Breast Cancer Screening by Physical Examination: Randomized Trial in the Phillipines
Final rept. 30 Sep 2004-29 Sep 2005
INTERNATIONAL AGENCY FOR RESEARCH ON CANCER LYONS (FRANCE)
Pagination or Media Count:
A high proportion of breast cancer cases in the Philippines and in developing countries in general present at advanced stages and have a rapid unfavorable outcome. Many of these cases could have a good prognosis if detected earlier. This was an intervention study to assess the feasibility and efficacy of screening by Clinical Breast Examination CBE in reducing mortality from breast cancer. Women resident in 12 municipalities of Manila were offered CBE performed by trained nurses, if detected positive they were referred to tumor clinics set up for the management of project cases. Though screening was well received, only 40 of women detected positive reported to the tumour clinics. The cost of treatment, lack of trust in the health system and fear of a disease still largely perceived as fatal, were the main reasons given to refuse clinical follow up. This is a reminder that when introducing community screening in developing countries specific culturally-related health-belief issues need also to be addressed. Nevertheless, the project also showed that good quality management could be provided with affordable and sustainable investments and that improved management can have a significant impact on clinical outcome. The median survival of screened-detected cases was significantly greater than median survivals of refusers and of symptomatic cases diagnosed in the control areas. A health system capable of improving survival will contribute to the credibility of awareness campaigns and help to change the negative attitude of the population.
- Medicine and Medical Research