Primary and Secondary Prevention of Breast Cancer. People can reduce the risk of breast cancer by healthy lifestly and early screening test.

1. In the name of Allah, Most Gracious, Most Merciful.

2. Primary & Secondary
Preventions
of
Breast Cancer
by
Shirin Gorjian
Master of science in nursing education.
Hamadan University of Medical Sciences (UMSHA)
Nursing & Midwifery Faculty
Hamadan-Iran
Sh_gorrjian@yahoo.com

3. The breast sit on the chest muscles that
cover the ribs.
Each breast is made of 15 to 20 lobes.
Lobes contain many smaller lobules.
Lobules contain groups of tiny glands
that can produce milk.
Milk flows from the lobules through
thin tubes called ducts to the nipple.
The nipple is in the center of a dark
area of skin called the areola.
Fat fills the spaces between the
lobules and ducts.

4. The normal breast
There is no such thing as a 'standard' breast. What is normal for one woman may
not be for another. Throughout your life your breasts will change; below are some
descriptions of a normal breast at different stages of your life:
Before the menopause
Normal breasts feel different at different times of the month. The milk-producing tissue
in the breast becomes active in the days before a period starts. In some women, the
breasts at this time feel tender and lumpy, especially near the armpits.
After a hysterectomy
The breasts usually show the same monthly differences until the time when your
periods would have stopped, unless your ovaries have also been removed.
After the menopause
Activity in the milk-producing tissue stops. Breasts normally feel soft, less firm and not
lumpy.

6. CANCER:a disease that is characterized by
uncontrolled cell growth in an organ, ie. the site the cells
originate from.
BREAST CANCER: begins in the breast tissue and
may start in the duct or lobe of the breast. When the
“controls” in breast cells are not working properly, they
divide continually and a lump or tumor is formed.

7. Ductal Carcinoma
 Originate in ducts that carry milk to nipples
 If cancer confined to duct = in situ (DCIS)
 Usually found on mammogram
 If moved beyond duct = invasive or
infiltrating
Lobular Carcinoma
 rare

8. 2nd leading cause of death
2nd most common cancer
Incidence increases with age
All women are at risk

9. A woman
has a one in eight chance of
developing breast cancer in her lifetime.

10. Breast cancer is always caused by a genetic abnormality (a
“mistake” in the genetic material). However, only 5-10% of
cancers are due to an abnormality inherited from your mother or
father. About 90% of breast cancers are due to genetic
abnormalities that happen as a result of the aging process and the
“wear and tear” of life in general.

11. Risk Factor: something that may raise your chances of getting
a disease. It does not mean you will get the disease.

12. Gender: female (1% males)
Race: more common in whites
Age: increases as a woman gets older.
Relative : (mother or sister)
Menstrual history :early on set & late menopause
Childbirth: first child After the age of 30 or having no
children at all
Pregnancy and breastfeeding are protective against breast
cancer …

13. Obesity
Diet: *Fat
*Alcohol
Lack of Physical Activity ; Stress
Radiation Exposure specially in childhood
History of cancer: breast, uterus, cervix, ovary
Hormones: estrogens in Hormone replacement
therapy & Birth control pills
Genetics : certain conditions that are inheritated
> 70% have no risk factors

14. All
women are
at risk
Obesity Non/Exercise
Non/Breastfeeding Alcohol
Hormone
Replacement
Therapy
Not having
children

15. The two highest risk factors are things you cannot
change:
Gender
Age

16. A family history of breast
cancer
High doses of radiation as
a child
Previous abnormal breast
biopsy
Ethnic origin
Where you live
Reproductive factors (early
onset of menstrual cycle,
having your first baby after
age 30, never having a
child, late menopause)

17. Risk factors you can change are things like
“Healthy Lifestyle”
choices

19. P ractice what you know
• eat healthy
• be active
• don’t smoke
I nvestigate the information
• know fact from fiction
N know what’s normal
• for your body and breasts
K nowledge is power

20. Choose a
HEALTHY LIFESTYLE

21. A healthy lifestyle is one which helps to keep and improve
people’s health and well-being. Many governments and non-
governments have made big efforts in healthy lifestyle and
health promotions.

