Annual Clinical Breast Examination Research Articles

Greek Women’s Knowledge and Perceptions Related to Breast Cancer Prevention

Background: Breast cancer is the most common form of cancer and the leading cause of cancer death in womenworldwide. The aim of this survey was to investigate Greece women’s knowledge and perceptions related tobreast cancer prevention.Methods: A reliable questionnaire from the literature was used which then was translated using the forward andbackward translation method. It contained 37 questions and the sample consisted of 650 women. The statisticalanalysis was completed using SPSS 25. The study found that the majority of the sample had knowledge regardingbreast cancer prevention, they knew the importance of breast self-examination and annual clinical breastexamination needed to be conducted as well as the age to undergo their first mammogram. Age, occupation,annual family income, education level, and marital status significantly influenced women’s knowledge andperceptions related to breast cancer prevention.Conclusions: The state, the media and schools contribute to raising awareness and the involvement of healthprofessionals is essential to better inform and educate adolescent girls and women on this issue.

Cost-effectiveness of screening mammography in a low income country: a Markov simulation analysis

BackgroundBreast cancer is the most common cancer diagnosed in women. Screening mammography is the only imaging screening study for breast cancer with a proven. mortality benefit. This study aims to analyze the cost-effectiveness of screening mammography in Ethiopia.MethodsMultistate Markov model was used for computer simulation to estimate cost and health benefits of screening mammography interventions for age-group of 40–49 years and 50–59 years. The cost-effectiveness analysis was made for 4 policies based on where the screening mammography procedures were conducted: government institution only, the private institution only, 50% ratio for each, and 10% private institution policy. Outputs were expressed in total cost, life-years gained (LYG) incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INMB).ResultsAll 4 policies of annual screening mammography failed to achieve acceptable ICER and lead to a net loss in INMB. The lowest ICER value was for government institution-only policy with 3510.3 USD/LYG and 3224.9 USD/LYG both above the cost-effectiveness threshold of 2808.5 USD. The cost per single death averted for each group was 110,206.7 USD and 77,088.2 USD for age-group 40–49 years and 50–59 years respectively.ConclusionScreening mammography could not be shown to be cost-effective in Ethiopia with the current low cost-effectiveness threshold. Alternative screening approach like annual clinical breast examination may need to be investigated.

Socio-economic Predictors of Annual and Bi-annual Clinical Breast Examination among Women in Northeast Brazil

Socio-economic Predictors of Annual and Bi-annual Clinical Breast Examination among Women in Northeast Brazil

Uptake of clinical breast examination services at an urban health centre following community-based awareness programme

Background: A significant proportion of women present in advanced stages of breast cancer due to lack of awareness and non-availability of preventive health checkups. Annual clinical breast examination (CBE) in women aged 40-60 years is estimated to reduce mortality in India comparable to that achieved by biennial mammography at considerably low cost. Aim of the project was to encourage women aged 30-70 years to regularly undergo annual CBE.Methods: The five year project was implemented in Mumbai in an estimated population of 15120 distributed in slums and low income group buildings. The beneficiaries of the project were women aged 30-70 years. Two Interventions, i.e. breast cancer education and screening were implemented by the project. List of women eligible for breast cancer screening, was used to track the utilisation of services.Results: Over the period of five years, 14249 one-one health education interactions took place and fourteen group health education sessions were conducted. 59.7% of the women had received health education at least once. Proportion of women trained in doing SBE was 51%. Proportion of women undergoing at least one CBE was 44.1%. Age was significantly associated with availing of services. Two women were detected with breast cancer.Conclusions: This project demonstrated that it is possible to motivate a large number of women to undergo screening, and such health education programmes will slowly improve the awareness and change health seeking behaviour.

