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Mini oral session - Policy and preventive strategies

1759MO - Clinical breast examination for early diagnosis of breast cancer: An Egyptian nationwide study


23 Oct 2023


Mini oral session - Policy and preventive strategies


Global Cancer Statistics;  Population Risk Factor;  Fundamentals of Cancer Care Organisation;  Cancer Registries;  Cancer Intelligence (eHealth, Telehealth Technology, BIG Data);  Secondary Prevention/Screening;  Cancer Care Equity Principles and Health Economics;  Statistics;  Global Cancer Control;  Cancer in Special Situations/ Populations

Tumour Site

Breast Cancer


Loay Kassem


Annals of Oncology (2023) 34 (suppl_2): S925-S953. 10.1016/S0923-7534(23)01945-2


H.A. Azim1, L. Kassem1, K.S. Shohdy2, Y. Safwat3, E. Khallaf3, S. Naguib4, M. Hegazy5, A. Selim6, N. Hussein7, A.H. Abdelaziz8, H.A. El Ghazaly9, M. Hassany7, A. Abdelaziz10, A.E.A. Kandil11, B.A. El Sayed7, T. Hashem12, S.S.M. Eid13, A. Morsy7, K. Abdelghaffar7, H. Zaid7

Author affiliations

  • 1 Department Of Clinical Oncology, Cairo University, 12311 - Giza/EG
  • 2 Department Of Clinical Oncology, Cairo University, 12613 - Giza/EG
  • 3 Department Of Surgery, Cairo University, 12613 - Giza/EG
  • 4 National Cancer Institute, Cairo University, 12613 - Giza/EG
  • 5 Department Of Surgical Oncology, Mansoura University, 35516 - Mansoura/EG
  • 6 Department Of Radiology, Cairo University, 12613 - Giza/EG
  • 7 Presidential Women's Health Initiative, Ministry of Health and Population, Cairo/EG
  • 8 Department Of Clinical Oncology, Ain Shams University, 11331 - Cairo/EG
  • 9 Department Of Clinical Oncology, Ain Shams University, 11311 - Cairo/EG
  • 10 Department Of Pathology, Cairo University, 12613 - Giza/EG
  • 11 Department Of Clinical Oncology, Alexandria University, 21131 - Alexandria/EG
  • 12 Department Of Clinical Oncology, Menoufia University, 32511 - Shebeen El-Kom/EG
  • 13 Department Of Clinical Oncology, Assiut University, 71516 - Assiut/EG


This content is available to ESMO members and event participants.

Abstract 1759MO


Screening mammography is the standard approach for early detection of breast cancer (BC). Clinical breast examination (CBE) may serve as an alternative screening tool in limited resource countries where the late presentation of BC and young age at diagnosis prevail.


We designed a nationwide screening program with a multistep approach based on two-stage CBE. All Egyptian women ≥18 years (ys) were invited to participate in one of the 3538 primary health care (PHC) units across Egypt. Women who were 18-35 ys of age with predefined risk factors and all women >35 ys underwent CBE. Those with abnormal CBE were subsequently referred to one of 102 tertiary cancer clinics (TCC) for a confirmatory breast examination conducted by a BC oncologist/surgeon. Diagnostic imaging was requested for those with clinically suspicious findings in the confirmatory CBE. Here we report the outcomes of the first 2 ys of the program.


From July 2019 to June 2021, 10,832,447 women participated in the program. Of those, 5,987,485 women met the criteria for CBE. Abnormal CBE was detected in 598,252 (10%) women. Of those, 390,633 (65.3%) presented to TCC for a confirmatory CBE with a median age of 43 ys. A total of 196,509 (50.3%) women had abnormal confirmatory CBE warranting breast imaging. The majority (162,898 (82.9%)) attended diagnostic imaging, with 14,794 cases reported as BIRADS 4 or 5 (9.1%). Among the 10,128 women who successfully performed a biopsy, 5,335 (52.6%) had malignant findings; of these, 5112 had mammary carcinoma. 270 women (5.1%) of the BC cases were ≤ 35 ys old. Stages 0-II were diagnosed in 80.5%, reflecting significant downstaging from prior historical cohorts. Risk factors for BC in Egyptian women were estimated for the first time on a nationwide scale (Table). Table: 1759MO

Risk factor Relative risk (95% CIs) Cases/Controls (5,112/5,389,233)
Oral contraceptive pills use ≥ 5 ys 1.16 (1.10-1.22) 1,082/984,086
BMI ≥ 30 kg/m2 1.59 (1.58-1.60) 4,860/3,217,506
Diabetes mellitus 1.82 (1.67-1.99) 460/266,495
Age of menopause ≥ 50 ys 2.12 (1.93-2.32) 422/209,822
Family history of breast/ovarian cancer 2.50 (2.36-2.64) 1,032/435,658
Prior breast biopsy 7.67 (6.80-8.65) 254/34,903


Personalized-risk CBE, as adopted in our program, is effective in downstaging BC. This is the largest study to report successful BC downstaging via CBE, meeting the WHO pillar 1 key performance indicator of ≥60% of stages 0-II.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Ministry of Health and Population-Egypt.


Presidential Women's Health Initiative, Ministry of Health and Population, Cairo, Egypt.


All authors have declared no conflicts of interest.

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