges of screening in SSA. DISCUSSION There is insufficient real-world data to support the systematic implementation of national breast cancer screening in SSA. Further research is needed to answer important questions about screening, and national and international partnerships are needed to ensure that appropriate diagnostic and treatment modalities are available to patients who screen positive.
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Affiliation(s)
- Yehoda M Martei
- Department of Medicine (Division of Hematology-Oncology), University of Pennsylvania, Philadelphia, PA, USA.
- Botswana UPenn Partnership, Gaborone, Botswana.
| | - Bege Dauda
- Center for Global Genomics and Health Equity, University of Pennsylvania, Philadelphia, PA, USA
| | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
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20
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Roslidar R, Syaryadhi M, Saddami K, Pradhan B, Arnia F, Syukri M, Munadi K. BreaCNet: A high-accuracy breast thermogram classifier based on mobile convolutional neural network. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:1304-1331. [PMID: 35135205 DOI: 10.3934/mbe.2022060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The presence of a well-trained, mobile CNN model with a high accuracy rate is imperative to build a mobile-based early breast cancer detector. In this study, we propose a mobile neural network model breast cancer mobile network (BreaCNet) and its implementation framework. BreaCNet consists of an effective segmentation algorithm for breast thermograms and a classifier based on the mobile CNN model. The segmentation algorithm employing edge detection and second-order polynomial curve fitting techniques can effectively capture the thermograms' region of interest (ROI), thereby facilitating efficient feature extraction. The classifier was developed based on ShuffleNet by adding one block consisting of a convolutional layer with 1028 filters. The modified Shufflenet demonstrated a good fit learning with 6.1 million parameters and 22 MB size. Simulation results showed that modified ShuffleNet alone resulted in a 72% accuracy rate, but the performance excelled to a 100% accuracy rate when integrated with the proposed segmentation algorithm. In terms of diagnostic accuracy of the normal and abnormal test, BreaCNet significantly improves the sensitivity rate from 43% to 100% and specificity of 100%. We confirmed that feeding only the ROI of the input dataset to the network can improve the classifier's performance. On the implementation aspect of BreaCNet, the on-device inference is recommended to ensure users' data privacy and handle an unreliable network connection.
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Affiliation(s)
- Roslidar Roslidar
- Doctoral Program, School of Engineering, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Electrical and Computer Engineering, Universitas Syiah Kuala, Indonesia
- Telematics Research Center, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Mohd Syaryadhi
- Department of Electrical and Computer Engineering, Universitas Syiah Kuala, Indonesia
| | - Khairun Saddami
- Department of Electrical and Computer Engineering, Universitas Syiah Kuala, Indonesia
| | - Biswajeet Pradhan
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
- Center of Excellence for Climate Change Research, King Abdulaziz University, Jeddah, Saudi Arabia
- Earth Observation Center, Institute of Climate Change, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Fitri Arnia
- Department of Electrical and Computer Engineering, Universitas Syiah Kuala, Indonesia
- Telematics Research Center, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Maimun Syukri
- Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Khairul Munadi
- Department of Electrical and Computer Engineering, Universitas Syiah Kuala, Indonesia
- Telematics Research Center, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Tsunami and Disaster Mitigation Research Center, Universitas Syiah Kuala, Banda Aceh, Indonesia
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21
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Sharma R. Breast cancer burden in Africa: evidence from GLOBOCAN 2018. J Public Health (Oxf) 2021; 43:763-771. [PMID: 32657321 DOI: 10.1093/pubmed/fdaa099] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 04/07/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Breast cancer is the leading malignancy in African females. This study aims to examine the breast cancer burden in Africa using recently released GLOBOCAN 2018 estimates. METHODS The incidence and mortality estimates of age- and country-wise burden of breast cancer in 54 African countries were obtained from GLOBOCAN 2018. RESULTS In Africa, breast cancer caused 74 072 deaths, and 168 690 cases were estimated to have occurred in 2018. The age-standardized incidence rate stood at 37.9/100 000 in Africa, varying from 6.9/100 000 in the Gambia to 69.6/100 000 in Mauritius. The age-standardized mortality rate stood at 17.2/100 000 in 2018, ranging from 4/100 000 in the Gambia to 29.1/100 000 in Somalia in 2018. Nigeria was the leading country in terms of absolute burden with 26 310 cases and 11 564 deaths, followed by Egypt with 23 081 new cases and 9254 deaths. The mortality-to-incidence ratio for Africa stood at 0.44, varying from 0.24 in Libya to 0.68 in the Central African Republic. CONCLUSION To tackle breast cancer burden in Africa, the main challenges are late-stage disease presentation, lack of screening and therapeutic infrastructure, lack of awareness and limited resources.
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Affiliation(s)
- Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, Delhi 110095, India
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22
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Diala PC, Randa M, Odhiambo J, Ganda G, Cohen CR, Mungo C. Barriers and Facilitators to Integrating Clinical Breast Examinations With Cervical Cancer Screening Programs in Outpatient Clinics in Western Kenya. JCO Glob Oncol 2021; 7:1722-1729. [PMID: 34936373 PMCID: PMC8710349 DOI: 10.1200/go.21.00272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/21/2021] [Accepted: 11/19/2021] [Indexed: 12/09/2022] Open
Abstract
PURPOSE Nearly half of Kenyan women with breast cancer present with advanced disease-owing partially to limited patient education and screening limitations in low- and middle-income countries. With increasing access to nurse-led cervical cancer screening (CCS) in government clinics in Kenya, we investigated provider-perceived barriers and facilitators to integrating clinical breast examinations (CBEs) with ongoing CCS programs in Kisumu County, Kenya. METHODS CCS providers within the Ministry of Health Clinics in Kisumu County, Kenya, were recruited to participate in a two-phase, sequential, mixed methods study. Knowledge of CBE guidelines was assessed with a questionnaire. Providers with significant CCS and CBE experience then completed a one-on-one interview discussing barriers and facilitators to integration. RESULTS Sixty-nine providers from 20 randomly selected facilities participated in the survey. Providers all agreed that breast cancer screening was very important. Although 93% said that they routinely offered CBEs, only 22% of these providers screened at least eight of their last 10 patients. Forty-four percent identified four or more of five signs and symptoms of breast cancer, and 33% identified four to five risk factors. Although providers showed enthusiasm for integration of CBEs into their practices, barriers were identified and grouped into four themes: (1) fragmentation of services, (2) staffing shortage and inadequate on-the-job training, (3) limited space and referral system challenges, and (4) limited patient awareness on need for cancer screening. CONCLUSION Addressing providers' concerns by providing routine on-the-job clinical training, improving staffing shortages, strengthening the diagnostic and treatment referral pathway, and increasing patient education are some of the first steps in facilitating integration of CBEs with CCS services in primary care clinics in Kenya.