Cost-effectiveness of Breast Cancer Screening With Magnetic Resonance Imaging for Women at Familial Risk

For women with a 20% or more familial risk of breast cancer without a known BRCA1/2 (BRCA1, OMIM 113705; and BRCA2, OMIM 114480) or TP53 (OMIM 151623) variant, screening guidelines vary substantially, and cost-effectiveness analyses are scarce. To assess the cost-effectiveness of magnetic resonance imaging (MRI) screening strategies for women with a 20% or more familial risk for breast cancer without a known BRCA1/2 or TP53 variant. In this economic evaluation, conducted from February 1, 2019, to May 25, 2020, microsimulation modeling was used to estimate costs and effectiveness on a lifetime horizon from age 25 years until death of MRI screening among a cohort of 10 million Dutch women with a 20% or more familial risk for breast cancer without a known BRCA1/2 or TP53 variant. A Dutch screening setting was modeled. Most data were obtained from the randomized Familial MRI Screening (FaMRIsc) trial, which included Dutch women aged 30 to 55 years. A health care payer perspective was applied. Several screening protocols with varying ages and intervals including those of the randomized FaMRIsc trial, consisting of the mammography (Mx) protocol (annual mammography and clinical breast examination) and the MRI protocol (annual MRI and clinical breast examination plus biennial mammography). Costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated and discounted by 3%. A threshold of €22 000 (US $24 795.87) per QALY was applied. This economic evaluation modeling study estimated that, on a lifetime horizon per 1000 women with the Mx protocol of the FaMRIsc trial, 346 breast cancers would be detected, and 49 women were estimated to die from breast cancer, resulting in 22 885 QALYs and total costs of €7 084 767 (US $7 985 134.61). The MRI protocol resulted in 79 additional QALYs and additional €2 657 266 (US $2 994 964.65). Magnetic resonance imaging performed only every 18 months between the ages of 35 and 60 years followed by the national screening program was considered optimal, with an ICER of €21 380 (US $24 097.08) compared with the previous nondominated strategy in the ranking, when applying the National Institute for Health and Care Excellence threshold. Annual screening alternating MRI and mammography between the ages of 35 and 60 years, followed by the national screening program, gave similar outcomes. Higher thresholds would favor annual MRI screening. The ICER was most sensitive to the unit cost of MRI and the utility value for ductal carcinoma in situ and localized breast cancer. This study suggests that MRI screening every 18 months between the ages of 35 and 60 years for women with a family history of breast cancer is cost-effective within the National Institute for Health and Care Excellence threshold for all densities. Higher thresholds would favor annual MRI screening. These outcomes support a change of current screening guidelines for this specific risk group and support MRI screening.

Políticas basadas en la evidencia científica: el caso del control del cáncer de mama en Colombia

Colombia, tiene un riesgo intermedio a desarrollar cáncer de mama con una tasa de incidencia estandarizada por edad en de 44,1 por 100,000 mujeres. A pesar de que en el país se recomienda la tamización mediante mamografía, en mujeres de 50 a 69 años de edad y examen clínico de mama anual así como detección temprana para mujeres sintomáticas independientemente de la edad, en Colombia no se no se ha podido reducir la mortalidad por esta causa. Múltiples causas parecen explicar este problema: baja participación en las actividades de tamización con mamografía por parte de la población objeto, baja calidad de la mamografía, y barreras de acceso para el diagnóstico oportuno y el tratamiento integral. Frente a esta problemática el 03 de octubre fue aprobado en primer debate el proyecto de ley No 259 de 2019 Cámara Proyecto de Ley “Por medio de la cual se establecen medidas para la prevención, diagnóstico, tratamiento oportuno, rehabilitación, y cuidados paliativos del cáncer de mama y se dictan otras disposiciones”. A fin de revisar el soporte científico del contenido del proyecto de ley y aportar a su adecuada discusión, el Instituto Nacional de Cancerología INC realizó un foro el día 9 de diciembre del 2019. El propósito de este artículo es presentar el análisis de los puntos de mayor controversia desde una perspectiva científica, como base para la adecuada toma de decisiones en materia de políticas de salud pública.

Results of a prospective phase II national study: Prophylactic radical fimbriectomy (NCT01608074), in women with a documented high risk of breast/ovarian cancer—Final pathological results and outcomes.

