title: Evaluation of a community-based intervention to enhance breast cancer screening practices in Brazil.
abstract: OBJECTIVE
  The primary aim of this study was to evaluate a programme called 'Touch of Life' (Toque de Vida in Portuguese) proposed to increase breast cancer screening awareness and provide free clinical breast examination (CBE) for asymptomatic women 40-69 years of age.
  
  
  METHODS
  Evaluation of the intervention used a before-and-after quasi-experimental design without control groups. A total of 11,762 women, living in three cities in the State of Mato Grosso do Sul, Brazil, were submitted to breast cancer screening by CBE. The evaluation indicators were participation rate, abnormal call rate, cancer detection rate and rate of advanced-stage breast cancers.
  
  
  RESULTS
  Mean age was 42.6 years. Most women belonged to the 40-69-year age group (56.7%) and had less than 8 years of formal education (60.9%). Mean age at menarche was 12.9 years (+/-1.7). The proportions of parous and nulliparous women were 85.1% and 14.8% respectively. Mean age of first pregnancy was 19.8 years (+/-4.4). Less than one-third (29.3%) of the women had a history of abortion or miscarriage. History of breastfeeding was reported by 79.3% of the women, and 14.4% had used hormone replacement therapy at some time. For women between 40 and 49 years of age, the participation rate was 74.9%. The abnormal call rate for CBE was 10.7%. The main abnormalities found were breast lumps in 630 women (5.4%), thickening in 332 (2.8%) and other suspicious lesions in 316 (2.7%). The breast cancer detection rate was 1.3 per thousand, and only 20.0% of women were diagnosed with advanced-stage disease (stages III and IV).
  
  
  CONCLUSIONS
  The intervention was effective in detecting new cases of breast cancer. A community-wide screening approach based on CBE may be effective to enhance breast cancer detection in vulnerable populations, especially in areas where mammography screening is not available.
authors.affiliation: Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil. lthuler@gmail.com
authors.forename: Luiz Claudio Santos
authors.initials: LC
authors.lastname: Thuler
authors.forename: Hilda Guimaraes
authors.initials: HG
authors.lastname: Freitas