title: Clinical breast examination: preliminary results from a cluster randomized controlled trial in India.
abstract: A cluster randomized controlled trial was initiated in the Trivandrum district (Kerala, India) on January 1, 2006, to evaluate whether three rounds of triennial clinical breast examination (CBE) can reduce the incidence rate of advanced disease incidence and breast cancer mortality. A total of 275 clusters that included 115,652 healthy women, aged 30-69 years, were randomly allocated to intervention (CBE; 133 clusters; 55,844 women) or control (no screening; 142 clusters; 59,808 women) groups. Performance characteristics (sensitivity, specificity, false-positive rate, and positive predictive value) of CBE were evaluated. An intention-to-treat analysis was performed for comparison of incidence rates between the intervention and control groups. Preliminary results for incidence are based on follow-up until May 31, 2009, when the first round of screening was completed. Of the 50,366 women who underwent CBE, 30 breast cancers were detected among 2880 women with suspicious findings in CBE screening that warranted further investigations. Sensitivity, specificity, false-positive rate, and positive predictive value of CBE were 51.7% (95% confidence interval [CI] = 38.2% to 65.0%), 94.3% (95% CI = 94.1% to 94.5%), 5.7% (95% CI = 5.5% to 5.9%), and 1.0% (95% CI = 0.7% to 1.5%), respectively. The age-standardized incidence rates for early-stage (stage IIA or lower) breast cancer were 18.8 and 8.1 per 100,000 women and for advanced-stage (stage IIB or higher) breast cancer were 19.6 and 21.7 per 100,000 women, in the intervention and control groups, respectively.
authors.affiliation: Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France. sankar@iarc.fr
authors.forename: Rengaswamy
authors.initials: R
authors.lastname: Sankaranarayanan
authors.forename: Kunnambath
authors.initials: K
authors.lastname: Ramadas
authors.forename: Somanathan
authors.initials: S
authors.lastname: Thara
authors.forename: Richard
authors.initials: R
authors.lastname: Muwonge
authors.forename: Jem
authors.initials: J
authors.lastname: Prabhakar
authors.forename: Paul
authors.initials: P
authors.lastname: Augustine
authors.forename: Muraleedharan
authors.initials: M
authors.lastname: Venugopal
authors.forename: Gopan
authors.initials: G
authors.lastname: Anju
authors.forename: Beela Sara
authors.initials: BS
authors.lastname: Mathew
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000517:prevention & control*; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D055088:Early Detection of Cancer / Q000379:methods; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D010173:Palpation; D010349:Patient Compliance; D010808:Physical Examination / Q000379:methods* / Q000592:standards; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012680:Sensitivity and Specificity