Randomized Trial of Breast self-examination in Shanghai: Methodology and Preliminary Results

Thomas, David B.; Gao, Dao Li; Self, Steven G.; Allison, Charlene J.; Yun, Tae-Jin; Mahloch, Janice; Ray, Roberta M.; Qin, Qin; Presley, Rodney; Porter, Peggy L.

doi:10.1093/jnci/89.5.355

Cited by 214 publications

(106 citation statements)

References 33 publications

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“…Dashes indicate that the data were not available from the published paper. Publications: China (Thomas, 1997(Thomas, , 2002 and Russia (Semiglazov, 1992(Semiglazov, , 1996(Semiglazov, , 1999. b For the UK trial, this is the number of women invited to attend BSE training or the number that were not (i.e.…”

Section: Resultsmentioning

confidence: 99%

“…Clinical trials One trial, from the UK, was nonrandomised (UK Trial of Early Detection of Breast Cancer Group, 1999) and two, from China (Thomas et al, 1997(Thomas et al, , 2002 and Russia (Semiglazov et al, 1992(Semiglazov et al, , 1996(Semiglazov et al, , 1999, were randomised. The nonrandomised trial was based on comparing the breast cancer death rates after 16 years follow-up in two centres, in which women aged 45 -64 years were invited to attend a BSE session, with the rates in four centres, in which women were not invited for either BSE training or mammography.…”

Section: Methods Data Sources and Study Selectionmentioning

confidence: 99%

“…The one from China (Thomas et al, 1997(Thomas et al, , 2002 was based on randomising 520 factories in Shanghai, in which all women in a particular factory were either given three sessions on how to practise BSE or they were not. In total, there were about 267 000 women aged 30 -69 years.…”

Section: Methods Data Sources and Study Selectionmentioning

confidence: 99%

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Breast self-examination and death from breast cancer: a meta-analysis

2003

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Breast self-examination (BSE) is widely recommended for breast cancer prevention. Following recent controversy over the efficacy of mammography, it may be seen as an alternative. We present a meta-analysis of the effect of regular BSE on breast cancer mortality. From a search of the medical literature, 20 observational studies and three clinical trials were identified that reported on breast cancer death rates or rates of advanced breast cancer (a marker of death) according to BSE practice. A lower risk of mortality or advanced breast cancer was only found in studies of women with breast cancer who reported practising BSE before diagnosis (mortality: pooled relative risk 0.64, 95% CI 0.56 -0.73; advanced cancer, pooled relative risk 0.60, 95% CI 0.46 -0.80). The results are probably due to bias and confounding. There was no difference in death rate in studies on women who detected their cancer during an examination (pooled relative risk 0.90, 95% CI 0.72 -1.12). None of the trials of BSE training (in which most women reported practising it regularly) showed lower mortality in the BSE group (pooled relative risk 1.01, 95% CI 0.92 -1.12). They did show that BSE is associated with considerably more women seeking medical advice and having biopsies. Regular BSE is not an effective method of reducing breast cancer mortality. British Journal of Cancer (2003) For many years, women have been taught methods of breast selfexamination (BSE) and it is recommended that they practise this regularly (Boyle et al, 1995; Shapiro et al, 1998), usually every month. There is a belief that among women who practise BSE, those who develop breast cancer are more likely to find it at an earlier stage and this is expected to lead to earlier treatment and hence decrease their risk of dying from the disease. Breast selfexamination is appealing as a routine screening method because the examination has no financial cost (apart from the initial instruction sessions) and can be conducted in private. Most studies on the effectiveness of BSE have been observational. They suggest that women who practise BSE are more likely to find their breast tumour themselves, that the tumour tends to be smaller and that these women have an increased survival (Hackshaw, 1996; International Agency for Research on Cancer (IARC), 2002). However, survival time as an outcome measure can be misleading because of lead-time bias, in which BSE only identifies cancers at an earlier stage but has no effect on prognosis. Using mortality rates instead of survival time can overcome much of this bias.Recently, the International Agency for Research on Cancer (2002) published a review on breast-cancer screening that reported the individual results from observational studies of BSE in relation to survival and stage of cancer, and those from randomised trials and cohort studies in relation to mortality. We here, however, present a meta-analysis of BSE and breast-cancer mortality by reviewing the published evidence from both observational studies and randomised trials, including t...

