Increased breast cancer screening and downstaging in Colombian women: A randomized trial of opportunistic breast-screening
| Autor: | Marion Piñeros, Lina Buitrago, Hsiang Yu, Oscar Gamboa, Teófilo Lozano, Raúl Murillo, César Poveda, Fernando Perry, Benjamin O. Anderson, Oswaldo Sánchez, Catherine Duggan, Ching Yun Wang, Sandra Díaz, David B. Thomas |
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| Rok vydání: | 2015 |
| Předmět: |
Cancer Research
medicine.medical_specialty low and middle income countries Tumor Markers and Signatures cluster randomized controlled trial Breast Neoplasms Disease Mastectomy Segmental law.invention opportunistic screening 03 medical and health sciences Breast cancer screening 0302 clinical medicine Breast cancer breast cancer Randomized controlled trial law Internal medicine Outcome Assessment Health Care medicine Mammography Humans 030212 general & internal medicine Cluster randomised controlled trial Stage (cooking) Early Detection of Cancer Research Articles Aged Neoplasm Staging Gynecology medicine.diagnostic_test business.industry Incidence (epidemiology) Middle Aged medicine.disease Oncology 030220 oncology & carcinogenesis Female Gynecological Examination business |
| Zdroj: | International Journal of Cancer |
| ISSN: | 1097-0215 |
| Popis: | The lack of breast cancer screening in low and middle‐income countries results in later stage diagnosis and worsened outcomes for women. A cluster randomized trial was performed in Bogotá, Colombia between 2008 and 2012 to evaluate effects of opportunistic breast cancer screening. Thirteen clinics were randomized to an intervention arm and 13 to a control arm. Physicians in intervention clinics were instructed to perform clinical breast examination on all women aged 50–69 years attending clinics for non‐breast health issues, and then refer them for mammographic screening. Physicians in control clinics were not explicitly instructed to perform breast screening or mammography referrals, but could do so if they thought it indicated (“usual care”). Women were followed for 2‐years postrandomization. 7,436 women were enrolled and 7,419 (99.8%) screened in intervention clinics, versus 8,419 enrolled and 1,108 (13.1%) screened in control clinics. Incidence ratios (IR) of early, advanced and all breast cancers were 2.9 (95% CI 1.1–9.2), 1.0 (0.3–3.5) and 1.9 (0.9–4.1) in the first (screening) year of the trial, and the cumulative IR for all breast cancers converged to 1.4 (0.7–2.8) by the end of follow‐up (Year 2). Eighteen (69.2%) of 26 women with early stage disease had breast conservation surgery (BCS) versus 6 (42.5%) of 14 women with late‐stage disease (p = 0.02). Fifteen (68.2%) of 22 women with breast cancer in the intervention group had BCS versus nine (50.0%) of 18 women in the control group (p = 0.34). Well‐designed opportunistic clinic‐based breast cancer screening programs may be useful for early breast cancer detection in LMICs. What's new? Breast cancer is a common malignancy in Colombia, and its mortality rates are rising. To catch the disease earlier, recently developed guidelines from the National Cancer Institute of Colombia center on opportunistic (hospital‐based) screening with biennial mammography and clinical breast examination. In this randomized trial involving patients at primary health‐care clinics in Bogotá, opportunistic breast screening was associated with increased rates of disease detection and use of breast‐conservation therapy. Cancers were diagnosed at earlier stages in women who underwent screening versus usual care. The data suggest that opportunistic breast screening can advance early detection in low‐resource settings. |
| Databáze: | OpenAIRE |
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