SCREENING FOR EARLY BREAST CANCER IN DEVELOPING COUNTRIES

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SCREENING FOR EARLY BREAST CANCER IN DEVELOPING
COUNTRIES
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The Cairo Breast Cancer Screening Trial
A PILOT STUDY OF 5000 WOMEN IN CAIRO

• Dr. Salwa Boulos (Italian Hospital Cairo
  Egypt)

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• In Egypt, breast cancer is the most common
  cancer in women.
• The disease is usually diagnosed at an
  advanced stage, and survival is poor.

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AIM OF STUDY (CBST)

• To test the feasibility of conducting a Breast
  Cancer Screening Program in a well defined,
  socio-economically modest population in the city
  of Cairo.
• To pilot a Randomized Trial of Breast Physical
  Examination (CBE) and Breast
  Self-Examination (BSE)

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• MATERIAL METHODS
• SAMPLE SIZE 5000 women ( 35 - 65 years)
• DURATION OF THE STUDY Started 07/05/00
• 
  ended 28/11/02
• PHASES OF THE SUDY
• The study was conducted in 2 phases
• Phase I
• Phase II

• Group A
• Group B

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METHODOLOGY 1. Geographical
definition

• An area around the Italian Hospital, named
  Abbasiah District, was defined. The maps of this
  area were obtained and divided into 8 blocks.

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METHODOLOGY (Cont.)2. Door-to-Door visits
4 Social workers were selected and
trained about the objectives and
methodology of the study.
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2. Door-to-Door visits (Cont.)
Questionnaire
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3. Women invited to attend a Health Education
Session in a primary health care center (PHC)
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(a) Brief health talk by doctors.
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( b ) Clinical Breast Examination (in a
private room)
( c ) Teaching of Breast Self Examination
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4- Referral to the Italian Hospital of any
woman with suspicious finding for a)
CBE by Chief Surgeon. (Confirm)

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b) Further investigation (/- MX and U.S.)

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c) Further surgical treatment (free of
cost).
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• Phase II Women who had previously been
• contacted were randomly
  classified into
• two groups (using area /
  block
• randomization) .
• Group A To be invited to attend once
• more the PHC for
  examination
• Group B To be visited only and asked
  about
• breast Problems

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RESULTS
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Results of phase IField Study Rates

• No. of women contacted ? 4116 out of 5000
  
• . Community Acceptance Rate ?

4116/5000
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Field Study Rates (Cont.)

• Compliance Rate at PRIMARY HEALTH CARE

2481/ 4116
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Results of CBE at PHC

• Total examined 2481
• Number found abnormal and referred to Italian
  Hospital for further evaluation
  
• 291 (11.7)

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Compliance Rate at ITALIAN HOSPITAL

• 55 out of 291 (18.9) women with abnormalities
  detected at PHC did not show up at the hospital
  for further investigation

236/291
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Results Of Investigations
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variables that were significantly associated with
breast cancer

• 1- Age (rate per 1000)

Age Groups ( years )
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Variables that were significantly associated
with breast cancer(Cont.)

• 2- Family History.
• 3- Gravida.
• 4- Regularity of menstrual cycle.
• 5- Occupation / Education.

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Variables that were not significantly associated
with breast cancer

• 1- Smoking.
• 2- Breast Feeding.
• 3- Birth Control Methods.
• 4- History of Hormonal Treatment.

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Results of Phase II GROUP A

• Total No. of Women contacted 1924
• Out of which
• 1237 Attended PHC during Phase I
• 687 did NOT attend

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Results of Phase II GROUP ABreast Cancer
Detection Rates (per 1000)

• Attended PHC and normal 0.8
• Attended PHC and referred with abnormal finding
  for Italian Hospital , but did not attend for
  diagnosis 49.4
• Did not attend PHC in Phase I, but attended PHC
  in Phase II 2.9

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Results of Phase II GROUP B

• Total No. of women contacted 1927
• Out of which
• 1062 had attended PHC Phase I
• 865 did Not attend PHC

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Results of Phase II GROUP B

• Interval cases of breast cancer following first
  screen
• Among women who attended PHC in phase I 3 /
  1062
• 2.8 per 1000
• Among women who did NOT attend
  3 / 865
• 3.5 per 1000

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Staging of Malignant Tumors (pathology stage)

• Staging Phase I Phase II (A)
  Phase II (B)
• n16 n7
  n5
• Stage 0 1 (6.2) 0 (0.0)
  0 (0.0)
• Stage I 4 (25.0) 2 (28.6) 0
  (0.0)
• Stage II 9 (56.2) 1 (14.3) 2
  (40.0)
• Stage III 1 (6.2) 3 (42.8) 3
  (60.0)
• Stage IV 1 (6.2) 1 (14.3) 0
  (0.0)

4 cases diagnosed by FNAC
1 case not doc.
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• In the year 2003/2004, the trial has been
  extended in Cairo by the identification,
  recruitment and randomization of a second group
  of 5000 women from a different district
• (( Area no.2 ))

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• From the start, women were randomly allocated
  into 2 groups
• Group A (2500) Study arm
  Group B (2500) Control arm
• Both areas of residency are quite far from
  each other.

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Results Area 2

• Study Group A
• No. of women contacted 2264 out
  
• of 2500
• Community acceptance rate (90.6)
• Compliance rate at PHC
• 
  1861/2264 (82)
• Compliance rate at Italian Hospital
• 
  77/88 (87.5)
• Cancer Detection rate
  10/1861
  (5.4 per 1000)

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Results (Cont.)

• Study Group B
• No. of women contacted 2176 out of
  2500
• Community acceptance rate 87

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Results (Cont.)

• Symptomatic cancer diagnosed as a
• result of study activities
• 1/2176 (0.5 per 1000)

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Staging of Malignant Tumors

• Staging No. Of cases ()
• Stage Group A
  Group B
• No10
  No1
• Stage 0 0
  1 ( 7.7)
• Stage I 3 (33.3)
• Stage II 4 (33.4)
• Stage III 3 (33.3)Stage IV
  
• Stage IV 0

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May 2005, follow up (Area 2 ) Group A - Study
arm

• Total number of women accepted to participate in
  phase 1 2264
• Total No. of women at risk for cancer in phase 2
  2254
• Compliance rate at PHC 1852/2254
  73
• Compliance rate at IH 52/56 93
• Cancer Detection rate 6 /1852
• 3.2 per 1000 women

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May 2005, follow up (Area 2 ) Group B- Control
arm

• Total number of women accepted to participate in
  phase 2 2215
• Community Acceptance Rate
  2215/2500 88.6
• Cancer Detection rate 2 /2202
• 0.9 per 1000 women

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New Area with 5000 women(( Area No. 3 ))

• April 2005, a third group of 5000 women from a
  different district were recruited and randomized
  as follows
• Group A (2500) Study arm
• Group B (2500) Control arm

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Thank You