I
n
t
e
r
n
at
io
n
al
Jou
r
n
al
of
A
d
van
c
e
s
i
n
A
p
p
li
e
d
S
c
ie
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e
s
(
I
JA
A
S
)
V
ol
.
1
5
, N
o.
1
,
M
a
r
c
h
20
2
6
, pp.
178
~
186
I
S
S
N
:
2252
-
8814
,
D
O
I
:
10.11591/
ij
a
a
s
.
v
1
5
.
i
1
.
pp
178
-
186
178
Jou
r
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al
h
om
e
page
:
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tp
:
//
ij
aas
.i
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du N
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ndi
a
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nn
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M.
A
. C
hi
da
m
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a
m
C
ol
l
e
ge
of
N
ur
s
i
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h
e
nna
i
, I
ndi
a
5
M
a
dha
c
ol
l
e
ge
of
N
ur
s
i
ng, C
h
e
nna
i
, I
ndi
a
A
r
t
ic
le
I
n
f
o
A
B
S
T
R
A
C
T
A
r
ti
c
le
h
is
to
r
y
:
R
e
c
e
iv
e
d
M
a
y 17, 2025
R
e
vi
s
e
d
N
ov 27, 2025
A
c
c
e
pt
e
d
J
a
n 1, 2026
The
breast
has
long
been
a
repr
esentation
of
women'
s
identity
a
nd
an
essential
component
of
fertilit
y.
The
breast
lesions
refer
to
an
a
rea
of
abnormal
breast
tissue.
One
frequent
medical
ailment
that
might
worry
women
is
breast
lesions.
It
is
estimated
that
at
least
20%
of
female
s
may
develop
breast
lesions.
It
may
vary
in
size,
shape,
and
texture
can
be
either
benign or malignant. Mammography, clinical
breast examination
(CB
E)
, and
self
-
breast
inspection
are
the
accepted
early
breast
cancer
detection
techn
iques.
Mammography
application
in
low
and
middle
-
income
co
untries
is
limited
because
most
of
the
women
in
th
es
e
countries
can
not
aff
ord
it.
Hence
,
iBreastExa
m
was
identified
and
validated
as
an
alternative
sou
rce
for
screening
at
the
village
level
to
identify
breast
lesions
at
an
early
sta
ge.
For
the
study,
a
cross
-
sectional
researc
h
design
using
a
quantitative
researc
h
methodology
was
used.
Adopted
areas
of
the
selected
colleges
we
re
the
setting
for
the
study
:
MA
Chidambaram
College
of
Nursing,
Adyar,
Chen
nai
;
Sri
Balaji
College
of
Nursing,
Chrompet,
Chennai
;
Madha
C
ollege
of
Nursing,
Kundrathur,
Chennai
;
Omayal
Achi
C
ollege
of
Nursing,
Puzhal,
Chennai.
The
sample
size
consisted
of
14,000
women
across
all
the
4
settings.
A c
onvenient sampling technique
was used to
select the samp
les for
the
study.
A
total
of
13,988
women
were
screened,
55
women
had
p
ositive
breast
lesions
,
and
out
of
this
5
were
confirmed
to
have
breast
cancer
through mammog
ram diagno
sis.
K
e
y
w
o
r
d
s
:
B
r
e
a
s
t
le
s
io
n
s
B
r
e
a
s
t
c
a
n
c
e
r
F
e
r
ti
li
ty
iB
r
e
a
s
tE
xa
m
M
a
m
m
ogr
a
m
W
om
a
nhood
This is an
open
acce
ss artic
le unde
r the
CC BY
-
SA
license.
C
or
r
e
s
pon
di
n
g A
u
th
or
:
S
a
m
ue
l
A
ni
G
r
a
c
e
K
a
la
im
a
th
i
T
he
T
a
m
il
N
a
du N
ur
s
e
s
a
nd M
id
w
iv
e
s
C
ounc
il
C
he
nna
i,
I
ndi
a
E
m
a
il
:
a
nni
e
ka
la
i@gma
il
.c
om
1.
I
N
T
R
O
D
U
C
T
I
O
N
W
om
e
n'
s
br
e
a
s
t
ha
s
a
lwa
y
s
be
e
n
a
vi
ta
l
pa
r
t
of
f
e
r
ti
li
ty
a
nd
a
ls
o
a
s
ym
bol
of
w
om
a
nhood.
I
t
is
a
m
odi
f
ie
d
s
w
e
a
t
or
ga
n
w
it
h
c
ons
id
e
r
a
bl
e
s
ig
ni
f
ic
a
nc
e
f
or
it
s
la
c
ta
ti
ng
c
a
pa
c
it
y
a
nd
f
or
c
os
m
e
ti
c
r
e
a
s
ons
.
T
hi
s
dyna
m
ic
or
ga
n,
unde
r
th
e
in
f
lu
e
nc
e
of
va
r
io
us
hor
m
one
s
,
is
s
ubj
e
c
te
d
to
c
on
s
ta
nt
phys
io
lo
gi
c
a
l
va
r
ia
ti
ons
th
r
oughout
th
e
r
e
pr
oduc
ti
ve
li
f
e
a
nd
be
yond,
gi
vi
ng r
is
e
to
va
r
io
us
ty
pe
s
of
br
e
a
s
t
a
bnor
m
a
li
ti
e
s
or
le
s
io
ns
[
1]
.
T
he
br
e
a
s
t
le
s
io
n
r
e
f
e
r
s
to
a
n
a
r
e
a
of
a
bnor
m
a
l
br
e
a
s
t
ti
s
s
u
e
.
O
ne
f
r
e
que
nt
m
e
di
c
a
l
a
il
m
e
nt
th
a
t
m
ig
ht
w
or
r
y
w
om
e
n
is
br
e
a
s
t
le
s
io
ns
.
I
t
i
s
e
s
ti
m
a
t
e
d
th
a
t
a
t
le
a
s
t
20
%
of
f
e
m
a
le
s
m
a
y
de
v
e
lo
p
br
e
a
s
t
le
s
io
ns
[
2]
.
I
t
m
a
y
va
r
y
in
s
iz
e
,
s
ha
pe
,
a
nd
te
xt
ur
e
c
a
n
be
e
it
he
r
be
ni
gn
or
m
a
li
gna
nt
.
C
ys
ts
,
f
ib
r
oa
de
nom
a
s
,
pa
pi
ll
om
a
s
,
duc
ta
l
c
a
r
c
in
om
a
in
s
it
u,
a
nd
in
va
s
iv
e
duc
ta
l
c
a
r
c
in
om
a
a
r
e
a
m
ong
th
e
s
e
ve
r
a
l
f
or
m
s
of
br
e
a
s
t
Evaluation Warning : The document was created with Spire.PDF for Python.
I
nt
J
A
dv A
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E
ff
e
c
ti
v
e
ne
s
s
of
i
B
r
e
a
s
t
e
x
am
in
at
io
n f
or
s
c
r
e
e
ni
ng br
e
a
s
t
le
s
io
n
s
am
ong …
(
Sam
ue
l
A
ni
G
r
ac
e
K
al
ai
m
at
hi
)
179
le
s
io
ns
[
3]
.
B
e
ni
gn
le
s
io
ns
a
r
e
not
li
f
e
-
th
r
e
a
te
ni
ng
a
nd
a
r
e
of
te
n
tr
e
a
te
d
by
e
xc
is
io
n
or
ob
s
e
r
va
ti
on.
I
n
c
ont
r
a
s
t,
m
a
li
gna
nt
le
s
io
ns
in
vol
ve
e
a
r
ly
id
e
nt
if
ic
a
ti
on
a
nd
pr
om
pt
tr
e
a
tm
e
nt
s
uc
h
a
s
c
he
m
ot
he
r
a
py,
r
a
di
a
ti
on
,
or
hor
m
one
th
e
r
a
py.