1594 Background: Risk-reducing salpingo-oophorectomy (RRSO) is the gold standard in surgical prophylaxis of pelvic high-grade serous carcinoma (HGSC) for women at risk of breast/ovarian cancer. Due to significant adverse effects of early oophorectomy, 20-30% of women delay or deny performing this operation. Recent data highlight the fallopian origin of most pelvic HGSC, especially its fimbrial part. Thus, we suggested a new two-step risk-reducing procedure: the radical fimbriectomy (RF) with delayed oophorectomy (DO) (Leblanc et al Gyn Oncol 2011), leading to the current RF/DO Phase 2 study. We present the definitive results on primary and secondary objectives of this trial. Methods: BRCA1/2 carriers or any women with a documented familial risk of breast/ovarian cancer were first counseled to perform a classical laparoscopic RRSO. If they denied, they were offered to enter the RF/DO study. All specimens were submitted to the SEE-FIM pathological protocol. Pathological data along with all intra- and 30-day and beyond post-operative adverse events were prospectively recorded. Follow-up consisted in an annual clinical breast and gynecological examination, with tumor markers and hormonal status assessment. Primary endpoint was the rate of pelvic serous carcinoma. Secondary endpoints were procedure morbidity, rates of tubal abnormalities, breast cancer, secondary oophorectomy. Results: From January 2012 to October 2014, 121 RF were performed: 120 by laparoscopy, 1 laparotomy (concurrent myomectomy). An occult neoplasia was found in 3 cases with 1 invasive HGSC. Intraoperative complications were two grade1 bleedings without transfusion with no grade ≥3 early post-operative or delayed complication. With a median follow-up of 5.3 years (0.2 -7.6), no patient developed any pelvic HGSC, 21 patients developed a breast cancer (3 de novo, 18 recurrences/contralateral.). 1 cancer-free BRCA1-mutated lady delivered safe twins, after an uneventful post-RF pregnancy obtained with assisted reproductive technology (ART). Overall, 29 women underwent DO (by choice: 12 or menopause: 17) resulting in grade 3b complication in 1 case, but no pathological abnormality. Conclusions: RF/DO appears as a safe, well tolerated and effective procedure in terms of occult neoplasia detection. A successful pregnancy with ART was possible after radical fimbriectomy. Longer follow-up and larger cohort are necessary to confirm its efficacy in terms of ovarian cancer prophylaxis. Clinical trial information: NCT01608074.

MRI versus mammography for breast cancer screening in women with familial risk (FaMRIsc): a multicentre, randomised, controlled trial.

Approximately 15% of all breast cancers occur in women with a family history of breast cancer, but for whom no causative hereditary gene mutation has been found. Screening guidelines for women with familial risk of breast cancer differ between countries. We did a randomised controlled trial (FaMRIsc) to compare MRI screening with mammography in women with familial risk. In this multicentre, randomised, controlled trial done in 12 hospitals in the Netherlands, women were eligible to participate if they were aged 30-55 years and had a cumulative lifetime breast cancer risk of at least 20% because of a familial predisposition, but were BRCA1, BRCA2, and TP53 wild-type. Participants who were breast-feeding, pregnant, had a previous breast cancer screen, or had a previous a diagnosis of ductal carcinoma in situ were eligible, but those with a previously diagnosed invasive carcinoma were excluded. Participants were randomly allocated (1:1) to receive either annual MRI and clinical breast examination plus biennial mammography (MRI group) or annual mammography and clinical breast examination (mammography group). Randomisation was done via a web-based system and stratified by centre. Women who did not provide consent for randomisation could give consent for registration if they followed either the mammography group protocol or the MRI group protocol in a joint decision with their physician. Results from the registration group were only used in the analyses stratified by breast density. Primary outcomes were number, size, and nodal status of detected breast cancers. Analyses were done by intention to treat. This trial is registered with the Netherlands Trial Register, number NL2661. Between Jan 1, 2011, and Dec 31, 2017, 1355 women provided consent for randomisation and 231 for registration. 675 of 1355 women were randomly allocated to the MRI group and 680 to the mammography group. 218 of 231 women opting to be in a registration group were in the mammography registration group and 13 were in the MRI registration group. The mean number of screening rounds per woman was 4·3 (SD 1·76). More breast cancers were detected in the MRI group than in the mammography group (40 vs 15; p=0·0017). Invasive cancers (24 in the MRI group and eight in the mammography group) were smaller in the MRI group than in the mammography group (median size 9 mm [5-14] vs 17 mm [13-22]; p=0·010) and less frequently node positive (four [17%] of 24 vs five [63%] of eight; p=0·023). Tumour stages of the cancers detected at incident rounds were significantly earlier in the MRI group (12 [48%] of 25 in the MRI group vs one [7%] of 15 in the mammography group were stage T1a and T1b cancers; one (4%) of 25 in the MRI group and two (13%) of 15 in the mammography group were stage T2 or higher; p=0·035) and node-positive tumours were less frequent (two [11%] of 18 in the MRI group vs five [63%] of eight in the mammography group; p=0·014). All seven tumours stage T2 or higher were in the two highest breast density categories (breast imaging reporting and data system categories C and D; p=0·0077) One patient died from breast cancer during follow-up (mammography registration group). MRI screening detected cancers at an earlier stage than mammography. The lower number of late-stage cancers identified in incident rounds might reduce the use of adjuvant chemotherapy and decrease breast cancer-related mortality. However, the advantages of the MRI screening approach might be at the cost of more false-positive results, especially at high breast density. Dutch Government ZonMw, Dutch Cancer Society, A Sister's Hope, Pink Ribbon, Stichting Coolsingel, J&T Rijke Stichting.

