School of Public Health Department of Biostatistics and Epidemiology, Addis Ababa University, Ethiopia.
Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
Oncologist. 2021 Jun;26(6):e1009-e1017. doi: 10.1002/onco.13737. Epub 2021 Mar 19.
Breast cancer (BC) is the most frequently diagnosed cancer and leading cause of cancer deaths among women in low-income countries. Ethiopia does not have a national BC screening program, and over 80% of patients are diagnosed with advanced stage disease. The aim of this study was to assess how many women self-report a breast abnormality and to determine their diagnoses in rural Ethiopia.
A community-based cross-sectional study was conducted among 7,573 adult women. Women were interviewed and educated about breast awareness, and those who reported breast abnormalities underwent clinical examination by experienced surgeons. Ultrasound-guided fine needle aspiration cytology (FNAC) was obtained, and cytological analysis was performed. The findings were projected to the female population of Ethiopia to estimate current and future burden of diseases.
Of the 7,573 women surveyed, 258 (3.4%) reported a breast abnormality, 246 (3.2%) received a physical examination, and 49 (0.6%) were found to be eligible for ultrasound-guided FNAC or nipple discharge evaluation. Of all the cases, five (10.2%) breast malignancies were diagnosed. We projected for Ethiopia that, approximately, 1 million women could self-report a breast abnormality, 200,000 women could have a palpable breast mass, and 28,000 women could have BC in the country.
The health care system needs to build capacity to assess and diagnose breast diseases in rural areas of Ethiopia. These data can be used for resource allocation to meet immediate health care needs and to promote detecting and treating BC at earlier stages of disease.
Routine mammography screening in a resource-limited country with a young population is neither sensitive nor affordable. Clinical breast examination with consecutive ultrasound-guided fine needle aspiration cytology may ensure early diagnosis, downstage disease, and reduce breast cancer mortality. This study had the unique opportunity to educate over 7,573 rural women about breast abnormalities and offer clinical and cytological diagnosis for reported breast abnormalities. The findings were extrapolated to show the nationwide burden of breast abnormalities and unmet diagnostic needs. These data will serve as policy guide to improve adequate referral mechanisms and breast diagnostic and treatment facilities.
乳腺癌（BC）是低收入国家女性中最常见的癌症和癌症死亡的主要原因。埃塞俄比亚没有国家乳腺癌筛查计划，超过 80%的患者被诊断为晚期疾病。本研究旨在评估有多少女性自我报告乳房异常，并确定农村埃塞俄比亚的诊断情况。
对 7573 名成年女性进行了一项基于社区的横断面研究。对女性进行了乳房意识的访谈和教育，那些报告乳房异常的女性接受了经验丰富的外科医生进行的临床检查。进行了超声引导下细针抽吸细胞学（FNAC）检查，并进行了细胞学分析。研究结果被投射到埃塞俄比亚的女性人群中，以估计当前和未来的疾病负担。
在所调查的 7573 名女性中，258 名（3.4%）报告了乳房异常，246 名（3.2%）接受了体格检查，49 名（0.6%）符合超声引导下 FNAC 或乳头溢液评估的条件。所有病例中，诊断出 5 例（10.2%）乳腺癌。我们预计埃塞俄比亚大约有 100 万女性可能会自我报告乳房异常，20 万女性可能会有可触及的乳房肿块，2.8 万名女性可能患有该国的乳腺癌。
埃塞俄比亚的医疗保健系统需要建立在农村地区评估和诊断乳房疾病的能力。这些数据可用于资源分配，以满足当前的医疗保健需求，并促进在疾病早期阶段检测和治疗乳腺癌。
在资源有限且人口年轻的国家进行常规乳房 X 线筛查既不敏感也不可行。结合后续超声引导下细针抽吸细胞学检查的临床乳房检查可确保早期诊断、降期疾病并降低乳腺癌死亡率。本研究有机会对 7573 名农村妇女进行乳房异常的教育，并为报告的乳房异常提供临床和细胞学诊断。研究结果被推断为显示全国范围内乳房异常和未满足诊断需求的负担。这些数据将作为政策指导，以改善适当的转诊机制和乳房诊断及治疗设施。