T
he
opt
im
a
l
c
our
s
e
of
th
e
r
a
py
w
il
l
de
pe
nd
on
th
e
le
s
io
n'
s
na
tu
r
e
a
nd
s
ta
ge
,
a
s
w
e
ll
a
s
th
e
w
om
a
n'
s
g
e
ne
r
a
l
he
a
lt
h
[
4]
.
A
lt
hough
non
-
c
a
n
c
e
r
ous
(
be
ni
gn)
br
e
a
s
t
le
s
io
ns
m
a
y
s
om
e
ti
m
e
s
pr
ogr
e
s
s
to
c
a
nc
e
r
,
th
e
y
do
not
ha
ve
th
e
c
a
pa
c
it
y
to
s
pr
e
a
d
to
ot
he
r
a
r
e
a
s
of
th
e
body
a
nd
r
e
s
ul
t
in
m
or
ta
li
ty
.
E
ve
n t
hough thi
s
m
e
ta
m
or
phos
is
i
s
unc
om
m
on, i
t
is
c
r
uc
ia
l
to
ha
ve
a
m
e
di
c
a
l
te
a
m
e
xa
m
in
e
a
ny br
e
a
s
t
le
s
io
n
in
or
de
r
to
ke
e
p a
n e
ye
out
f
or
a
ny gr
ow
th
or
c
ha
nge
s
. U
nt
r
e
a
te
d be
ni
gn br
e
a
s
t
le
s
io
ns
m
ig
ht
pot
e
nt
ia
ll
y
r
a
is
e
th
e
c
ha
nc
e
of
ge
tt
in
g br
e
a
s
t
c
a
nc
e
r
l
a
te
r
on
[
5]
.
B
e
ni
gn
le
s
io
n
s
a
r
e
of
te
n
tr
e
a
ta
bl
e
w
it
h
in
s
pe
c
ti
on
a
nd
do
not
p
os
e
a
da
nge
r
to
li
f
e
.
O
n
th
e
c
ont
r
a
r
y,
m
a
li
gna
nt
le
s
io
ns
ne
c
e
s
s
it
a
te
ti
m
e
ly
c
la
s
s
if
ic
a
ti
on
a
nd
r
a
pi
d
tr
e
a
tm
e
nt
[
6]
.
T
he
na
tu
r
e
a
nd
s
ta
ge
of
th
e
le
s
io
n
a
nd
th
e
w
om
a
n’
s
ove
r
a
ll
he
a
lt
h
w
il
l
e
s
ta
bl
is
h
th
e
a
ppr
opr
ia
t
e
c
our
s
e
of
th
e
r
a
py.
N
or
m
a
l
(
non
-
c
a
nc
e
r
ous
)
br
e
a
s
t
le
s
io
ns
m
a
y
s
om
e
ti
m
e
s
de
ve
lo
p
in
to
c
a
nc
e
r
,
but
th
e
y
c
a
nnot
s
pr
e
a
d
to
ot
he
r
a
r
e
a
s
of
th
e
body
a
nd
r
e
s
ul
t
in
de
a
th
[
7]
.
E
ve
n i
f
th
is
m
e
ta
m
or
phos
is
i
s
unc
om
m
on, i
t
i
s
ne
ve
r
th
e
le
s
s
c
r
uc
ia
l
to
ha
ve
a
m
e
di
c
a
l
te
a
m
a
s
s
e
s
s
a
ny
br
e
a
s
t
le
s
io
ns
in
or
de
r
to
m
oni
to
r
f
or
a
ny
c
ha
ng
e
s
[
8]
.
U
nt
r
e
a
te
d
be
ni
gn
br
e
a
s
t
le
s
io
ns
m
a
y
pot
e
nt
ia
ll
y
in
c
r
e
a
s
e
th
e
c
ha
nc
e
of
de
ve
lo
pi
ng
in
to
br
e
a
s
t
c
a
nc
e
r
in
th
e
f
ut
ur
e
[
9]
.
B
r
e
a
s
t
c
a
nc
e
r
i
s
th
e
m
os
t
c
om
m
on
c
a
nc
e
r
a
m
ong
w
om
e
n
in
I
ndi
a
a
nd
a
c
c
ount
s
f
or
14%
of
a
ll
c
a
nc
e
r
s
in
w
om
e
n.
I
ndi
a
i
s
f
a
c
e
d
w
it
h
a
s
iz
a
bl
e
c
a
nc
e
r
in
c
id
e
nc
e
bur
de
n,
w
hi
c
h
c
ont
in
u
e
s
to
gr
ow
e
xpone
nt
ia
ll
y
[
10]
.
T
he
2020
W
or
ld
H
e
a
lt
h
O
r
ga
ni
z
a
ti
on
(
W
H
O
)
r
a
nki
ng
on
c
a
nc
e
r
bur
de
n
in
te
r
m
s
of
ne
w
ye
a
r
ly
r
e
por
te
d
c
a
s
e
s
ha
d
r
a
nk
e
d
I
ndi
a
a
t
th
e
th
ir
d
pos
it
io
n
a
f
te
r
C
hi
na
a
nd
th
e
U
.S
.,
r
e
s
p
e
c
ti
ve
ly
[
11]
.
A
G
L
O
B
O
C
A
N
2020
r
e
s
e
a
r
c
h
f
ound
th
a
t
a
w
om
a
n
in
I
ndi
a
r
e
c
e
iv
e
s
a
br
e
a
s
t
c
a
nc
e
r
di
a
gnos
is
e
ve
r
y
f
our
m
in
ut
e
s
.
E
ve
r
y
ye
a
r
,
a
r
ound
1,78,
000
ne
w
c
a
s
e
s
a
r
e
di
a
gnos
e
d
[
12]
.
B
r
e
a
s
t
c
a
nc
e
r
is
now
th
e
m
os
t
f
r
e
que
nt
c
a
nc
e
r
a
m
ong
I
ndi
a
n
w
om
e
n,
s
ur
pa
s
s
in
g
c
e
r
vi
c
a
l
c
a
nc
e
r
in
f
r
e
que
nc
y.
T
he
f
a
c
t
th
a
t
it
is
in
c
r
e
a
s
in
gl
y
be
in
g
id
e
nt
if
ie
d
in
I
ndi
a
te
n
ye
a
r
s
s
oone
r
th
a
n
in
th
e
W
e
s
t
is
e
ve
n
m
or
e
c
onc
e
r
ni
ng
[
13]
.
T
r
a
gi
c
a
ll
y,
a
w
om
a
n
in
th
e
n
a
ti
on
di
e
s
f
r
om
br
e
a
s
t
c
a
nc
e
r
e
ve
r
y
e
ig
ht
m
in
ut
e
s
,
a
c
c
ount
in
g
f
or
90,000
f
a
ta
li
ti
e
s
a
nnua
ll
y
[
14]
.
O
ne
w
om
a
n
di
e
s
f
r
om
br
e
a
s
t
c
a
nc
e
r
f
or
e
ve
r
y
two
w
ho
ge
t
a
di
a
gnos
is
. D
e
la
y
s
i
n e
a
r
ly
de
te
c
ti
on a
nd a
l
a
c
k of
pr
e
ve
nt
a
ti
ve
br
e
a
s
t
he
a
lt
h e
xa
m
s
a
r
e
t
he
t
w
o m
a
in
c
a
us
e
s
of
th
e
s
ta
r
tl
in
gl
y
hi
gh
de
a
th
r
a
te
.
T
he
r
e
f
or
e
,
it
is
e
s
s
e
nt
ia
l
to
c
r
e
a
t
e
a
s
c
r
e
e
ni
ng
m
e
th
od
th
a
t
is
bot
h
e
c
onomi
c
a
l
a
nd e
f
f
ic
ie
nt
i
n or
de
r
t
o a
id
i
n t
he
e
a
r
ly
i
de
nt
if
ic
a
ti
on a
nd t
im
e
l
y t
r
e
a
tm
e
nt
of
br
e
a
s
t
di
s
e
a
s
e
s
[
15]
.