22. Nutrition
Mental
Health
exercise
stress
Smoking
Alcohole
Sleep

23. Step 1:
Top 20 Cancer Fighting Foods

24. No single food can prevent cancer, but
the right combination of foods may help
make a difference. At mealtimes, strike
a balance of at least two-thirds plant-
based foods and no more than one-third
animal protein.
This "New American Plate" is an
important cancer fighting tool,
according to the American Institute for
Cancer Research. Check out better and
worse choices for your plate.

26. Folat is an important B vitamin that may help
protect against cancers of the colon, rectum,
and breast.
You can find it in abundance on the “breakfast
table”.
Fortified breakfast cereals and whole wheat
products are good sources of folat. So are
orange juice, melons, and strawberries.

27. Whether it's the Lycopene the pigment
that gives tomatoes their red color or
something else isn't clear.
But some studies have linked eating
tomatoes to reduced risk of several
types of cancer, including prostate and
breast cancer. Studies also suggest that
processed tomato products such as
juice, sauce, or paste increase the
cancer-fighting potential.

28. Even though the evidence is still spotty,
tea, especially Green Tea, may be a
strong cancer fighter. In laboratory
studies, green tea has slowed or
prevented the development of cancer in
colon, liver, breast, and prostate cells. It
also had a similar effect in lung tissue
and skin. And in some longer term
studies, tea was associated with lower
risks for bladder, stomach, and
pancreatic cancers.

29. Grapes and grape juice, especially
purple and red grapes, contain
Resveratrol. Resveratrol has strong
antioxidant and anti-inflammatory
properties. In laboratory studies, it
has prevented the kind of damage
that can trigger the cancer process in
cells. There is not enough evidence
to say that eating grapes or drinking
grape juice (or taking supplements)
can prevent or treat cancer.

30. Water not only quenches your thirst,
but it may protect you against
cancer specially bladder cancer. The
lower risk comes from water
diluting concentrations of potential
cancer-causing agents in the
bladder. Also, drinking more fluids
causes you to urinate more
frequently. That lessens the amount
of time those agents stay in contact
with the bladder lining.

31. Beans are so good for you, it's no
surprise they may help fight cancer,
too. They contain several potent
phytochemicals that may protect the
body's cells against damage that can
lead to cancer. In the lab these
substances slowed tumor growth and
prevented tumors from releasing
substances that damage nearby cells.

32. Cruciferous vegetables include
broccoli, cauliflower, cabbage, Brussels
sprouts, bokchoy, and kale. These
members of the cabbage family make
an excellent stir fry and can really liven
up a salad. But most importantly,
components in these vegetables may
help your body defend against cancers
such as colon, breast, lung, and cervix..

33. Dark green leafy vegetables such as
mustard greens, lettuce, kale, chicory,
spinach, and chard have an
abundance of fiber, foliate, and
carotenoids. These nutrients may
help protect against cancer of the
mouth, larynx, pancreas, lung, skin,
and stomach.

34. Curcumin is the main ingredient in the
Indian spice turmeric and a potential
cancer fighter. Lab studies show it can
suppress the transformation, proliferation,
and invasion of cancerous cells for a wide
array of cancers.

35. How you cook meat can make a
difference in how big a cancer risk it
poses. Frying, grilling, and broiling
meats at very high temperatures causes
chemicals to form that may increase
cancer risk. Other cooking methods
such as stewing, braising, or steaming
appear to produce fewer of those
chemicals. And when you do stew the
meat, remember to add plenty of
healthy, protective vegetables.

36. Vitamins may help protect against cancer. But
that's when you get them naturally from food.
Both the American Cancer Society and the
American Institute for Cancer Research
emphasize that getting cancer-fighting nutrients
from foods like nuts, fruits, and green leafy
vegetables is vastly superior to getting them
from supplements.
Eating a healthy diet is best.

37. Recent news from researchers has
demonstrated that oranges can play a
significant role in preventing cancer.
Amazingly, we routinely throw out this most
potent part of the orange. In the oil of the peel
of citrus fruits is a phytonutrient known as
Limonene. Oranges, mandarins, lemons, and
limes contain significant amounts of limonene
in the peel. Limonene stimulates our
antioxidant detoxification enzyme system, thus
helping to stop cancer before it can even begin.
Limonene stimulates our antioxidant
detoxification enzyme system, thus helping to
stop cancer before it can even begin. Vit C.

