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Breast cancer



Study sites: Thiruvananthapuram (formerly called Trivandrum), Kerala, India
Principal investigator (PI) from IARC: R. Sankaranarayanan
PIs from collaborating institutions:K. Ramadas (PI), S. Thara, Beela Sarah Mathew, Elizabeth Abraham, Gigi Thomas, Jem Prabhakar, Paul Augustine, Ramani Wesley, R. Rejnish Kumar; Regional Cancer Centre (RCC), Thiruvananthapuram, Kerala, India
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Start date: 2006
Closure date:Ongoing
Objectives: To evaluate whether three rounds of triennial clinical breast examination (CBE) can reduce the incidence rate of advanced breast cancers and reduce the rate of mortality from breast cancer
Methodology:
Study outcomes: This community-based cluster randomized controlled trial involving 120 000 women evaluates the role of intervention packages consisting of breast awareness, health education, opportunities for early clinical diagnosis (i.e. CBE), and the provision of readily accessible diagnosis and treatment services for the early detection and improved outcome of breast cancer. The intervention trial is being conducted in 14 administrative regions (“panchayats”) in Thiruvananthapuram District, Kerala, India. Approximately 120 000 households and about 120 000 women aged 30–69 years in the two sub-districts were grouped into about 275 clusters based on wards; 133 clusters were randomized to the intervention group to receive CBE. The other 142 clusters were randomized to the control group to receive the existing usual health care and health education on early detection of breast cancer. We have already demonstrated significant downstaging of breast cancers through CBE screening. The 10-year follow-up of the cohorts revealed the high negative predictive value of CBE: the invasive breast cancer detection rate in the CBE-negative women was very low.
Publications: Search in Medline for Sankaranarayanan R., Ramadas K., Thara S., Muwonge R., Prabhakar J., Augustine P., Venugopal M., Anju G., Mathew B.S. Clinical breast examination: preliminary results from a cluster randomized controlled trial in India. J Natl Cancer Inst. 2011;103(19):1476-80.Sankaranarayanan R., Ramadas K., Thara S., Muwonge R., Prabhakar J., Augustine P., Venugopal M., Anju G., Mathew B.S. Clinical breast examination: preliminary results from a cluster randomized controlled trial in India. J Natl Cancer Inst. 2011;103(19):1476-80.
PMID: 21862730
Search in Medline for Grosse Frie K., Ramadas K., Anju G.A., Mathew B., Muwonge R., Sauvaget C., Thara S., Sankaranarayanan R. Determinants of participation in a breast cancer screening trial in Trivandrum District, India. Asian Pac J Cancer Prev. 2013;14(12):7301-7.Grosse Frie K., Ramadas K., Anju G.A., Mathew B., Muwonge R., Sauvaget C., Thara S., Sankaranarayanan R. Determinants of participation in a breast cancer screening trial in Trivandrum District, India. Asian Pac J Cancer Prev. 2013;14(12):7301-7.
PMID: 24460292
Funding: Intramural funds from IARC
Media:
Study sites:
  • Centre for Epidemiology and Prevention in Oncology (CPO), Italy
  • Cancer Society of Finland (CSF), Mass Screening Registry, Finland
Principal investigator (PI) from IARC: R. Sankaranarayanan
PIs from collaborating institutions:
  • Antonio Ponti, Carlo Senore, Guglielmo Ronco, Nereo Segnan, CPO, Italy
  • Ahti Antilla, CSF, Mass Screening Registry, Finland
  • Representatives from EU Member States: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, United Kingdom
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Start date: 2015
Closure date:2017
Objectives:
  • To update and expand the scope of the first report
  • To report the updated status and organization of the population-based breast, cervical, and colorectal cancer screening programmes in the 28 EU Member States
  • To estimate selected indicators on programme performance included in the EU quality assurance guidelines for breast, cervical, and colorectal cancer screening
Methodology:
  • More than 100 experts from the 28 Member States contributed to the preparation of the report.
