Background
Implementation of population-based, organised mammography screening is not always feasible in low- and middle- income countries (LMICs) due to high costs, lack of infrastructure, resources and trained personnel. However, increasing awareness of the early signs and symptoms of breast cancer, and screening by clinical breast examination (CBE) linked with treatment, are alternative options with the potential to reduce breast cancer mortality in these settings. 

Clinical Breast Examination (CBE) Trial
The International Agency for Research on Cancer (IARC), in collaboration with the Regional Cancer centre (RCC) in Trivandrum district, India, undertook a trial to evaluate whether rounds of triennial clinical breast examination (CBE) provided by health workers can reduce the incidence of advanced breast cancer and mortality.

A total of 115,652 healthy women were randomly assigned to one of two groups in which they received either CBE screening or the usual  existing care. Women with abnormal CBE results were referred for further examination to confirm or exclude breast cancer, and those with confirmed breast cancer received appropriate treatment.

Impact
Of the 50,366 women receiving the first round of CBE, 30 breast cancers were detected among 2880 CBE-positive women (5.7%). Comparison between the cases of breast cancer diagnosed in the intervention and control groups showed a significant decrease in tumour stage and size at diagnosis and a non-significant decrease in axillary lymph node involvement. In addition, the study found a significant increase in breast conservation surgery in the intervention group.

Conclusion
Given these encouraging results, it is anticipated that further down-staging (detecting breast cancer at an earlier stage) and reductions in advanced disease and mortality will be observed as the study progresses and the remaining two rounds of screening are completed. This study may provide much needed evidence on the effectiveness of alternative methods for breast cancer screening that can be implemented in low resource settings.

Provided by the International Agency for Research on Cancer