A
c
c
or
di
ng
to
a
r
e
c
e
nt
s
ys
te
m
a
ti
c
r
e
vi
e
w
a
nd
m
e
ta
-
a
na
ly
s
is
of
br
e
a
s
t
c
a
nc
e
r
r
is
k
f
a
c
to
r
s
,
w
om
e
n
be
twe
e
n
th
e
a
ge
s
of
40
a
nd
49
w
ho
h
a
ve
v
e
r
y
th
ic
k
br
e
a
s
ts
a
nd
f
ir
s
t
-
de
gr
e
e
r
e
la
ti
ve
s
w
it
h
br
e
a
s
t
c
a
n
c
e
r
a
r
e
a
t
le
a
s
t
twi
c
e
a
s
li
ke
ly
to
ge
t
br
e
a
s
t
c
a
n
c
e
r
[
16]
.
P
e
r
s
ona
li
z
e
d
m
a
m
m
ogr
a
phy
s
c
r
e
e
ni
ng
m
a
y
b
e
ne
f
it
f
r
om
a
n
a
w
a
r
e
ne
s
s
of
th
e
s
e
r
is
k
va
r
ia
bl
e
s
[
17]
.
I
n
I
ndi
a
,
br
e
a
s
t
c
a
n
c
e
r
oc
c
ur
r
e
nc
e
pe
a
ks
b
e
f
or
e
th
e
a
g
e
of
50
ye
a
r
s
,
a
nd
a
c
ur
r
e
nt
e
va
lu
a
ti
on
of
th
e
e
vi
de
nc
e
e
s
ta
bl
is
h
e
d
on
e
ig
ht
tr
ia
ls
c
onduc
te
d
be
twe
e
n
2001
a
nd
2008
pr
opos
e
d
th
a
t
m
a
m
m
ogr
a
phi
c
s
c
r
e
e
ni
ng
is
a
ls
o
he
lp
f
ul
in
th
is
younge
r
a
ge
gr
oup
[
18]
.
T
he
r
e
f
or
e
,
s
c
r
e
e
ni
ng
w
om
e
n
be
twe
e
n
th
e
a
g
e
s
of
40
a
nd
49
is
n
e
c
e
s
s
a
r
y
to
d
e
te
r
m
in
e
th
e
e
f
f
e
c
ti
ve
ne
s
s
of
br
e
a
s
t
c
a
nc
e
r
s
c
r
e
e
ni
ng
in
t
hi
s
de
m
ogr
a
phi
c
[
6]
.
B
r
e
a
s
t
c
a
nc
e
r
m
a
y
be
id
e
nt
if
ie
d
a
nd
tr
e
a
te
d
e
a
r
ly
s
in
c
e
it
d
e
ve
l
ops
in
a
vi
s
ib
le
or
ga
n
4.
I
f
id
e
nt
if
ie
d
e
a
r
ly
,
th
e
5
-
ye
a
r
s
ur
vi
va
l
r
a
te
is
85%
;
if
de
te
c
te
d
la
te
,
it
is
56%
[
19]
.
C
om
m
on
br
e
a
s
t
c
a
nc
e
r
s
c
r
e
e
ni
ng
m
e
th
ods
th
a
t
ha
v
e
be
e
n
pr
opos
e
d
to
r
e
duc
e
m
or
bi
di
ty
a
nd
m
or
ta
li
ty
in
c
lu
de
br
e
a
s
t
s
e
lf
-
e
xa
m
s
(
B
S
E
)
,
c
li
ni
c
a
l
-
br
e
a
s
t
e
xa
m
in
a
ti
on
s
(
C
B
E
)
,
a
nd
m
a
m
m
ogr
a
m
s
[
20]
.
F
or
th
e
m
a
jo
r
it
y
of
pe
opl
e
,
br
e
a
s
t
c
a
nc
e
r
doe
s
not
e
xi
s
t
ti
ll
th
e
ir
s
a
f
e
one
s
a
r
e
m
a
nuf
a
c
tu
r
e
d.
A
f
te
r
th
a
t,
it
g
oe
s
w
it
hout
s
a
yi
ng
th
a
t
m
os
t
in
di
vi
dua
ls
onl
y
gi
ve
w
he
n
th
e
il
ln
e
s
s
s
ta
r
ts
to
s
how
s
ym
pt
om
s
,
a
nd
m
os
t
"
s
ym
pt
om
a
ti
c
"
m
a
li
gna
nc
ie
s
a
r
e
of
te
n
s
ta
ge
2b
a
nd
a
bove
[
21]
.
P
a
ti
e
nt
s
w
it
h
b
r
e
a
s
t
c
a
nc
e
r
a
r
e
not
in
c
li
ne
d
to
li
ve
lo
nge
r
if
th
e
d
is
e
a
s
e
is
di
s
c
ov
e
r
e
d
la
te
r
,
s
in
c
e
,
e
ve
n
w
it
h
s
uc
c
e
s
s
f
ul
th
e
r
a
py,
th
e
s
iz
e
of
th
e
tu
m
or
a
t
di
a
gnos
is
s
ig
ni
f
ic
a
nt
ly
a
f
f
e
c
ts
s
ur
vi
va
l.
O
ne
m
a
jo
r
s
tr
a
te
gy
in
r
e
duc
in
g
br
e
a
s
t
c
a
nc
e
r
hum
a
ni
ty
i
s
th
e
ha
bi
t
of
s
c
r
e
e
ni
ng
m
e
th
ods
,
f
or
in
s
t
a
n
c
e
[
22]
.
B
S
E
is
a
pr
om
is
in
g
c
li
ni
c
a
l
r
e
s
ul
t
a
m
ong
br
e
a
s
t
c
a
nc
e
r
pa
ti
e
nt
s
.
E
a
r
ly
di
s
c
ove
r
y
a
s
s
i
s
ts
in
th
e
tr
e
a
tm
e
nt
b
e
f
or
e
m
e
ta
s
ta
s
i
s
a
nd
is
c
onn
e
c
te
d
w
it
h
a
n
out
s
t
a
ndi
ng
f
or
e
c
a
s
t.
B
r
e
a
s
t
c
a
nc
e
r
s
c
r
e
e
ni
ng
is
e
s
ta
bl
is
he
d
to
m
in
im
iz
e
th
e
r
is
k
of
hum
a
ni
ty
by
20%
.
D
e
s
pi
te
th
e
e
xi
s
t
e
nc
e
of
s
e
v
e
r
a
l
s
c
r
e
e
ni
ng
m
e
th
od
s
,
c
om
m
on
of
br
e
a
s
t
c
a
nc
e
r
c
a
s
e
s
a
r
e
id
e
nt
if
ie
d
by
w
om
e
n
th
e
m
s
e
lv
e
s
,
s
tr
e
s
s
in
g
th
e
s
ig
n
if
ic
a
nc
e
of
B
S
E
[
23]
.
F
ig
ur
e
1
e
xpl
a
in
s
th
e
W
e
ib
ul
l
di
s
tr
ib
ut
io
n
of
a
ll
f
il
le
r
c
onc
e
nt
r
a
ti
ons
.
N
um
be
r
of
ne
w
c
a
s
e
s
in
f
e
m
a
le
s
in
2020.
I
n
a
ddi
ti
on,
F
ig
ur
e
2 e
xpl
a
in
s
t
he
iB
r
e
a
s
tE
xa
m
.
S
ig
ni
f
ic
a
nc
e
a
nd
ne
e
d
f
or
s
tu
dy
:
th
e
m
os
t
c
om
m
on
di
s
e
a
s
e
a
n
d
th
e
pr
im
a
r
y
c
a
us
e
of
c
a
nc
e
r
-
r
e
la
te
d
m
or
ta
li
ty
f
or
w
om
e
n
gl
oba
ll
y
is
br
e
a
s
t
c
a
nc
e
r
[
23]
.
