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SCREENING FOR EARLY BREAST CANCER IN DEVELOPING COUNTRIES

SCREENING FOR EARLY BREAST CANCER IN DEVELOPING COUNTRIES. The Cairo Breast Cancer Screening Trial. A PILOT STUDY OF 5000 WOMEN IN CAIRO. Dr. Salwa Boulos (Italian Hospital – Cairo – Egypt). In Egypt, breast cancer is the most common cancer in women.

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SCREENING FOR EARLY BREAST CANCER IN DEVELOPING COUNTRIES

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  1. SCREENING FOR EARLY BREAST CANCER IN DEVELOPING COUNTRIES Annual Meeting 2005

  2. The Cairo Breast Cancer Screening Trial A PILOT STUDY OF 5000 WOMEN IN CAIRO • Dr. Salwa Boulos (Italian Hospital – Cairo – Egypt)

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

  4. 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)

  5. 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

  6. 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.

  7. *METHODOLOGY (Cont.):2. Door-to-Door visits4 Social workers were selected and trained about the objectives and methodology of the study.

  8. 2. Door-to-Door visits (Cont.)Questionnaire

  9. 3. Women invited to attend a Health Education Session in a primary health care center (PHC)

  10. (a) Brief health talk by doctors.

  11. ( b ) Clinical Breast Examination (in a private room) ( c ) Teaching of Breast Self Examination

  12. 4- Referral to the Italian Hospital of any woman with suspicious finding for:a) CBE by Chief Surgeon. (Confirm)

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

  14. c) Further surgical treatment (free of cost).

  15. 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

  16. RESULTS

  17. Results of phase IField Study Rates • No. of women contacted  4116 out of 5000 • . Community Acceptance Rate  4116/5000

  18. Field Study Rates (Cont.) • Compliance Rate at PRIMARY HEALTH CARE : 2481/ 4116

  19. Results of CBE at PHC • Total examined: 2481 • Number found abnormal and referred to Italian Hospital for further evaluation: 291 (11.7%)

  20. 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

  21. Results Of Investigations

  22. variables that were significantly associated with breast cancer 1- Age (rate per 1000) Age Groups ( years )

  23. Variables that were significantly associated with breast cancer(Cont.) • 2- Family History. • 3- Gravida. • 4- Regularity of menstrual cycle. • 5- Occupation / Education.

  24. Variables that were not significantly associated with breast cancer • 1- Smoking. • 2- Breast Feeding. • 3- Birth Control Methods. • 4- History of Hormonal Treatment.

  25. 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

  26. 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

  27. 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

  28. 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

  29. Staging of Malignant Tumors (pathology stage) Staging Phase I Phase II (A) Phase II (B) n=16 n=7 n=5 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.

  30. 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 ))

  31. 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.

  32. 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)

  33. Results (Cont.) • Study Group B: * No. of women contacted 2176 out of 2500 * Community acceptance rate 87%

  34. Results (Cont.) *Symptomatic cancer diagnosed as a result of study activities: 1/2176 (0.5 per 1000)

  35. Staging of Malignant Tumors: Staging No. Of cases (%) Stage Group A Group B No=10 No=1 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

  36. 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

  37. 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

  38. 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

  39. Thank You

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