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Affiliation(s)
- Prisca C. Diala
- University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Magdalene Randa
- Family AIDS Care and Education Services (FACES), Kisumu, Kenya
| | - Jackline Odhiambo
- School of Public Health and Community Development, Maseno University, Kisumu, Kenya
| | - Gregory Ganda
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Chemtai Mungo
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
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23
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Menes TS, Coster D, Coster D, Shenhar-Tsarfaty S. Contribution of clinical breast exam to cancer detection in women participating in a modern screening program. BMC WOMENS HEALTH 2021; 21:368. [PMID: 34666735 PMCID: PMC8524962 DOI: 10.1186/s12905-021-01507-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022]
Abstract
Purpose Despite the controversy surrounding the role of clinical breast exam (CBE) in modern breast cancer screening, it is widely practiced. We examined the contribution of CBE in women undergoing routine screening mammography and in women under the screening age. Methods A retrospective cohort study including all women participating in a voluntary health screening program between 2007 and 2016. All participants undergo CBE; Screening mammography is done selectively based on age, breast imaging history and insurance coverage. Data collected included demographics, risk factors, previous imaging, and findings on CBE and mammography. Cancer detection rates within 3 months of the visit were calculated separately for women undergoing routine screening mammography, and women under the screening age. Results There were 14,857 CBE completed in 8378; women; 7% were abnormal. Within 3 months of the visit, 35 breast cancers (2.4 per 1000 visits) were diagnosed. In women within the screening age who completed a mammogram less than one year prior to the visit (N = 1898), 4 cancers (2.1 cancers per 1000 visits) were diagnosed. Only one was diagnosed in a woman with an abnormal CBE, suggesting that the cancer detection rate of CBE in women undergoing regular screening is very low (0.5 per 1000 visits). In women under the screening age (45), 3 cancers (0.4 per 1000 visits) were diagnosed; all were visualized on mammography, one had an abnormal CBE. Conclusions The contribution of CBE to cancer detection in women undergoing routine screening and in women under the screening age is rare. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01507-x.
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Affiliation(s)
- Tehillah S Menes
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Surgery C and Surgical Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Dan Coster
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Blavatnik School of Computer Science, Tel-Aviv University, Tel Aviv, Israel
| | - Daniel Coster
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shani Shenhar-Tsarfaty
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
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Singh A, Bhat V, Sudhakar S, Namachivayam A, Gangadharan C, Pulchan C, Sigamani A. Multicentric study to evaluate the effectiveness of Thermalytix as compared with standard screening modalities in subjects who show possible symptoms of suspected breast cancer. BMJ Open 2021; 11:e052098. [PMID: 34667011 PMCID: PMC8527152 DOI: 10.1136/bmjopen-2021-052098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Machine learning in computer-assisted diagnostics improves sensitivity of image analysis and reduces time and effort for interpretation. Compared to standard mammograms, a thermal scan is easily scalable and is a safer screening tool. We evaluate the performance of Thermalytix (an automated thermographic screening algorithm) compared with other standard breast cancer screening modalities. METHODS A prospective multicentre study was conducted to assess the non-inferiority of sensitivity of Thermalytix (test device) to that of standard modalities in detecting malignancy in subjects who show possible symptoms of suspected breast cancer. Standard screening modalities and Thermalytix were obtained and interpreted independently in a blinded fashion. A receiver operating characteristic (ROC) curve was constructed to identify the best cut-off point, non-inferiority margin of ≥10% to demonstrate the non-inferiority. RESULTS We recruited 258 symptomatic women who first underwent a thermal scan, followed by mammogram and/or ultrasound. At Youden's Index of ROC curve, the test device had a sensitivity of 82.5% (95% CI 73.2 to 91.9) and specificity of 80.5% (95% CI 75.0 to 86.1) as compared with diagnostic mammogram, which had sensitivity of 92% (95% CI 80.7 to 97.8) and specificity of 45.9% (95% CI 34.3 to 57.9) when BI-RADS 3 (Breast Imaging-Reporting and Data System) was considered as test-positive. The overall area under the curve (AUC) was 0.845. For women aged <45 years, the test device had a sensitivity and specificity of 87.0% (95% CI 66.4 to 97.2) and 80.6% (95% CI 72.9 to 86.9), respectively. For women aged ≥45 years, the sensitivity and specificity were 80.5% (95% CI 65.1 to 91.2) and 86.5% (95% CI 78.0 to 92.6, respectively). CONCLUSION We evaluated Thermalytix, a new AI-based modality for detecting breast cancer. The high AUC in both women under 45 years and above 45 years shows the potential of Thermalytix to be a supplemental diagnostic modality for all ages. Further evaluation on larger sample size is needed. TRIAL REGISTRATION NUMBER CTRI/2017/10/0 10 115.
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Affiliation(s)
- Akshita Singh
- Department of Surgical Breast Oncology, Mazumdar Shaw Medical Centre, Narayana Hrudayalaya Limited, Narayana Hrudayalaya Health City, Bangalore, Karnataka, India
| | - Venkatraman Bhat
- Department of Radiology, Mazumdar Shaw Medical Centre, Narayana Hrudayalaya Limited, Narayana Hrudayalaya Health City, Bangalore, Karnataka, India
| | - S Sudhakar
- Department of Radiology, HCG Cancer Hospital, HealthCare Global Enterprises Ltd, Bangalore, Karnataka, India
| | | | - Charitha Gangadharan
- Department of Clinical Research, Narayana Hrudayalaya Limited, Narayana Hrudayalaya Health City, Bangalore, Karnataka, India
| | - Candice Pulchan
- Department of Radiology (Ultrasonographer III (Ag)), South-West Regional Health Authority, San Fernando, Trinidad and Tobago
| | - Alben Sigamani
- Department of Clinical Research, Narayana Hrudayalaya Health City, Bangalore, Karnataka, India
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O'Neil DS, Nxumalo S, Ngcamphalala C, Tharp G, Jacobson JS, Nuwagaba-Biribonwoha H, Dlamini X, Pace LE, Neugut AI, Harris TG. Breast Cancer Early Detection in Eswatini: Evaluation of a Training Curriculum and Patient Receipt of Recommended Follow-Up Care. JCO Glob Oncol 2021; 7:1349-1357. [PMID: 34491814 PMCID: PMC8423396 DOI: 10.1200/go.21.00124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/08/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
[Figure: see text].
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Affiliation(s)
- Daniel S. O'Neil
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Sifiso Nxumalo
- ICAP at Columbia University Mailman School of Public Health, New York, NY
| | | | - G Tharp
- ICAP at Columbia University Mailman School of Public Health, New York, NY
| | | | | | | | - Lydia E. Pace
- Brigham and Women's Hospital, Harvard University, Boston, MA
| | - Alfred I. Neugut
- Mailman School of Public Health, Columbia University, New York, NY
- Department of Medicine and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | - Tiffany G. Harris
- ICAP at Columbia University Mailman School of Public Health, New York, NY
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Desai A, Mathew A. The Great Breast Cancer Screening Conundrum. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1731859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Aakash Desai
- Division of Medical Oncology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Aju Mathew
- Department of Oncology, MOSC Medical College, Kolenchery, Kerala, India
- Department of Internal Medicine, Markey Cancer Center, University of Kentucky, Lexington, Kentucky, United States
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Clanahan JM, Reddy S, Broach RB, Rositch AF, Anderson BO, Wileyto EP, Englander BS, Brooks AD. Clinical Utility of a Hand-Held Scanner for Breast Cancer Early Detection and Patient Triage. JCO Glob Oncol 2021; 6:27-34. [PMID: 32031433 PMCID: PMC6998011 DOI: 10.1200/jgo.19.00205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Globally, breast cancer represents the most common cause of cancer death among women. Early cancer diagnosis is difficult in low- and middle-income countries, most of which are unable to support population-based mammographic screening. Triage on the basis of clinical breast examination (CBE) alone can be difficult to implement. In contrast, piezo-electric palpation (intelligent Breast Exam [iBE]) may improve triage because it is portable, low cost, has a short learning curve, and provides electronic documentation for additional diagnostic workup. We compared iBE and CBE performance in a screening patient cohort from a Western mammography center. METHODS Women presenting for screening or diagnostic workup were enrolled and underwent iBE then CBE, followed by mammography. Mammography was classified as negative (BI-RADS 1 or 2) or positive (BI-RADS 3, 4, or 5). Measures of accuracy and κ score were calculated. RESULTS Between April 2015 and May 2017, 516 women were enrolled. Of these patients, 486 completed iBE, CBE, and mammography. There were 101 positive iBE results, 66 positive CBE results, and 35 positive mammograms. iBE and CBE demonstrated moderate agreement on categorization (κ = 0.53), but minimal agreement with mammography (κ = 0.08). iBE had a specificity of 80.3% and a negative predictive value of 94%. In this cohort, only five of 486 patients had a malignancy; iBE and CBE identified three of these five. The two cancers missed by both modalities were small—a 3-mm retro-areolar and a 1-cm axillary tail. CONCLUSION iBE performs comparably to CBE as a triage tool. Only minimal cancers detected through mammographic screening were missed on iBE. Ultimately, our data suggest that iBE and CBE can synergize as triage tools to significantly reduce the numbers of patients who need additional diagnostic imaging in resource-limited areas.
