Home / Reseach Projects / Breast cancer early detection
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Research projects
Breast cancer early detection
| Study sites: | Thiruvananthapuram (formerly called Trivandrum), Kerala, India |
| Principal investigator (PI) from IARC: | P. Basu |
| 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: |  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 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: | Lyon, France |
| Principal investigator (PI) from IARC: | P. Villain |
| PIs from collaborating institutions: | |
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| Start date: | 2019 |
| Closure date: | Ongoing |
| Objectives: | Based on the Action Plan for the renovation of organized breast cancer screening provided par INCa, the project aims to create a free and private social network open only to women receiving a letter of invitation to participate in the organized screening program for breast cancer. This network will be a decision-making tool for women and also a tool to help the "shared medical decision" about screening as it will provide for participation of health care providers. |
| Methodology: | In order to develop this network (content and functionality), two expert committees (national and international) will be set up, including representatives of public health, health professionals (generalists, gynaecologists, nurses), breast cancer screening specialists and representatives of patient organizations. The international committee, by supporting a systematic review of the scientific literature, will be responsible for producing recommendations and specifications for development (content - decision support, tools to help with "shared medical decision" and scales/tools evaluation - and functionality) of this network. |
| Funding: | National Cancer Institute, France |
| Study sites: | China: Shanxi Province, Sichuan Province |
| Principal investigator (PI) from IARC: | P. Basu |
| 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. |
| Study sites: | Morocco: Casablanca, Fez, Rabat |
| Principal investigator (PI) from IARC: | P. Basu |
| PIs from collaborating institutions: |
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| 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. The publication Patterns of care for women with breast cancer in Morocco: an assessment of breast cancer diagnosis, management, and survival in two leading oncology centres summarizes the outcomes of a patterns-of-care study implemented by IARC in collaboration with the Ministry of Health of the Kingdom of Morocco and the Lalla Salma Foundation for Cancer Prevention and Treatment, to assess how far state-of-the-art cancer diagnostics and therapy have been disseminated into routine oncology practice in Morocco. The findings highlight the improvements in breast cancer care that occurred in Morocco as a result of pragmatic policies and systematic planning by the Moroccan Ministry of Health. Recommendations for strengthening breast cancer care in Morocco are also included in the publication. View the publication, and the IARC news. | Publications: | Thankappan K., Subramanian S., Balasubramanian D., Kuriakose M.A., Sankaranarayanan R., Iyer S. Cost-effectiveness of oral cancer screening approaches by visual examination: A systematic review. Head Neck. 2021 Jul 14. PMID: 34260118 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 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 |
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| Study sites: | Rabat and Casablanca, Morocco |
| Principal investigator (PI) from IARC: | P. Basu |
| PIs from collaborating institutions: | Dr Karima Bendahhou |
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| Start date: | 2019 |
| Closure date: | Ongoing |
| Objectives: | To compare the breast cancer cases diagnosed through the program (participants) and those diagnosed outside the program (comparison group) in terms of stage at presentation, management and improvement in quality of life after treatment. |
| Methodology: | A longitudinal study will be conducted at the oncology centres of Rabat and Casablanca with specialized breast cancer management unit. All the breast cancer patients registered with the oncology centers during the first two years of the study will be approached and will be recruited after obtaining written informed consent. We expect to include in the study about 1500 breast cancer patients (1000 in Rabat oncology center and 500 in Casablanca oncology center) each year. A form will be used to extract information from the medical charts of the breast cancer patients from the oncology centres. Data collection will be made by trained staff through visits of the medical records department (MRD). The records of all the recruited patients will be updated every three months to collect information on the clinical stage, histopathology report of the tumour, estrogen receptor status, the post-operative pathology report, the tumour board decision and the adjuvant (or neo-adjuvant) treatment received. The response to treatment and the disease status and vital status at last follow up will be collected from the follow up records. For quality of life assessment, we will use the third version of the QLQ-C30 questionnaire of the European Organization for Research and Treatment of Cancer (EORTC). We will assess the mean duration between detection by CBE or onset of symptoms and the confirmation of diagnosis and onset of treatment, the distribution of breast cancer stage (clinical TNM and pathology TNM), lymph node status, IHC status and type of treatment, the rate of breast conserving surgeries, the treatment response rate and the functional dimensions and symptoms scores on QOL study and improvement between pre- and post-treatment scores by groups. |
| Funding: | Institut de Recherche sur le Cancer (IRC) |
| Study sites: | Ghana: Accra, Kumasi |
| Principal investigator (PI) from IARC: | P. Basu |
| Study investigators: |
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| Start date: | 2017 |
| Closure date: | 2019 |
| Objectives: | The study will assess the following parameters among women who have undergone CBE at the screening clinics conducted by BCI in Ghana:
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| 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: | 2019 |
| 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 |
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| Publications: | 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 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 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 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) |
Legend: Ongoing projects (blue), Completed projects (green)
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