EARLY DETECTION
vaginal bleeding such as passing blood clots or inter-menstrual well versed in providing CBE. CBE consists of physical
bleeding, bleeding after sexual intercourse or pain during examination of both breasts, both axillae, and the neck. CBE
vaginal intercourse, persistent, foul-smelling discharge, can be readily taught to primary health workers using manuals
persistent low backache. Such women should be offered a and digital learning resources7. Equipping primary health
speculum examination under bright light and the presence of centres with silicon breast models is a valuable investment in
ulcero-proliferative or indurated growth on the cervix should improving CBE skills of health workers and in creating breast
receive prompt referral to secondary or tertiary care awareness among women attending the health centres. The
(depending on where diagnosis and treatment services are silicon models can be used for training health care workers in
available in that region) for diagnostic confirmation and performing CBE and women may be made familiar with the
management. The 5-year survival from stage I cervical cancer concept of breast awareness and detecting breast lumps using
exceeds 90% whereas from stage IV, cancer survival seldom these models.
exceeds 10%. In women with a normal appearing cervix, the Women with a palpable breast lump or any change in the
appearance of aceto-white lesions following the application of shape, consistency, or density of the breast, unilateral nipple
3–5% acetic acid or mustard-yellow lesion following discharge, skin changes such as eczematous changes in or
application of Lugol’s iodine should arouse suspicion of around the nipple or areola, skin tethering, and skin or nipple
cervical precancerous lesions or subclinical invasive cancer retraction, whether associated with other symptoms or risk
and such women should be referred for further management. factors, should be referred to a secondary or tertiary care
Primary care workers have a major responsibility in facility (depending upon where such services are available)
improving awareness among the general public who report to where diagnosis, staging, and treatment of breast cancer can
their services about the preventability and curability of be efficiently carried out.
cervical cancer when detected early, symptoms and signs of Women found with no abnormalities on CBE should be
cervical cancer, the safety and efficacy of treatment for educated on breast cancer signs and symptoms, encouraging
cervical neoplasia. They should also advise on the possibility of them to be aware of what is “normal” for them and of the
preventing cervical cancer by HPV vaccination of young occurrence of any changes by periodic self-palpation when
adolescents aged 9–18 by person to person communication getting dressed or bathing. They should be advised to seek
and by displaying educational materials and posters in the medical care promptly in case of any future abnormalities.
health centres and by delivering general awareness talks in Breast awareness and empowering women to seek prompt
their communities. Such educational messages from primary care have far reaching implications for breast cancer control,
care practitioners are very valuable in improving general given the fact that breast cancer survival significantly
awareness of cervical cancer and its control in the general improved and breast cancer mortality started declining well
population and in empowering women to seek services. before the introduction of mammography screening
Improved public awareness and early diagnosis and treatment programmes in many developed countries around 1975. The
significantly contributed to reduced mortality from cervical frequency of advanced breast cancers fell significantly and
cancer even before the introduction of screening programmes survival rates increased considerably in the United Kingdom
in developed countries16,17. and in Connecticut, USA mainly due to increased awareness
among women and health care providers, before the
Early detection of breast cancer in primary care introduction of mammography screening programmes20,21.
Systematic screening with breast imaging is not feasible in
many less-developed countries leaving improved awareness Conclusion
and early clinical diagnosis as the major options for breast In low-income countries, the vast majority of cancer patients
cancer early detection. Presence of a lump in the breast is the are diagnosed in advanced clinical stages and health care
single most important symptom and sign in the early detection services are extremely limited. Hence, early clinical diagnosis
of breast cancer. It is generally considered that breast lumps of of cancer is the most feasible and effective strategy for early
≥1cm diameter are readily palpable by health care workers, detection in less-developed countries. Screening is a resource
although even breast lumps of 5mm may be palpable18,19. intensive early detection strategy that may be considered as a
Women presenting with symptoms such as breast lumps, cancer control option when the resources are committed and
skin changes in breasts, nipple discharge, nipple retraction or the health systems have sufficiently evolved. Strengthening
ulceration of the breast skin should undergo clinical breast the capacity of primary care services in providing affordable
examination (CBE) by the primary care physician or a nurse early detection tests for breast and cervical cancer and to
70 CANCER CONTROL 2013