Implementation of a clinical breast exam and referral program in a rural district of Pakistan

• Published in: BMC health services research Vol. 24; no. 1; p. 616
• Main Authors: Martins, Russell Seth, Arif, Aiman, Yameen, Sahar, Noordin, Shanila, Masroor, Taleaa, Muhammad, Shah, Channa, Mukhtiar, Soofi, Sajid Bashir, Sattar, Abida K
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.05.2024; BioMed Central; BMC
• Subjects: Adult; Breast cancer; Breast examination; Breast Neoplasms - diagnosis; Breast Neoplasms - diagnostic imaging; Care and treatment; Clinical breast exam; Community outreach program; Diagnosis; Early Detection of Cancer; Evaluation; Female; Health Knowledge, Attitudes, Practice; Healthcare workers; Humans; Industrialized nations; Management; Medical referral; Methods; Middle Aged; Mortality; Outreach services; Pakistan; Physical Examination; Referral and Consultation; Risk factors; Rural health services; Rural Population; Surveys and Questionnaires; Pakistan; United States > US; Karachi Pakistan; Breast cancer; Healthcare workers; Clinical breast exam; Community outreach program
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-024-11051-7

The role of clinical breast examination (CBE) for early detection of breast cancer is extremely important in lower-middle-income countries (LMICs) where access to breast imaging is limited. Our study aimed to describe the outcomes of a community outreach breast education, home CBE and referral program for early recognition of breast abnormalities and improvement of breast cancer awareness in a rural district of Pakistan. Eight health care workers (HCW) and a gynecologist were educated on basic breast cancer knowledge and trained to create breast cancer awareness and conduct CBE in the community. They were then deployed in the Dadu district of Pakistan where they carried out home visits to perform CBE in the community. Breast cancer awareness was assessed in the community using a standardized questionnaire and standard educational intervention was performed. Clinically detectable breast lesions were identified during home CBE and women were referred to the study gynecologist to confirm the presence of clinical abnormalities. Those confirmed to have clinical abnormalities were referred for imaging. Follow-up home visits were carried out to assess reasons for non-compliance in patients who did not follow-through with the gynecologist appointment or prescribed imaging and re-enforce the need for follow-up. Basic breast cancer knowledge of HCWs and study gynecologist improved post-intervention. HCWs conducted home CBE in 8757 women. Of these, 149 were warranted a CBE by a physician (to avoid missing an abnormality), while 20 were found to have a definitive lump by HCWs, all were referred to the study gynecologist (CBE checkpoint). Only 50% (10/20) of those with a suspected lump complied with the referral to the gynecologist, where 90% concordance was found between their CBEs. Follow-up home visits were conducted in 119/169 non-compliant patients. Major reasons for non-compliance were a lack of understanding of the risks and financial constraints. A significant improvement was observed in the community's breast cancer knowledge at the follow-up visits using the standardized post-test. Basic and focused education of HCWs can increase their knowledge and dispel myths. Hand-on structured training can enable HCWs to perform CBE. Community awareness is essential for patient compliance and for early-detection, diagnosis, and treatment.