Early Breast Cancer Detection Through Clinical Breast Examination Training For Midwives In Rural...

8/8/2019 Early Breast Cancer Detection Through Clinical Breast Examination Training For Midwives In Rural Jakarta, Indonesia

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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

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