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Affiliation(s)
- Julie M Clanahan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sanjana Reddy
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robyn B Broach
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Benjamin O Anderson
- Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Ari D Brooks
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Are advancements in screening technology contributing to breast cancer over-diagnosis? Curr Opin Oncol 2021; 33:533-537. [PMID: 34310411 DOI: 10.1097/cco.0000000000000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Advancements in breast screening technology have increased the sensitivity of screening and thereby increased the detection rates of nonlethal cancers. Thus, improvements in breast screening technology may contribute to 'over-diagnosis', which refers to detection of cancers that pose no threat to life and that, in the absence of screening, might never have been detected. The purpose of this review is to draw attention to risks of over-diagnosis and provide a rationale for evaluating screening clinical breast examination (CBE) as an alternative to modern technology-based (mammography) screening. RECENT FINDINGS Novel screening technologies have been adopted largely on the basis of their abilities to increase tumor-detection rates. However, as breast cancer treatments have improved, the mortality benefits of screening have declined. Moreover, there is evidence suggesting that, in the modern era of effective adjuvant systemic therapies, the mortality benefit of screening CBE may now be comparable to that of modern screening mammography, but screening CBE carries less risk of over-diagnosis. SUMMARY A randomized trial comparing modern mammography screening versus screening CBE is warranted. If confirmed that the mortality benefits of the two screening strategies are now comparable, then screening CBE might be considered a reasonable alternative to mammography screening.
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Trends in breast and cervical cancer in India under National Cancer Registry Programme: An Age-Period-Cohort analysis. Cancer Epidemiol 2021; 74:101982. [PMID: 34280846 DOI: 10.1016/j.canep.2021.101982] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Trend analysis in cancer quantifies the incidence rate and explains the trend and pattern. Breast and cervical cancers are the two most common cancers among Indian women which contributed 39.4 % to the total cancer in India for the year 2020. This study aimed to report the time trends in cancer incidence of breast and cervical cancer using Age-Period-Cohort (APC) model from five Population Based Cancer Registries (PBCRs) in India for the period of 1985-2014. METHOD Age-Period-Cohort model was fitted to five PBCRs of Bangalore, Chennai, Delhi, Bhopal and Barshi rural for breast and cervical cancer for 25-74 age-groups. The Estimated Annual Percent Change (EAPC) was calculated. Rate Ratio (RR) of cohort effects were estimated with a constraint of period slope to be zero (p = 0) since cohort has a stronger association with incidence than period. RESULT A significant increase was noted in breast cancer in all PBCRs (EAPC, Range: Delhi, 1.2 % to Bangalore, 2.7 %) while significant decrease in cervical cancer (EAPC, Range: Bangalore -2.5 % to Chennai, -4.6 %) from all the PBCRs including Barshi rural during the period. RR estimates for breast cancer showed increasing trend whereas cervical cancer showed decreasing trend in successive birth cohorts across all five PBCRs. CONCLUSION In both breast and cervical cancers, a significant age, cohort and period effect was noted in Bangalore, Chennai and Delhi. Despite period effect, the cohort effect was predominant and it may be attributed to the generational changes in risk factors among cancer breast and cervix.
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Georgieva M, Rennert J, Brochhausen C, Stroszczynski C, Jung EM. Suspicious breast lesions incidentally detected on chest computer tomography with histopathological correlation. Breast J 2021; 27:715-722. [PMID: 34124813 DOI: 10.1111/tbj.14259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To evaluate incidental breast lesions on chest computed tomography with histopathological correlation. It is important for general radiologist to characterize a breast lesion as benign, indetermined, or sufficiently suspicious to warrant further work-up. METHODS A total of 35.000 chest CT examinations were performed between January 2016 and December 2020. 27 patients (mean age 70 years, age range 48-87 years) with incidental breast lesions were identified in this retrospective study. Two radiologists scored incidental breast lesions independently regarding their morphology, and the results were compared to histopathology which was obtained by an ultrasound-guided core needle biopsy or a surgical excision. RESULTS Out of 35.000 chest CT examinations, a total of 31 incidental breast lesions in 27 patients were detected. Among the 31 lesions, 23 were malignant and 8 benign. The malignant lesions included 17 carcinomas and 6 metastases (4 lymphomas and 2 melanomas). The benign lesions contained 2 hematomas, 4 fat necrosis, and 2 fibrosis lumps. CONCLUSION Chest computed tomography as a standard imaging technique is helpful for evaluation of suspicious breast lesions. This may ultimately influence patient management and lead to further imaging.
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Affiliation(s)
- Martina Georgieva
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Janine Rennert
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Ernst-Michael Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Aklilu S, Bain C, Bansil P, de Sanjose S, Dunstan JA, Castillo V, Tsu V, Contreras I, Balassanian R, Hayes Constant TK, Scheel JR. Evaluation of diagnostic ultrasound use in a breast cancer detection strategy in Northern Peru. PLoS One 2021; 16:e0252902. [PMID: 34115775 PMCID: PMC8195385 DOI: 10.1371/journal.pone.0252902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
To evaluate the diagnostic impact of point-of-care breast ultrasound by trained primary care physicians (PCPs) as part of a breast cancer detection program using clinical breast exam in an underserved region of Peru. Medical records and breast ultrasound images of symptomatic women presenting to the Breast Cancer Detection Model (BCDM) in Trujillo, Peru were collected from 2017–2018. Performance was measured against final outcomes derived from regional cancer center medical records, fine needle aspiration results, patient follow-up (sensitivity, specificity, positive, and negative predictive values), and by percent agreement with the retrospective, blinded interpretation of images by a fellowship-trained breast radiologist, and a Peruvian breast surgeon. The diagnostic impact of ultrasound, compared to clinical breast exam (CBE), was calculated for actual practice and for potential impact of two alternative reporting systems. Of the 171 women presenting for breast ultrasound, 23 had breast cancer (13.5%). Breast ultrasound used as a triage test (current practice) detected all cancer cases (including four cancers missed on confirmatory CBE). PCPs showed strong agreement with radiologist and surgeon readings regarding the final management of masses (85.4% and 80.4%, respectively). While the triage system yielded a similar number of biopsies as CBE alone, using the condensed and full BI-RADS systems would have reduced biopsies by 60% while identifying 87% of cancers immediately and deferring 13% to six-month follow-up. Point-of-care ultrasound performed by trained PCPs improves diagnostic accuracy for managing symptomatic women over CBE alone and enhances access. Greater use of BI-RADS to guide management would reduce the diagnostic burden substantially.