38. Recently many researchers have been looking at
the different elements of a Japanese diet that is
higher in foods made from soy beans.
Soy is the main source of protein for many
Asian women and is a source of various phyto
chemicals in the legume. Genistein, daidzein
and the Bowman-Birk inhibitor are three
examples of phytochemicals in soy that appear
to have anti- breast cancer activity.

39. Step 2:
21 Healthy Ways to Lose Weight
Without Dieting

40. Diabetes
Heart
Disease
GERD
HBP
Sleep
Apnea
Cancer
Obesity

41. Set a timer for 20 minutes and
reinvent yourself as a slow eater. This
is one of the top habits for slimming
down without a complicated diet plan.
Savor each bite and make them last
until the bell chimes. Paced meals
offer great pleasure from smaller
portions and trigger the body's
fullness hormones. When you wolf
your food down in a hurry, your
stomach doesn't have time to tell your
brain it's full. That leads to overeating.

42. The top habit of slim people is to stick
with modest food portions at every
meal, five days a week or more.
"Always slim" people do it and
successful losers do it, too, according
to a Consumer Reports survey. After
measuring portions a few times, it can
become automatic. Make it easier with
small "snack" packs and by keeping
serving dishes off the table at meal
time.

43. Choose a 10-inch lunch plate instead of
a 12-inch dinner plate to automatically
eat less. Cornell's Brian Wansink, PhD,
found in test after test that people serve
more and eat more food with larger
dishes. Shrink your plate or bowl to cut
out 100-200 calories a day and 10-20
pounds in a year. In Wansink's tests, no
one felt hungry or even noticed when
tricks of the eye shaved 200 calories off
their daily intake.
1Inch = 2/54 cm
1pound = 453.56 grams

44. Sugar may not cause cancer directly. But it
may displace other nutrient-rich foods that
help protect against cancer. And it increases
calorie counts, which contributes to
overweight and obesity. Excess weight is also
a cancer risk. Fruit offers a sweet alternative
in a vitamin-rich package.

45. Sleeping an extra hour a night could
help a person drop 14 pounds in a year,
according to a University of Michigan
researcher who ran the numbers for a
2,500 calorie per day intake. His
scenario shows that when sleep
replaces idle activities and the usual
mindless snacking, you can effortlessly
cut calories by 6%. Results would vary
for each person, but sleep may help in
another way, too. There's evidence that
getting less than 7 hours of sleep revs
up your appetite, making you
uncommonly hungry.

46. Serve three vegetables with dinner tonight,
instead of just one, and you'll eat more
without really trying. Greater variety
tricks people into eating more food and
eating more fruits and vegetables is a great
way to lose weight. The high fiber and
water content fills you up with fewer
calories. Cook them without added fat.
And season with lemon juice and herbs
rather than drowning their goodness in
high-fat sauces or dressings.

47. Add a broth-based soup to your day and
you'll fill up on fewer calories. Think
minestrone, tortilla soup, or Chinese won-
ton. Soup's especially handy at the
beginning of a meal because it slows your
eating and curbs your appetite. Start with
a low-sodium broth or canned soup, add
fresh not frozen vegetables and simmer.
Beware of creamy soups, which can be
high in fat and calories.

48. Whole grains such as brown rice, barley, oats,
buckwheat, and whole wheat also belong in
your stealthy weight loss strategy. They help
fill you up with fewer calories and may
improve your cholesterol, too. Whole grains
are now in many products including waffles,
pizza crust, English muffins, pasta, and soft
"white" whole-wheat bread.
‫غالت‬‫سبوس‬‫دار‬

49. Choose vegetable toppings for pizza
instead of meat and you may be able to
shave 100 calories from your meal.
Other skinny pizza tricks: Go light on the
cheese or use reduced-fat cheese and
choose a thin, bread-like crust made with
just a touch of olive oil

50. Replace one sugary drink like regular soda
with water or a zero-calorie seltzer and
you'll avoid about 10 teaspoons of sugar.
Add lemon, mint or frozen strawberries for
flavor and fun.
The liquid sugar in soda appears to bypass
the body's normal fullness cues. One study
compared an extra 450 calories per day
from jelly beans vs. soda. The candy eaters
unconsciously ate fewer calories overall,
but not so for the soda drinkers. They
gained 2.5 pounds in four weeks.

