Thuler Luiz Claudio Santos, Freitas Hilda Guimaraes
Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
J Eval Clin Pract. 2008 Dec;14(6):1012-7. doi: 10.1111/j.1365-2753.2007.00934.x.
The primary aim of this study was to evaluate a programme called 'Touch of Life' (Toque de Vida in Portuguese) proposed to increase breast cancer screening awareness and provide free clinical breast examination (CBE) for asymptomatic women 40-69 years of age.
Evaluation of the intervention used a before-and-after quasi-experimental design without control groups. A total of 11,762 women, living in three cities in the State of Mato Grosso do Sul, Brazil, were submitted to breast cancer screening by CBE. The evaluation indicators were participation rate, abnormal call rate, cancer detection rate and rate of advanced-stage breast cancers.
Mean age was 42.6 years. Most women belonged to the 40-69-year age group (56.7%) and had less than 8 years of formal education (60.9%). Mean age at menarche was 12.9 years (+/-1.7). The proportions of parous and nulliparous women were 85.1% and 14.8% respectively. Mean age of first pregnancy was 19.8 years (+/-4.4). Less than one-third (29.3%) of the women had a history of abortion or miscarriage. History of breastfeeding was reported by 79.3% of the women, and 14.4% had used hormone replacement therapy at some time. For women between 40 and 49 years of age, the participation rate was 74.9%. The abnormal call rate for CBE was 10.7%. The main abnormalities found were breast lumps in 630 women (5.4%), thickening in 332 (2.8%) and other suspicious lesions in 316 (2.7%). The breast cancer detection rate was 1.3 per thousand, and only 20.0% of women were diagnosed with advanced-stage disease (stages III and IV).
The intervention was effective in detecting new cases of breast cancer. A community-wide screening approach based on CBE may be effective to enhance breast cancer detection in vulnerable populations, especially in areas where mammography screening is not available.
本研究的主要目的是评估一项名为“生命之触”（葡萄牙语为Toque de Vida）的项目，该项目旨在提高乳腺癌筛查意识，并为40至69岁无症状女性提供免费临床乳房检查（CBE）。
对干预措施的评估采用前后对照的准实验设计，无对照组。巴西南马托格罗索州三个城市的11762名女性接受了CBE乳腺癌筛查。评估指标为参与率、异常召回率、癌症检出率和晚期乳腺癌发病率。
平均年龄为42.6岁。大多数女性属于40至69岁年龄组（56.7%），正规教育年限少于8年（60.9%）。月经初潮的平均年龄为12.9岁（±1.7）。经产妇和未产妇的比例分别为85.1%和14.8%。首次怀孕的平均年龄为19.8岁（±4.4）。不到三分之一（29.3%）的女性有流产史。79.3%的女性有母乳喂养史，14.4%的女性曾在某个时期使用过激素替代疗法。40至49岁女性的参与率为74.9%。CBE的异常召回率为10.7%。发现的主要异常情况为630名女性乳房肿块（5.4%）、332名女性乳房增厚（2.8%）和316名女性其他可疑病变（2.7%）。乳腺癌检出率为千分之一，只有20.0%的女性被诊断为晚期疾病（III期和IV期）。
该干预措施在发现乳腺癌新病例方面有效。基于CBE的社区范围筛查方法可能有效地提高弱势群体中的乳腺癌检出率，特别是在无法进行乳房X光筛查的地区。
