Association of Previous Clinical Breast Examination With Reduced Delays and Earlier-Stage Breast Cancer Diagnosis Among Women in Peru

Romanoff, Anya; Constant, Tara Hayes; Johnson, Kay M.; Guadiamos, Manuel Cedano; Vega, Ana Maria Burga; Zunt, Joseph R.; Anderson, Benjamin O.

doi:10.1001/jamaoncol.2017.1023

Cited by 47 publications

(48 citation statements)

References 8 publications

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“…42,43 Clinical breast examination has been associated with shorter delays to diagnosis and may also be of value as an educational tool for breast awareness in resource limited settings. 44 More advanced stage at diagnosis in recently pregnant women has been found internationally, 21,45,46 but this study is the first such report from SSA and was consistent across its countries. It may indicate a common hormonal-driver of proliferation and more diagnostic challenges within lactating breasts, or it may simply reflect greater time demands of raising infant children, as the majority were women who had given birth 2-3 years ago.…”

Section: Discussionsupporting

confidence: 61%

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Drivers of advanced stage at breast cancer diagnosis in the multicountryAfrican breast cancer – disparities in outcomes (ABC‐DO) study

McKenzie

Zietsman

Galukande

et al. 2017

Intl Journal of Cancer

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Breast cancer (BC) survival rates in sub‐Saharan Africa (SSA) are low in part due to advanced stage at diagnosis. As one component of a study of the entire journey of SSA women with BC, we aimed to identify shared and setting‐specific drivers of advanced stage BC. Women newly diagnosed in the multicountry African Breast Cancer–Disparities in Outcomes (ABC‐DO) study completed a baseline interview and their stage information was extracted from medical records. Ordinal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for advanced stage (I, II, III, IV) in relation to individual woman‐level, referral and biological factors. A total of 1795 women were included from Nigeria, Uganda, Zambia, and the multiracial populations of Namibia and South Africa, 1091 of whom (61%) were stage III/IV. Stage was lower in women with greater BC knowledge (OR 0.77 (95% CI: 0.70, 0.85) per point on a 6 point scale). More advanced stage was associated with being black (4.00 (2.79, 5.74)), having attended

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Section: Discussionsupporting

confidence: 61%

“…In addition to increasing awareness in communities, awareness in health professionals has also been tackled in successful down‐staging interventions . Clinical breast examination has been associated with shorter delays to diagnosis and may also be of value as an educational tool for breast awareness in resource limited settings …”

Section: Discussionmentioning

confidence: 99%

Drivers of advanced stage at breast cancer diagnosis in the multicountryAfrican breast cancer – disparities in outcomes (ABC‐DO) study

McKenzie

Zietsman

Galukande

et al. 2017

Intl Journal of Cancer

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“…Breast self-examination and clinical breast examination periodicity were not associated with a longer time interval to attend the first medical visit constrasting with previous studies 21,32,33 . Moreover, these practices are not recommended for breast cancer screening on recent national directive 4 .…”

Section: Discussionsupporting

confidence: 82%

Factors associated with time interval between the onset of symptoms and first medical visit in women with breast cancer

et al. 2020

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Women presenting with advanced breast cancer tumors are common in Brazil. Little is known about factors contributing to the delay in seeking care. The aim of this study was to identify factors associated with longer time intervals between the onset of breast cancer symptoms and the first medical visit in the Federal District, Brazil. The analysis included 444 symptomatic women with incident breast cancer, interviewed between September, 2012 and September, 2014, during their admission for breast cancer treatment in nine public hospitals in the Federal District. Patients with metastatic disease at diagnosis were not included in this study. The outcome was time interval between symptom onset and the first medical visit, whether > 90 (34% of patients) or ≤ 90 days. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95%CI). In the multivariate analysis, the > 90 day interval was significantly associated with patients not performing mammography and/or breast ultrasound in the two years prior to breast cancer diagnosis (OR = 1.97; 95%CI: 1.26-3.08), and with more advanced stages (OR = 1.72; 95%CI: 1.10-2.72). Furthermore, there was a lower chance of delay in patients with higher levels of education (OR = 0.95; 95%CI: 0.91-0.99). A relatively high proportion of breast cancer patients in the Brazilian Federal District experienced delay to attend the first medical consultation after the symptoms onset. Increasing breast cancer awareness, especially among women with low educational levels and those not participating in mammography screening programs could contribute to reduce this delay.

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“…A significant proportion of breast cancer in LMICs is diagnosed at an advanced stage (American Joint Committee on Cancer stage III or IV), ranging from 30% to 50% in Latin America to 75% in Sub‐Saharan Africa 5,6 . The great majority of these advanced cancers are initially detected by the patient herself based on changes that she appreciates as a lump, thickening, or other progressive change 7,8 . Once she presents to the health care system with signs and/or symptoms in the breast, diagnostic services need to be available such that a prompt and accurate diagnosis (benign vs malignant) can be provided.…”

Section: Implementation Phasesmentioning

confidence: 99%

“…Although the WHO does not recommend population‐based, organized screening with CBE in any resource setting, in the absence of well organized, mammogram‐based screening programs, CBE is considered a reasonable approach in a lower resource setting, provided it is evaluated in a research context 22 . A recent cross‐sectional study of women with newly diagnosed breast cancer in Peru 8 demonstrated that women who had undergone a previous CBE (unrelated to their current diagnosis) had shorter delays from symptom development to presentation and were more likely to be diagnosed with earlier stage disease (American Joint Committee on Cancer stages 0, I, and II) compared with women who had never had a CBE. This also suggests that CBE as part of comprehensive breast health awareness may have value in improving the opportunities for early diagnosis of a (potential) future breast cancer.…”

Section: Implementation Phasesmentioning

confidence: 99%

Breast cancer early detection: A phased approach to implementation

Ginsburg

Yip

Brooks

et al. 2020

Cancer

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383

208

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When breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered. Cancer 2020;126:2379-2393.

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Association of Previous Clinical Breast Examination With Reduced Delays and Earlier-Stage Breast Cancer Diagnosis Among Women in Peru

Cited by 47 publications

References 8 publications

Drivers of advanced stage at breast cancer diagnosis in the multicountryAfrican breast cancer – disparities in outcomes (ABC‐DO) study

Drivers of advanced stage at breast cancer diagnosis in the multicountryAfrican breast cancer – disparities in outcomes (ABC‐DO) study

Factors associated with time interval between the onset of symptoms and first medical visit in women with breast cancer

Breast cancer early detection: A phased approach to implementation

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