Breast Cancer Screening by Physical Examination: Randomized Trial in the Phillipines

Abstract : Most breast cancer cases in the Philippines present at advanced stages and have a rapid unfavorable outcome. Breast Clinical Examination (CBE) undertaken by health workers appears to be an attractive compromise with a good cost-effectiveness ratio suitable for a country with limited resources. We conducted an intervention study to assess the feasibility and efficacy of screening by CBE in reducing mortality from breast cancer. However, the sensitivity of the screening program in the real context is low. Moreover, despite high compliance with the examination, this intervention failed to improve compliance with clinical investigation. The natural development of the lesson learnt from the screening project is the need to device sustainable programs that can overcome the barriers currently causing the delay of diagnosis and high fatality rates for a disease that is potentially curable even with limited resource. The protocol of a demonstration project that aims to improve access to and quality of breast cancer care within the limits of the local health system is being developed. Key elements of the program include promoting collaboration between the referral cancer center and primary health units. The first will provide expert examiners and appropriate treatment regiments according to agreed guidelines. The second will promote early diagnosis in the resident population and ensure timely liaison with the cancer center. A monitoring system will be set up to measure progress.