MUMBAI: Laying to rest a long-running debate in oncology, a 20-year study from
Tata Memorial Hospital
has proved that
clinical breast examination
is as effective as
to check for
The study, published in the UK’s BMJ, found clinical breast examination conducted by trained female health workers over a 15- to 20-minute period led to its early detection and reduced mortality by nearly 30% in women aged 50 and older, said Tata Memorial Centre’s director Dr Rajendra Badwe. The study, which began in 1998, recruited 1.5 lakh women.
The technique could help avoid 15,000 breast cancer deaths in India and 40,000 in low- and medium-income countries, he said.
Breast cancer is not only the most common cancer among Indian women, it has, in recent years, emerged as the largest cause of cancer deaths in the country. One of the reasons is late detection of the cancer. In Mumbai, the incidence of breast cancer rose nearly 40% between 1992 and 2016.
“The incidence of breast cancer in India is approximately 30 per 1,00,000 population annually. The death rate is 15 per 1,00,000 per year. Hence, the 30% reduction in the death rate with clinical breast examination is significant,” said Dr Badwe, who is one of the authors of the study.
The study’s take-home method is that low-income countries with resource crunch can use a simple and inexpensive technique to reduce the burden of breast cancer.
There are three main ways of detecting breast cancer — self breast examination, clinical breast examination by a health worker or a scan such as mammography. “There is evidence to show that self breast examination is effective enough. While studies had previously shown that mammography scans reduced breast cancer deaths by 30% in women 50 years, there was no similar study regarding clinical breast examination,” said Dr Gauravi Mishra from the preventive oncology department of Tata Memorial Hospital.
While mammography is popular in Western countries and urban centres in India, the scans are not available at taluka levels. Moreover, mammography scans cost over Rs 2,000. “Hence, when talking about screening the population, mammography is not a feasible option,” said the doctor.
The BMJ study, which compared screening by clinical breast examination versus no screening, began in 1998. Tata Memorial Hospital started training SSC-pass girls on conducting clinical breast examination. Teams would visit 20 slum pockets to conduct the examination. “Each of the 75,000 women in the screening arm was tested four times over an eight-year period,” said Dr Mishra. The remaining received one round of cancer awareness followed by eight rounds of active surveillance every two years.
The study said breast cancer was detected at an earlier age in the screening arm than in the control arm (55 versus 57 years). There also was a significant reduction in the proportion of women with more advanced (Stage III or IV) disease, known as downstaging, said Dr Badwe.
A significant reduction in breast cancer mortality of nearly 30% was seen in women aged 50 and older. “In women younger than 50, despite successful downstaging, no mortality reduction was seen,” said the study. The Tata team has trained health volunteers from 19 states to conduct clinical breast examination.