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Affiliation(s)
- Segen Aklilu
- Department of Radiology, University of Washington, Seattle, Washington, United States of America
| | - Carolyn Bain
- PATH, Seattle, Washington, United States of America
| | - Pooja Bansil
- PATH, Seattle, Washington, United States of America
| | | | | | | | - Vivien Tsu
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Ronald Balassanian
- Department of Pathology, University of California San Francisco, San Francisco, California, United States of America
| | | | - John R. Scheel
- Department of Radiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Rositch AF, Unger-Saldaña K, DeBoer RJ, Ng'ang'a A, Weiner BJ. The role of dissemination and implementation science in global breast cancer control programs: Frameworks, methods, and examples. Cancer 2021; 126 Suppl 10:2394-2404. [PMID: 32348574 DOI: 10.1002/cncr.32877] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/11/2020] [Accepted: 03/11/2020] [Indexed: 01/24/2023]
Abstract
Global disparities in breast cancer outcomes are attributable to a sizable gap between evidence and practice in breast cancer control and management. Dissemination and implementation science (D&IS) seeks to understand how to promote the systematic uptake of evidence-based interventions and/or practices into real-world contexts. D&IS methods are useful for selecting strategies to implement evidence-based interventions, adapting their implementation to new settings, and evaluating the implementation process as well as its outcomes to determine success and failure, and adjust accordingly. Process models, explanatory theories, and evaluation frameworks are used in D&IS to develop implementation strategies, identify implementation outcomes, and design studies to evaluate these outcomes. In breast cancer control and management, research has been translated into evidence-based, resource-stratified guidelines by the Breast Health Global Initiative and others. D&IS should be leveraged to optimize the implementation of these guidelines, and other evidence-based interventions, into practice across the breast cancer care continuum, from optimizing public education to promoting early detection, increasing guideline-concordant clinical practice among providers, and analyzing and addressing barriers and facilitators in health care systems. Stakeholder engagement through processes such as co-creation is critical. In this article, the authors have provided a primer on the contribution of D&IS to phased implementation of global breast cancer control programs, provided 2 case examples of ongoing D&IS research projects in Tanzania, and concluded with recommendations for best practices for researchers undertaking this work.
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Affiliation(s)
- Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Rebecca J DeBoer
- Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Anne Ng'ang'a
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, Washington
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Sharma R. Examination of incidence, mortality and disability-adjusted life years and risk factors of breast cancer in 49 Asian countries, 1990-2019: estimates from Global Burden of Disease Study 2019. Jpn J Clin Oncol 2021; 51:826-835. [PMID: 33621341 DOI: 10.1093/jjco/hyab004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study presents an up-to-date, comprehensive and comparative examination of breast cancer's temporal patterns in females in Asia in last three decades. METHODS The estimates of incidence, mortality, disability-adjusted-life-years and risk factors of breast cancer in females in 49 Asian countries were retrieved from Global Burden of Disease 2019 study. RESULTS In Asia, female breast cancer incidence grew from 245 045[226 259-265 260] in 1990 to 914 878[815 789-1025 502] in 2019 with age-standardized incidence rate rising from 21.2/100 000[19.6-22.9] to 35.9/100 000[32.0-40.2] between 1990 and 2019. The death counts more than doubled from 136 665[126 094-148 380] to 337 822[301 454-375 251]. The age-standardized mortality rate rose marginally between 1990 and 2019 (1990: 12.1[11.0-13.1]; 2019: 13.4[12.0-14.9]). In 2019, age-standardized incidence rate varied from 17.2/100 000[13.95-21.4] in Mongolia to 122.5[92.1-160.7] in Lebanon and the age-standardized mortality rate varied 4-fold from 8.0/100 000 [7.2-8.8] in South Korea to 51.9[39.0-69.8] in Pakistan. High body mass index (5.6%), high fasting plasma glucose (5.6%) and secondhand smoke (3.5%) were the main contributory risk factors to all-age disability-adjusted-life-years due to breast cancer in Asia. CONCLUSION With growing incidence, escalating dietary and behavioural risk factors and lower survival rates due to late-disease presentation in low- and medium-income countries of Asia, breast cancer has become a significant public health threat. Its rising burden calls for increasing breast cancer awareness, preventive measures, early-stage detection and cost-effective therapeutics in Asia.
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Affiliation(s)
- Rajesh Sharma
- Assistant Professor, University School of Management and Entrepreneurship, Delhi Technological University, Delhi, India
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Mittra I, Mishra GA, Dikshit RP, Gupta S, Kulkarni VY, Shaikh HKA, Shastri SS, Hawaldar R, Gupta S, Pramesh CS, Badwe RA. 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; 372:n256. [PMID: 33627312 PMCID: PMC7903383 DOI: 10.1136/bmj.n256] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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.
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Affiliation(s)
- Indraneel Mittra
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Mumbai 400 012, Maharashtra, India
| | - Gauravi A Mishra
- Centre for Cancer Epidemiology, Department of Preventive Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Rajesh P Dikshit
- Centre for Cancer Epidemiology, Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Kharghar, Mumbai, India
| | - Subhadra Gupta
- Centre for Cancer Epidemiology, Department of Preventive Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Vasundhara Y Kulkarni
- Centre for Cancer Epidemiology, Department of Preventive Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Heena Kauser A Shaikh
- Centre for Cancer Epidemiology, Department of Preventive Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Surendra S Shastri
- Centre for Cancer Epidemiology, Department of Preventive Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Rohini Hawaldar
- Research Administration Council, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Mumbai 400 012, Maharashtra, India
| | - Rajendra A Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Mumbai 400 012, Maharashtra, India
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Sharma R. Global, regional, national burden of breast cancer in 185 countries: evidence from GLOBOCAN 2018. Breast Cancer Res Treat 2021; 187:557-567. [PMID: 33515396 DOI: 10.1007/s10549-020-06083-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 12/29/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aims to examine the burden of breast cancer in 185 countries in 2018. METHODS The estimates of incidence, mortality, and prevalence of breast cancer were drawn from GLOBOCAN 2018. The overall burden of breast cancer was gauged using breast cancer burden index (BRCBI)-a novel index comprising age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), mortality-to-incidence ratio (MIR), prevalence-to-incidence ratio (PIR), and prevalence-to-mortality ratio (PMR). The socioeconomic status of countries was measured using human development index (HDI) RESULTS: Globally, breast cancer was responsible for an estimated 626,679 deaths at age-standardized rate of 13/100,000; there were 2.1 million cases diagnosed in 2018 at age-standardized rate of 46.3/100,000. The ASIR varied 22-fold from 5/100,000 (Bhutan) to 113.2/100,000 (Belgium). The ASMR varied 13-fold from 2.7/100,000 (Bhutan) to 36.9/100,000 (Fiji). The HDI exhibited a positive gradient with ASIR (r = 0.73), PIR (r = 0.98), and PMR (r = 0.85); with MIR, however, it exhibited a negative association (r = - 0.83). The BRCBI spanned from 0.70 in Somalia to 78.92 in South Korea and exhibited a positive association with HDI (r = 0.76). An additional 46,823 female lives in 2018 and a cumulative total of 333,304 lives could have been saved over 2013-2018, had countries performed as per their HDI. CONCLUSIONS The substantial burden of breast cancer in developing and low-resource economies calls for a holistic approach to cancer management and control that includes oncologic infrastructure to provide cost-effective screening, diagnostic, therapeutic, and palliative services, greater breast cancer awareness, and mitigation of risk factors.