Underdiagnosis is the main challenge in breast cancer screening.

In The Lancet Oncology, Sepideh Saadatmand and colleagues1 present the results of a multicentre, randomised, controlled trial that compared the performance of MRI plus mammography with that of mammography alone for breast cancer screening in women aged 30–55 years with familial risk of breast cancer, but without a documented mutation in a breast cancer susceptibility gene. Participants were randomly allocated to receive either annual MRI and clinical breast examination plus biennial mammography (MRI group) or annual mammography and clinical breast examination (mammography group).

Breast Cancer Perceptions and Screening Behaviours Among Korean Women in Australia.

Little is known about breast cancer screening behaviours among immigrant-Korean women in Australia. This study reported breast cancer screening status and whether demographic factors and cultural beliefs associated with their screening behaviours. A convenience sample of 258 Korean-Australian women completed the Korean version of the Breast Cancer Screening Beliefs Questionnaire. Only 16.9% paid special attention to their breasts monthly whereas 31.4% and 54.5% attended annual clinical breast examination and biannual mammograms respectively. Employment status and the length of stay in Australia are significant factors that affect women's breast cancer screening behaviour. Women who engaged in regular breast awareness and clinical breast examination had significantly higher scores on Knowledge of breast cancer subscale, whereas, those who attended mammography has significantly higher scores on Attitudes toward health check-ups. The research highlights that certain cultural and attitudinal issues are detrimental factors for breast cancer screening behaviour among Korean-Australian women.

Prevalence and sociodemographic correlates of routine breast cancer screening practices among migrant‐Australian women

Objective:To evaluate breast cancer screening (BCS) practice and explore the relationship between sociodemographic factors and breast awareness (BA), clinical breast examination (CBE) and mammography in migrant‐Australian women. Method:Secondary analysis was performed on the pooled sample (n=1,744) from five cross‐sectional studies of BCS rates among immigrant‐Australian women, and the associated sociodemographic factors. Results:Only 19% of women participated in routine BA, 27.4% of women in the target group of >40 year presented for an annual CBE, and 60.6% of women in the target group of 50–74 years received a biennial mammogram. Associated sociodemographic factors differed by modality except for length of Australian residency. In multivariable analysis, age, length of Australian residency, marital status, and employment status accounted for more than 50% of the variance in regular BA and CBE. Conclusion:These findings indicate suboptimal BCS rates persist among migrant‐Australian women, and suggest the importance of certain sociodemographic factors in BCS practice. Implications for public health:Further education is required for BA and CBE practice in immigrant‐Australian women, especially for those who have resided in Australia less than 12 years without a partner.

Patterns and determinants of receipt of follow-up mammography and/or clinical examination in a cohort of Italian breast cancer survivors.

