NEW YORKA randomized trial enrolling 150,000 women and funded
by the US National Cancer Institute is underway in India to screen
for breast and cervical cancer using simple methods.
Mammography is a very fine tool, but most of the developing
world cannot afford mammography, so we have to devise simple
techniques, said Indraneel Mittra, MBBS, PhD, professor of
medicine and chief of the Surgical Breast Service, Tata Memorial
Hospital, Bombay. He spoke at the International Breast Cancer
Roundtable, sponsored by the American-Italian Cancer Foundation and
the Komen Breast Cancer Foundation.
Instead, the Indian trial depends on physical examinations performed
by trained health workers. These are women educated to the
level of high school, Professor Mittra said. You
cant have doctors go out into the community and examine
thousands of women.
The health workers provide instruction in cancer awareness along with
printed materials to all women in the study. For the control group,
this is the only intervention. Clinical breast examinations are
performed on those in the study group, and the health workers teach
them breast self-examination.
The health workers also screen all women randomized to the study
group for cervical cancer. Were not using the Pap
smear, he said. The Pap smear sounds simple, but it
requires many trained technicians and cytopathologists.
Instead, the health workers do a visual inspection of the cervix
after applying a 4% acetic acid solution.
In this study, four rounds of screening intervention will be given
every 18 months. The final endpoint is a reduction in mortality from
breast and cervical cancer.
The incidence of breast cancer is rising in every country in the
world, but faster in the developing countries, Professor
Mittra observed. Among the factors he cited for this surge is women
delaying childbirth because of working outside the home. Another
factor affecting all types of cancer, he indicated, is increased
longevity with the control of infectious diseases.
In India, it is estimated that life expectancy between 1995 and
2025 will increase by 9 years, he said. This will
increase the incidence of cancer by 300%.