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Section: Resultsmentioning

confidence: 99%

Section: Methods Data Sources and Study Selectionmentioning

confidence: 99%

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Breast self-examination and death from breast cancer: a meta-analysis

2003

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“…11,12 All currently working and retired female employees of the Shanghai Textile Industry Bureau (STIB), who were born between January 1, 1925 and December 31,1958, were eligible to participate in the trial. From October 1989 to October 1991, 266,064 women were enrolled in the trial.…”

Section: Study Populationmentioning

confidence: 99%

“…As part of the BSE trial, 11,12 all malignant breast lesions were read by a reference pathologist and classified by ICD-0 code. For the present study, slides of the extra-tumoral tissue from women with cancer, and slides from the lesions from women with benign fibrocystic conditions, were also reviewed, by a single study pathologist, and classified according to the scheme developed by Stalsberg et al 13 The pathologist first sorted out the slides from the women with malignancy that contained malignant tissue.…”

Section: Validation Of Diagnosis and Histologic Classificationmentioning

confidence: 99%

Dietary and other risk factors in women having fibrocystic breast conditions with and without concurrent breast cancer: A nested case‐control study in Shanghai, China

Ray

Lampe

et al. 2005

Intl Journal of Cancer

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Risk of breast cancer is increased in women with proliferative benign breast conditions. Most of these conditions, however, do not progress to breast cancer. The purpose of our study was to identify factors possibly associated with this progression. Women with proliferative fibrocystic breast conditions alone (214), and women with proliferative fibrocystic breast conditions and concurrent breast cancer (130), were compared to each other, and each of these groups of women were also compared to 1,070 controls; and 176 women with non-proliferative benign breast conditions alone, and 155 also with breast cancer, were similarly compared. All study subjects were selected from a cohort of women enrolled in a trial of breast self-examination in Shanghai. Women were interviewed to ascertain information on suspected risk factors for breast cancer and dietary habits. Conditional logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Increased risks of both proliferative fibrocystic breast conditions alone, and with breast cancer, were associated with low parity, a prior benign breast lump and breast cancer in a first-degree relative. Decreasing trends in the risk of both conditions with increasing intake of fruits and vegetables were observed. No factors were significantly associated with risk of breast cancer relative to risk of proliferative changes. Similar, but in some instances weaker, associations were observed for non-proliferative fibrocystic conditions with and without breast cancer. The possible risk or protective factors that were observed in our study most likely alter the risk of breast cancer at an early stage in the carcinogenic process, and probably do not alter risk of progression from proliferative fibrocystic breast conditions to breast cancer. ' 2005 Wiley-Liss, Inc.Key words: breast cancer; fibrocystic breast conditions; risk factors; diet; fruits; vegetables Women who have undergone a breast biopsy for benign breast disease are at increased risk of breast cancer. 1 Although nonproliferative breast conditions do not seem to be associated with increased risk of breast cancer, proliferative fibrocystic breast conditions without and with atypia have been associated with 2-fold and 4-fold increased risks of breast cancer, respectively. 2-8 Most women who are diagnosed with proliferative fibrocystic breast conditions do not develop breast cancer, however, suggesting the presence of risk factors necessary for progression.Breast cancer presumably results when a cell first undergoes an initiating genetic alteration, and then either this cell or one of its daughter cells, which inherits that initiating genetic damage is transformed into a cell with malignant characteristics by undergoing one or more subsequent events. In this scenario, proliferative activity may play an important role by increasing the expansion of initiated cells and the likelihood that one will undergo subsequent events ultimately leading to transformation to a malignant phenotype. 9,10 The morp...

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Causes of Physician Delay in the Diagnosis of Breast Cancer

Goodson

Moore²

2002

Arch Intern Med

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The leading cause of physician delay in diagnosis of breast cancer continues to be inappropriate reassurance that a mass is benign without biopsy. Reducing delay in diagnosis will require less willingness to rely on clinical examination to decide that a mass is benign, less reliance on benign mammography reports to decide not to biopsy a mass, and a requirement that fine-needle aspiration biopsy be done by persons with demonstrated competence for the procedure.

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Randomized Trial of Breast self-examination in Shanghai: Methodology and Preliminary Results

Abstract: At this time, there is insufficient evidence to recommend for or against the teaching of breast self-examination.

Cited by 214 publications

References 33 publications

Breast self-examination and death from breast cancer: a meta-analysis

Breast self-examination and death from breast cancer: a meta-analysis

Dietary and other risk factors in women having fibrocystic breast conditions with and without concurrent breast cancer: A nested case‐control study in Shanghai, China

Causes of Physician Delay in the Diagnosis of Breast Cancer

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