title: Feasibility Study of Case-Finding for Breast Cancer by Community Health Workers in Rural Bangladesh.
abstract: BACKGROUND
  Mortality from breast cancer is high in low- and middle-income countries, in part because most patients have advanced stage disease when first diagnosed. Case-finding may be one approach to changing this situation.
  
  
  METHODS
  We conducted a pilot study to explore the feasibility of population-based case finding for breast cancer by community health workers (CHWs) using different data collection methods and approaches to management of women found to have breast abnormalities. After training 8 CHWs in breast problem recognition, manual paper data collection and operation of a cell-phone software platform for reporting demographic, history and physical finding information, these CHWs visited 3150 women >age 18 and over they could find--from 2356 households in 8 villages in rural Bangladesh. By 4 random assignments of villages, data were collected manually (Group 1), or with the cell-phone program alone (Group 2) or with management algorithms (Groups 3 and 4), and women adjudged to have a serious breast problem were shown a motivational video (Group 3), or navigated/accompanied to a breast problem center for evaluation (Group 4).
  
  
  RESULTS
  Only three visited women refused evaluation. The manual data acquisition group (1) had missing data in 80% of cases, and took an average of 5 minutes longer to acquire, versus no missing data in the cell phone-reporting groups (2,3 and 4). One woman was identified with stage III breast cancer, and was appropriately treated.
  
  
  CONCLUSIONS
  Among very poor rural Bangladeshi women, there was very limited reluctance to undergo breast evaluation. The estimated rarity of clinical breast cancer is supported by these population-based findings. The feasibility and efficient use of mobile technology in this setting is supported. Successor studies may most appropriately be trials focusing on improving the suggested benefits of motivation and navigation, on increasing the numbers of cases found, and on stage of disease at diagnosis as the primary endpoint.
authors.affiliation: Dhaka, Bangladesh E-mail : richardibcrf@gmail.com.
authors.forename: Touhidul Imran
authors.initials: TI
authors.lastname: Chowdhury
authors.forename: Richard Reed
authors.initials: RR
authors.lastname: Love
authors.forename: Mohammad Touhidul Imran
authors.initials: MT
authors.lastname: Chowdhury
authors.forename: Abu Saeem
authors.initials: AS
authors.lastname: Artif
authors.forename: Hasib
authors.initials: H
authors.lastname: Ahsan
authors.forename: Anwarul
authors.initials: A
authors.lastname: Mamun
authors.forename: Tahmina
authors.initials: T
authors.lastname: Khanam
authors.forename: James
authors.initials: J
authors.lastname: Woods
authors.forename: Reza
authors.initials: R
authors.lastname: Salim
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D001943:Breast Neoplasms / Q000175:diagnosis*; D040421:Cell Phone; D003150:Community Health Workers; D003625:Data Collection; D003906:Developing Countries / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D012424:Rural Population / Q000706:statistics & numerical data*; D055815:Young Adult