51. Use a tall, skinny glass instead of a short,
wide tumbler to cut liquid calories -- and
your weight without dieting. You'll drink
25%-30% less juice, soda, wine, or any
other beverage.
How can this work? Brian Wansink, PhD,
says visual cues can trick us into consuming
more or less. His tests at Cornell University
found all kinds of people poured more into
a short, wide glass even experienced
bartenders.

52. Drinking green tea may also be a
good weight loss strategy. Some
studies suggest that it can rev up the
body's calorie-burning engine
temporarily, possibly through the
action of phytochemicals called
Catechins. At the very least, you'll get
a refreshing drink without tons of
calories.

53. Women who do yoga tend to weigh less
than others, according to a study in the
Journal of the American Dietetic
Association. What's the connection? The
yoga regulars reported a more "mindful"
approach to eating. For example, they
tend to notice the large portions in
restaurants but eat only enough to feel
full. Researchers think the calm self-
awareness developed through yoga may
help people resist overeating.

54. Eat home-cooked meals at least five
days a week. A Consumer Reports
survey found this was a top habit of
"successful losers." Sound daunting?
Cooking may be easier than you think.
Shortcut foods can make for quick
meals, such as pre-chopped lean beef for
fajitas, washed lettuce, pre-cut veggies,
canned beans, cooked chicken strips, or
grilled deli salmon.

55. Most people have a natural "eating
pause," when they drop the fork for a
couple of minutes. Watch for this moment
and don't take another bite. Clear your
plate and enjoy the conversation. This is
the quiet signal that you're full, but not
stuffed. Most people miss it.

56. Chew sugarless gum with a strong
flavor when you're at risk for a snack
attack. Making dinner after work,
socializing at a party, watching TV, or
surfing the Internet are a few dangerous
scenarios for mindless snacking. Gum
with a big flavor punch overpowers
other foods so they don't taste good.

57. More people around the world are
conditioned to keep eating until
they're stuffed, but residents of
Okinawa eat until they're 80% full.
They even have a name for this
naturally slimming habit: hara hachi
bu. We can adopt this healthy habit by
dishing out 20% less food, according
to researcher Brian Wansink, PhD.
His studies show most people don't
miss it.

58. The tomato-based sauces tend to have
fewer calories and much less fat than
cream-based sauces. But remember,
portion size still counts. A serving of
pasta is one cup or roughly the size of a
tennis ball.

59. Dietary fiber is only found in foods from the
plant kingdom so the more foods such as
meat, cheese, milk and eggs are eaten, the
fewer fruits, vegetables, grains and beans are
consumed. This means that the typical diet of
fast food hamburgers with fries, pizza and
turkey sandwiches has very little dietary fiber
and is associated with a relatively high
incidence of breast cancer.
Japanese women have about half the
incidence of breast cancer compared with
American women but when Japanese women
move to the United States and adopt a
different diet they begin to get breast cancer
as often as women born here.

60. Lose 10 pounds in a year without dieting by
burning an extra 100 calories every day. Try one
of these activities:
Walk 1 mile, about 20 minutes.
Mow the lawn for 20 minutes.
Clean house for 30 minutes.
Jog for 10 minutes
1mile = 1.6 kilometer
1pound = 453.56 grams

61. Step 3:
Healthy Mind

63. َ
‫خ‬
ْ
‫ال‬ َ‫ن‬ِ‫م‬ ٍ‫ء‬ْ‫ي‬
َ
‫ش‬ِ‫ب‬ ْ‫م‬
ُ
‫ك‬َّ‫ن‬َ‫و‬
ُ
‫ل‬ْ‫ب‬َ‫ن‬
َ
‫ل‬َ‫و‬
َ
‫ال‬ َ‫ن‬ِ‫م‬ ٍ‫ص‬ ْ‫ق‬
َ
‫ن‬َ‫و‬ ِ‫وع‬ ُ‫ج‬
ْ
‫ال‬َ‫و‬
ْ
‫وف‬ِ‫ال‬َ‫و‬ َ‫م‬
َّ‫الص‬ِ‫ر‬ ِ‫ش‬َ‫ب‬َ‫و‬ ِ‫ات‬َ‫ر‬ َ‫م‬
َّ
‫الث‬َ‫و‬ ِ‫س‬ ُ‫النف‬َ‫و‬َ‫ين‬ِ‫ر‬ِ‫اب‬
(‫البقرة‬‫ه‬‫ر‬‫سو‬-155)

