Download
1 / 19

- PowerPoint PPT Presentation


  • 329 Views
  • Uploaded on

IARC perspectives on the development of a research agenda for early detection and control of breast cancer in developing countries . R. Sankaranarayanan MD Head, Early Detection and Prevention Section (EDP) Head, Screening Group (SCR).

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about '' - Jeffrey


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Slide2 l.jpg

IARC perspectives on the development of a research agenda for early detection and control of breast cancer in developing countries

R. Sankaranarayanan MDHead, Early Detection and Prevention Section (EDP)Head, Screening Group (SCR)


Slide3 l.jpg

Age-standardized incidence rates of breast cancer in selected populations in each continents, 1998-2002

SOURCE: Cancer Incidence in Five Continents, Vol. IX. IARC Scientific Publications No. 160, Lyon, IARC. (2007)

Age-standardized rate (World) per 100,000

OCEANIA EUROPE ASIA N. AMERICA S. AMERICA AFRICA


Slide4 l.jpg

IARC perspectives: Current status of health services infrastructure and investments

  • Poorly developed and invested (most countries with per capita GNI <1000 USD; no or extremely limited diagnostic/treatment services)

  • Moderately developed and invested (Countries with per capita GNI 1000-10,000 USD, urban rural differences, intracountry variation)


Slide5 l.jpg

5-Year Survival from breast cancer (diagnosed during 1993-2001)

21,810 cases

{range: 58-90%}

9,442

{range: 78-84}

1,329

  • Breast Cancer (ICD-10:C50)

  • Highest in Hong Kong SAR

  • Lowest in Gambia

  • Intra-country variation

  • Pronounced in China (urban  and rural ) & India & Philippines

  • No difference in South Korea & Thailand

3,204

2,169

2,462

298

{range: 57-65}

2,354

{range: 31-54}

11,013

1,714

{range: 40-55}

162

258

61


Slide6 l.jpg

5-year absolute survival for localised and regional extent of disease among more and less developed health services – Breast cancer

Absolute survival for localized and regional extent of disease among more and less developed health services - Breast cancer

Singapore & Turkey: 14 645 cases

Costa Rica, India, Philippines, Saudi Arabia, Thailand: 17 640 cases


Modalities for early detection of breast cancer l.jpg

Awareness! of disease among more and less developed health services – Breast cancer

Self examination

Clinical breast examination (CBE)

Ultrasonography

Mammography

Fine needle aspiration cytology (FNAC)

Core biopsy

Triple diagnosis

Modalities for early detection of breast cancer


Slide8 l.jpg

Breast awareness of disease among more and less developed health services – Breast cancer

  • Making women aware of normal breast to facilitate finding abnormalities at the earliest possibility

  • Breast awareness makes each women to appreciate what is normal for them


Triple diagnosis l.jpg
Triple diagnosis of disease among more and less developed health services – Breast cancer

  • The use of diagnostic mammography, diagnostic ultrasonography and fine-needle aspiration biopsy for diagnosing palpable lumps

  • If any of the three modalities suggests cancer, excisional biopsy warranted

  • Excellent sensitivity (99%) and specificity (99%)

  • Very good potential for early clinical diagnosis if linked with awareness programmes

  • Important strategy to improve breast cancer control in low-and medium-resourced countries.


Iarc perspectives focussed research priorities l.jpg
IARC PERSPECTIVES: FOCUSSED RESEARCH PRIORITIES of disease among more and less developed health services – Breast cancer

  • Documentation of the pattern and trends in burden of disease, stage distribution and survival in several resource poor areas (PBCRs, MRDs, improving staging practice, medical records)

  • Impact of awareness, education and investments/improvement in health services on stage distribution, 2- and 5-year survival, mortality

  • Evaluation of the efficacy and cost-effectiveness of CBE in reducing breast cancer mortality

  • Identifying factors influencing participation of women in early detection, diagnosis, treatment and follow-up care


Iarc perspectives exit strategies l.jpg
IARC PERSPECTIVES:EXIT STRATEGIES of disease among more and less developed health services – Breast cancer

  • Strategic placement of the research activity

  • Contribution to capacity building in health services

  • Continuity, sustainability of service activities depending on the outcome of research

  • Roll out and scaling up


Iarc perspectives learning from past experiences l.jpg
IARC PERSPECTIVES: LEARNING FROM PAST EXPERIENCES of disease among more and less developed health services – Breast cancer

  • WHO-Russia BSE study

  • IARC-Philippines CBE study

  • Shanghai BSE study

  • Recent successes of IARC oral and cervix cancer screening trials

  • Efficient information systems/collaborating partners/institutions


Objective l.jpg

Trivandrum Breast Cancer Screening Study (TBCS) of disease among more and less developed health services – Breast cancer

Objective:

To evaluate the extent of stage shift, survival improvement and mortality reduction observed following the implementation of a package of interventions consisting of improving public and professional awareness on breast cancer, its early clinical diagnosis and prompt treatment and offering clinical breast examination (CBE)


Slide14 l.jpg

Trivandrum Breast Cancer Screening Study (TBCS) of disease among more and less developed health services – Breast cancer

Aims:

  • Decrease the frequency of advanced (stages IIB, III, IV) breast cancers from the current 70% of all breast cancer cases to 45% over a period of 7 years

  • Decrease the incidence rate of advanced (II B plus) breast cancers by 30% over a 7-year period

  • Increase 5-year survival of breast cancer patients from the current 55% to 80%

  • Reduce breast cancer mortality by 20% in the intervention group as compared to the control group


Trivandrum breast cancer screening study tbcs l.jpg
Trivandrum Breast Cancer Screening Study (TBCS) of disease among more and less developed health services – Breast cancer

First round of screening: participation and compliance (2006-2009)

In collaboration with RCC, Trivandrum, India


Trivandrum breast cancer screening study tbcs16 l.jpg
Trivandrum Breast Cancer Screening Study (TBCS) of disease among more and less developed health services – Breast cancer

First round of screening: Investigation rates

In collaboration with RCC, Trivandrum, India


First round of screening intermediate outcome 2006 2009 l.jpg

Trivandrum Breast Cancer Screening Study (TBCS) of disease among more and less developed health services – Breast cancer

First round of screening: intermediate outcome (2006-2009)

In collaboration with RCC, Trivandrum, India


Predictability of breast cancer l.jpg

Trivandrum Breast Cancer Screening Study (TBCS) of disease among more and less developed health services – Breast cancer

Predictability of breast cancer

In collaboration with RCC, Trivandrum, India


Iarc perspectives focussed research initiatives l.jpg
IARC PERSPECTIVES: FOCUSSED RESEARCH INITIATIVES of disease among more and less developed health services – Breast cancer

  • Organization of a three arm cluster randomised trial in 2010 for comparative evaluation of routine care, focussed breast awareness and CBE

  • Will involve around 400, 000 women and follow-up for a minimum of 9 years!

  • Currently the project proposal is being developed

  • Funding will be sought


ad