Information regarding the use of mammography by breast cancer survivors is limited. This study aimed at evaluating the compliance to surveillance mammography and/or clinical breast examination and the associated factors among patients living in northern Italy. A cancer registry-based cohort of 1304 patients living in the Health Care District of Forlì was followed up for 10years. Eighty percent of patients had a mammogram and/or clinical breast examination during the first year after treatment. The proportion decreased to 67% at 10years of follow-up. Three demographic characteristics were independently associated with lower odds of having an annual mammogram and/or clinical breast examination: age at diagnosis [odds ratio (OR) 0.51, 95% confidence interval (CI) 0.41-0.63 for patients aged 65-74years; and OR 0.14, 95% CI 0.11-0.18, for patients ≥75years versus patients aged <64year]; socio-economic status (OR 0.81, 95% CI 0.65-1.00, for deprived patients versus patients of the reference class); and hospital travel time greater than 30min (OR 0.44, 95% CI 0.29-0.68 versus ≤15min). With respect to clinical and disease characteristics, lower odds were observed for patients treated with mastectomy (OR 0.79, 95% CI 0.65-0.97), for patients diagnosed with in situ breast cancer (OR 0.68, 95% CI 0.46-0.99)as well as with stage II+breast cancer (OR 0.77, 95% CI 0.63-0.94), and for patients with ≥3 Elixhauser comorbidities (OR 0.43, 95% CI 0.26-0.71). Adherence to follow-up declined over time. Knowledge of associated factors may assist in improving access to care for breast cancer survivors.

Population-Based Breast Cancer Screening With Risk-Based and Universal Mammography Screening Compared With Clinical Breast Examination: A Propensity Score Analysis of 1 429 890 Taiwanese Women.

Different screening strategies for breast cancer are available but have not been researched in quantitative detail. To assess the benefits and the harms of risk-based and universal mammography screening in comparison with annual clinical breast examination (CBE). Population-based cohort study comparing incidences of stage II+ disease and death from breast cancer across 3 breast cancer screening strategies, with adjustment for a propensity score for participation based on risk factors for breast cancer and comparing the 3 strategies for overdetection between January 1999 and December 2009. Asymptomatic women attending outreach screening in the community or undergoing mammography in hospitals were enrolled in the 3 screening programs. Risk-based biennial mammography, universal biennial mammography, and annual CBE. Detection rates, stage II+ disease incidence, mortality from breast cancer, and overdiagnosis were compared using a time-dependent Cox proportional hazards regression model. A total of 1 429 890 asymptomatic women attending outreach screening in the community or undergoing mammography in hospitals were enrolled in the 3 screening programs. Detection rates (prevalent screen and subsequent screens per 1000) were the highest for universal biennial mammography (4.86 and 2.98, respectively), followed by risk-based mammography (2.80 and 2.77, respectively), and lowest for annual CBE (0.97 and 0.70, respectively). Universal biennial mammography screening, compared with annual CBE, was associated with a 41% mortality reduction (risk ratio, 0.59; 95% CI, 0.48-0.73) and a 30% reduction of stage II+ breast cancer (RR, 0.70; 95% CI, 0.66-0.74). Risk-based mammography screening was associated with an 8% reduction of stage II+ breast cancer (RR, 0.92; 95% CI, 0.86-0.99) but was not associated with a statistically significant mortality reduction (risk ratio [RR], 0.86; 95% CI, 0.73-1.02). Estimates of overdiagnosis were no different from CBE for risk-based screening and 13% higher than CBE for universal mammography. Compared with population-based screening for breast cancer with annual CBE, universal biennial mammography resulted in a substantial reduction in breast cancer deaths, whereas risk-based biennial mammography resulted in only a modest benefit. Compared with annual CBE, risk-based and universal mammography screening did not result in significant overdiagnosis of breast cancer.

Health Beliefs and Breast Cancer Screening Behavior among a Group of Female Health Professionals in Turkey.

