Breast cancer screening
in the community of Santos Suárez

Marianela Prendes Labrada M.D., Verónica C. Soler Fonseca M.D. and
William Morales Cáceres M.D.2

ABSTRACT:   Three family doctor offices associated with the Santo Suárez polyclinic were selected for a 1996 descriptive study aimed at determining the incidence of breast cancer and the use of early detection methods. Six hundred randomly chosen women over 20 years of age, were included in the sample.  They were routinely screened for breast cancer and asked to respond to a survey. The breast cancer incidence rate was 3%.   22.5% of  the women sampled were classified as subjects at high risk for breast cancer and 83.3% of those in whom breast cancer was detected were high risk women over the age of 50.  58.2% of the women knew nothing about breast self-examination and 64% never practiced it.   45.1% had never had their breasts examined by a physician.

Breast cancer has had a devastating impact on  the world's female population for decades1,2. In the USA, one of every nine women develops breast cancer. Its incidence has increased 3% yearly since 1980; in 1991 140,000 cases were diagnosed3.

In Cuba, this is the primary cause of death from malignant neoplasms for women, and 1,600 new cases are diagnosed every year--unfortunately most of them in advanced stages.

Breast cancer prevention programs have not been as successful as ex-pected.  Thus, early diagnosis is still the only sure way to reduce the impact of the disease.

In Cuba, the National Breast Cancer Program includes the three diagnostic methods used most often throughout the world:  clinical examination of the breast,  self-examination and  mammography4.

Family doctors  play an important role in the implementation of the  National Cancer Pro-gram, but in fact implementation has not been completely effective due to a number of difficulties including inadequacies in the area of breast self-examination education and promotion, in the practice of  periodic clinical breast exams;  and in systematic screen-ing of the high-risk female population.   These issues have affected the key role of the primary health care team in reducing cancer mortality, as well as reducing the potential for support and participation of community organizations in early detection programs.

The purpose of this study is  to determine the incidence of breast malignancies and to analyze the use of early detection methods.

Methods

Three family doctor offices from the Santos Suárez Polyclinic in Havana were selected as sites for a one- year descriptive study beginning in February 1995.

The sample included 600 randomly chosen women over 20 years of age (from a total number of 1,162 women who receive medical attention at the three offices) who were screened for malignant breast disorders through physical examination. The women were also surveyed to assess awareness and practice of breast self-examination and to determine the presence of risk factors for breast cancer; which were then classified as high- or low-risk factors.

The survey form developed by the National Screening Program for Breast Cancer was used to determine risk categories, and the researchers evaluated the participants' degree and application of knowledge of breast self-examination technique.

Later, participants were given a thorough clinical breast examination.  Women with abnormalities were referred to a specialist in Gynecology and Obstetrics, and studied completely by ultrasonography, mammography and/or biopsy, on a case-by-case basis. These patients were followed closely through final diagnosis.

The information was processed using percentage analysis.

Results

Table 1 shows that the breast disorders most frequently found were: dysplasia, single nodule or lump and fibroadenoma. The incidence rate breast cancer in all the women screened was 3%, with those over 50 being the most frequently affected.

Table 1. Incidence of breast disorders.

Concerning the use of early detection methods, we found that a majority of the women did not know about or practice breast self-examination (58.2% and 64%, respectively).  Of these, most were concentrated in the 40-49 year age group (87.6%) and the over-50 group (83.8%), those with the higher levels of risk for developing breast cancer (Table 4).

Table 4.  Awareness and practice of breast self-examination.

Discussion

Results in terms of incidence of benign and malignant breast disorders were as expected, with a predominance of benign disorders requiring treatment and follow-up.

As far as the incidence of breast cancer is concerned, our findings correspond to those reported in the medical literature reviewed5,6 which stresses the increasing possibility of developing a breast cancer after the age of 40, with an incidence of 3-4% approximately. This fact indi-cates the need and possibility of population screening in order to apply human and mate-rial resources to the most vulnerable groups and thus reduce the cancer mortality rate.

