Early Diagnosis of Breast Cancer in the Absence of Population-Based Mammographic Screening in Asia
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Purpose of Review
Asia is made up of mainly low- and middle-income countries, where the majority of breast cancer presents as late-stage disease where survival is poor even with treatment. We review methods of early diagnosis of breast cancer in countries where population-based mammographic screening is not feasible.
While there is insufficient evidence that breast self-examination and clinical breast examination (CBE) lead to a reduction in breast cancer mortality, recent trials have shown that screening with CBE successfully reduces stage at diagnosis, which may translate to improved breast cancer survival with longer follow-up. CBE may have an educational component whereby women with new breast lumps may seek care earlier.
Overcoming sociocultural barriers to early detection in Asia is important before any early detection programme can be implemented. Public education, together with strengthening existing public health services, is key to earlier diagnosis of breast cancer.
KeywordsBreast cancer Early diagnosis Low- and middle-income countries Asia Mammographic screening
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 1.•• Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray, F. GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr, accessed on 18 Feb 2018. This website is an important soource for worldwide cancer incidence and mortality.
- 2.Stenning-Persivale K, Franco MJS, Cordero-Morales A, Cruzado-Burga J, Poquioma E, Nava ED, et al. The mortality-incidence ratio as an indicator of five-year cancer survival in metropolitan Lima. Ecancermedicalscience. 2018;12:799. https://doi.org/10.3332/ecancer.2018.799.CrossRefPubMedPubMedCentralGoogle Scholar
- 3.•• Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Niksic M et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391(10125):1023-75.. https://doi.org/10.1016/S0140-6736(17)33326-3. Cancer survival in 71 countries
- 7.Leong BD, Chuah JA, Kumar VM, Rohamini S, Siti ZS, Yip CH. Trends of breast cancer treatment in Sabah, Malaysia: a problem with lack of awareness. Singap Med J. 2009;50(8):772–6.Google Scholar
- 9.•• Nelson HD, Pappas M, Cantor A, Griffin J, Daeges M, Humphrey L. Harms of breast cancer screening: systematic review to update the 2009 U.S. preventive services task force recommendation. Ann Intern Med. 2016;164(4):256–67. https://doi.org/10.7326/M15-0970. Latest breast cancer screening guidelines from the USPTF CrossRefPubMedGoogle Scholar
- 11.Burton RC, Bell RJ, Thiagarajah G, Stevenson C. Adjuvant therapy, not mammographic screening, accounts for most of the observed breast cancer specific mortality reductions in Australian women since the national screening program began in 1991. Breast Cancer Res Treat. 2012;131(3):949–55. https://doi.org/10.1007/s10549-011-1794-6.CrossRefPubMedGoogle Scholar
- 12.•• Lauby-Secretan B, Scoccianti C, Loomis D, Benbrahim-Tallaa L, Bouvard V, Bianchini F, et al. Breast-cancer screening—viewpoint of the IARC working group. N Engl J Med. 2015;372(24):2353–8. https://doi.org/10.1056/NEJMsr1504363. Recommendation by IARC on breast cancer screening CrossRefPubMedGoogle Scholar
- 13.Ng EH, Ng FC, Tan PH, Low SC, Chiang G, Tan KP, et al. Results of intermediate measures from a population-based, randomized trial of mammographic screening prevalence and detection of breast carcinoma among Asian women: the Singapore Breast Screening Project. Cancer. 1998;82(8):1521–8.CrossRefPubMedGoogle Scholar
- 18.Kikuchi M, Tsunoda H, Koyama T, Kawakita T, Suzuki K, Yamauchi H, et al. Opportunistic breast cancer screening by mammography in Japan for women in their 40s at our preventive medical center: harm or benefit? Breast Cancer. 2014;21(2):135–9. https://doi.org/10.1007/s12282-012-0367-9.CrossRefPubMedGoogle Scholar
- 23.http://data.un.org/Data.aspx?d=WHO&f=MEASURE_CODE%3AWHS7_143. Accessed 6 May 18.