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Affiliation(s)
- Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, Delhi, India.
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Dykstra M, Malone B, Lekuntwane O, Efstathiou J, Letsatsi V, Elmore S, Castro C, Tapela N, Dryden-Peterson S. Impact of Community-Based Clinical Breast Examinations in Botswana. JCO Glob Oncol 2021; 7:17-26. [PMID: 33405960 PMCID: PMC8081526 DOI: 10.1200/go.20.00231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE We evaluated a clinical breast examination (CBE) screening program to determine the prevalence of breast abnormalities, number examined per cancer diagnosis, and clinical resources required for these diagnoses in a middle-income African setting. METHODS We performed a retrospective review of a CBE screening program (2015-2018) by Journey of Hope Botswana, a Botswana-based nongovernmental organization (NGO). Symptomatic and asymptomatic women were invited to attend. Screening events were held in communities throughout rural and periurban Botswana, with CBEs performed by volunteer nurses. Individuals who screened positive were referred to a private tertiary facility and were followed by the NGO. Data were obtained from NGO records. RESULTS Of 6,120 screened women (50 men excluded), 452 (7.4%) presented with a symptom and 357 (5.83%) were referred for further evaluation; 257 ultrasounds, 100 fine-needle aspirations (FNAs), 58 mammograms, and 31 biopsies were performed. In total, 6,031 were exonerated from cancer, 78 were lost to follow-up (67 for ≤ 50 years and 11 for > 50 years), and 11 were diagnosed with cancer (five for 41-50 years and six for > 50 years, 10 presented with symptoms). Overall breast cancer prevalence was calculated to be 18/10,000 (95% CI, 8 to 29/10,000). The number of women examined per breast cancer diagnosis was 237 (95% CI, 126 to 1910) for women of age 41-50 years and 196 (95% CI, 109 to 977) for women of age > 50 years. Median time to diagnosis for all women was 17.5 [1 to 32.5] days. CBE-detected tumors were not different than tumors presenting through standard care. CONCLUSION In a previously unscreened population, yield from community-based CBE screening was high, particularly among symptomatic women, and required modest diagnostic resources. This strategy has potential to reduce breast cancer mortality.
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Affiliation(s)
- Michael Dykstra
- Beth Israel Deaconess Medical Center, Boston, MA.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Brighid Malone
- Bokamoso Private Hospital, Gaborone, Botswana.,Journey of Hope Botswana, Gaborone, Botswana
| | | | | | | | - Shekinah Elmore
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | | | - Neo Tapela
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,University of Oxford, Oxford, UK
| | - Scott Dryden-Peterson
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Brigham and Women's Hospital, Boston, MA.,Harvard School of Public Health, Boston, MA
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Sbaity E, Bejjany R, Kreidieh M, Temraz S, Shamseddine A. Overview in Breast Cancer Screening in Lebanon. Cancer Control 2021; 28:10732748211039443. [PMID: 34538124 PMCID: PMC8450617 DOI: 10.1177/10732748211039443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Breast cancer (BC) is the most common cancer in women and men combined, and it is the second cause of cancer deaths in women after lung cancer. In Lebanon, the same epidemiological profile applies where BC is the leading cancer among Lebanese females, representing 38.2% of all cancer cases. As per the Center for Disease Control, there was a decline in BC mortality rate from 2003 to 2012 reflecting the adoption of national mammographic screening as the gold standard for BC detection by Western countries. The aim of this review study is to summarize current recommendations for BC screening and the available modalities for detecting BC in different countries, particularly in Lebanon. It also aims at exploring the impact of screening campaigns on BC early stage diagnosis in Lebanon. Despite the considerable debates whether screening mammograms provides more harm than benefits, screening awareness should be stressed since its benefits far outweigh its risks. In fact, the majority of BC mortality cases in Western countries are non-preventable by the use of screening mammograms alone. As such, Lebanon adopted a public focus on education and awareness campaigns encouraging early BC screening. Several studies showed the impact of early detection that is reflected by an increase in early stage disease and a decrease in more aggressive stages. Further studies should shed the light on the effect of awareness campaigns on early breast cancer diagnosis and clinical down staging at a national scope; therefore, having readily available data on pre- and post-adoption of screening campaigns is crucial for analyzing trends in mortality of breast cancer origin and reduction in advanced stages diseases. There is still room for future studies evaluating post-campaigns knowledge, attitudes, and practices of women having participated, emphasizing on the barriers refraining Lebanese women to contribute in BC screening campaigns.
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Affiliation(s)
- Eman Sbaity
- Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rachelle Bejjany
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malek Kreidieh
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Temraz
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Ngan TT, Nguyen NTQ, Van Minh H, Donnelly M, O'Neill C. Effectiveness of clinical breast examination as a 'stand-alone' screening modality: an overview of systematic reviews. BMC Cancer 2020; 20:1070. [PMID: 33167942 PMCID: PMC7653771 DOI: 10.1186/s12885-020-07521-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022] Open
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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Affiliation(s)
- Tran Thu Ngan
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
- Centre for Population Health Sciences, Hanoi University of Public Health, Hanoi, Viet Nam.