T
he
m
a
jo
r
i
ty
of
br
e
a
s
t
c
a
nc
e
r
c
a
s
e
s
a
r
e
di
s
c
ove
r
e
d
e
a
r
ly
in
hi
gh
-
in
c
om
e
na
ti
ons
w
it
h
s
tr
ong
he
a
lt
hc
a
r
e
s
y
s
te
m
s
a
nd
p
opul
a
ti
on
s
c
r
e
e
ni
ng
in
it
ia
ti
ve
s
,
a
nd
tr
e
a
tm
e
nt
r
e
s
ul
ts
a
r
e
e
xc
e
ll
e
nt
.
L
ow
-
in
c
om
e
a
nd
m
id
dl
e
-
in
c
om
e
c
ount
r
ie
s
(
L
M
I
C
s
)
of
te
n
h
a
ve
a
dva
nc
e
d
pr
e
s
e
nt
a
ti
on
s
,
a
nd
tr
e
a
tm
e
nt
r
e
s
ul
ts
a
r
e
s
ubpa
r
be
c
a
us
e
of
de
la
ye
d
di
s
c
ove
r
y,
a
la
c
k
of
di
a
gnos
ti
c
to
ol
s
,
a
nd
li
m
it
e
d
a
c
c
e
s
s
to
he
a
lt
hc
a
r
e
.
A
s
a
r
e
s
ul
t,
in
it
ia
ti
ve
s
to
e
nha
n
c
e
e
a
r
ly
di
a
gn
os
is
w
il
l
be
b
e
ne
f
ic
ia
l
[
24]
.
M
a
m
m
ogr
a
phy,
c
li
ni
c
a
l
br
e
a
s
t
e
xa
m
in
a
ti
on,
a
nd
s
e
lf
-
br
e
a
s
t
in
s
pe
c
ti
on
a
r
e
th
e
a
c
knowle
dge
d
e
a
r
ly
br
e
a
s
t
c
a
nc
e
r
de
te
c
ti
on
te
c
hni
que
s
[
25]
.
M
a
m
m
ogr
a
m
s
a
r
e
th
e
gol
d
s
ta
nda
r
d
f
or
s
c
r
e
e
ni
ng
f
or
br
e
a
s
t
c
a
nc
e
r
in
hi
gh
-
in
c
om
e
na
ti
ons
.
M
a
m
m
ogr
a
phy
a
ppl
ic
a
ti
on
in
lo
w
-
a
nd
m
id
dl
e
-
in
c
om
e
c
ount
r
ie
s
is
li
m
it
e
d
be
c
a
us
e
m
os
t
w
om
e
n
in
th
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
S
N
:
2252
-
8814
I
nt
J
A
dv A
ppl
S
c
i
,
V
ol
. 15, No. 1, M
a
r
c
h 2026
:
178
-
186
180
c
om
m
uni
ti
e
s
can
not
a
f
f
or
d
a
m
a
m
m
ogr
a
m
[
26]
.
H
e
nc
e
,
iB
r
e
a
s
tE
xa
m
w
a
s
id
e
nt
if
ie
d
a
nd
v
a
li
da
te
d
a
s
a
n
a
lt
e
r
na
te
s
our
c
e
f
or
s
c
r
e
e
ni
ng a
t
th
e
vi
ll
a
ge
l
e
ve
l
to
i
de
nt
if
y br
e
a
s
t
le
s
io
ns
a
t
a
n e
a
r
ly
s
ta
g
e
[
27]
.
F
ig
ur
e
1
. W
e
ib
ul
l
di
s
tr
ib
ut
io
n of
a
ll
f
i
ll
e
r
c
onc
e
nt
r
a
ti
on
num
be
r
s
of
ne
w
c
a
s
e
s
i
n f
e
m
a
le
s
, 2020
[
12]
F
ig
ur
e
2
. 2
iB
r
e
a
s
tE
xa
m
T
he
iB
r
e
a
s
tE
xa
m
is
a
noni
nva
s
iv
e
,
ha
ndhe
ld
,
qui
c
k
,
a
nd
e
a
s
y
s
ol
ut
io
n
f
or
br
e
a
s
t
le
s
io
n
de
te
c
ti
on.
I
t
is
a
c
om
pl
e
te
ly
s
a
f
e
,
pa
in
a
nd
r
a
di
a
ti
on
-
f
r
e
e
te
c
hni
que
w
it
h
l
ow
c
os
t
a
t
th
e
vi
ll
a
ge
le
ve
l,
a
nd
it
s
de
a
li
ngs
ti
s
s
ue
e
la
s
ti
c
it
y
a
nd
id
e
nt
if
ie
s
a
bnor
m
a
l
(
s
ti
f
f
e
r
a
nd
ha
r
de
r
)
br
e
a
s
t
ti
s
s
u
e
a
s
s
m
a
ll
a
s
3
m
m
w
it
hi
n
5
m
in
ut
e
s
.
B
y
c
ont
a
c
ti
ng
th
e
s
ki
n'
s
s
ur
f
a
c
e
f
r
om
th
e
to
p
dow
n,
th
is
in
e
x
pe
ns
iv
e
e
la
s
ti
c
m
odul
us
s
e
ns
or
c
a
n
de
te
r
m
in
e
th
e
s
ti
f
f
ne
s
s
a
nd
c
om
pr
e
s
s
io
n
of
ti
s
s
u
e
.
T
he
ga
dg
e
t
is
c
onne
c
t
e
d
to
a
s
m
a
r
tp
hone
a
pp
th
a
t
a
le
r
ts
th
e
us
e
r
in
th
e
e
ve
nt
th
a
t
a
be
r
r
a
nt
ti
s
s
ue
is
f
ound.
CBE
s
houl
d
be
us
e
d
in
c
onj
unc
ti
on
w
it
h
th
e
iB
r
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a
s
tE
xa
m
onc
e
it
is
c
om
pl
e
te
ly
a
c
c
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s
s
ib
le
,
pr
io
r
it
iz
in
g
th
e
w
om
e
n f
or
f
ur
th
e
r
t
e
s
ti
ng. T
he
r
e
f
or
e
, t
he
iB
r
e
a
s
tE
xa
m
m
a
y be
a
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ul
to
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f
or
e
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r
ly
pr
e
-
s
c
r
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e
ni
ng of
c
li
ni
c
a
ll
y i
m
por
ta
nt
br
e
a
s
t
a
bnor
m
a
li
ti
e
s
.
T
he
m
a
nuf
a
c
tu
r
e
r
a
nd one
of
t
he
s
tu
dy'
s
l
e
a
d i
nve
s
ti
ga
to
r
s
(
O
O
)
pr
ovi
de
iB
r
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a
s
tE
xa
m
tr
a
in
in
g.
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a
c
h
nur
s
e
c
om
pl
e
te
d
30
i
B
r
e
a
s
tE
xa
m
e
xa
m
s
pr
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r
to
e
nr
ol
li
ng,
w
hi
c
h
w
e
r
e
r
e
vi
e
w
e
d
by
th
e
pr
im
a
r
y
a
ge
nt
to
in
it
ia
te
te
c
hni
que
a
bi
li
ty
(
i.
e
.,
pr
ope
r
de
vi
c
e
pe
r
f
or
m
a
nc
e
a
nd
pr
e
s
e
nc
e
of
e
nt
ir
e
br
e
a
s
t
ti
s
s
ue
)
.
T
he
iB
r
e
a
s
tE
xa
m
w
a
s
a
na
ly
ti
c
a
ll
y
m
ot
iv
a
te
d
ove
r
th
e
br
e
a
s
ts
w
hi
le
t
he
pa
ti
e
nt
s
w
e
r
e
in
th
e
pr
o
s
tr
a
te
pos
it
io
n.
O
n
th
e
c
ol
our
c
ha
r
t,
gr
e
e
n
in
di
c
a
te
s
ne
g
a
ti
vi
ty
a
nd
r
e
d
in
di
c
a
te
s
po
s
it
iv
it
y.
