Randomized clinical trial: breast cancer screening based on physical examination performed by community health workers

Abstract

Objective: The aim of this study was to evaluate partial results after 1 year of data collection from breast cancer screening conducted by community health workers (CHW), according to the ITABERAÍ Project. Methodology: A multicenter
randomized clinical trial phase III, where the unit of observation was data from women aged 40 years or older, without a
diagnosis of breast cancer, who consented to participate in the study and were randomized by CHW and registered in the
Rosa Application. Randomization considered the National Health Strategies (NHS) of each CHW, which were randomly
allocated into control group and intervention group. The Intervention was considered as the physical breast examination
(PBE) performed by the CHW. Results: After 1 year of data collection, 3101 women were randomized, with 1607 (51.8%)
in the control group and 1,494 (48.2%) in the intervention group. The mean age was 58.1 years, with 57.8 years ±11.1 in the
control group and 58.5 years ±11.1 in the intervention group (p>0.05). Of the total participants, 2,989 reported on mammography (MMG) status, of which 1,550 were in the control group and 1,439 in the intervention group. Among women in the
control group, only 615 (38.3%) had undergone MMG in the last 2 years, while in the intervention group, it was 647 (43.3%).
CHW identified 315 (10.2%) abnormal cases, and after screening in NHS 71 (22.5%) women received specialist medical
care. After further examinations, 13 (18.3%) were referred for biopsy, with diagnostic confirmation in 9 women (69.2%),
6 (66.7%) from the intervention group and 3 (33.3%) from the control group. Of the confirmed cancers, three underwent
conservative surgeries (quadrantectomy), one mastectomy, four were referred for neoadjuvant chemotherapy, and one is
pending treatment decision. Conclusion: Initially, the results suggest that properly trained CHW are an important strategy that can contribute to improving breast cancer screening in Brazil.