| | - Nga T Q Nguyen
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Department of Pharmaceutical Administration, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Hoang Van Minh
- Centre for Population Health Sciences, Hanoi University of Public Health, Hanoi, Viet Nam
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Ba DM, Ssentongo P, Agbese E, Yang Y, Cisse R, Diakite B, Traore CB, Kamate B, Kassogue Y, Dolo G, Dembele E, Diallo H, Maiga M. Prevalence and determinants of breast cancer screening in four sub-Saharan African countries: a population-based study. BMJ Open 2020; 10:e039464. [PMID: 33046473 PMCID: PMC7552834 DOI: 10.1136/bmjopen-2020-039464] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Breast cancer is the most prevalent cancer and the second leading cause of cancer-related deaths among women after cervical cancer in much of sub-Saharan Africa. This study aims to examine the prevalence and sociodemographic-socioeconomic factors associated with breast cancer screening among women of reproductive age in sub-Saharan Africa. DESIGN A weighted population-based cross-sectional study using Demographic and Health Surveys (DHS) data. We used all available data on breast cancer screening from the DHS for four sub-Saharan African countries (Burkina Faso, Ivory Coast, Kenya and Namibia). Breast cancer screening was the outcome of interest for this study. Multivariable Poisson regression was used to identify independent factors associated with breast cancer screening. SETTING Four countries participating in the DHS from 2010 to 2014 with data on breast cancer screening. PARTICIPANTS Women of reproductive age 15-49 years (N=39 646). RESULTS The overall prevalence of breast cancer screening was only 12.9% during the study period, ranging from 5.2% in Ivory Coast to 23.1% in Namibia. Factors associated with breast cancer screening were secondary/higher education with adjusted prevalence ratio (adjusted PR)=2.33 (95% CI: 2.05 to 2.66) compared with no education; older participants, 35-49 years (adjusted PR=1.73, 95% CI : 1.56 to 1.91) compared with younger participants 15-24 years; health insurance coverage (adjusted PR=1.57, 95% CI: 1.47 to 1.68) compared with those with no health insurance and highest socioeconomic status (adjusted PR=1.33, 95% CI : 1.19 to 1.49) compared with lowest socioeconomic status. CONCLUSION Despite high breast cancer mortality rates in sub-Saharan Africa, the prevalence of breast cancer screening is substantially low and varies gradually across countries and in relation to factors such as education, age, health insurance coverage and household wealth index level. These results highlight the need for increased efforts to improve the uptake of breast cancer screening in sub-Saharan Africa.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Edeanya Agbese
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Yanxu Yang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Ramata Cisse
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Brehima Diakite
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Cheick Bougadari Traore
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Bakarou Kamate
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Yaya Kassogue
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Guimogo Dolo
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Etienne Dembele
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Hama Diallo
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Mamoudou Maiga
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
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Kakileti ST, Madhu HJ, Krishnan L, Manjunath G, Sampangi S, Ramprakash HV. Observational Study to Evaluate the Clinical Efficacy of Thermalytix for Detecting Breast Cancer in Symptomatic and Asymptomatic Women. JCO Glob Oncol 2020; 6:1472-1480. [PMID: 33001739 PMCID: PMC7605380 DOI: 10.1200/go.20.00168] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the sensitivity and specificity of Thermalytix, an artificial intelligence-based computer-aided diagnostics (CADx) engine, to detect breast malignancy by comparing the CADx output with the final diagnosis derived using standard screening modalities. METHODS This multisite observational study included 470 symptomatic and asymptomatic women who presented for a breast health checkup in two centers. Among them, 238 women had symptoms such as breast lump, nipple discharge, or breast pain, and the rest were asymptomatic. All participants underwent a Thermalytix test and one or more standard-of-care tests for breast cancer screening, as recommended by the radiologists. Results from Thermalytix and standard modalities were obtained independently in a blinded fashion for comparison. The ground truth used for analysis (normal or malignant) was the final impression of an expert clinician based on the symptoms and the available reports of standard modalities (mammography, ultrasonography, elastography, biopsy, fine-needle aspiration cytology, and so on). RESULTS For the 470 women, Thermalytix resulted in a sensitivity of 91.02% (symptomatic, 89.85%; asymptomatic, 100%) and specificity of 82.39% (symptomatic, 69.04%; asymptomatic, 92.41%) in detection of breast malignancy. Thermalytix showed an overall area under the curve (AUC) of 0.90, with an AUC of 0.82 for symptomatic and 0.98 for asymptomatic women. CONCLUSION High sensitivity and high AUC of Thermalytix in women of all age groups demonstrates the efficacy of the tool for breast cancer screening. Thermalytix, with its automated scoring and image annotations of potential malignancies and vascularity, can assist the clinician in better decision making and improve quality of care in an affordable and radiation-free manner. Thus, we believe Thermalytix is poised to be a promising modality for breast cancer screening.
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Affiliation(s)
| | | | | | | | | | - H V Ramprakash
- Central Diagnostic Research Foundation Wellness, Bangalore, India
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41
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Basu P, Zhang L, Hariprasad R, Carvalho AL, Barchuk A. A pragmatic approach to tackle the rising burden of breast cancer through prevention & early detection in countries 'in transition'. Indian J Med Res 2020; 152:343-355. [PMID: 33380699 PMCID: PMC8061594 DOI: 10.4103/ijmr.ijmr_1868_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 12/16/2022] Open
Abstract
Among the emerging economies Brazil, Russia, India, China and South Africa (together known as the BRICS countries) share collectively approximately 40 per cent of the global population and contribute to 25 per cent of the world gross domestic products. All these countries are facing the formidable challenge of rising incidence of breast cancer and significant number of premature deaths from the disease. A multidimensional approach involving prevention, early detection and improved treatment is required to counteract the growing burden of breast cancer. A growing trend in the prevalence of major preventable risk factors of breast cancer such as obesity, western dietary habits, lack of physical activity, consumption of alcohol and smoking is contributing significantly to the rising burden of the disease in BRICS nations. Specific interventions are needed at the individual and population levels to mitigate these risk factors, preferably within the broader framework of non-communicable disease control programme. Population-based quality assured mammography-based screening of the 50-69 yr old women can reduce breast cancer mortality at least by 20 per cent. However, none of the BRICS countries have been able to implement population-based organized screening programme. Large scale opportunistic screening with mammography targeting predominantly the younger women is causing harms to the women and wasting precious healthcare resources. There are recent national recommendations to screen women with mammography in Brazil and Russia and with clinical breast examination in China (along with ultrasound) and India. Given the challenges of implementing systematic screening of the population, the BRICS countries should prioritize the early diagnosis approach and invest in educating the women about the breast cancer symptoms, training the frontline health providers to clinically detect breast cancers and appropriately refer for diagnostic confirmation, and creating improved access to good quality diagnostic and treatment facilities for breast cancer. The early diagnosis approach has been proved to achieve downstaging and improve survival at a fraction of the resources needed for population screening. The countries also need to focus on improving the services and capacity for multidisciplinary treatment of breast cancer, histopathology and immunohistochemistry, safe administration of chemotherapy and palliative care.
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Affiliation(s)
- Partha Basu
- Screening Group, Early Detection & Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Li Zhang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Roopa Hariprasad
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Andre L. Carvalho
- Screening Group, Early Detection & Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Anton Barchuk
- Faculty of Social Sciences/Health Sciences, Tampere University, Tampere, Finland
- N.N. Petrov National Research Medical Center of Oncology, Saint Petersburg, Russia
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42
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Dickerson JC, Ragavan MV, Parikh DA, Patel MI. Healthcare delivery interventions to reduce cancer disparities worldwide. World J Clin Oncol 2020; 11:705-722. [PMID: 33033693 PMCID: PMC7522545 DOI: 10.5306/wjco.v11.i9.705] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/07/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Globally, cancer care delivery is marked by inequalities, where some economic, demographic, and sociocultural groups have worse outcomes than others. In this review, we sought to identify patient-facing interventions designed to reduce disparities in cancer care in both high- and low-income countries. We found two broad categories of interventions that have been studied in the current literature: Patient navigation and telehealth. Navigation has the strongest evidence base for reducing disparities, primarily in cancer screening. Improved outcomes with navigation interventions have been seen in both high- and low-income countries. Telehealth interventions remain an active area of exploration, primarily in high income countries, with the best evidence being for the remote delivery of palliative care. Ongoing research is needed to identify the most efficacious, cost-effective, and scalable interventions to reduce barriers to the receipt of cancer care globally.