S
ur
ve
ys
on
th
e
e
ve
nt
w
e
r
e
c
om
pl
e
te
d
by
w
om
e
n.
I
t
is
c
onf
ir
m
e
d
how
lo
ng
it
ta
ke
s
to
c
om
pl
e
te
th
e
i
B
r
e
a
s
tE
xa
m
a
nd
th
e
C
B
E
.
T
h
e
R
ot
a
r
y
C
lu
b
of
C
he
nna
P
a
tn
a
th
r
ough
it
s
gl
oba
l
gr
a
nt
pr
oj
e
c
t
unde
r
th
e
c
h
a
i
r
m
a
ns
hi
p
of
D
r
.
A
ni
G
r
a
c
e
K
a
la
im
a
th
i
,
ha
d
c
hos
e
n
to
s
c
r
e
e
n
14,000
w
om
e
n
f
or
br
e
a
s
t
le
s
io
ns
u
s
in
g
th
e
iB
r
e
a
s
tE
xa
m
.
T
he
iB
r
e
a
s
tE
xa
m
S
c
a
n
K
it
c
ons
is
te
d
of
a
n
iB
r
e
a
s
t
s
c
a
nn
e
r
,
one
A
ndr
oi
d
m
obi
le
phone
w
i
th
c
ha
r
ge
r
,
a
nd
s
e
v
e
n
s
e
n
s
or
c
a
r
tr
id
ge
s
.
E
a
c
h
s
e
ns
or
c
a
r
tr
id
ge
ha
s
500 li
c
e
ns
e
s
f
r
om
U
E
L
if
e
S
c
ie
nc
e
s
.
I
n
w
om
e
n,
br
e
a
s
t
c
a
nc
e
r
is
a
pr
e
va
le
nt
m
a
li
gna
nc
y.
I
n
bot
h
e
s
ta
bl
is
he
d
a
nd
e
m
e
r
gi
ng
lo
c
a
ti
ons
,
it
is
a
r
e
c
ur
r
in
g
c
a
nc
e
r
.
B
r
e
a
s
t
c
a
nc
e
r
is
be
c
om
in
g
m
or
e
c
om
m
on
in
I
ndi
a
,
th
e
m
os
t
populous
de
ve
lo
pi
ng
na
ti
on.
I
n
I
ndi
a
,
br
e
a
s
t
c
a
nc
e
r
ha
s
s
ur
pa
s
s
e
d
c
e
r
vi
c
a
l
c
a
nc
e
r
a
s
th
e
m
os
t
pr
e
va
le
nt
m
a
li
gna
nc
y
a
m
ong
w
om
e
n
in
a
num
be
r
of
r
e
gi
ons
.
B
r
e
a
s
t
c
a
n
c
e
r
m
or
ta
li
ty
r
a
te
s
a
r
e
unne
c
e
s
s
a
r
il
y
hi
gh
in
I
ndi
a
,
w
he
r
e
th
e
a
ge
-
s
ta
nda
r
di
z
e
d
in
c
id
e
nc
e
r
a
te
is
22.9/100,000,
one
-
th
ir
d
th
a
t
of
W
e
s
te
r
n
n
a
ti
ons
.
T
h
e
da
t
a
f
r
om
a
tl
a
s
pr
oj
e
c
t
r
e
c
om
m
e
nd
th
a
t
br
e
a
s
t
c
a
nc
e
r
in
c
it
y
r
e
gi
ons
of
I
ndi
a
is
th
r
e
e
ti
m
e
s
s
up
e
r
io
r
to
in
r
ur
a
l
r
e
gi
ons
of
th
e
c
ount
r
y.
T
he
r
e
is
no
pl
a
nne
d,
s
ys
te
m
a
ti
c
,
a
dm
in
is
tr
a
ti
on
-
f
unde
d
s
c
r
e
e
ni
ng
pr
ogr
a
m
f
or
br
e
a
s
t
c
a
nc
e
r
in
I
ndi
a
.
T
he
s
c
r
e
e
ni
ng
in
f
or
m
ul
a
ti
ng c
ount
r
ie
s
c
a
n be
r
e
ga
r
de
d a
s
"
oppor
tu
ni
s
ti
c
s
c
r
e
e
ni
ng
"
.
T
he
W
H
O
s
ugge
s
ts
m
a
m
m
ogr
a
phy e
ve
r
y
1
-
2
ye
a
r
s
f
or
w
om
e
n
a
ge
d
50
-
69.
I
n
I
ndi
a
,
b
r
e
a
s
t
c
a
nc
e
r
oc
c
ur
r
e
nc
e
pe
a
ks
be
f
or
e
th
e
a
ge
of
50
ye
a
r
s
,
a
nd
a
r
e
c
e
nt
e
va
lu
a
ti
on of
t
he
pr
oof
i
n younge
r
w
om
e
n ba
s
e
d on e
ig
ht
t
r
ia
ls
gui
de
d a
m
ong 2001 a
nd 2008 int
im
a
te
s
th
a
t
m
a
m
m
ogr
a
phi
c
s
c
r
e
e
ni
ng
is
a
l
s
o
va
lu
a
bl
e
in
th
is
you
nge
r
a
ge
gr
oup.
I
n
or
de
r
to
de
te
r
m
in
e
th
e
e
f
f
e
c
ti
ve
ne
s
s
of
br
e
a
s
t
c
a
nc
e
r
s
c
r
e
e
ni
ng, wome
n be
tw
e
e
n t
he
a
g
e
s
of
40 a
nd 49 mus
t
be
s
c
r
e
e
ne
d.
F
or
c
ount
r
ie
s
w
it
h
li
m
it
e
d
r
e
s
our
c
e
s
,
w
he
r
e
tr
e
a
tm
e
nt
a
nd
di
a
gnos
ti
c
c
a
pa
bi
li
ti
e
s
a
r
e
la
c
ki
ng,
a
nd
w
he
r
e
th
e
c
o
s
t
of
a
ppr
opr
ia
te
br
e
a
s
t
c
a
nc
e
r
c
a
r
e
of
te
n
e
xc
e
e
ds
m
ont
hl
y
r
e
ve
nue
s
,
th
e
r
e
i
s
a
gr
e
a
t
de
a
l
of
di
s
a
gr
e
e
m
e
nt
.
A
c
c
or
di
ng
to
s
e
ve
r
a
l
s
tu
di
e
s
c
onduc
te
d
in
s
e
tt
in
gs
w
it
h
li
m
it
e
d
r
e
s
our
c
e
s
,
th
e
m
a
jo
r
it
y
of
br
e
a
s
t
c
a
nc
e
r
pa
ti
e
nt
s
ge
t
th
e
ir
di
a
gnos
is
a
t
a
la
te
s
ta
ge
,
m
a
ki
n
g
tr
e
a
tm
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nt
m
or
e
di
f
f
ic
ul
t
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le
s
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e
s
s
f
ul
.
B
ot
h
s
ys
te
m
ic
(
poor
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a
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c
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s
s
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it
y
of
he
a
lt
h
c
a
r
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s
e
r
vi
c
e
s
,
de
f
ic
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y
of
s
pe
c
if
ic
publ
ic
s
e
r
vi
c
e
s
a
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s
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e
nt
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dr
ugs
,
e
le
va
te
d
di
a
gnos
is
a
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c
ti
on
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o
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ts
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n
d
s
m
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ll
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t
br
e
a
s
t
c
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pons
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)
a
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r
r
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f
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if
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a
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to
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ppe
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ff
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c
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ne
s
s
of
i
B
r
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a
s
t
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x
am
in
at
io
n f
or
s
c
r
e
e
ni
ng br
e
a
s
t
le
s
io
n
s
am
ong …
(
Sam
ue
l
A
ni
G
r
ac
e
K
al
ai
m
at
hi
)
181
but
f
e
w
or
no
s
c
r
e
e
ni
ng
pr
ogr
a
m
s
e
xi
s
t
in
L
M
I
C
s
,
w
h
e
r
e
tr
e
a
tm
e
nt
opt
io
ns
a
r
e
li
m
it
e
d
lo
c
a
ll
y
,
a
nd
th
e
popula
ti
on
is
young.