64. ‫ا‬ ً‫ر‬ ْ‫س‬ ُ‫ي‬ ِ‫ر‬ ْ‫س‬ ُ‫ع‬ ْ‫ال‬ َ‫ع‬ َ‫م‬ َّ‫ن‬ ِ‫إ‬(‫سوره‬
‫الشرح‬-6)
َ‫ک‬ َ‫ر‬ ْ‫د‬ َ‫ص‬ َ‫ک‬ َ‫ل‬ ْ‫ح‬ َ‫ر‬ ْ‫ش‬ َ‫ن‬ ْ‫م‬ َ‫ل‬ َ‫أ‬(‫سوره‬
‫الشرح‬-1)
‫ن‬ ِ‫ئ‬ َ‫م‬ ْ‫ط‬ َ‫ت‬ َ‫و‬ ‫وا‬ ُ‫ن‬ َ‫آم‬ َ‫ذين‬ َّ‫ال‬
َ‫أ‬ َِّ‫اَّلل‬ ِ‫ر‬ ْ‫ك‬ ِ‫ذ‬ ِ‫ب‬ ْ‫م‬ ُ‫ه‬ ُ‫وب‬ ُ‫ل‬ ُ‫ق‬ِ‫ر‬ ْ‫ك‬ ِ‫ذ‬ ِ‫ب‬ ‫ال‬
ُ‫وب‬ ُ‫ل‬ ُ‫ق‬ ْ‫ال‬ ‫ن‬ ِ‫ئ‬ َ‫م‬ ْ‫ط‬ َ‫ت‬ َِّ‫اَّلل‬(‫سوره‬‫الرعد‬
–28)
ْ‫ب‬ َ‫ع‬ ٍ‫اف‬ َ‫ك‬ ِ‫ب‬ ُ‫ـه‬ َّ‫الل‬ َ‫س‬ ْ‫ي‬ َ‫ل‬ َ‫أ‬ُ‫ه‬ َ‫د‬

65. Certain scents like Lavender may soothe.
In one study, nurses who pinned small
vials of lavender oil to their clothes felt
their stress ease, while nurses who didn’t
felt more stressed. Lavender may
intensify the effect of some painkillers
and anti-anxiety medications, so if
you’re taking either, check with your
doctor before use.

66. Feeling less stressed is as close as
your next breath. Focusing on your
breath curbs your body’s “fight or
flight” reaction to pressure or fear,
and it pulls your attention away
from negative thoughts.
Sit comfortably in a quiet place.
Breathe in slowly through your
nose, letting your chest and lower
belly rise and your abdomen
expand. Breathe out just as slowly,
repeating a word or phrase that
helps you relax. To reap the most
benefit, repeat for at least 10
minutes.

67. We all have a constant stream of thoughts
running through our heads, and sometimes
what we tell ourselves isn’t so nice. Staying
positive and using compassionate Self-Talk
will help you calm down and get a better grip
on the situation. Talk to yourself in the same
gentle, encouraging way you’d help a friend in
need.
“Everything will be OK,” for instance, or "I'll
figure out how to handle this."

68. Soothes the tummy and the soul
A mild, Relaxing Tea with a delicate
flavor, it contains oils that relax the
smooth muscles in the stomach. Three
cups daily will ease indigestion, irritable
bowel problems, and colitis. Choose
100% pure chamomile flowers with a
strong, fresh apple aroma. Use 1
tablespoon of flowers per cup of boiling
water. Take for 2 months or more for
chronic problems.

69. Jotting down your thoughts can be a
great emotional outlet. Once they're
on paper, you can start working out a
plan to resolve them. It doesn’t
matter whether you prefer pen and
notebook, a phone app, or a file on
your laptop. The important thing is
that you’re honest about your
feelings.

70. Spending time outdoors, even close to
home, is linked to better well-being.
You're in a natural setting, and you're
usually doing something active, like
walking or hiking. Even a few minutes
can make a difference in how you feel.
‫حمام‬‫جنگل‬

71. Don’t roll your eyes the next time someone
advises you to “grin and bear it.” In times of
tension, keeping a smile on your face
especially a genuine smile that’s formed by
the muscles around your eyes as well as your
mouth reduces your body’s stress responses,
even if you don’t feel happy. Smiling also
helps lower heart rates faster once your
stressful situation ends.