The purpose of this study was to identify the health beliefs and breast cancer (BC) screening behavior of a group of female health professionals (FHPs) [physicians, nurses and midwives] in Turkey. This descriptive study was conducted at primary and secondary level healthcare institutions in Central Anatolia, Turkey. The study group included 720 FHPs. Data was collected by a questionnaire and the Turkish version of Champion's Health Belief Model Scales (CHBMS). The mean age of the FHPs was 30.2 years (±6.12 range; 20-50), 8.9 % of them were ≥40 years. The majority (93.9%) of FHPs did not have annual mammography (MMG) or clinical breast examination (CBE) (95.1%); and 42.9% reported to perform breast self-examinations (BSE). None of the physicians reported having a CBE or MMG. The physicians' perception of susceptibility, severity and barriers to screening was lower than the nurses and midwives; however, their perception of benefits, self-efficacy and health motivation was higher. The perception of benefit among nurses, and self-efficacy and perception of health motivation among midwives were lower than those of the physicians. The perception of barriers to screening was highest among nurses. The compliance rate with early detection practices for BC screening was low among FHPs. Health beliefs influenced their behavior on BC screening.

Do Primary Care Physician Perform Clinical Breast Exams Prior to Ordering a Mammogram?

Both the American Cancer Society and National Comprehensive Cancer Network recommend annual clinical breast examination (CBE) along with screening mammogram (SM) for patients starting at 40 years of age. However, patients with a palpable breast mass should have a diagnostic mammogram (DM) during workup. Review at our institution demonstrated that 11% of patients with newly diagnosed breast cancer and self-identified breast mass had SM instead of DM. This led us to question whether primary care physicians (PCP) perform CBE prior to ordering mammography. As part of the routine preimaging screening, patients were asked if they had undergone breast examination by a medical provider prior to mammogram order. Data on mammogram type, ordering physician specialty, and presence of symptoms on day of mammogram were recorded. Of 6,109 mammograms, 4,823 were ordered by PCPs. CBE was performed prior to 67.2% SM and 64.8% DM (p = 0.12). OB/GYN performed statistically significantly higher CBE (81.6%) compared to internal (45.4%) and family (50.5%) medicine physicians (p < 0.001). Of patients with self-reported breast symptoms, 8.7% had SM ordered rather than DM. Despite recommendations, approximately 1/3 of women report not having CBE prior to mammogram. The chances of having a CBE varied significantly by PCP specialty. Lack of CBE can lead to incorrect type of mammogram, with possibly increased cost and delay in diagnosis. Further evaluation is needed to understand why CBE was not performed in some patients.

Breast cancer knowledge, attitudes and screening behaviors among Indian–Australian women

Purpose of researchThe aims of the study were to report breast cancer screening practices among Indian–Australian women and to examine the relationship between demographic characteristics, cultural beliefs and women's breast cancer screening (BCS) behaviors. MethodA descriptive and cross-sectional method was used. Two hundred and forty two Indian–Australian women were recruited from several Indian organizations. English versions of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ) were administered. The main research variables are BCS practices, demographic characteristics and total scores on each of the BCSBQ subscales. ResultThe majority of participants (72.7%–81.4%) had heard of breast awareness, clinical breast examination (CBE) and mammograms. Only 28.9% performed a BSE monthly and although 60% had practiced CBE, only 27.3% of women within the targeted age group had annual CBE. Only 23.6% of women within the targeted age group reported they had a mammogram biennial. Marital status and length of stay in Australia were positively associated with women's screening behaviors. In terms of BCSBQ score, women who had the three screening practices regularly as recommended obtained significantly higher scores on the “attitude towards general health check-ups” and “barriers to mammographic screening” subscales. There was a significant difference in the mean score of the “knowledge and perceptions about breast cancer” between women who did and who did not engage in breast awareness. ConclusionsOur study reveals that attitudes toward health check-ups and perceived barriers to mammographic screening were influential in determining compliance with breast cancer screening practices among Indian–Australian women.

