early breast cancer detection through clinical breast examination training for midwives in rural...
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EARLY BREAST CANCER DETECTION
THROUGHCLINICAL BREAST EXAMINATION TRAINING
FOR MIDWIVES
IN
RURAL JAKARTA, INDONESIA
Project Investigator:
Kardinah (Dharmais Cancer Hospital, National Cancer Center/Jakarta Breast HealthFoundation)Sri Indiyastutik (Yappika)
Funded by Breast Health Global Initiative (PRP019)June 2007 March 2009
Presented November 10 2008
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Background
Stage III and IV
Limited Resources
Unawareness among health provider
No cancer program developed yet
Down staged breast cancer?
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How to implement BHGI recommendation ?
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Purpose
Increasing CBEability in midwives
Increasingawareness inhealth provider
Strengthen
referral systemfrom primary careto district hospital
Increasingawareness among
volunteers about-Breast healthaccess incommunity
-Awareness ofearly detection in
breast cancer
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Sub district KOJA JAKARTA UTARA
Location
Population : 592.586 peoplesMale : 308.957 peoplesFemale : 283.626 peoples
Primary health care : 6
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Participation
Kelurahan Rawa Badak Selatan
Kelurahan Tugu Utara
Kelurahan Lagoa
Islamic Center
Kecamatan Koja
Rumah susun Koja
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Project summary
Female healthprovider
Primary health care
Midwives
CBE
Validating with
mammography
Public Participation
Public awareness
Volunteer
Organizing theactivity
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Activities
CBE training formidwives (target30 person)
Half day Short lecture about
breast cancer Practice of CBE
with breastphantom
Hospital tour
Early detectionof breast cancerfor volunteers(target 30
volunteers) Half day Short lecture
about breastcancer
Hospital tour
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Activities on location
Midwives: presentinghow to do breast selfexamination
Practice CBEsupervising byexperienced physician
A midwife - examined50 women withmammography
validation
Organizingpresentation with title:
How to do Breast SelfExamination
(approx. 60 women)
Organizing mobilemammography(Jakarta Breast HealthFoundation) andmobile audiovisual aid(Yappika Life)
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Preliminary result
Midwivestraining:30 person
Midwives activelyperform CBE : 25person
Volunteertraining 15person
Organizing 30presentation
Participants:1072 (CBE only)1179 (CBE andmammography)
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Variable N Percentage
Age 35 yr
> 35 yr
PresentationYesNo
CBEYesNo
QuestionerYes
No
MammographyYesNo
52
1177
12272
116366
1178
51
12290
4.2
95.8
99.80.2
94.65.4
95.9
4.1
1000
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First Menarche 12 yr
> 12 yr
Menopause 50 yr
> 50 yr
First Pregnancy
35 yr> 35 yr
Contraception(Pill) 5 yr
> 5 yr
Contraception(Injection) 5 yr
> 5 yr
339882
332145
108856
246143
268222
27.872.2
69.630.4
88.54.6
63.236.8
54.745.3
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OthersContraceptionImplantSpiral
IUDSterileCondomOthers
History of
GynecologySurgeryYesNo
History of BreastSurgery
YesNo
Family HistoryYesNo
8108
5914
431186
351194
921137
680
3.76.70.73
3.596.5
2.897.2
7.592.5
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Breast Imaging
Breast Imaging Reporting Data System(BIRADS)
BIRADS 1: NORMAL
BIRADS 2: BENIGN
BIRADS 3: SUSPICOUS BENIGN
BIRADS 4: SUSPICIOUS MALIGNANT BIRADS 5 : MALIGNANT
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Variable
CBE Result
NormalAbnormal
MammographyResultNormal
Abnormal
USG DiagnosticYesNo
USG ResultNormalBenignMalignantCysticOthers
Not Coming
N
1011168
1045
184
1961001
721113295
14
%
85.814.2
85
15
16.483.6
507.6920.13.5
9.7
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Sensitivity : 62/180 x 100% = 34.4%Specificity : 893/999 x 100% = 89.4%
CBE Result
Mammography Result
TotalAbnormal
(+)
Normal
(-)
Abnormal
(+) 62 106 168
Normal
(-)118 893 1011
Total 180 999 1179
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Tumor size (CBE and Mammography) Age (year) 50.8 Tumor size (cm) 3.3 cm
42 2.1 x 2.0
56 3.5 x 2.1
48 2.4 x 2.3
42 2.2 x 1.4
53 3.9 x 3.5
47 1.4 x 1.1
48 3.3 x 2.0
53 5.1 x 3.4
45 4.4 x 3.4
54 6.5 x 5.1
40 5.1 x 3.2
42 2.2 x 2.1
46 2.6 x 1.4
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Further result
Management of malignant lesions: pathology ,radiation, chemotherapy, complication
Discordances in CBE and Mammography
should be performed breast ultrasound Abnormal CBE (only) group : Breast Ultrasound
Mammography quality : Positioning and MeanGlandular Dose (MGD)
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CBE Only
CBE
Normal Abnormal
Ultrasound
Normal Abnormal
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Obstacles
Non continuing equipment maintenance willcause below standard quality of mammogram
Inhibition access to the community forvolunteers due to lack of support fromgovernment officer (sub districts) and localprimary health care
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Tentative conclusion
CBE could be a first lineexamination to detectcancer
Ultrasound is useful
breast imaging for lumpevaluation
Mammography quality isdepend on the equipmentcondition, processing thefilm and competency ofradiographer(technologist)
Volunteers are animportant factor toincrease informationaccess of breast health
Government support isessential to increase ofcommunity empowerment