Impact of regular Breast Self-Examination on breast cancer size, stage, and mortality in Thailand.

Abstract

The Breast JournalVolume 26, Issue 4 p. 822-824 COMMENTARYOpen Access Impact of regular Breast Self-Examination on breast cancer size, stage, and mortality in Thailand Vallop Thaineua MD, Vallop Thaineua MD Breast Foundation Under The Patronage of Her Royal Highness The Princess Mother, Bangkok, ThailandSearch for more papers by this authorTamnit Ansusinha MD, Tamnit Ansusinha MD Breast Foundation Under The Patronage of Her Royal Highness The Princess Mother, Bangkok, ThailandSearch for more papers by this authorNanta Auamkul MD, MPH, Nanta Auamkul MD, MPH College of Public Health Sciences, Chulalongkorn University, Bangkok, ThailandSearch for more papers by this authorSurasak Taneepanichskul MD, MPH, Surasak Taneepanichskul MD, MPH College of Public Health Sciences, Chulalongkorn University, Bangkok, ThailandSearch for more papers by this authorChonlatit Urairoekkun MD, MPH, Chonlatit Urairoekkun MD, MPH Department of Health, Ministry of Public Health, Nonthaburi, ThailandSearch for more papers by this authorJaruwun Jongvanich MPH, Jaruwun Jongvanich MPH Department of Health, Ministry of Public Health, Nonthaburi, ThailandSearch for more papers by this authorChalermdej Kannawat MD, Chalermdej Kannawat MD Breast Foundation Under The Patronage of Her Royal Highness The Princess Mother, Bangkok, ThailandSearch for more papers by this authorPatrinee Traisathit PhD, Patrinee Traisathit PhD orcid.org/0000-0003-2918-1928 Data Science Research Center, Faculty of Science, Chiang Mai University, Chiang Mai, ThailandSearch for more papers by this authorImjai Chitapanarux MD, Corresponding Author Imjai Chitapanarux MD imjai@hotmail.com orcid.org/0000-0002-8552-0149 Chiang Mai Cancer Registry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Correspondence Imjai Chitapanarux, Faculty of Medicine, Chiang Mai Cancer Registry, Chiang Mai University, Chiang Mai, Thailand. Email: imjai@hotmail.comSearch for more papers by this author Vallop Thaineua MD, Vallop Thaineua MD Breast Foundation Under The Patronage of Her Royal Highness The Princess Mother, Bangkok, ThailandSearch for more papers by this authorTamnit Ansusinha MD, Tamnit Ansusinha MD Breast Foundation Under The Patronage of Her Royal Highness The Princess Mother, Bangkok, ThailandSearch for more papers by this authorNanta Auamkul MD, MPH, Nanta Auamkul MD, MPH College of Public Health Sciences, Chulalongkorn University, Bangkok, ThailandSearch for more papers by this authorSurasak Taneepanichskul MD, MPH, Surasak Taneepanichskul MD, MPH College of Public Health Sciences, Chulalongkorn University, Bangkok, ThailandSearch for more papers by this authorChonlatit Urairoekkun MD, MPH, Chonlatit Urairoekkun MD, MPH Department of Health, Ministry of Public Health, Nonthaburi, ThailandSearch for more papers by this authorJaruwun Jongvanich MPH, Jaruwun Jongvanich MPH Department of Health, Ministry of Public Health, Nonthaburi, ThailandSearch for more papers by this authorChalermdej Kannawat MD, Chalermdej Kannawat MD Breast Foundation Under The Patronage of Her Royal Highness The Princess Mother, Bangkok, ThailandSearch for more papers by this authorPatrinee Traisathit PhD, Patrinee Traisathit PhD orcid.org/0000-0003-2918-1928 Data Science Research Center, Faculty of Science, Chiang Mai University, Chiang Mai, ThailandSearch for more papers by this authorImjai Chitapanarux MD, Corresponding Author Imjai Chitapanarux MD imjai@hotmail.com orcid.org/0000-0002-8552-0149 Chiang Mai Cancer Registry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Correspondence Imjai Chitapanarux, Faculty of Medicine, Chiang Mai Cancer Registry, Chiang Mai University, Chiang Mai, Thailand. Email: imjai@hotmail.comSearch for more papers by this author First published: 06 September 2019 https://doi.org/10.1111/tbj.13611Citations: 3AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat The incidence of breast cancer in Thailand has increased during the past decade. Besides, most of the patient present with the locally advanced stage.1 Mammography has not reached all women in Thailand. Breast self-examination (BSE) is simple and feasible for breast cancer screening among developing countries comparing to mammography and clinical breast examination (CBE).2 We evaluate a cohort study of 1 906 697 women without a history of breast cancer aged 30-70 years who participated in a breast cancer awareness program in Thailand. We excluded women with known breast cancer or in process of investigation. BSE program in this study was shown in Figure 1. The village health volunteers (VHV) helped reminding the cohorts to perform BSE regularly through the use of BSE record booklet. The innovative BSE record booklet contained the instruction to help cohort to