Training health workers in clinical breast examination for early detection of breast cancer in low- and middle-income countries

Abstract

Background Most women living in low‐ and middle‐income countries (LMICs) present with advanced‐stage breast cancer. Limitations of poor serviceable health systems, restricted access to treatment facilities, and lack of breast cancer screening programmes all likely contribute to the late presentation of women with breast cancer living in these countries. Women are diagnosed with advanced disease and frequently do not complete their care due to a number of factors, including financial reasons as health expenditure is largely out of pocket resulting in financial toxicity; health system failures, such as missing services or health worker lack of awareness on common signs and symptoms of cancer; and sociocultural barriers, such as stigma and use of alternative therapies. Clinical breast examination (CBE) is an inexpensive early detection technique for breast cancer in women with palpable breast masses. Training health workers from LMICs to conduct CBE has the potential to improve the quality of the technique and the ability of health workers to detect breast cancers early. Objectives To assess whether training in CBE affects the ability of health workers in LMICs to detect early breast cancer. Search methods We searched the Cochrane Breast Cancer Specialised Registry, CENTRAL, MEDLINE, Embase, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, and ClinicalTrials.gov up to 17 July 2021. Selection criteria We included randomised controlled trials (RCTs) (including individual and cluster‐RCTs), quasi‐experimental studies and controlled before‐and‐after studies if they fulfilled the eligibility criteria. Data collection and analysis Two review authors independently screened studies for inclusion, and extracted data, assessed risk of bias, and assessed the certainty of the evidence using the GRADE approach. We performed statistical analysis using Review Manager software and presented the main findings of the review in a summary of findings table. Main results We included four RCTs that screened a total population of 947,190 women for breast cancer, out of which 593 breast cancers were diagnosed. All included studies were cluster‐RCTs; two were conducted in India, one in the Philippines, and one in Rwanda. Health workers trained to perform CBE in the included studies were primary health workers, nurses, midwives, and community health workers. Three of the four included studies reported on the primary outcome (breast cancer stage at the time of presentation). Amongst secondary outcomes, included studies reported CBE coverage, follow‐up, accuracy of health worker‐performed CBE, and breast cancer mortality. None of the included studies reported knowledge attitude practice (KAP) outcomes and cost‐effectiveness. Three studies reported diagnosis of breast cancer at early stage (at sta...

Factors influencing the time to diagnosis and treatment of breast cancer among women in low- and middle-income countries: A systematic review

“…This review also identified that patients referred from a public health facility experienced longer time to treatment that could be related to the lack of expertise in the public health facility or proper guidelines for referrals. All of these findings signify the need to strengthen the capacity of primary/public healthcare professionals in the early detection of BC [ 50 ] and to develop a proper referral mechanism for BC diagnosis and treatment in LMICs.…”

Advancements in Telehealth: Enhancing Breast Cancer Detection and Health Automation through Smart Integration of IoT and CNN Deep Learning in Residential and Healthcare Settings

“…The foundational concept at the heart of IoT involves collecting data from the surrounding environment, which may be challenging for humans to perform [8]. Discussions by [9] have explored the applicability of IoT as it plays a role in monitoring users' heart rate by gathering essential health metrics from individuals seeking medical attention. Moreover, integrating breast cancer into the IoT framework holds significant potential for early detection and monitoring.…”

“…Traditionally, healthcare professionals have employed physical exams involving the manual examination of the breasts for lumps or abnormalities. Additional physical examinations may include observing changes in skin colour or organ enlargement [9]. Another diagnostic method is laboratory tests utilizing physiological samples such as urine and blood.…”

Breast biopsy techniques in a global setting—clinical practice review

“…This has naturally led to different clinical presentations of breast cancer. In countries without organized screening programs, the majority of women present with palpable breast cancers ( 3 , 4 ), while women in affluent countries present with image-detected lesions. Clinical strategies for diagnosis and treatment therefore necessarily differ.…”