Impact of Community-Based Clinical Breast Examinations in Botswana

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Impact of Community-Based Clinical Breast Examinations in Botswana


JournalJCO Global Oncology
Article typeJournal research article – Clinical research
Publication date – Jan – 2021
Authors – Michael Dykstra, Brighid Malone, Onica Lekuntwane, Jason Efstathiou, Virginia Letsatsi, Shekinah Elmore, Cesar Castro, Neo Tapela, and Scott Dryden-Peterson
KeywordsBreast Cancer, clinical breast examination (CBE), diagnosis
Open access – Yes
SpecialityGeneral surgery, Obstetrics and Gynaecology, Surgical oncology
World region Southern Africa
Country: Botswana
Language – English
Submitted to the One Surgery Index on January 17, 2021 at 7:28 am
Abstract:

PURPOSE
We evaluated a clinical breast examination (CBE) screening program to determine the prevalence of breast abnormalities, number examined per cancer diagnosis, and clinical resources required for these diagnoses in a middle-income African setting.

METHODS
We performed a retrospective review of a CBE screening program (2015-2018) by Journey of Hope Botswana, a Botswana-based nongovernmental organization (NGO). Symptomatic and asymptomatic women were invited to attend. Screening events were held in communities throughout rural and periurban Botswana, with CBEs performed by volunteer nurses. Individuals who screened positive were referred to a private tertiary facility and were followed by the NGO. Data were obtained from NGO records.

RESULTS
Of 6,120 screened women (50 men excluded), 452 (7.4%) presented with a symptom and 357 (5.83%) were referred for further evaluation; 257 ultrasounds, 100 fine-needle aspirations (FNAs), 58 mammograms, and 31 biopsies were performed. In total, 6,031 were exonerated from cancer, 78 were lost to follow-up (67 for ≤ 50 years and 11 for > 50 years), and 11 were diagnosed with cancer (five for 41-50 years and six for > 50 years, 10 presented with symptoms). Overall breast cancer prevalence was calculated to be 18/10,000 (95% CI, 8 to 29/10,000). The number of women examined per breast cancer diagnosis was 237 (95% CI, 126 to 1910) for women of age 41-50 years and 196 (95% CI, 109 to 977) for women of age > 50 years. Median time to diagnosis for all women was 17.5 [1 to 32.5] days. CBE-detected tumors were not different than tumors presenting through standard care.

CONCLUSION
In a previously unscreened population, yield from community-based CBE screening was high, particularly among symptomatic women, and required modest diagnostic resources. This strategy has potential to reduce breast cancer mortality.

OSI Number – 20875

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