Mammograms show a normal breast (left) and a breast with cancer (right). Credit: Public Domain

A study published today by the BMJ shows that regular breast exams by trained female health workers in Mumbai resulted in earlier diagnosis and a reduction in deaths from breast cancer in women aged 50 and over.

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

Breast cancer rates are increasing worldwide, especially in low and middle income countries.

Mammography is the established screening tool in developed countries, but because of its cost and complexity, it may not be a suitable approach in low and middle income countries. In addition, most women in low- and middle-income countries are under the age of 50 and mammography is less effective in this age group.

Although the clinical breast exam is an alternative screening method, doctors are still unsure whether it will reduce the number of deaths from breast cancer.

A research team based in Mumbai wanted to test whether screening through clinical breast exams could lead to earlier diagnosis and reduced mortality from breast cancer compared to no screening.

Their results are based on 20-year data from 151,538 women aged 35 to 64 years with no history of breast cancer who lived in 20 geographically diverse clusters in Mumbai, India.

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

Women in the screening arm (75,360) received four rounds of screening every two years of clinical breast exam (performed by trained female health care professionals) and cancer awareness, followed by five rounds of active monitoring every two years.

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

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

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

However, a significant decrease in breast cancer mortality of nearly 30% has been observed in women aged 50 and over (25 versus 35 deaths per 100,000 person-years).

In women under 50 years of age, no reduction in mortality was found despite successful downstaging.

There was a 5% reduction in all-cause mortality in the screening arm compared to the control arm, but it was not statistically significant.

The researchers suggest that some cancer stage and cause of death data may have been overlooked and that some remaining uncertainties cannot be ruled out.

However, this was a well-designed study conducted by researchers who fully understood the realities that affect the conduct of complex randomized public health studies in low- and middle-income countries.

As such, they say, “Our study suggests that population screening through clinical breast exams is possible in low- and middle-income countries, provided that adequate screening provider training, careful monitoring and quality of service are ensured . “

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

The death rate from breast cancer has stopped falling in younger women

More information:
Effect of screening by clinical breast examination on the incidence and mortality of breast cancer at 20 years: prospective, cluster-randomized controlled trial in Mumbai, BMJ (2021). DOI: 10.1136 / bmj.n256 Provided by the British Medical Journal

Quote: Regular breast exams by trained health workers related to fewer breast cancer deaths in India (2021, February 24) were posted on February 24, 2021 from -linked retrieved .html

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