72. Music can help you calm down. In one
study, people had lower levels of the stress
hormone cortisol when they listened to a
recording of music before doing something
stressful (like doing math out loud or giving
a speech) than when they listened to a
recording of rippling water.

73. Step 4:
Secondary Prevention:
Screening

74. A Good Breast Health Plan is:
Self Awareness (Monthly Self Exams) (BSE)
Clinical Breast Examination (CBE)
Mammograms (Mammography)

75. Average-size lump found by woman practicing
occasional breast self-exam (BSE)
Average-size lump found by woman practicing
regular breast self-exam (BSE)
Average-size lump found by first mammogram
Average-size lump found by getting regular mammograms

76. Opportunity for woman to
become familiar with her breasts
Monthly exam of the breasts and
underarm area
May discover any changes early
Begin at age 20, continue
monthly

77. Menstruating women- 5 to 7 days after the beginning of
their period
Menopausal women same date each month
Pregnant women same date each month
Takes about 10 minutes
Perform BSE at least once a month
Examine all breast tissue

83. Breast exam may reveal the following:
Swelling in the armpit
Pain or tenderness in the breast
A change in the nipple
An unusual discharge from the nipple
A flattening or indentation in the breast
A lump in the armpit that does not go away after a menstrual cycle
A change in the size, contour, texture or temperature of the breast

84. Performed by doctor or trained nurse practitioner
Annually for women over 40yrs
At least every 3 years for women between 20 and 40yrs
More frequent examination for high risk patients

85. The earlier breast cancer is found, the easier it
is to treat. And mammograms, X-rays of the
breast, can detect tumors before they are large
enough to feel. The American Cancer Society
recommends yearly mammograms beginning
at age 40 for women at average risk. The U.S.
Preventive Services Task Force recommends
a screening mammogram every two years from
age 50 to 74.
It also notes that before age 50, each woman
should check with a doctor to find out what
screening schedule is right for her, considering
the potential benefits and harms.

86. Besides a mammogram, your doctor may order additional imaging with
breast ultrasound. An ultrasound can help determine the presence of
cysts, fluid-filled sacs that are not cancer.
An MRI may be recommended along with a mammogram for routine
screening in certain women who have a higher risk of breast cancer.

87. The only sure way to determine whether a
lump is cancer is to do a biopsy. This
involves taking a tissue sample for further
examination in the lab, sometimes through
a small needle. Sometimes surgery is done
to take part of or the entire lump for
testing. The results will show whether the
lump is cancer, and if so, what type. There
are several forms of breast cancer, and
treatments are carefully matched to the
type of cancer.

88. Step 5:
What is the
Breast Cancer Symptoms?

90. See your health care provider if you:
Find a new lump (or any change) that feels different from the
rest of your breast
Find a new lump (or any change) that feels different from your
other breast .
Feel something that is different from what you felt before

91. Change in the outline or shape, especially caused by
arm movements or by lifting the breasts.
Any puckering or dimpling of the skin.

92. In most cases, this change are not cancer. For example, breast
pain is more common with benign (not cancer) breast conditions
than with breast cancer. However, the only way to know for sure
is to see a provider. If you have breast cancer, it is best to find it
at an early stage, when the chances of survival are highest.

93. Discharge that is new to you and not milky.
Bleeding, Moist reddish areas that do not
heal easily
Position if the nipple is pulled in or pointing
differently.
Rash appearing on or around the nipple

94. Changes in skin color
and/or texture
Change in the size or shape
of the breast
Change in the appearance of
the nipple
Discharge from the nipple
Lump or thickening in
the breast

95. 1. Anderson BO et al. (2008). Guideline implementation for breast healthcare in low-income and middle-income countries:
overview of the Breast Health Global Initiative Global Summit 2007. Cancer, 113, 2221–43.
2. Coleman MP et al. (2008). Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet
Oncol, 9, 730–56.
3. Danaei G et al. (2005). Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental
risk factors. Lancet, 366, 1784–93.
4. Sankaranarayanan R, Ramadas K, Thara S et al. (2011). Clinical breast examination: preliminary results from a randomized
controlled trial in India. Journal of the National Cancer Institute, 103:1476-1480
5. IARC (2002). Breast cancer screening, IARC handbooks for cancer prevention, volume 7, Lyon, International Agency for
Research on Cancer, IARCpress.
6. IARC (2008). World cancer report 2008. Lyon, International Agency for Research on Cancer.
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