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Affiliation(s)
- James C Dickerson
- Department of Internal Medicine, Stanford University, Stanford, CA 94305, United States
| | - Meera V Ragavan
- Department of Internal Medicine, Stanford University, Stanford, CA 94305, United States
| | - Divya A Parikh
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, United States
| | - Manali I Patel
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, United States
- Center for Health Policy/Primary Care Outcomes Research, Stanford University, Stanford, CA 94305, United States
- VA Palo Alto Health Care System, Palo Alto, CA 94306, United States
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43
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Yurtsal ZB, Bekar M, Güler H, Çetin P, Cesur B. Breast self-examination, mammography and Pap test among Turkish women: Role of healthcare professionals in Sivas. Eur J Midwifery 2020; 4:32. [PMID: 33537633 PMCID: PMC7839102 DOI: 10.18332/ejm/124112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The aim of the present study is to determine how often women perform breast self-examination (BSE) and undergo mammography and Pap test, and how healthcare professionals affect them to do so. METHODS This descriptive study was carried out with 1025 women, aged 20-82 years and living in the central district of Sivas, who presented to the Gynecology and Obstetrics Outpatient Clinics of Hospitals between January and December 2010, and who volunteered to participate in the study and gave their verbal agreement to the researchers. RESULTS Out of the participants, 46.9% lacked mammogram knowledge, 13.2% received advice from healthcare professionals, and 20.1% thought that they were healthy and thus did not need mammography. Out of the participants, 45.9% lacked knowledge about the Pap test, 11.8% received advice from healthcare professionals, and 18.9% thought that they were healthy and thus did not need a 'Pap test'. CONCLUSIONS While one-fourth of the participants stated that they performed BSE and underwent mammography at least once, more than half reported that they did not have a Pap test. In preventive healthcare services, periodic health examinations and screenings for the most common types of women cancers should be increased; midwives should give education and counseling, and the importance of practices aimed at raising social awareness should be emphasized.
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Affiliation(s)
- Z. Burcu Yurtsal
- Department of Midwifery,Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas,Turkey
| | - Mine Bekar
- Department of Midwifery,Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas,Turkey
| | - Handan Güler
- Department of Midwifery,Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas,Turkey
| | - Perihan Çetin
- Patient Care Service, Izmir Katip Celebi University, Izmir,Turkey
| | - Büşra Cesur
- Department of Midwifery,Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas,Turkey
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44
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Autier P, Sullivan R. Population Screening for Cancer in High-Income Settings: Lessons for Low- and Middle-Income Economies. J Glob Oncol 2020; 5:1-5. [PMID: 30715958 PMCID: PMC6426516 DOI: 10.1200/jgo.18.00235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health at International Prevention Research Institute, Ecully, Lyon, France.,International Prevention Research Institute, Lyon, France
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45
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Gadgil A, Sauvaget C, Roy N, Muwonge R, Lucas E, Sankaranarayanan R. Setting up a Breast Cancer Awareness Project in Mumbai: Methodology, Experiences and Challenges. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:579-588. [PMID: 30863980 DOI: 10.1007/s13187-019-01500-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
More than two thirds of breast cancers in developing countries are diagnosed at a late stage. Awareness-based screening programmes, integrated into existing infrastructure, are the way forward for cancer control in these countries. We aim to describe a structured screening programme established in an urban community in Mumbai, India. We conducted a breast cancer awareness survey in this urban community covered by employees' health scheme. A brochure was designed to inform women about early signs of breast cancer and was posted for the women in the community. We described early signs and symptoms of breast cancer and encouraged the women to seek healthcare in the breast clinics specifically designed for early referral. A multidisciplinary team was established for further in-house care at the community hospital. A database of the detected cancers was maintained. A total of 22,500 brochures were sent in each round of mailing. Four such rounds were conducted in 3 years. A total of 3547 women reported for clinical breast examination (CBE) for various breast complaints or screening. Of these women, 53% were asymptomatic. CBE was normal in 2843 women, and 767 (21%) women were referred for further investigations. Eighty-three breast cancers were detected with 72% having early (stage I-II) cancers. Our exploratory study revealed that awareness-based screening programmes with organised infrastructure and referral pattern could lead to diagnosing early cancers.
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Affiliation(s)
- Anita Gadgil
- Department of Surgery, Bhabha Atomic Research Centre Hospital, WHO-CC for Surgical Care Delivery in LMIC, Mumbai, India
| | - Catherine Sauvaget
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France.
| | - Nobhojit Roy
- Department of Surgery, Bhabha Atomic Research Centre Hospital, WHO-CC for Surgical Care Delivery in LMIC, Mumbai, India
| | - Richard Muwonge
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Eric Lucas
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France
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46
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Pace LE, Dusengimana JMV, Shulman LN, Schleimer LE, Shyirambere C, Rusangwa C, Muvugabigwi G, Park PH, Huang C, Bigirimana JB, Hategekimana V, Rugema V, Umwizerwa A, Keating NL, Mpunga T. Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of Rwanda. J Glob Oncol 2020; 5:1-13. [PMID: 31774713 PMCID: PMC6882507 DOI: 10.1200/jgo.19.00209] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Feasible and effective strategies are needed to facilitate earlier diagnosis of breast cancer in low-income countries. The goal of this study was to examine the impact of health worker breast health training on health care utilization, patient diagnoses, and cancer stage in a rural Rwandan district. METHODS We conducted a cluster randomized trial of a training intervention at 12 of the 19 health centers (HCs) in Burera District, Rwanda, in 2 phases. We evaluated the trainings’ impact on the volume of patient visits for breast concerns using difference-in-difference models. We used generalized estimating equations to evaluate incidence of HC and hospital visits for breast concerns, biopsies, benign breast diagnoses, breast cancer, and early-stage disease in catchment areas served by intervention versus control HCs. RESULTS From April 2015 to April 2017, 1,484 patients visited intervention HCs, and 308 visited control HCs for breast concerns. The intervention led to an increase of 4.7 visits/month for phase 1 HCs (P = .001) and 7.9 visits/month for phase 2 HCs (P = .007) compared with control HCs. The population served by intervention HCs had more hospital visits (115.1 v 20.5/100,000 person-years, P < .001) and biopsies (36.6 v 8.9/100,000 person-years, P < .001) and higher breast cancer incidence (6.9 v 3.3/100,000 person-years; P = .28). The incidence of early-stage breast cancer was 3.3 per 100,000 in intervention areas and 0.7 per 100,000 in control areas (P = .048). CONCLUSION In this cluster randomized trial in rural Rwanda, the training of health workers and establishment of regular breast clinics were associated with increased numbers of patients who presented with breast concerns at health facilities, more breast biopsies, and a higher incidence of benign breast diagnoses and early-stage breast cancers.
