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临床乳房检查:中低收入国家的一种筛查工具。

Clinical breast examination: A screening tool for lower- and middle-income countries.

机构信息

Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India.

Homi Bhabha National Institute (HBNI), Navi Mumbai, India.

出版信息

Asia Pac J Clin Oncol. 2024 Dec;20(6):690-699. doi: 10.1111/ajco.14126. Epub 2024 Sep 29.

Abstract

Breast cancer (BC) remains a global health challenge, devastatingly impacting women's lives. Low-and-middle-income countries (LMIC), such as India, experience a concerning upward trend in BC incidence, necessitating the implementation of cost-effective screening methods. While mammography, ultrasonography, and magnetic resonance imaging are preferred screening modalities in resource-rich settings, limited resources in LMICs make clinical breast examination (CBE) the method of choice. This review explores the merits of CBE, its coverage, barriers, and facilitators in the Indian context for developing strategies in resource-constrained settings. CBE has shown significant down-staging and cost-effectiveness. Performed by trained health workers in minutes, CBE offers an opportunity for education about BC. Various individual and health system barriers, such as stigma, financial constraints, and the absence of opportunistic screening hinder CBE coverage. Promising facilitators include awareness programs, capacity building, and integrating CBE through universal health care. No healthcare provider must miss any screening opportunity through CBE.

摘要

乳腺癌(BC)仍然是一个全球性的健康挑战,对女性的生活造成了毁灭性的影响。印度等中低收入国家(LMIC)的 BC 发病率呈令人担忧的上升趋势,因此需要实施具有成本效益的筛查方法。虽然在资源丰富的环境中,乳腺 X 线摄影、超声和磁共振成像等是首选的筛查方式,但在 LMIC 中资源有限,使得临床乳房检查(CBE)成为首选方法。本综述探讨了在印度资源有限的情况下,CBE 的优点、覆盖范围、障碍和促进因素,以制定资源受限环境下的策略。CBE 已显示出显著的降期和成本效益。经过培训的卫生工作者在几分钟内进行 CBE,可以提供有关 BC 的教育机会。各种个人和卫生系统障碍,如耻辱感、经济限制以及缺乏机会性筛查,阻碍了 CBE 的覆盖范围。有前途的促进因素包括宣传计划、能力建设以及通过全民健康保险整合 CBE。没有医疗保健提供者可以错过任何通过 CBE 进行的筛查机会。

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