IARC perspectives on the development of a research agenda for early detection and control of breast cancer in developing countries - PowerPoint PPT Presentation

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IARC perspectives on the development of a research agenda for early detection and control of breast cancer in developing countries

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IARC perspectives on the development of a research agenda for early detection and control of breast cancer in developing countries R. Sankaranarayanan MD Head, Early ... – PowerPoint PPT presentation

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Title: IARC perspectives on the development of a research agenda for early detection and control of breast cancer in developing countries


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(No Transcript)
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IARC perspectives on the development of a
research agenda for early detection and control
of breast cancer in developing countries
  • R. Sankaranarayanan MD Head, Early Detection and
    Prevention Section (EDP)Head, Screening Group
    (SCR)

3
Age-standardized incidence rates of breast cancer
in selected populations in each continents,
1998-2002
SOURCE Cancer Incidence in Five Continents, Vol.
IX. IARC Scientific Publications No. 160, Lyon,
IARC. (2007)
Age-standardized rate (World) per 100,000
OCEANIA EUROPE ASIA N. AMERICA S. AMERICA AFRICA
4
IARC perspectives Current status of health
services infrastructure and investments
  • Poorly developed and invested (most countries
    with per capita GNI lt1000 USD no or extremely
    limited diagnostic/treatment services)
  • Moderately developed and invested (Countries with
    per capita GNI 1000-10,000 USD, urban rural
    differences, intracountry variation)

5
5-Year Survival from breast cancer (diagnosed
during 1993-2001)
range 58-90
21,810 cases
range 78-84
9,442
1,329
  • Breast Cancer (ICD-10C50)
  • Highest in Hong Kong SAR
  • Lowest in Gambia
  • Intra-country variation
  • Pronounced in China (urban ? and rural ?) India
    Philippines
  • No difference in South Korea Thailand

3,204
2,169
2,462
298
range 57-65
2,354
range 31-54
11,013
range 40-55
1,714
162
258
61
6
5-year absolute survival for localised and
regional extent of disease among more and less
developed health services Breast cancer
Absolute survival for localized and regional
extent of disease among more and less developed
health services - Breast cancer
Singapore Turkey 14 645 cases Costa Rica,
India, Philippines, Saudi Arabia, Thailand 17
640 cases
7
Modalities for early detection of breast cancer
  • Awareness!
  • Self examination
  • Clinical breast examination (CBE)
  • Ultrasonography
  • Mammography
  • Fine needle aspiration cytology (FNAC)
  • Core biopsy
  • Triple diagnosis

8
Breast awareness
  • Making women aware of normal breast to facilitate
    finding abnormalities at the earliest possibility
  • Breast awareness makes each women to appreciate
    what is normal for them

9
Triple diagnosis
  • The use of diagnostic mammography, diagnostic
    ultrasonography and fine-needle aspiration biopsy
    for diagnosing palpable lumps
  • If any of the three modalities suggests cancer,
    excisional biopsy warranted
  • Excellent sensitivity (99) and specificity (99)
  • Very good potential for early clinical diagnosis
    if linked with awareness programmes
  • Important strategy to improve breast cancer
    control in low-and medium-resourced countries.

10
IARC PERSPECTIVES FOCUSSED RESEARCH PRIORITIES
  • Documentation of the pattern and trends in burden
    of disease, stage distribution and survival in
    several resource poor areas (PBCRs, MRDs,
    improving staging practice, medical records)
  • Impact of awareness, education and
    investments/improvement in health services on
    stage distribution, 2- and 5-year survival,
    mortality
  • Evaluation of the efficacy and cost-effectiveness
    of CBE in reducing breast cancer mortality
  • Identifying factors influencing participation of
    women in early detection, diagnosis, treatment
    and follow-up care

11
IARC PERSPECTIVESEXIT STRATEGIES
  • Strategic placement of the research activity
  • Contribution to capacity building in health
    services
  • Continuity, sustainability of service activities
    depending on the outcome of research
  • Roll out and scaling up