T
he
y
a
r
e
li
ke
ly
to
be
e
xc
lu
s
iv
e
a
s
w
e
ll
a
s
uns
uc
c
e
s
s
f
ul
.
M
e
a
s
ur
in
g
th
e
pr
e
va
le
nc
e
of
br
e
a
s
t
s
ym
pt
om
s
th
a
t
ne
e
d
di
a
gnos
ti
c
s
e
r
vi
c
e
s
,
pr
oba
bl
e
f
ol
lo
w
-
up,
a
nd
tr
e
a
tm
e
nt
is
e
s
s
e
nt
ia
l
f
or
th
e
im
pr
ove
m
e
nt
,
e
xt
e
ns
io
n,
a
nd
a
m
pl
if
ic
a
ti
on
of
he
a
lt
h
c
a
r
e
p
la
ns
a
nd
br
e
a
s
t
c
a
n
c
e
r
s
c
r
e
e
ni
ng
pr
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a
m
s
.
N
one
th
e
le
s
s
,
th
e
di
s
c
ov
e
r
y
of
br
e
a
s
t
s
c
r
e
e
ni
ng
is
c
ove
r
e
d
in
a
r
e
la
ti
ve
ly
li
tt
le
a
m
ount
of
li
te
r
a
tu
r
e
.
T
he
r
e
f
or
e
,
th
e
r
e
is
r
oom
to
a
s
s
e
s
s
th
e
c
li
ni
c
a
l
pr
of
il
e
a
nd
pr
e
va
le
nc
e
of
br
e
a
s
t
il
ln
e
s
s
e
s
in
N
e
pa
le
s
e
w
om
e
n
a
s
w
e
ll
a
s
th
e
ir
r
e
la
ti
ons
hi
p t
o s
oc
io
e
c
onomi
c
f
a
c
to
r
s
.
I
n
th
e
U
ni
t
e
d
K
i
ngdom
(
UK
)
,
s
c
r
e
e
ni
ng
m
a
m
m
ogr
a
m
s
f
or
b
r
e
a
s
t
c
a
nc
e
r
a
r
e
pr
e
s
e
nt
ly
of
f
e
r
e
d
to
w
om
e
n
be
t
w
e
e
n
th
e
a
ge
s
of
50
a
nd
7
0
e
ve
r
y
t
hr
e
e
ye
a
r
s
.
L
if
e
e
xpe
c
ta
n
c
y
i
s
i
nc
r
e
a
s
e
d
w
it
h
br
e
a
s
t
s
c
r
e
e
n
in
g.
A
c
c
or
d
in
g
t
o
th
e
p
a
ne
l'
s
a
na
l
ys
i
s
of
th
e
be
ne
f
it
e
vi
d
e
n
c
e
,
w
hi
c
h
in
c
lu
d
e
s
bot
h
c
on
te
m
por
a
r
y
o
bs
e
r
va
ti
ona
l
s
tu
di
e
s
a
nd
ol
d
e
r
r
a
nd
om
iz
e
d
c
o
nt
r
ol
le
d
tr
ia
l
s
(
R
C
T
s
)
,
w
om
e
n w
ho
a
r
e
i
nvi
te
d
f
or
s
c
r
e
e
n
in
g
h
a
d
a
20%
l
ow
e
r
de
a
th
r
a
t
e
.
A
lt
hou
gh
t
he
r
e
i
s
a
lo
t
of
unc
e
r
ta
in
ty
i
n
th
i
s
e
s
ti
m
a
te
,
it
i
s
th
e
p
a
n
e
l'
s
s
um
m
a
r
y
of
t
he
da
t
a
.
T
hi
s
tr
a
ns
l
a
te
s
t
o
o
ne
de
a
th
pr
e
v
e
nt
e
d
f
r
om
br
e
a
s
t
c
a
nc
e
r
f
or
e
v
e
r
y
1
80
w
om
e
n
w
ho
a
tt
e
nd
s
c
r
e
e
ni
ng
a
nd
o
ne
de
a
th
pr
e
ve
nt
e
d f
or
e
v
e
r
y 235 wom
e
n a
s
k
e
d t
o do s
o d
ur
in
g a
20
-
y
e
a
r
pe
r
io
d. A
c
c
or
di
n
g t
o t
he
p
a
ne
l'
s
be
s
t
e
s
ti
m
a
te
,
th
e
U
K
'
s
br
e
a
s
t
s
c
r
e
e
ni
n
g
pr
ogr
a
m
,
w
h
ic
h
i
nvi
te
s
p
e
opl
e
b
e
tw
e
e
n
t
he
a
ge
s
of
5
0
a
n
d
70
e
ve
r
y
th
r
e
e
ye
a
r
s
,
a
voi
d
s
a
r
o
und
1
,
300
d
e
a
th
s
f
r
om
br
e
a
s
t
c
a
n
c
e
r
a
nnu
a
ll
y,
w
hi
c
h i
s
a
r
e
a
ll
y
po
s
it
iv
e
th
in
g
f
or
bot
h
p
ubl
ic
he
a
lt
h
a
nd w
om
e
n.
S
in
c
e
2004,
a
c
ount
r
yw
id
e
s
tu
dy
known a
s
th
e
K
or
e
a
n
N
a
ti
ona
l
C
a
nc
e
r
S
c
r
e
e
ni
ng
S
ur
ve
y
(
K
N
C
S
S
)
ha
s
be
e
n
c
a
r
r
ie
d
out
e
ve
r
y
ye
a
r
.
T
he
pur
pos
e
of
th
is
r
e
s
e
a
r
c
h
w
a
s
to
e
xa
m
in
e
th
e
tr
e
nds
in
K
or
e
a
'
s
c
a
n
c
e
r
s
c
r
e
e
ni
ng
r
a
te
s
f
or
th
e
f
iv
e
m
a
in
c
a
nc
e
r
s
:
s
to
m
a
c
h,
li
ve
r
,
c
ol
o
r
e
c
ta
l,
br
e
a
s
t,
a
nd
c
e
r
vi
x
ut
e
r
i.
T
hi
s
r
e
s
e
a
r
c
h
m
a
de
us
e
of
K
N
C
S
S
da
ta
g
a
th
e
r
e
d
f
r
om
2004
to
2011.
S
in
c
e
2
004,
th
e
r
e
ha
s
be
e
n
a
r
is
e
in
li
f
e
ti
m
e
s
c
r
e
e
ni
ng
r
a
te
s
a
s
w
e
ll
a
s
s
c
r
e
e
ni
ng
r
a
te
s
w
it
h
r
e
c
om
m
e
nda
ti
ons
.
O
n
a
v
e
r
a
ge
,
s
c
r
e
e
ni
ng
r
a
te
s
w
it
h
r
e
c
om
m
e
nda
ti
ons
ha
ve
in
c
r
e
a
s
e
d
by
0.2%
(
95%
C
I
,
-
0.9%
-
1.3%
)
f
o
r
c
e
r
vi
c
a
l
c
a
nc
e
r
a
nd
4.0%
(
95%
C
I
,
3.0%
-
4.9%
)
f
o
r
br
e
a
s
t
c
a
nc
e
r
a
nnu
a
ll
y.
S
c
r
e
e
ni
ng
r
a
te
s
f
or
s
to
m
a
c
h
a
nd
br
e
a
s
t
c
a
nc
e
r
,
in
pa
r
ti
c
ul
a
r
,
s
how
e
d
a
c
ons
id
e
r
a
bl
e
r
is
e
.
