Screening and clinical breast

examination in LMICs:

What is evidence-based?

Dr Partha Basu, Head, Early Detection, Prevention and Infections Branch, IARC, presented the results of studies analysing the impact of clinical breast examination (CBE) and interventions to increase breast awareness on breast cancer staging and mortality.

The Mumbai randomised controlled trial study (Mittra, et al, BMJ, 372:n256, 25 Feb 2021) conducted over a period of 20 years highlighted that CBE conducted every two years by primary health workers significantly downstaged breast cancer at diagnosis and led to a significant reduction of mortality of nearly 30%. It also showed that increased breast awareness even without CBE was linked with improved diagnosis time.

Furthermore, the Trivandrum randomised controlled trial study (Ramadas, et al, ACS Journal, 2022) shows that CBE is a valuable tool for diagnosis of breast cancer in symptomatic women especially in areas where breast cancer screening programmes are not widely available.

Although there can be a high variability in performance in screening programmes, key take away messages on CBE include:

• CBE is a very useful tool in the assessment of symptomatic women

• CBE screening has demonstrated to contribute to downstaging of the disease and improved survival rates

• Breast awareness linked with improved access to prompt diagnosis and treatment may be equally effective.

Table Discussion

What would it take to achieve the target of 60% of invasive breast cancers diagnosed at stage I or II in the setting in which you operate?

Following Dr Basu’s presentation, the participants of the workshop, mainly composed of civil society representatives, discussed the key actions to take in order for LMICs to progress towards the first target of the GBCI. The discussions highlighted common themes across all tables and regions.

The main actions envisaged to accelerate progress in having 60% of breast cancers diagnosed at stages I or II include (in order of importance):

• Raise awareness and health literacy amongst the general public, involving survivors and advocates, and addressing stigma around the disease.

• Improve the availability of early diagnosis services for women through their formal inclusion in the health system (early diagnosis programme in the NCCP, availability of screening guidelines, declaring breast cancer as a national prioritiy, development of referral pathways) and adopting an integrated approach to educate and assess symptomatic women.

• Train the healthcare workforce on CBE and patient navigation.