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Evaluation of clinical early detection of breast cancer in Trivandrum district India (In collaboration with the Regional Cancer Centre, Trivandrum and the Kerala State Health Services, India).
Breast cancer is the most common cancer in women in many countries, including developing countries, with an estimated 999,000 new cases and 375,000 deaths in the year 2000. Breast cancer incidence and mortality rates are increasing in most countries of Africa and Asia. Early detection linked to appropriate treatment is currently the most effective strategy to reduce breast cancer mortality. Mammography screening is expensive, involve substantial financial and manpower resources and thus not feasible in developing countries. The efficacy of organized early detection programmes based on breast self-examination (BSE) and/or clinical breast examination (CBE) remains inconclusive and controversial. It seems that much could be achieved by increasing the awareness of the population on breast cancer symptoms and signs, the good prognosis associated with treatment of early stage disease and by providing readily accessible and effective diagnostic and treatment services.
- We propose a community-based cluster randomised controlled trial, involving 120,000 women, to evaluate the role of interventions "packages" consisting of breast awareness, health education, opportunities for clinical early diagnosis (Clinical Breast Examination (CBE)) and the provision of readily accessible diagnosis and treatment services in the early detection and improved outcome of breast cancer. The intervention trial will be conducted in 14 administrative regions (“panchayaths”) in Trivandrum district, Kerala, India. The panchayaths are further sub-divided into smaller administrative units called wards. The risk of breast cancer in this district is moderately high as compared to rest of the country: 65 per 100,000 women aged 30-69 years. There are approximately 120,000 households and around 120,000 women aged 30-69 years in the two sub-districts and they will be grouped into about 156 clusters based on wards: 78 clusters will be randomised to an intervention group to establish a breast cancer early detection programme, based on awareness and prompting women to seek services for early clinical diagnosis/treatment. Women in the other 78 clusters will be randomised to the control group and will receive the existing usual health care and health education on early detection and prevention of cervix cancer. The objective is to reduce the proportion of advanced (stages IIB, III, IV) breast cancers from the current 80% to 60% and to increase 3-year survival from the current 55% to 75%. Over a period of 7 years, the breast cancer incidence, stage, survival and mortality in the intervention and control groups will be compared.
- Development of a digital and printed atlas and clinical manual to facilitate the early detection of breast cancers
- Evaluation of breast screening programme in Uruguay
Fred Hutchinson Cancer Research Center: The Breast Health Global Initiative
National Cancer Institute, Breast Cancer web page
Oncolink, Breast cancer web page
Susan G. Komen for the Cure
Collaborative institutes website:
Tata Memorial Centre, Mumbai, India
Trivandrum Regional Cancer Centre, Trivandrum, India