12
IARC PERSPECTIVES LEARNING FROM PAST EXPERIENCES
  • WHO-Russia BSE study
  • IARC-Philippines CBE study
  • Shanghai BSE study
  • Recent successes of IARC oral and cervix cancer
    screening trials
  • Efficient information systems/collaborating
    partners/institutions

13
Objective
Trivandrum Breast Cancer Screening Study (TBCS)
  • To evaluate the extent of stage shift, survival
    improvement and mortality reduction observed
    following the implementation of a package of
    interventions consisting of improving public and
    professional awareness on breast cancer, its
    early clinical diagnosis and prompt treatment and
    offering clinical breast examination (CBE)

14
Aims
Trivandrum Breast Cancer Screening Study (TBCS)
  • Decrease the frequency of advanced (stages IIB,
    III, IV) breast cancers from the current 70 of
    all breast cancer cases to 45 over a period of 7
    years
  • Decrease the incidence rate of advanced (II B
    plus) breast cancers by 30 over a 7-year period
  • Increase 5-year survival of breast cancer
    patients from the current 55 to 80
  • Reduce breast cancer mortality by 20 in the
    intervention group as compared to the control
    group

15
Trivandrum Breast Cancer Screening Study (TBCS)
First round of screening participation and
compliance (2006-2009)
Control Control Intervention Intervention
Number () Number ()
Total eligible women 59,447 55,844
Eligible women interviewed 53,692 (90) 52,011 (93)
Received CBE 50,366 (90)
Women positive on CBE 2,880 (6)
Complied to referral for clinical triage by doctors 1,415 (49)
Negative on CBE and attend referral clinic 394
Not screened and attend referral clinic 57
Referred for diagnostic investigations 986
Complied to diagnostic investigations 872 (88)
In collaboration with RCC, Trivandrum, India
16
Trivandrum Breast Cancer Screening Study (TBCS)
First round of screening Investigation rates
Investigation Number Rate per 1000 Women screened
Mammography 825 14.8
Ultrasonography of the breast 831 14.9
Fine needle aspiration cytology 335 6.0
Excision biopsy 70 1.3
Nipple discharge for cytology 43 0.8
In collaboration with RCC, Trivandrum, India
17
First round of screening intermediate outcome
(2006-2009)
Trivandrum Breast Cancer Screening Study (TBCS)
Control Control Intervention Intervention p-value
Number Number p-value
Breast cancers cases 62 77
Early clinical stage breast cancers (0-IIA) 20 (32.3) 35 (46.1) 0.095
Size of tumor lt2cm 4 (7.3) 14 (20.6) 0.026
Negative clinical node 30 (48.4) 38 (50.0) 0.815
Early pathological stage breast cancers (0-IIA) 18 (35.3) 39 (60.0) 0.008
Negative pathological node 22 (43.1) 39 (60.0) 0.069
ER positive breast cancers 22 (48.9) 27 (45.8) 0.771
Received conservative surgery 3 (4.8) 14 (18.2) 0.011
Deaths 6 (9.7) 3 (3.9) 0.159
In collaboration with RCC, Trivandrum, India
18
Predictability of breast cancer
Trivandrum Breast Cancer Screening Study (TBCS)
Criteria for screen positivity Number Breast cancers diagnosed ()
Breast lump 1,767 31 (1.8)
Others excluding lump 902 1 (0.1)
In collaboration with RCC, Trivandrum, India
19
IARC PERSPECTIVES FOCUSSED RESEARCH INITIATIVES
  • Organization of a three arm cluster randomised
    trial in 2010 for comparative evaluation of
    routine care, focussed breast awareness and CBE
  • Will involve around 400, 000 women and follow-up
    for a minimum of 9 years!
  • Currently the project proposal is being developed
  • Funding will be sought
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