  • Qualitative data (nature and organization of the programme, protocol of screening and diagnosis, mode of invitation and recall, quality assurance practices, etc.) were collected through online questionnaires completed by the country data providers. The data providers were requested to provide the most up-to-date information as of July 2016.
  • Performance data (screening rate, coverage by invitation/examination, participation rate, and other indicators) were collected for the index year 2013 for countries having population-based programmes using structured data tables. The completeness of data collection across the screening and diagnosis processes was estimated.
  • Analysed data and the draft report were shared with the data providers and the scientific committee for review and validation.
Publications: Search in Medline for Basu P., Ponti A., Anttila A., Ronco G., Senore C., Vale D. B., Segnan N., Tomatis M., Soerjomataram I., Primic Zakelj M., Dillner J., Elfstrom K. M., Lonnberg S., Sankaranarayanan R. Status of implementation and organization of cancer screening in The European Union Member States-Summary results from the second European screening report. Int J Cancer; 2018; 142(1): 44-56.Basu P., Ponti A., Anttila A., Ronco G., Senore C., Vale D. B., Segnan N., Tomatis M., Soerjomataram I., Primic Zakelj M., Dillner J., Elfstrom K. M., Lonnberg S., Sankaranarayanan R. Status of implementation and organization of cancer screening in The European Union Member States-Summary results from the second European screening report. Int J Cancer; 2018; 142(1): 44-56.
PMID: 28940326
Search in Medline for Basu P., Ponti A., Anttila A., Ronco G., Senore C., Vale D.B., Segnan N., Tomatis M., Soerjomataram I., Primic Žakelj M., Dillner J., Elfström K.M., Lönnberg S., Sankaranarayanan R. Author's reply to: Cancer screening policy in Hungary. Int J Cancer. 2018 Aug 15;143(4):1005.Basu P., Ponti A., Anttila A., Ronco G., Senore C., Vale D.B., Segnan N., Tomatis M., Soerjomataram I., Primic Žakelj M., Dillner J., Elfström K.M., Lönnberg S., Sankaranarayanan R. Author's reply to: Cancer screening policy in Hungary. Int J Cancer. 2018 Aug 15;143(4):1005.
PMID: 29524204
Search in Medline for Basu P., Ponti A., Anttila A., Ronco G., Senore C., Vale D.B., Segnan N., Tomatis M., Soerjomataram I., Žakelj M.P., Dillner J., Elfström K.M., Lönnberg S., Sankaranarayanan R. Author's reply to: Implementation and organization of cancer screening in France. Int J Cancer. 2018 Jun 26. doi: 10.1002/ijc.31629.Basu P., Ponti A., Anttila A., Ronco G., Senore C., Vale D.B., Segnan N., Tomatis M., Soerjomataram I., Žakelj M.P., Dillner J., Elfström K.M., Lönnberg S., Sankaranarayanan R. Author's reply to: Implementation and organization of cancer screening in France. Int J Cancer. 2018 Jun 26. doi: 10.1002/ijc.31629.
PMID: 29943811
Search in Medline for Senore C., Basu P., Anttila A., Ponti A., Tomatis M., Vale D.B., Ronco G., Soerjomataram I., Primic-Žakelj M., Riggi E., Dillner J., Elfström M.K., Lönnberg S., Sankaranarayanan R., Segnan N. Performance of colorectal cancer screening in the European Union Member States: data from the second European screening report. Gut. 2018 Dec 10.Senore C., Basu P., Anttila A., Ponti A., Tomatis M., Vale D.B., Ronco G., Soerjomataram I., Primic-Žakelj M., Riggi E., Dillner J., Elfström M.K., Lönnberg S., Sankaranarayanan R., Segnan N. Performance of colorectal cancer screening in the European Union Member States: data from the second European screening report. Gut. 2018 Dec 10.