- 25.•• Mittra I, Mishra GA, Singh S, Aranke S, Notani P, Badwe R, et al. A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening. Int J Cancer. 2010;126(4):976–84. https://doi.org/10.1002/ijc.24840. Results from the clinical breast examination RCT in India PubMedCrossRefGoogle Scholar
- 28.Kardinah D, Anderson BO, Duggan C, Ali IA, Thomas DB. Short report: limited effectiveness of screening mammography in addition to clinical breast examination by trained nurse midwives in rural Jakarta, Indonesia. Int J Cancer. 2014;134(5):1250–5. https://doi.org/10.1002/ijc.28442.CrossRefPubMedGoogle Scholar
- 30.Zulkipli AF, Islam T, Mohd Taib NA, Dahlui M, Bhoo-Pathy N, Al-Sadat N, et al. Use of complementary and alternative medicine among newly diagnosed breast cancer patients in Malaysia: an early report from the MyBCC study. Integr Cancer Ther. 2017;1534735417745248 https://doi.org/10.1177/1534735417745248.
- 31.Mohd Mujar NM, Dahlui M, Emran NA, Abdul Hadi I, Wai YY, Arulanantham S, et al. Complementary and alternative medicine (CAM) use and delays in presentation and diagnosis of breast cancer patients in public hospitals in Malaysia. PLoS One. 2017;12(4):e0176394. https://doi.org/10.1371/journal.pone.0176394.CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Lim JN, Potrata B, Simonella L, Ng CW, Aw TC, Dahlui M, et al. Barriers to early presentation of self-discovered breast cancer in Singapore and Malaysia: a qualitative multicentre study. BMJ Open. 2015;5(12):e009863. https://doi.org/10.1136/bmjopen-2015-009863.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.ACTION Group, Kimman M, Jan S, Yip CH, Thabrany H, Peters SA, et al. Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries. BMC Med. 2015;13:190. https://doi.org/10.1186/s12916-015-0433-1. CrossRefGoogle Scholar
- 37.Kong YC, Bhoo-Pathy N, Subramaniam S, Bhoo-Pathy N, Taib NA, Jamaris S, et al. Advanced stage at presentation remains a major factor contributing to breast cancer survival disparity between public and private hospitals in a middle-income country. Int J Environ Res Public Health. 2017;14(4) https://doi.org/10.3390/ijerph14040427.
- 38.•• Breast cancer in asia the challenge and response A report from The Economist Intelligence Unit. https://www.eiuperspectives.economist.com/sites/default/files/EIU%20Breast%20Cancer%20in%20Asia_Final.pdf. Accessed 6 May 18. A report on the state of breast cancer in Asia.
- 39.• Azenha G, Bass LP, Caleffi M, Smith R, Pretorius L, Durstine A, et al. The role of breast cancer civil society in different resource settings. Breast. 2011;20(Suppl 2):S81–7. https://doi.org/10.1016/j.breast.2011.02.005. The role of civil society in breast cancer control CrossRefPubMedGoogle Scholar
- 42.Controlling cancer The state of national cancer control plans in Asia. A report from the Economist Intelligence Unit 2015. http://perspectives.eiu.com/healthcare/controlling-cancer/white-paper/controlling-cancer?redirect=TRUE Accessed 6 May 18.
- 44.Wong XY, Chong KJ, van Til JA, Wee HL. A qualitative study on Singaporean women’s views towards breast cancer screening and Single Nucleotide Polymorphisms (SNPs) gene testing to guide personalised screening strategies. BMC Cancer. 2017;17(1):776. https://doi.org/10.1186/s12885-017-3781-8. CrossRefPubMedPubMedCentralGoogle Scholar
- 46.Nakamura S, Kwong A, Kim SW, Iau P, Patmasiriwat P, Dofitas R, et al. Current status of the management of hereditary breast and ovarian cancer in Asia: first report by the Asian BRCA consortium. Public Health Genomics. 2016;19(1):53–60. https://doi.org/10.1159/000441714. CrossRefPubMedGoogle Scholar
- 50.Romanoff A, Constant TH, Johnson KM, Guadiamos MC, Vega AMB, Zunt J, et al. Association of previous clinical breast examination with reduced delays and earlier-stage breast cancer diagnosis among women in Peru. JAMA Oncol. 2017;3(11):1563–7. https://doi.org/10.1001/jamaoncol.2017.1023.CrossRefPubMedPubMedCentralGoogle Scholar
- 51.•• Yip CH, Smith RA, Anderson BO, Miller AB, Thomas DB, Ang ES, et al. Guideline implementation for breast healthcare in low- and middle-income countries: early detection resource allocation. Cancer. 2008;113(8 Suppl):2244–56. https://doi.org/10.1002/cncr.23842. Resource stratified guidelines for early detection of breast cancer CrossRefPubMedGoogle Scholar