The fact that malignant breast neoplasm was most frequently found among the high-risk women is logical, particularly considering that most of the women belonging to this category were those over 40. The more advanced age, the greater the possibility of adding other risk factors7.

Nevertheless,  the fact that significant numbers of women are classified as low-risk should not suggest that they  cannot develop cancer.  In fact, in our study 16.6% of these subjects developed  breast cancer.

If cancer detection programs are to be successful, women must understand the impor-tance of early diagnosis in breast cancer, and also its impact on therapy and long-term survival, including the importance of regular breast self-examination and clinical breast examination by their physician.

It is universally recognized that prevention, early detection and maintenance of good health are key to the reduction of health care expenses.  In addition, early detection and treatment  can significantly  reduce the loss of productivity and  years of life8.

In our study, an important number of women were not aware of breast self-examina-tion methods, a finding which matches those reported by other authors9-11. Furthermore, among those who do practice breast self-examination, most do so incorrectly, greatly reducing their chances for early diagnosis.  This situation is exacerbated by  the fact that most family doctors are not doing clinical breast exams as established by official standards of  practice.

Cancer screening programs using  mammography are expensive and in Cuba can only cover the high-risk population, making it all the more important for family doctors and all health care professionals to promote breast self-examination, the practice of which has been shown to increase significantly after only a few educational sessions performed by  qualified personnel12.

Periodic clinical breast examinations by the family doctor should also be incorporated as a part of  routine care to further ensure early diagnosis of breast cancer13.

The results of this study demonstrate that the incidence of breast cancer is 3%; that most women do not know or practice breast self-examination; and that many have never been given a breast examination by a physician.

We recommend increasing education, promotion and practice of  breast cancer early detection methods.

References

1.Hernández ML, Díaz V. Valoración del conocimiento sobre el autoexamen mamario en sectores del médico de la familia.  Rev Cubana Med Gen Integr 1993;9(1):28-35.

2.Prabhanathi G, Nama MD. ¿Cómo examinar sus senos?.  Briddone Press, 1992:4.

3.Duckers P, Ricci AD. Disease of the breast.  Comit Current Therapy 36th. Philadelphia: Wonders, 1992:994-1003.

4.Miller AB.   The rate of screening in the fight against breast cancer.  World Health Forum 1992;12(4):277-85.

5.Bouch ML.  Cáncer mamario.  Rev Cubana Med Gen Integr 1992;8(1):4-5.

6.Fernández L, Molina A, Bouch ML, Camacho R.  El médico de la familia y su equipo en el diagnóstico precoz del cáncer de mama.  Rev Cubana Med Gen Integr 1994;10(3):225-9.

7.Moral Re del. Supervivencia global y supervivencia libre de enfermedad en el cáncer de mama.  Factores de influencia.  Oncología 1989;12(2):83-84.

8.Heidemann E.   El sistema de asistencia canadiense:  costo y calidad.  Bol Of Sanit Panam 1994;117(5):381-8.

9.Schencke M, Espinoza S, Muñoz N, Messing H. Actitud y conducta frente al autoexamen de mama entre profesionales de salud en Chile.  Bol Of Sanit Panam 1993;114(4):317-25.

10.Wise BP.  El médico de familia y su criterio del cáncer mamario.  Clin Quir Norteam 1984;6:1235-8.

11.Díaz EM, Cordero MA.  Nódulo de mama.  Papel del médico general integral para su detección precoz mediante la enseñanza y el control del autoexamen de mama.  Rev Cubana Med Gen Integr 1991;7(4):328-34.

12.Carter AC.  Methods of motivating the practice of breast self-examination.  A randomized trial.  Prev Med 1985;14(5):555-72.

13.Moreno LF, Pérez IM.  Tratamiento del cáncer de mama.  INOR 1985:4-10.

This article originally appeared in Spanish in the Revista Cubana de Medicina General Integral, Vol. 14, No. 2, (pp. 165-70), March - April, 1998.

 

Copyright (c) 1999, MEDICC - Medical Education Cooperation with Cuba