perform BSE precisely and record monthly in the booklet which was verified by the VHV and confirmed by health personnel. The participants had been followed up from October 2012 to September 2017. The participants who reached the regularity (at least once in every 2 months) of BSE within 12 months before diagnosis were defined as regular BSE. When abnormalities presented, the participants were referred for screening by CBE then confirmed by imaging and pathology. The data of BSE and Breast Cancer Individual (BCI) Record Form were collected and analyzed. There were 2,956 women diagnosed with breast cancer in this study (Figure 2). Breast cancer size and stage were diagnosed according to the AJCC 7th staging system. We categorized tumor size into small (≤2 cm) and large (>2 cm) and stage into early (0–II) and late (III-IV). Death due to breast cancer was also recorded. Figure 1Open in figure viewerPowerPoint The process of data collection and analysis Figure 2Open in figure viewerPowerPoint Flow chart of breast cancer diagnosis Of 1 906 697 women who participated in this study, 61% were aged < 50 years. 72% of participants performed BSE regularly. During 5 years of follow-up, 2956 participants were diagnosed with breast cancer. The average incidence rate per year was 31 (range 27.5-33.5) per 100 000 women aged between 30 and70 years old (Table 1). 97.9% of them found a breast lump themselves and were sent for confirmation by imaging and histopathology. The other presenting symptoms were breast pain (12.8%) and unequal breast size (7.9%). Some of participants (1.2%) did not have any signs or symptoms. Data on breast cancer size were available for 2,031 patients (68.7% of all patients with breast cancer). The risk of a large tumor size in nonregular BSE patients was 1.348-fold higher than regular BSE patients. Data on breast cancer stage were available for 2659 patients (90.0% of all patients with breast cancer). Most of the patients were diagnosed with stage II, (47.9%) and 31.5% were diagnosed with stage III-IV. The risk of late-stage breast cancer in nonregular BSE patients was 1.319-fold higher than in regular BSE. Of 2956 patients, 176 (5.9%) died during 5 years of follow-up. The survival rate of regular BSE patients was significantly higher than nonregular BSE patients (95.7% vs 92.6%, P-value < .001). Nonregular BSE patients had a 1.702-fold higher incidence of mortality than regular BSE patients (OR = 1.702; 95%CI = 1.235-2.347; P-value < .05) (Table 2). Table 1. Participants characteristics n (%) Participants 1 906 697 (100) BSE data 1 754 310 (92.0) Regular BSE 1 262 241 (72.0) Breast cancer patients 2956 (0.2) 2013 631 (21.3) 2014 582 (19.7) 2015 579 (19.6) 2016 639 (21.6) 2017 525 (17.8) Incidence rate/year (per 100 000) 31.0 Size ≤ 2 cm 843 (41.5) Stage 0–II 1820 (68.5) Breast cancer mortality 176 (5.9) Table 2. Breast self-examination and breast cancer size, stage, and mortality Breast self-examination Size (N = 1938) P-value Stage (N = 2557) P-value Mortality (N = 2804) P-value ≤2 cm >2 cm Odds ratio Early Late Odds ratio Alive Dead Odds ratio n (%) n (%) (95%CI) n (%) n (%) (95%CI) n (%) n (%) (95%CI) Regular 602 (43.1) 794 (56.9) 1.348 (1.090-1.667) <.01 1300 (70.3) 550 (29.7) 1.319 (1.094-1.591) <.01 1901 (95.0) 100 (5.0) 1.702 (1.235-2.347) <.05 Nonregular 202 (37.3) 340 (62.7) 458 (64.8) 249 (35.2) 737 (91.8) 66 (8.2) This study has higher rate of regular BSE than others 3-5 because of the strong collaboration from VHV and BSE booklet. Most of women who developed breast cancer from BCI record found breast lump themselves. Our findings are consistent with the others 6, 7; we reported a significantly higher proportion of smaller tumor size, earlier stage, and better survival rate in regular BSE practiced women rather than nonpracticing women. In the developed countries, they recommend women aged 50-74 years should have mammography screening once every 2-3 years,8, 9 which indicates that mammography could not cover all age groups. Despite the efficacy of BSE to decrease breast cancer mortality is largely unproven. This large Thai cohort study indicates that regular BSE recorded in the BSE record booklet and monitored by VHV is effective for the early detection of breast cancer. REFERENCES 1Rakkapao N, Promthet S, Moore MA, Solikhah S, Hurst C. Assessing breast cancer awareness in Thai Women: Validation of the breast cancer awareness scale (B-CAS). Asian Pac J Cancer Prev. 2017; 18: 995- 1005. PubMedGoogle Scholar 2Bebis H, Altunkurek SZ, Acikel C, Akar I, Altunkurek SZ. Evaluation of breast self-examination (BSE) application in first and second degree relatives of patients with breast cancer. Asian Pac J Cancer Prev. 2013; 14: 4925- 4930. CrossrefPubMedGoogle Scholar 3Yoo BN, Choi KS, Jung KW, Jun JK. 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