Self-detection and clinical breast examination: Comparison of the two “classical” physical examination methods for the diagnosis of breast cancer

This is the first comprehensive analysis comparing specific aspects of tumor detection between the two “traditional” breast cancer detection methods self-detection (SD) and clinical breast examination (CBE).a) Which method is better in detecting smaller tumors? Both methods showed similar mean tumor diameters (SD: 22.1 mm vs. CBE: 21.9 mm; p = 0.991).b) Different frequency distributions of tumor locations would indicate that certain locations in the breast are more difficult to palpate: comparison of both methods showed comparable results (p = 0.835).c) General differences in tumor sizes with regard to certain locations would be of importance because the patients and/or the physicians could be educated to pay particular attention to certain locations during physical examination, where larger tumors tend to be found: tumors located in the central region were with 25.0 mm significantly larger than those in the peripheral regions of the breast (superior: 21.6 mm, p = 0.001; inferior: 21.6 mm, p = 0.015; lateral: 21.9 mm, p = 0.002; medial (20.9 mm, p = 0.001). Tumor sizes within the four peripheral regions did not differ significantly.d) Patients whose tumors were found by CBE were older than those whose tumors were found by SD (67 years vs. 60 years, p < 0.001). Conclusion: annual CBE should be an integral part of general medical care in older women.

Access to early breast cancer diagnosis in the Brazilian Unified National Health System: an analysis of data from the Health Information System

The recent reduction in breast cancer mortality in high-income countries resulted from improvements in early detection and treatment. Breast cancer is the most common cancer in Brazilian women. Since 2004, the government has recommended annual clinical breast examination for women aged ≥ 40 years and biannual mammograms for those aged 50-69. This article investigates the degree of implementation of these guidelines using data from the Brazilian Unified National Health System for 2010 according to major geographic region and age group. The findings showed low national mammogram coverage in the target population (32% in the 50-59-year group; 25% from 60 to 69 years). The percentage of women with abnormal radiological findings who underwent biopsy was also low (27% for 50-59 years; 63% for 60-69 years). The number of breast cancer surgeries exceeded the number of cases detected by mammography but was well below the estimated number of incident breast cancer cases in 2010. There are striking regional inequalities in access to early detection and surgery, being the lowest access in the North Region and the highest in the South Region.

Preventive care and evaluation of the adolescent with a breast mass.

Adolescents have little knowledge of preventive breast care or breast screening, yet exposures in youth influence the risk of future breast disease.Nipple piercing increases the risk of trauma and breast infection. Alcohol consumption, smoking, nutrition, obesity, reproductive factors, previous cancer and chest radiotherapy, family history of breast cancer or genetic mutation increase the risk of breast cancer. Breast cancer is rare in adolescents and currently genetic testing is not recommended in those under 18 years, as medical surveillance is not usually recommended until around 25 years. Screening measures include clinical breast exam every 1 to 3 years, and breast self-awareness in healthy women from 20 years; and at least annual breast self examination, with annual clinical breast examination, mammography and magnetic resonance imaging in high-risk patients from 25 years. Breast ultrasound is used in diagnostic evaluation of breast masses in adolescents as mammography is less sensitive in young women.

Surveillance of women at increased risk of breast cancer using mammography and clinical breast examination: Further evidence of benefit

Women with a significant family history of breast cancer are generally offered early surveillance by mammography and often clinical breast examination (CBE). The evidence base for surveillance has been questioned. We reviewed its effectiveness in terms of tumour size, lymph node status and survival in 7,475 women seen over a 22-year period in the Manchester Family History Clinic. We diagnosed 139 invasive and 26 in situ breast cancers. Seventy-six percent of the invasive cancers were screen detected, 65% node negative and 71% <2 cm in diameter at diagnosis. Twenty-one tumours were BRCA1 positive and were significantly more likely to be grade 3, ER/PR negative (p < 0.0001) and have a poorer survival. CBE contributed to 30% of cancer diagnoses and was responsible for discovery of nine mammographically occult tumours. The cost per quality life year was estimated at £13,080 for tumours detected by CBE and not by mammography. We conclude that screening by annual mammography and CBE between age 35-50 years and 18 monthly from 50 to 60 years may diagnose breast cancer in a less advanced state in terms of size and node status compared with symptomatic cancers and, apart from BRCA1 carriers, is likely to contribute to improved long-term outcome compared with no surveillance.