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Brief Report
May 25, 2017

Association of Previous Clinical Breast Examination With Reduced Delays and Earlier-Stage Breast Cancer Diagnosis Among Women in Peru

Author Affiliations
  • 1Department of Global Health, University of Washington, Seattle
  • 2Department of Surgery, Mount Sinai Hospital, New York, New York
  • 3Department of Anthropology, University of Washington, Seattle
  • 4Department of Medicine, University of Washington, Seattle
  • 5Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
  • 6Department of Surgery, Instituto Regional de Enfermedades Neoplásicas del Norte, Trujillo, Peru
  • 7Department of Epidemiology and Statistics, Instituto Regional de Enfermedades Neoplásicas del Norte, Trujillo, Peru
  • 8Department of Surgery, University of Washington, Seattle
  • 9Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
JAMA Oncol. Published online May 25, 2017. doi:10.1001/jamaoncol.2017.1023
Key Points

Question  Is previous clinical breast examination associated with earlier presentation of self-detected disease and earlier breast cancer stage at diagnosis?

Findings  In this cross-sectional investigation of 113 women studied at a regional cancer center in Peru, 105 had self-detected breast cancers. Women who underwent previous clinical breast examination were more likely to have shorter delays from symptom development to presentation and be diagnosed with early-stage cancer.

Meaning  In a health care system that relies on women presenting with symptoms of breast cancer, interaction with a health care professional, including clinical breast examination, may improve awareness, reduce delays, and lead to earlier-staged disease at diagnosis.

Abstract

Importance  Mammographic screening is impractical in most of the world where breast cancers are first identified based on clinical signs and symptoms. Clinical breast examination may improve early diagnosis directly by finding breast cancers at earlier stages or indirectly by heightening women’s awareness of breast health concerns.

Objective  To investigate factors that influence time to presentation and stage at diagnosis among patients with breast cancer to determine whether history of previous clinical breast examination is associated with earlier presentation and/or earlier cancer stage at diagnosis.

Design, Setting, and Participants  In this cross-sectional analysis of individual patient interviews using a validated Breast Cancer Delay Questionnaire, 113 (71.1%) of 159 women with breast cancer treated at a federally funded tertiary care referral cancer center in Trujillo, Peru, from February 1 through May 31, 2015, were studied.

Main Outcomes and Measures  Method of breast cancer detection and factors that influence time to and stage at diagnosis.

Results  Of 113 women with diagnosed cancer (mean [SD] age, 54 [10.8] years; age range, 32-82 years), 105 (92.9%) had self-detected disease. Of the 93 women for whom stage was documented, 45 (48.4%) were diagnosed with early-stage disease (American Joint Committee on Cancer [AJCC] stage 0, I, or II), and 48 (51.6%) were diagnosed with late-stage disease (AJCC stage III or IV). Mean (SD) total delay from symptom onset to initiation of treatment was 407 (665) days because of patient (mean [SD], 198 [449] days) and health care system (mean [SD], 241 [556] days) delay. Fifty-two women (46.0%) had a history of clinical breast examination, and 23 (20.4%) had undergone previous mammography. Women who underwent a previous clinical breast examination were more likely to have shorter delays from symptom development to presentation compared with women who had never undergone a previous clinical breast examination (odds ratio, 2.92; 95% CI, 1.30-6.60; P = .01). Women diagnosed with shorter patient delay were more likely to be diagnosed with early-stage disease (AJCC stage 0, I, or II) than those with longer patient delay (31 [58.5%] vs 11 [30.6%], P = .01). Women who underwent a previous clinical breast examination were more likely to be diagnosed with early-stage disease compared with women who had never undergone previous clinical breast examination; this relationship remained significant after controlling for insurance and household income (odds ratio, 2.44; 95% CI, 1.01-5.95; P = .048).

Conclusions and Relevance  In a population in which most breast cancers are self-detected, previous clinical breast examination was associated with shorter patient delay and earlier stage at breast cancer diagnosis. In regions of the world that lack mammographic screening, the routine use of clinical breast examination may provide a resource-appropriate strategy for improving breast cancer early diagnosis.

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