PMID: 30530530
Search in Medline for Vale D.B., Anttila A., Ponti A., Senore C., Sankaranaryanan R., Ronco G., Segnan N., Tomatis M., Žakelj M.P., Elfström K.M., Lönnberg S., Dillner J., Basu P. Invitation strategies and coverage in the population-based cancer screening programmes in the European Union. Eur J Cancer Prev. 2018 Mar 21.Vale D.B., Anttila A., Ponti A., Senore C., Sankaranaryanan R., Ronco G., Segnan N., Tomatis M., Žakelj M.P., Elfström K.M., Lönnberg S., Dillner J., Basu P. Invitation strategies and coverage in the population-based cancer screening programmes in the European Union. Eur J Cancer Prev. 2018 Mar 21.
PMID: 29570103
View the report
Funding: The European Union Public Health Programme (scientific and technical support to the European Partnership for Action Against Cancer)
Study sites: Ghana: Accra, Kumasi
Principal investigator (PI) from IARC: P. Basu
Study investigators:
  • Beatrice Wiafe Addai, Breast Care International (BCI), Kumasi, Ghana
  • Chiara Scoccianti, IARC, Lyon, France
Map:
Start date: 2017
Closure date:Ongoing
Objectives: The study will assess the following parameters among women who have undergone CBE at the screening clinics conducted by BCI in Ghana:
  • Performance characteristics of the CBE screening methodology (test positivity rate, cancer detection rates, false positivity rate, etc.)
  • The stage distribution of the breast cancers diagnosed through the CBE screening programme
  • The estimated proportion of estrogen receptor (ER)–positive breast cancers among the cancers diagnosed through the CBE screening programme
  • Compliance with referral for disease confirmation among CBE-positive women
  • Compliance with treatment of the breast cancers detected through the programme
  • Response to treatment among the breast cancers detected through the programme
  • Overall and disease-free survival of the women treated for breast cancer
Methodology:This retrospective study will be conducted at the centres in Ghana performing community-based breast cancer screening, as well as at the tertiary care hospitals to which CBE-positive women are referred. Women who underwent breast cancer screening by CBE at the breast cancer screening clinics organized by BCI’s offices in Accra and Kumasi, Ghana, from 1 January 2012 to 31 December 2016 will be included in the study. The paper-based records of the women who have undergone CBE are maintained at the screening centres. The records of the CBE-positive women seen at the tertiary care hospitals are available from the computerized databases maintained at the hospitals. The study questionnaire will allow investigators to reconstruct the patients’ trajectory in the health care system during screening, investigation, treatment, and follow-up.
Funding: Intramural funds from IARC
Study sites: Mumbai, India
Principal investigator (PI) from IARC: R. Sankaranarayanan
PIs from collaborating institutions:Anita Gadgil, Bhabha Atomic Research Centre (BARC) Hospital, Homi Bhabha National Institute University, Mumbai, India
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Start date: 2013
Closure date:Ongoing
Objectives: To implement a programme on breast cancer to increase awareness and early detection by clinical breast examination (CBE) among 22 500 women aged 30–69 years (members of a large health maintenance organization) in order to bring about breast cancer case downstaging, to offer different treatment modalities, and to achieve better survival and quality of life
Methodology:
  • Mail brochures on breast cancer (signs, symptoms, information on self-examination and on breast clinics) to the registered women.
  • Organize regular breast clinics to screen women by CBE.
  • Organize prompt referral of CBE-positive women for mammography, ultrasonography, and cytology.
  • Provide care and follow-up of breast cancer cases.
Publications: Search in Medline for Gadgil A., Roy N., Sankaranarayanan R., Muwonge R., Sauvaget C. Effect of comprehensive breast care on breast cancer outcomes: a community hospital based study from Mumbai, India. Asian Pac J Cancer Prev. 2012;13(4):1105-9.Gadgil A., Roy N., Sankaranarayanan R., Muwonge R., Sauvaget C. Effect of comprehensive breast care on breast cancer outcomes: a community hospital based study from Mumbai, India. Asian Pac J Cancer Prev. 2012;13(4):1105-9.