D
e
s
pi
te
ha
vi
ng
a
f
or
m
a
li
z
e
d
s
c
r
e
e
ni
ng
pr
ogr
a
m
,
S
r
i
L
a
nka
n
f
e
m
a
le
he
a
lt
hc
a
r
e
pr
of
e
s
s
io
na
l
s
'
knowle
dge
a
nd
be
ha
vi
or
s
a
bout
br
e
a
s
t
a
nd
c
e
r
vi
c
a
l
c
a
nc
e
r
s
c
r
e
e
ni
ng
a
r
e
w
id
e
s
pr
e
a
d.
C
onv
e
ni
e
nt
s
a
m
pl
e
te
c
hni
qu
e
s
w
e
r
e
us
e
d
to
pi
c
k
219
f
e
m
a
le
he
a
lt
h
c
a
r
e
pr
of
e
s
s
io
na
ls
f
r
om
s
ix
d
is
tr
ic
ts
in
S
r
i
L
a
nka
,
in
c
lu
di
ng
publ
ic
he
a
lt
h
m
id
w
iv
e
s
(
68.9%
)
,
f
or
a
c
r
os
s
-
s
e
c
ti
ona
l
s
tu
dy.
T
he
da
ta
c
a
m
e
f
r
om
a
c
a
pa
c
it
y
-
bui
ld
in
g
tr
a
in
in
g
pr
ogr
a
m
us
in
g a
s
e
lf
-
a
dm
in
is
te
r
e
d que
s
ti
onna
ir
e
a
s
a
pr
e
te
s
t.
M
or
e
t
ha
n 98%
w
e
r
e
a
w
a
r
e
of
t
he
s
e
lf
-
b
r
e
a
s
t
e
xa
m
. O
nl
y
47.9%
pr
a
c
ti
c
e
d
it
on
a
m
ont
hl
y
ba
s
is
,
de
s
pi
te
th
e
f
a
c
t
th
a
t
84.1%
di
d.
64.3%
a
nd
94.1%
o
f
pe
opl
e
w
e
r
e
a
w
a
r
e
of
m
a
m
m
ogr
a
phy a
nd C
B
E
, r
e
s
pe
c
ti
ve
ly
. J
us
t
3.6%
ha
d
e
ve
r
ha
d a
m
a
m
m
ogr
a
m
, a
nd 19.2%
ha
d ha
d a
C
B
E
dur
in
g t
he
pr
e
vi
ous
12 mont
hs
.
T
he
c
ont
r
ove
r
s
y
a
r
ound
m
a
m
m
ogr
a
phy
s
c
r
e
e
ni
ng
f
or
w
om
e
n
unde
r
50
ha
s
be
e
n
r
e
ki
ndl
e
d
by
r
e
c
e
nt
r
e
c
om
m
e
nda
ti
ons
f
r
om
th
e
U
ni
te
d
S
ta
te
s
pr
e
ve
nt
iv
e
ta
s
k
f
or
c
e
(
U
S
P
T
F
)
.
F
o
r
w
om
e
n
be
twe
e
n
th
e
a
ge
s
of
40
a
nd
49,
th
e
U
S
P
S
T
F
a
dvi
s
e
s
a
voi
di
ng
r
e
gul
a
r
s
c
r
e
e
ni
ng
m
a
m
m
ogr
a
m
s
.
I
ndi
vi
dua
l
f
a
c
to
r
s
,
s
uc
h
a
s
th
e
pa
ti
e
nt
'
s
vi
e
w
s
a
bout
c
e
r
ta
in
a
dva
nt
a
ge
s
a
nd
ha
z
a
r
ds
,
s
houl
d
be
ta
ke
n
in
to
a
c
c
ount
w
he
n
de
c
id
in
g
w
h
e
th
e
r
to
be
gi
n
r
out
in
e
,
bi
a
nnua
l
s
c
r
e
e
ni
ng
m
a
m
m
ogr
a
phy
be
f
or
e
th
e
a
ge
of
50.
F
or
w
om
e
n
a
ge
d
50
to
74,
th
e
U
S
P
S
T
F
a
dvi
s
e
s
s
c
r
e
e
ni
ng
m
a
m
m
ogr
a
m
s
e
ve
r
y
two
ye
a
r
s
.
A
nnua
l
m
a
m
m
ogr
a
m
s
a
r
e
a
dvi
s
e
d
by
th
e
A
m
e
r
ic
a
n
C
a
nc
e
r
S
oc
ie
ty
be
gi
nni
ng
a
t
a
ge
40
a
nd
c
ont
in
ui
ng
f
or
a
s
lo
ng
a
s
a
w
om
a
n
is
he
a
lt
hy.
W
om
e
n
40
ye
a
r
s
of
a
ge
a
nd
ol
de
r
s
houl
d
ge
t
a
C
B
E
a
nnua
ll
y.
F
or
w
om
e
n
40
ye
a
r
s
of
a
g
e
a
nd
ol
de
r
,
s
c
r
e
e
ni
ng
m
a
m
m
ogr
a
m
s
a
r
e
a
dvi
s
e
d
by
a
ll
m
a
jo
r
U
S
m
e
di
c
a
l
or
ga
ni
z
a
ti
ons
.
A
t
14
ye
a
r
s
of
f
ol
lo
w
-
up,
s
c
r
e
e
ni
ng
m
a
m
m
ogr
a
phy
lo
w
e
r
s
br
e
a
s
t
c
a
nc
e
r
m
or
ta
li
ty
by
a
r
ound
20%
to
35%
in
w
om
e
n
a
ge
d
50
-
69
a
nd
s
om
e
w
ha
t
le
s
s
i
n w
om
e
n a
g
e
d 40
-
49.
T
he
iB
r
e
a
s
tE
xa
m
is
a
noni
nva
s
iv
e
,
ha
ndhe
ld
,
qui
c
k
,
a
nd
e
a
s
y
s
ol
ut
io
n
f
or
br
e
a
s
t
le
s
io
n
de
te
c
ti
on.
I
t
is
a
c
om
pl
e
te
ly
s
a
f
e
,
pa
in
a
nd
r
a
di
a
ti
on
-
f
r
e
e
te
c
hni
que
w
it
h
l
ow
c
os
t
a
t
th
e
vi
ll
a
ge
le
ve
l,
a
nd
it
m
e
a
s
ur
e
s
ti
s
s
ue
e
la
s
ti
c
it
y
a
nd
de
te
c
ts
a
bnor
m
a
l
(
s
ti
f
f
e
r
a
nd
ha
r
de
r
)
br
e
a
s
t
ti
s
s
ue
a
s
s
m
a
ll
a
s
3
m
m
w
it
hi
n
5
m
in
ut
e
s
.
I
t
is
a
lo
w
-
c
os
t
e
la
s
ti
c
m
odul
us
s
e
ns
or
th
a
t
c
a
n
m
e
a
s
ur
e
ti
s
s
u
e
c
o
m
pr
e
s
s
io
n
a
nd
s
ti
f
f
ne
s
s
by
to
p
-
dow
n
to
uc
hi
ng
of
th
e
s
ki
n
s
ur
f
a
c
e
.
W
he
n
th
e
iB
r
e
a
s
tE
xa
m
is
to
ta
ll
y
a
c
c
e
s
s
i
bl
e
,
CBE
m
us
t
c
om
pl
e
m
e
nt
th
e
iB
r
e
a
s
tE
xa
m
,
tr
ia
gi
ng
th
e
w
om
e
n
f
or
f
ur
th
e
r
in
ve
s
ti
ga
ti
ons
.
S
o
,
th
e
iB
r
e
a
s
tE
xa
m
c
a
n
be
a
pr
om
is
in
g
to
ol
f
o
r
pr
e
-
s
c
r
e
e
ni
ng
of
c
li
ni
c
a
ll
y r
e
le
va
nt
br
e
a
s
t
le
s
io
ns
a
t
a
n e
a
r
ly
s
ta
g
e
.
2.
M
E
T
H
O
D
2.1.
