Implementing clinical breast examinations may help with breast cancer diagnosis at an early stage or provide awareness of breast health in low to middle income countries.
The lack of symptoms associated with breast cancer make screenings essential. Though mammograms are used to detect abnormalities in the breast, they are impractical or unavailable in some parts of the world. Therefore, it is important to understand the factors involved in early diagnosis of women from low and middle income countries. Sporadic and opportunistic use of mammographic detection method can contribute to advanced stage diagnosis. For this reason, identification of breast cancer diagnoses in low and middle income countries usually involves the appearance of clinical signs and symptoms. Clinical breast exams by trained health care providers are done to detect changes or abnormalities around the breasts, underarm, and breast bone area, such as lumps. The cancerous growth that results from abnormal cell growth usually starts in the ducts or lobules of the breast, but can travel to other areas in the body and lead to advanced stages of the disease. A study performed at the Instituto Regional de Enfermedades Neoplasicas in northern Peru investigated the likelihood that breast cancers were self-detected, whether previous clinical breast examination was associated with earlier prevention of self-detected disease, and whether early presentation is associated with early cancer stage diagnosis.
This study determined if factors such as, income, marriage, education, age, or health insurance influenced the stage and time of breast cancer diagnosis. In this cross sectional investigation, participants consisted of 113 patients who visited a surgeon and received care from a public hospital in northern Peru for 4 months. The Breast Cancer Delay Questionnaire, which was previously validated in Mexico, was modified for Peru and collected information on demographic characteristics, general breast health knowledge, breast cancer detection methods, initial perception of breast problems, associated symptoms, patient-identified factors that contribute to delays in receipt of medical attention, past use of health care services, diagnosis, and treatment. Breast cancer patients with data on cancer stage were categorized, and those with early stage breast cancer were further grouped based on delay of symptom onset before initiation of treatment; a delay onset of less than 90 days or delay onset greater than 90 days.
Out of the 113 breast cancer cases, 105 were self-detected, 1 was detected by a clinical breast examination, and 7 were initially detected after a mammography screening. Women who initially had a clinical breast examination were more likely to have a shorter patient delay of symptom development and presentation, be married, have a higher income, and have employer or private insurance. These women were also more likely to be diagnosed with early stage breast cancer rather than late stage disease. Of the 113 women diagnosed with breast cancer, 45 had early stage disease, 48 had late stage disease, and 20 of the women did not have a recorded stage. Diagnosis at an earlier stage was associated with being married, having employer or private insurance, and living within 3-hours of the cancer hospital. However, a history of self-breast examinations was not associated with diagnosed stage.
Overall, clinical breast examinations can serve to provide breast health awareness and contribute to cancer down-staging. With self-detection of breast cancer already being of the norm for women from low and middle income countries, routine inclusion of clinical breast examinations can serve to improve breast cancer early diagnosis in places that lack mammographic screening.
Written By: Viola Lanier, Ph. D., M. Sc.