PMID: 22799289
Search in Medline for Gadgil A., Sauvaget C., Roy N., Grosse Frie K., Chakraborty A., Lucas E., Bantwal K., Haldar I., Sankaranarayanan R. Breast cancer awareness among middle class urban women - a community-based study from Mumbai, India. Asian Pac J Cancer Prev. 2015;16(15):6249-54.Gadgil A., Sauvaget C., Roy N., Grosse Frie K., Chakraborty A., Lucas E., Bantwal K., Haldar I., Sankaranarayanan R. Breast cancer awareness among middle class urban women - a community-based study from Mumbai, India. Asian Pac J Cancer Prev. 2015;16(15):6249-54.
PMID: 26434824
Search in Medline for Gadgil A., Sauvaget C., Roy N., Muwonge R., Kantharia S., Chakrabarty A., Bantwal K., Haldar I., Sankaranarayanan R. Cancer early detection program based on awareness and clinical breast examination: Interim results from an urban community in Mumbai, India. Breast. 2017;31:85-9.Gadgil A., Sauvaget C., Roy N., Muwonge R., Kantharia S., Chakrabarty A., Bantwal K., Haldar I., Sankaranarayanan R. Cancer early detection program based on awareness and clinical breast examination: Interim results from an urban community in Mumbai, India. Breast. 2017;31:85-9.
PMID: 27829200
Search in Medline for Gadgil A., Sauvaget C., Roy N., Muwonge R., Lucas E., Sankaranarayanan R. Setting up a Breast Cancer Awareness Project in Mumbai: Methodology, Experiences and Challenges. J Cancer Educ. 2019 Mar 12. doi: 10.1007/s13187-019-01500-x.Gadgil A., Sauvaget C., Roy N., Muwonge R., Lucas E., Sankaranarayanan R. Setting up a Breast Cancer Awareness Project in Mumbai: Methodology, Experiences and Challenges. J Cancer Educ. 2019 Mar 12. doi: 10.1007/s13187-019-01500-x.
PMID: 30863980
Funding: Bhabha Atomic Research Centre (BARC)
Study sites: Udaipur, India
Principal investigator (PI) from IARC: P. Basu
PIs from collaborating institutions:Manoj Mahajan (PI), Kirti Jain, Nilesh Patira, GBH Memorial Cancer Hospital, Udaipur, India
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Start date: 2017
Closure date:Ongoing
Objectives: To evaluate the feasibility and acceptability of the model of delivering community health worker (CHW)–driven home-based comprehensive noncommunicable disease (NCD) control services aimed to prevent premature deaths from cardiovascular diseases; stroke; and breast, cervical, and oral cancers in hard-to-reach men and women
Methodology:
The implementation research has two main components, which will be conducted simultaneously:
  1. Evaluation of the social, cultural, and behavioural factors that impact the uptake of the NCD prevention and control services among women, using the RARE methodology
  2. Evaluation of the feasibility and acceptability of delivery of the NCD early detection services by the trained community health workers in home settings
Participants will be screened for hypertension, diabetes, oral cancer (for habitual users of tobacco products and/or consumers of alcoholic beverages), and cervical cancer (for women only, by HPV testing on self-collected specimens). Women will be made aware of common symptoms and signs of breast cancer. All services will be provided at home. The screen-positive men and women will be navigated to reach appropriate diagnostic and treatment centres.
Publications: Search in Medline for Basu P., Mahajan M., Patira N., Prasad S., Mogri S., Muwonge R., Lucas E., Sankaranarayanan R., Iyer S., Naik N., Jain K. A pilot study to evaluate home-based screening for the common non-communicable diseases by a dedicated cadre of community health workers in a rural setting in India. BMC Public Health. 2019 Jan 3;19(1):14.Basu P., Mahajan M., Patira N., Prasad S., Mogri S., Muwonge R., Lucas E., Sankaranarayanan R., Iyer S., Naik N., Jain K. A pilot study to evaluate home-based screening for the common non-communicable diseases by a dedicated cadre of community health workers in a rural setting in India. BMC Public Health. 2019 Jan 3;19(1):14.
