Impact of Community-Based Clinical Breast Examinations in Botswana

Abstract

PURPOSE We evaluated a clinical breast examination (CBE) screening program to determine the prevalence of breast abnormalities, number examined per cancer diagnosis, and clinical resources required for these diagnoses in a middle-income African setting. METHODS We performed a retrospective review of a CBE screening program (2015-2018) by Journey of Hope Botswana, a Botswana-based nongovernmental organization (NGO). Symptomatic and asymptomatic women were invited to attend. Screening events were held in communities throughout rural and periurban Botswana, with CBEs performed by volunteer nurses. Individuals who screened positive were referred to a private tertiary facility and were followed by the NGO. Data were obtained from NGO records. RESULTS Of 6,120 screened women (50 men excluded), 452 (7.4%) presented with a symptom and 357 (5.83%) were referred for further evaluation; 257 ultrasounds, 100 fine-needle aspirations (FNAs), 58 mammograms, and 31 biopsies were performed. In total, 6,031 were exonerated from cancer, 78 were lost to follow-up (67 for ≤ 50 years and 11 for > 50 years), and 11 were diagnosed with cancer (five for 41-50 years and six for > 50 years, 10 presented with symptoms). Overall breast cancer prevalence was calculated to be 18/10,000 (95% CI, 8 to 29/10,000). The number of women examined per breast cancer diagnosis was 237 (95% CI, 126 to 1910) for women of age 41-50 years and 196 (95% CI, 109 to 977) for women of age > 50 years. Median time to diagnosis for all women was 17.5 [1 to 32.5] days. CBE-detected tumors were not different than tumors presenting through standard care. CONCLUSION In a previously unscreened population, yield from community-based CBE screening was high, particularly among symptomatic women, and required modest diagnostic resources. This strategy has potential to reduce breast cancer mortality.

Mapping Evidence on the Burden of Breast, Cervical, and Prostate Cancers in Sub-Saharan Africa: A Scoping Review

“…We also found studies conducted in Ghana ( n = 6) ( 50 , 71 , 111 , 123 , 134 , 155 ), Kenya ( n = 5) ( 70 , 96 , 115 , 132 , 139 ), Zambia ( n = 4) ( 44 , 77 , 102 , 126 ), and Eritrea ( n = 3) ( 60 – 62 ). There were seven countries with two studies each [Botswana ( 43 , 47 ), the Central African Republic ( 31 , 32 ), Mozambique ( 57 , 58 ), Rwanda ( 130 , 136 ), Senegal ( 147 , 156 ), Sudan ( 84 , 114 ) and Zimbabwe ( 38 , 39 )]. The countries with a single study were Cote d'Ivoire ( 128 ), Democratic Republic of Congo ( 99 ), Mali ( 85 ), Swaziland ( 76 ), Tanzania ( 49 ), and The Gambia ( 30 ).…”

“…Two studies were from Ghana, of which one was a cross-sectional study ( 134 ) and the other a retrospective record review of patient files ( 50 ). There was one study from each of the following countries: a retrospective record review of pathology reports from the Central African Republic ( 32 ), another retrospective record review of non-governmental records in Botswana ( 43 ), one cross-sectional study from Sudan ( 114 ), one cross-sectional study in both South Africa and Uganda ( 120 ), one retrospective record review of registry from Kenya ( 96 ), and a retrospective record review of pathology reports in Zambia ( 44 ).…”

Breast Cancer Early Detection in Eswatini: Evaluation of a Training Curriculum and Patient Receipt of Recommended Follow-Up Care

“… 11 In Kenya, Botswana, and Tanzania, at discrete BC screening events open to interested women, CBE yielded PPVs of 9%, 3%-4%, and 5%, respectively. 10 , 14 , 15 …”

Review of the use of R Programming for Data Analysis in Botswana Research

“…Descriptive analysis from data collected from regions of Botswana has helped to understand the actuality of treatment distribution, on-going treatment research and health institution management. For example, in an impact community breast examination study by [15] used records from a large clinical breast examination (CBE) initiative by a Botswana-based NGO. They sought to determine screening uptake, prevalence of breast abnormalities, number screened per breast cancer diagnosis, and clinical resources required to achieve diagnoses.…”

“…Not only did the reviewed articles use R packages, but they also used Base R to carry out their statistical models. Under Health Care, [15] evaluated a clinical breast examination (CBE) screening program to determine the prevalence of breast abnormalities, number examined per cancer diagnosis, and clinical resources required for these diagnoses in rural and urban Botswana.…”