Effectiveness of triennial screening with clinical breast examination: 14-years follow-up outcomes of randomized clinical trial in Trivandrum, India.
Autor: | Ramadas K; Karkinos Healthcare, Kerala Operations, Ernakulam, India., Basu P; Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France., Mathew BS; Regional Cancer Centre, Trivandrum, India., Muwonge R; Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France., Venugopal M; Regional Cancer Centre, Trivandrum, India., Prakasan AM; Regional Cancer Centre, Trivandrum, India., Malu R; Regional Cancer Centre, Trivandrum, India., Lucas E; Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France., Augustine P; Regional Cancer Centre, Trivandrum, India., Mony RP; Regional Cancer Centre, Trivandrum, India., Thara S; Regional Cancer Centre, Trivandrum, India., Sankaranarayanan R; Karkinos Healthcare, Kerala Operations, Ernakulam, India.; Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France. |
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Jazyk: | angličtina |
Zdroj: | Cancer [Cancer] 2023 Jan 15; Vol. 129 (2), pp. 272-282. Date of Electronic Publication: 2022 Nov 01. |
DOI: | 10.1002/cncr.34526 |
Abstrakt: | Background: This study presents the preliminary results of a randomized controlled trial (RCT) initiated in January 2006 in India to evaluate the effectiveness of clinical breast examination (CBE) in reducing breast cancer mortality as compared to a no-screening control group reported significant downstaging in the intervention group. The present manuscript reports long-term follow-up outcomes. Methods: Women 30-69 years old from 133 intervention clusters and 141 control clusters were invited to participate. Women in the intervention arm underwent three rounds of CBE every 3 years. CBE-positive women were reexamined by a physician, and triple-assessment was performed on those confirmed to have abnormalities. All participants were followed through home visits and linkage with population-based cancer registry. Results: Of the 55,843 eligible women in the intervention arm, 95.7% had CBE at least once and 11.5% were CBE-positive. Breast cancers were diagnosed in 335 participants in the intervention group and 273 in the control group (N = 59,447). Age-standardized incidence rate of early cancer was 30.4 of 100,000 in the intervention and 21.9 of 100,000 in the control group, with a rate ratio (RR) of 1.4 (95% confidence interval [CI], 1.1-1.8). The age-standardized breast cancer mortality rates were 11.3 and 11.1 per 100,000 in intervention and control arms, respectively (RR, 1.1; 95% CI, 0.8-1.5) after 15 years. Five-year breast cancer survival rates were 77.0% in the intervention and 71.2% in the control groups (overall p value = .043). Conclusions: Triennial CBE screening failed to demonstrate any mortality benefit despite achieving a shift toward earlier stage at detection and improved survival in the intervention arm. CBE is a valuable tool for diagnosis of breast cancer in symptomatic women especially in areas where mammography and/or breast cancer screening programs are not widely available. (© 2022 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.) |
Databáze: | MEDLINE |
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