Early Breast Cancer Detection Through Clinical Breast Examination Training For Midwives In Rural Jakarta, Indonesia | Mammography | Birth Control

EARLY BREAST CANCER DETECTION THROUGH CLINICAL BREAST EXAMINATION TRAINING FOR MIDWIVES IN RURAL JAKARTA, INDONESIA

Project Investigator: Kardinah (Dharmais Cancer Hospital, National Cancer Center/Jakarta Breast Health Foundation) Sri Indiyastutik (Yappika)

Funded by Breast Health Global Initiative (PRP019) June 2007 – March 2009 Presented November 10 2008

Background

• • • •

Stage III and IV Limited Resources Unawareness among health provider No cancer program developed yet

Down staged breast cancer?

How to implement BHGI recommendation ?

Purpose
• Increasing CBE • Increasing ability in midwives awareness among volunteers about • Increasing awareness in -Breast health health provider access in community • Strengthen referral system -Awareness of from primary care early detection in to district hospital breast cancer

Location

Sub district KOJA – JAKARTA UTARA

Population : 592.586 peoples Male : 308.957 peoples Female : 283.626 peoples Primary health care : 6

Participation
• • • • • • Kelurahan Rawa Badak Selatan Kelurahan Tugu Utara Kelurahan Lagoa Islamic Center Kecamatan Koja Rumah susun Koja

Project summary
• Female health provider • Primary health care Midwives
CBE Validating with mammography Organizing the activity

• Public Participation • Public awareness

Volunteer

Activities
• CBE training for midwives (target 30 person) • Half day • Short lecture about breast cancer • Practice of CBE with breast phantom • Hospital tour

• Early detection of breast cancer for volunteers (target 30 volunteers) • Half day • Short lecture about breast cancer • Hospital tour

Activities on location
• Midwives: presenting how to do breast self examination
• Practice CBE supervising by experienced physician • A midwife - examined 50 women with mammography validation

• Organizing presentation with title: How to do Breast Self Examination (approx. 60 women)
• Organizing mobile mammography(Jakart a Breast Health Foundation) and mobile audiovisual aid (Yappika Life)

Preliminary result
• Midwives training: 30 person • Midwives actively perform CBE : 25 person • Volunteer training 15 person • Organizing 30 presentation • Participants: 1072 (CBE only) 1179 (CBE and mammography)

Variable
Age ≤ 35 yr > 35 yr

N
52 1177 1227 2

Percentage
4.2 95.8 99.8 0.2

Presentation Yes No
CBE Yes No Questioner Yes No Mammography Yes No

1163 66
1178 51 1229 0

94.6 5.4
95.9 4.1 100 0

First Menarche ≤ 12 yr > 12 yr Menopause ≤ 50 yr > 50 yr First Pregnancy ≤ 35 yr > 35 yr Contraception (Pill) ≤ 5 yr > 5 yr

339 882

27.8 72.2

332 145

69.6 30.4

1088 56 246 143

88.5 4.6 63.2 36.8

Contraception (Injection) ≤ 5 yr > 5 yr

268 222

54.7 45.3

Others Contraception Implant Spiral IUD Sterile Condom Others
History of Gynecology Surgery Yes No History of Breast Surgery Yes No Family History Yes No

8 108 5 9 1 4

6 80 3.7 6.7 0.7 3

43 1186

3.5 96.5

35 1194 92 1137

2.8 97.2 7.5 92.5

CBE and Mammography
CBE Normal Mammography CBE abnormal Mammography

Normal

Abnormal

Abnormal

Normal

Diagnostic imaging: Ultrasound

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

Variable
CBE Result Normal Abnormal Mammography Result Normal Abnormal USG Diagnostic Yes No USG Result Normal Benign Malignant Cystic Others Not Coming

N
1011 168

%
85.8 14.2

1045 184 196 1001 72 11 13 29 5 14

85 15 16.4 83.6 50 7.6 9 20.1 3.5 9.7

Mammography Result CBE Result Abnormal (+) Abnormal (+) Normal (-) Total 62 118 180 Normal (-) 106 893 999 168 1011 1179 Total

Sensitivity : 62/180 x 100% = 34.4% Specificity : 893/999 x 100% = 89.4%

Tumor size (CBE and Mammography)
Age (year) 50.8 Tumor size (cm) 3.3 cm

42
56 48 42

2.1 x 2.0
3.5 x 2.1 2.4 x 2.3 2.2 x 1.4

53
47 48 53

3.9 x 3.5
1.4 x 1.1 3.3 x 2.0 5.1 x 3.4

45
54 40 42

4.4 x 3.4
6.5 x 5.1 5.1 x 3.2 2.2 x 2.1

46

2.6 x 1.4

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 Mean Glandular Dose (MGD)

CBE Only
CBE

Normal

Abnormal

Ultrasound

Normal

Abnormal

Obstacles
• Non continuing equipment maintenance will cause below standard quality of mammogram • Inhibition access to the community for volunteers due to lack of support from government officer (sub districts) and local primary health care

Tentative conclusion
• CBE could be a first line examination to detect cancer • Ultrasound is useful breast imaging for lump evaluation • Mammography quality is depend on the equipment condition, processing the film and competency of radiographer (technologist) • Volunteers are an important factor to increase information access of breast health • Government support is essential to increase of community empowerment

Sign up to vote on this title
UsefulNot useful

Master Your Semester with Scribd & The New York Times

Special offer for students: Only $4.99/month.

Master Your Semester with a Special Offer from Scribd & The New York Times

Cancel anytime.