PMID: 30606132
Search in Medline for Mahajan M., Naik N., Jain K., Patira N., Prasad S., Mogri S., Muwonge R., Lucas E., Faruq F., Sankaranarayanan R., Iyer S., Basu P. Study of Knowledge, Attitudes, and Practices Toward Risk Factors and Early Detection of Noncommunicable Diseases Among Rural Women in India. J Glob Oncol. 2019 Apr;(5):1-10.Mahajan M., Naik N., Jain K., Patira N., Prasad S., Mogri S., Muwonge R., Lucas E., Faruq F., Sankaranarayanan R., Iyer S., Basu P. Study of Knowledge, Attitudes, and Practices Toward Risk Factors and Early Detection of Noncommunicable Diseases Among Rural Women in India. J Glob Oncol. 2019 Apr;(5):1-10.
PMID: 30998427
Funding: American International Health Management Ltd
Study sites: Morocco: Casablanca, Fez, Rabat
Principal investigator (PI) from IARC: R. Sankaranarayanan
PIs from collaborating institutions:
  • Professor Errihani, Medical School, Mohammed V University, Rabat
  • Dr Bendahhou, Cancer Centre Mohammed VI, Casablanca
  • Professor El Rhazi, National Institute of Research on Cancer, Fez
Map:
Start date: 2016
Closure date:Ongoing
Objectives: To evaluate the quality of care for women diagnosed with breast and cervical cancer within the public health delivery system of Morocco
Methodology:The basis of the study is a questionnaire survey based on medical charts. The key information that will be obtained from this retrospective study includes information regarding the mode of diagnosis, the gap between the onset of symptoms and diagnosis, the waiting time for start of treatment, and the factors influencing delays in diagnosis and initiation of treatment. The study will also gather information on the protocol followed for the diagnosis and treatment of breast and cervical cancers in the leading oncology centres in Morocco, and on the patients’ adherence to such protocols. Information on the quality of recordkeeping in the institutions will also be gathered from the study.
Publications: Search in Medline for Basu P., Selmouni F., Belakhel L., Sauvaget C., Abousselham L., Lucas E., Muwonge R., Sankaranarayanan R., Khazraji Y.C. Breast Cancer Screening Program in Morocco: Status of implementation, organization and performance. Int J Cancer. 2018 Jul 14.Basu P., Selmouni F., Belakhel L., Sauvaget C., Abousselham L., Lucas E., Muwonge R., Sankaranarayanan R., Khazraji Y.C. Breast Cancer Screening Program in Morocco: Status of implementation, organization and performance. Int J Cancer. 2018 Jul 14.
PMID: 30006933
Search in Medline for Selmouni F., Zidouh A., Belakhel L., Sauvaget C., Bennani M., Khazraji Y.C., Benider A., Wild C.P., Bekkali R., Fadhil I., Sankaranarayanan R. Tackling cancer burden in low-income and middle-income countries: Morocco as an exemplar. Lancet Oncol. 2018 Feb;19(2):e93-e101.Selmouni F., Zidouh A., Belakhel L., Sauvaget C., Bennani M., Khazraji Y.C., Benider A., Wild C.P., Bekkali R., Fadhil I., Sankaranarayanan R. Tackling cancer burden in low-income and middle-income countries: Morocco as an exemplar. Lancet Oncol. 2018 Feb;19(2):e93-e101.
PMID: 29413484
Funding:
  • Lalla Salma Foundation for Cancer Prevention and Treatment
  • IARC
Study sites: China: Shanxi Province, Sichuan Province
Principal investigator (PI) from IARC: R. Sankaranarayanan
PIs from collaborating institutions:Youlin Qiao, Cancer Institute and Hospital, Chinese Academy of Medical Sciences (CICAMS)
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Start date: 2011
Closure date:Ongoing
Objectives: To test whether the transillumination breast device is effective in detecting breast lumps and early breast cancers in a chosen setting
Methodology:This is a hospital-based cross-sectional study including women aged 35–69 years referred to two provincial hospitals for breast complaints needing further investigation. All women receive clinical breast examination, TBS, mammography, and echography if needed. The performance of TBS is compared with that of clinical breast examination (CBE) screening and of mammography screening; histology results are used as the gold standard.

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