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Affiliation(s)
- Lydia E Pace
- Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | - Paul H Park
- Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - ChuanChin Huang
- Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | | | | | | | - Nancy L Keating
- Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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Duggan C, Dvaladze A, Rositch AF, Ginsburg O, Yip CH, Horton S, Rodriguez RC, Eniu A, Mutebi M, Bourque JM, Masood S, Unger-Saldaña K, Cabanes A, Carlson RW, Gralow JR, Anderson BO. The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource-Stratified Phased Implementation: Methods and overview. Cancer 2020; 126 Suppl 10:2339-2352. [PMID: 32348573 PMCID: PMC7482869 DOI: 10.1002/cncr.32891] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Breast Health Global Initiative (BHGI) established a series of resource-stratified, evidence-based guidelines to address breast cancer control in the context of available resources. Here, the authors describe methodologies and health system prerequisites to support the translation and implementation of these guidelines into practice. METHODS In October 2018, the BHGI convened the Sixth Global Summit on Improving Breast Healthcare Through Resource-Stratified Phased Implementation. The purpose of the summit was to define a stepwise methodology (phased implementation) for guiding the translation of resource-appropriate breast cancer control guidelines into real-world practice. Three expert consensus panels developed stepwise, resource-appropriate recommendations for implementing these guidelines in low-income and middle-income countries as well as underserved communities in high-income countries. Each panel focused on 1 of 3 specific aspects of breast cancer care: 1) early detection, 2) treatment, and 3) health system strengthening. RESULTS Key findings from the summit and subsequent article preparation included the identification of phased-implementation prerequisites that were explored during consensus debates. These core issues and concepts are key components for implementing breast health care that consider real-world resource constraints. Communication and engagement across all levels of care is vital to any effectively operating health care system, including effective communication with ministries of health and of finance, to demonstrate needs, outcomes, and cost benefits. CONCLUSIONS Underserved communities at all economic levels require effective strategies to deploy scarce resources to ensure access to timely, effective, and affordable health care. Systematically strategic approaches translating guidelines into practice are needed to build health system capacity to meet the current and anticipated global breast cancer burden.
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Affiliation(s)
| | | | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ophira Ginsburg
- Perlmutter Cancer Center, Section for Global Health, Division of Health and Behavior, Department of Population Health, New York University Langone Health, NY, USA
| | | | - Susan Horton
- University of Waterloo, Waterloo, Ontario, Canada
| | | | - Alexandru Eniu
- Hopital Riviera Chablais, Vaud-Valais, Rennaz, Switzerland
| | - Miriam Mutebi
- Breast Surgical Oncology, Aga Khan University Hospital, Nairobi, Kenya
| | - Jean-Marc Bourque
- Department of Radiation Oncology, University of Ottawa, Ottawa, Canada
- Department of Medicine, McGill University, Montreal, Canada
| | - Shahla Masood
- University of Florida Health Jacksonville Breast Center, Jacksonville, FL, USA
| | | | | | - Robert W. Carlson
- National Comprehensive Cancer Center, Plymouth Meeting, Pennsylvania, USA
| | | | - Benjamin O Anderson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
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Doval DC, Radhakrishna S, Tripathi R, Kashinath RI, Talwar V, Batra U, Mullapudi NA, Kumar K, Dewan AK, Chaturvedi H, Tayal J, Mehta A, Gupta S, Nimmagadda RBV. A multi-institutional real world data study from India of 3453 non-metastatic breast cancer patients undergoing upfront surgery. Sci Rep 2020; 10:5886. [PMID: 32246015 PMCID: PMC7125186 DOI: 10.1038/s41598-020-62618-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/16/2020] [Indexed: 12/27/2022] Open
Abstract
The present analysis reports the clinical, pathological, treatment profile and overall survival (OS) and disease-free survival (DFS) outcomes of consecutive breast cancer patients from three Indian centres, who underwent curative surgery as their first treatment. Among the 3453 patients, stage I, II, and III cases were 11.75%, 66.79%, and 21.64%, respectively while hormone receptor positive/HER2 negative, triple negative (TNBC) and hormone receptor any/HER2 positive cases were 55.2%, 24.2% and 20.6%, respectively. The five-year OS in the entire cohort, node-negative and node-positive patients were 94.1% (93.25–94.98), 96.17% (95.2–97.15) and 91.83% (90.36–93.31), respectively, and the corresponding DFS were 88.1% (86.96–89.31), 92.0% (90.64–93.39) and 83.93% (82.03–85.89), respectively. The five-year OS in hormone receptor positive/HER2 negative, TNBC and HER2 subgroups were 96.11% (95.12–97.1), 92.74% (90.73–94.8) and 90.62% (88.17–93.15), respectively, and the corresponding DFS were 91.59% (90.19–93.02), 85.46% (82.79–88.22) and 81.29% (78.11–84.61), respectively. This is the largest dataset of early breast cancer patients from India with survival outcome analysis and can therefore serve as a benchmark for future studies.
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Affiliation(s)
- Dinesh Chandra Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India.
| | - Selvi Radhakrishna
- Department of Surgical Oncology, Chennai Breast Centre, Chennai, Tamil Nadu, India
| | - Rupal Tripathi
- Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Renu Iyer Kashinath
- Department of Medical Oncology, Apollo Cancer Institutes, Chennai, Tamil Nadu, India
| | - Vineet Talwar
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | | | - Kapil Kumar
- Department of Surgical Oncology, Fortis Hospital, Delhi, India
| | - Ajay Kumar Dewan
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | | | - Juhi Tayal
- Department of Research (Biorepository), Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Anurag Mehta
- Department of Laboratory and Transfusion Services, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ramesh B V Nimmagadda
- Department of Medical Oncology, Apollo Cancer Institutes, Chennai, Tamil Nadu, India.
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Antabe R, Kansanga M, Sano Y, Kyeremeh E, Galaa Y. Utilization of breast cancer screening in Kenya: what are the determinants? BMC Health Serv Res 2020; 20:228. [PMID: 32183801 PMCID: PMC7079358 DOI: 10.1186/s12913-020-5073-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 03/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer accounts for 23% of all cancer cases among women in Kenya. Although breast cancer screening is important, we know little about the factors associated with women's breast cancer screening utilization in Kenya. Using the Andersen's behavioural model of health care utilization, we aim to address this void in the literature. METHODS We draw data on the Kenya Demographic and Health Survey and employ univariate, bivariate, and multivariate analyses. RESULTS We find that women's geographic location, specifically, living in a rural area (OR = 0.89; p < 0.001) and the North Eastern Province is associated with lower odds of women being screened for breast cancer. Moreover, compared to the more educated, richer and insured, women who are less educated, poorer, and uninsured (OR = 0.74; p < 0.001) are less likely to have been screened for breast cancer. CONCLUSION Based on these findings, we recommend place and group-specific education and interventions on increasing breast cancer screening in Kenya.
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Affiliation(s)
- Roger Antabe
- Department of Geography, Western University, 1151 Richmond Street, Social Science Building, London, Ontario, N6A 3K7, Canada
| | - Moses Kansanga
- Department of Geography, Western University, 1151 Richmond Street, Social Science Building, London, Ontario, N6A 3K7, Canada
| | - Yujiro Sano
- Department of Sociology, Western University, 1151 Richmond Street, Social Science Building, London, Ontario, N6A 3K7, Canada
| | - Emmanuel Kyeremeh
- Department of Geography, Western University, 1151 Richmond Street, Social Science Building, London, Ontario, N6A 3K7, Canada
| | - Yvonne Galaa
- Department of Planning, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, KNUST, Kumasi, Ghana.
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Jatoi I. Breast Cancer Screening: a Paradigm Change Is Needed-the PB Desai Oration. Indian J Surg Oncol 2020; 11:19-22. [PMID: 32205963 PMCID: PMC7064690 DOI: 10.1007/s13193-019-01017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022] Open
Abstract
This editorial summarizes the key points of the PB Desai Oration, delivered by the author at the National Conference of the Indian Association of Surgical Oncology in Kolkata, India, on September 21, 2019.
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Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology and Endocrine Surgery, University of Texas Health and Science Center, 7703 Floyd Curl Drive, Mail Code 7738, San Antonio, TX 78229 USA
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