{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T08:04:43Z","timestamp":1793261083125,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,11,1]],"date-time":"2022-11-01T00:00:00Z","timestamp":1667260800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2023,1,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study presents the preliminary results of a randomized controlled trial (RCT) initiated in January 2006 in India to evaluate the effectiveness of clinical breast examination (CBE) in reducing breast cancer mortality as compared to a no\u2010screening control group reported significant downstaging in the intervention group. The present manuscript reports long\u2010term follow\u2010up outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Women 30\u201369\u00a0years old from 133 intervention clusters and 141 control clusters were invited to participate. Women in the intervention arm underwent three rounds of CBE every 3 years. CBE\u2010positive women were reexamined by a physician, and triple\u2010assessment was performed on those confirmed to have abnormalities. All participants were followed through home visits and linkage with population\u2010based cancer registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 55,843 eligible women in the intervention arm, 95.7% had CBE at least once and 11.5% were CBE\u2010positive. Breast cancers were diagnosed in 335 participants in the intervention group and 273 in the control group (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a059,447). Age\u2010standardized incidence rate of early cancer was 30.4 of 100,000 in the intervention and 21.9 of 100,000 in the control group, with a rate ratio (RR) of 1.4 (95%\u00a0confidence interval [CI], 1.1\u20131.8). The age\u2010standardized breast cancer mortality rates were 11.3 and 11.1 per 100,000 in intervention and control arms, respectively (RR, 1.1; 95% CI, 0.8\u20131.5) after 15\u00a0years. Five\u2010year breast cancer survival rates were 77.0% in the intervention and 71.2% in the control groups (overall\n                      <jats:italic>p<\/jats:italic>\n                      value\u00a0=\u00a0.043).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Triennial CBE screening failed to demonstrate any mortality benefit despite achieving a shift toward earlier stage at detection and improved survival in the intervention arm. CBE is a valuable tool for diagnosis of breast cancer in symptomatic women especially in areas where mammography and\/or breast cancer screening programs are not widely available.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.34526","type":"journal-article","created":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T02:26:21Z","timestamp":1667355981000},"page":"272-282","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Effectiveness of triennial screening with clinical breast examination: 14\u2010years follow\u2010up outcomes of randomized clinical trial in Trivandrum, India"],"prefix":"10.1002","volume":"129","author":[{"given":"Kunnambath","family":"Ramadas","sequence":"first","affiliation":[{"name":"Karkinos Healthcare Kerala Operations  Ernakulam India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0124-4050","authenticated-orcid":false,"given":"Partha","family":"Basu","sequence":"additional","affiliation":[{"name":"Early Detection, Prevention &amp; Infections Branch International Agency for Research on Cancer  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beela S.","family":"Mathew","sequence":"additional","affiliation":[{"name":"Regional Cancer Centre  Trivandrum India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Muwonge","sequence":"additional","affiliation":[{"name":"Early Detection, Prevention &amp; Infections Branch International Agency for Research on Cancer  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muraleedharan","family":"Venugopal","sequence":"additional","affiliation":[{"name":"Regional Cancer Centre  Trivandrum India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparna M.","family":"Prakasan","sequence":"additional","affiliation":[{"name":"Regional Cancer Centre  Trivandrum India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafi","family":"Malu","sequence":"additional","affiliation":[{"name":"Regional Cancer Centre  Trivandrum India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Lucas","sequence":"additional","affiliation":[{"name":"Early Detection, Prevention &amp; Infections Branch International Agency for Research on Cancer  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Augustine","sequence":"additional","affiliation":[{"name":"Regional Cancer Centre  Trivandrum India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rari P.","family":"Mony","sequence":"additional","affiliation":[{"name":"Regional Cancer Centre  Trivandrum India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somanathan","family":"Thara","sequence":"additional","affiliation":[{"name":"Regional Cancer Centre  Trivandrum India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rengaswamy","family":"Sankaranarayanan","sequence":"additional","affiliation":[{"name":"Karkinos Healthcare Kerala Operations  Ernakulam India"},{"name":"Early Detection, Prevention &amp; Infections Branch International Agency for Research on Cancer  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"Global Cancer Observatory: Cancer Today","author":"Ferlay J","year":"2020"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2021.100985"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010015\u20101092\u20109"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2214\u2010109x(16)30259\u20105"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1470\u20102045(09)70335\u20103"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmsr1504363"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.2217\/bmt.13.11"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djp241"},{"issue":"10","key":"e_1_2_8_11_1","first-page":"1459","article-title":"Canadian National Breast Screening Study: 1. 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