Clinical Examination as Effective as Mammography in Breast Cancer Diagnosis: Study
Mumbai: A 20-year study from Tata Memorial Hospital, Parel, has concluded that the efficacy of screening by clinical breast examination is similar to mammography in downstaging breast cancer at diagnosis and in reducing mortality from the disease when compared with no screening. This study validates clinical breast examination as an alternative modality of breast screening. The results have major implications in low and middle-income countries like India where mammography can't be used as a general strategy because of its cost and complexity.
The randomized trial that compared CBE screening with no screening, published in the UK's BMJ, recruited 1.5 lakh Mumbai women aged 35-64 with no history of breast cancer. A Mumbai based team trained 10th pass female volunteers to perform clinical breast examination in the women of 20 geographically distinct slum areas of Mumbai.
Dr. Gauravi Mishra from the Preventive Oncology Department of Tata Memorial Hospital, Parel told Times of India "Each of the 75,000 women in the screening arm was tested four times over an eight-year period. The remaining received one round of cancer awareness followed by eight rounds of active surveillance every two years."
Over a 20-year period of observation, the study found clinical breast examination conducted by trained female health workers led to a downstaging of breast cancer at diagnosis and reduced mortality from the disease by nearly 30% in women aged 50 and older, but with no mortality reduction seen in women younger than 50. It also found that biennial CBE performed by trained female primary health workers significantly advanced breast cancer diagnosis by 16 months, and also downstaged the disease with fewer stage III or IV cancers in screened women.
Tata Memorial center's Director Dr. Rajendra Badwe told the Times of India "The incidence of breast cancer in India is approximately 30 per 1,00,000 population annually. The death rate is 15 per 1,00,000 per year. Hence a 30% reduction in death rate by clinical breast examination is significant." "The technique could help avoid 15,000 breast cancer deaths a year in India and 40,000 in low and middle-income countries." he further adds.
In India, breast cancer has surpassed cancers of the cervix and the oral cavity to be the most common cancer and the leading cause of cancer deaths. In 2018, 162,468 new cases of breast cancer were diagnosed, representing 27.7% of all new cancers among Indian women and 11.1% of all cancer deaths. Breast cancers in low and middle-income countries are frequently detected in advanced stages, and consequently, more than half the global deaths from breast cancer occur in these countries.
Breast self-examination, clinical breast examination, and Mammography are the established screening tools for breast cancer. Self-examination is not a reliable general strartegy because of doubtful compliance. Mammography, which is widely practiced in Western countries, might not be an appropriate approach in low and middle-income countries because of its cost and complexity. Furthermore, most women in low and middle-income countries are younger than 50, and mammography is less effective in this age group.
Dr. Garvi Mishra told TOI "There is evidence to show that self-breast examination is effective enough. While studies have previously shown that mammography scans have reduced breast cancer deaths by 30% in women above 50 years, there were no similar studies regarding clinical breast examination"
The results of the study validate that clinical breast examination is an effective, simple and inexpensive technique of breast examination.This alternative modality of CBE screening by primary health workers is replicable in the general population. The study suggests that clinical breast examination may be considered as a general strategy in low and middle income countries provided that adequate training of screening providers, careful monitoring and quality of performance are assured.