S
t
at
e
m
e
n
t
of
t
h
e
p
r
ob
le
m
I
n
I
ndi
a
,
br
e
a
s
t
c
a
nc
e
r
ha
s
be
c
om
e
on
e
of
th
e
m
a
in
c
a
us
e
s
of
c
a
nc
e
r
-
r
e
la
te
d
m
or
bi
di
ty
a
nd
de
a
th
f
or
w
om
e
n.
B
e
c
a
us
e
of
lo
w
knowle
dge
,
poor
s
c
r
e
e
ni
ng
f
a
c
il
it
ie
s
,
a
nd
s
oc
io
e
c
onomi
c
hur
dl
e
s
,
a
la
r
ge
pe
r
c
e
nt
a
ge
of
c
a
s
e
s
a
r
e
di
s
c
ove
r
e
d
a
t
a
n
a
dva
nc
e
d
s
ta
ge
.
E
ve
n
th
ough
m
a
m
m
ogr
a
phy
is
a
n
e
xc
e
ll
e
nt
s
c
r
e
e
ni
ng
m
e
th
od,
it
is
of
te
n
una
va
il
a
bl
e
in
r
ur
a
l
a
nd
s
e
m
i
-
ur
ba
n
a
r
e
a
s
be
c
a
us
e
to
hi
gh
pr
ic
e
s
,
a
s
hor
ta
ge
of
qua
li
f
ie
d
r
a
di
ol
ogi
s
ts
,
r
a
di
a
ti
on
e
xpos
ur
e
c
onc
e
r
ns
,
a
nd
lo
w
f
e
m
a
le
c
om
pl
ia
nc
e
.
T
he
r
e
f
or
e
,
in
I
ndi
a
,
e
a
r
ly
di
a
gnos
is
of
br
e
a
s
t
le
s
io
ns
c
ont
in
ue
s
t
o be
a
s
ig
ni
f
ic
a
nt
publi
c
he
a
lt
h c
onc
e
r
n.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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J
A
dv A
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S
c
i
,
V
ol
. 15, No. 1, M
a
r
c
h 2026
:
178
-
186
182
2.2.
R
e
s
e
ar
c
h
ob
j
e
c
t
iv
e
s
A
c
r
os
s
-
s
e
c
ti
ona
l
s
tu
dy
to
s
c
r
e
e
n
f
or
br
e
a
s
t
le
s
io
ns
a
m
ong
w
om
e
n
us
in
g
br
e
a
s
t
e
xa
m
s
in
s
e
le
c
te
d
s
e
tt
in
gs
.
T
hi
s
s
tu
dy
a
im
e
d
to
de
te
c
t
th
e
br
e
a
s
t
c
a
nc
e
r
r
a
te
.
T
o
s
c
r
e
e
n
f
or
b
r
e
a
s
t
le
s
io
ns
us
in
g
iB
r
e
a
s
tE
xa
m
a
m
ong wome
n
a
ge
d
30 ye
a
r
s
a
nd a
bove
r
e
s
id
in
g i
n t
he
s
e
le
c
t
e
d
s
e
tt
in
gs
.
2.3.
O
p
e
r
at
io
n
al
d
e
f
in
it
io
n
s
B
r
e
a
s
t
le
s
io
ns
r
e
f
e
r
to
w
om
e
n
w
it
h
a
bnor
m
a
li
ti
e
s
in
th
e
br
e
a
s
t
ti
s
s
ue
,
s
u
c
h
a
s
lu
m
ps
,
pa
in
,
a
nd
ni
ppl
e
di
s
c
ha
r
ge
,
a
s
a
s
s
e
s
s
e
d
by
i
B
r
e
a
s
t
s
c
a
n
e
qui
pm
e
nt
.
iB
r
e
a
s
tE
xa
m
is
a
noni
nva
s
iv
e
,
ha
ndh
e
ld
/
e
a
s
il
y
por
ta
bl
e
,
pa
in
—
a
nd
r
a
di
a
ti
on
-
f
r
e
e
de
vi
c
e
to
de
te
c
t
non
-
pa
lp
a
bl
e
br
e
a
s
t
le
s
io
n
s
a
t
a
n
e
a
r
ly
s
ta
ge
.
W
om
e
n
r
e
pr
e
s
e
nt
s
w
ho a
r
e
i
n t
he
a
g
e
gr
oup of
30 ye
a
r
s
a
nd a
bove
r
e
s
id
in
g i
n t
he
s
e
le
c
te
d
s
e
tt
in
gs
.
2.
4.
R
e
s
e
ar
c
h
ap
p
r
oac
h
an
d
d
e
s
ig
n
A
qua
nt
it
a
ti
ve
r
e
s
e
a
r
c
h
a
ppr
oa
c
h
u
s
in
g
a
c
r
os
s
-
s
e
c
ti
ona
l
r
e
s
e
a
r
c
h
de
s
ig
n
w
a
s
a
dopt
e
d
f
or
th
e
r
e
s
e
a
r
c
h w
or
k
:
‒
P
opul
a
ti
on:
a
ll
w
om
e
n
w
ho
w
e
r
e
a
ge
d
30
y
e
a
r
s
a
nd
a
bove
w
e
r
e
th
e
ta
r
ge
t
popula
ti
on
a
nd
w
om
e
n
r
e
s
id
in
g i
n t
he
a
dopt
e
d a
r
e
a
s
of
t
he
s
e
le
c
te
d
c
ol
le
ge
s
w
e
r
e
t
he
a
c
c
e
s
s
ib
le
popula
ti
on.
‒
S
a
m
pl
e
:
w
om
e
n a
ge
d 30 ye
a
r
s
or
a
bove
w
ho f
ul
f
il
le
d t
he
i
nc
lu
s
io
n c
r
it
e
r
ia
w
e
r
e
s
e
le
c
te
d a
s
s
a
m
pl
e
s
.
‒
S
a
m
pl
e
s
iz
e
:
t
he
s
a
m
pl
e
c
ons
i
s
te
d of
14,000 wome
n i
n a
ll
4 s
e
tt
in
gs
.
‒
S
a
m
pl
in
g
te
c
hni
que
:
a
c
onve
ni
e
nt
s
a
m
pl
in
g t
e
c
hni
que
w
a
s
u
s
e
d
t
o s
e
le
c
t
th
e
s
a
m
pl
e
s
f
or
t
he
s
tu
dy.
2.
5.
R
e
s
e
ar
c
h
s
e
t
t
in
g
A
dopt
e
d a
r
e
a
s
of
t
he
s
e
le
c
te
d c
ol
le
g
e
s
w
e
r
e
t
he
s
e
tt
in
g f
or
t
he
s
tu
dy
:
‒
M
.A
. C
hi
da
m
ba
r
a
m
C
ol
le
g
e
of
N
ur
s
in
g, A
dya
r
, C
he
nna
i
.
‒
S
r
i
B
a
la
ji
C
ol
le
ge
of
N
ur
s
in
g, C
hr
om
pe
t,
C
he
nna
i
.
‒
M
a
dha
C
ol
le
g
e
of
N
ur
s
in
g, K
undr
a
th
ur
, C
he
nna
i
.
‒
O
m
a
ya
l
A
c
hi
C
ol
le
ge
of
N
ur
s
in
g, P
uz
ha
l,
C
h
e
nna
i
.
2.
6
.
C
r
it
e
r
ia
f
or
s
e
le
c
t
io
n
of
s
am
p
le
s
I
nc
lu
s
io
n c
r
it
e
r
ia
:
w
om
e
n w
ho a
r
e
:
‒
r
e
s
id
in
g i
n t
he
a
dopt
e
d a
r
e
a
s
of
t
he
c
om
m
uni
ty
he
a
lt
h c
e
nt
e
r
of
s
e
le
c
te
d c
ol
le
g
e
s
.
‒
a
ge
d 30 ye
a
r
s
a
nd
a
bove
.
E
xc
lu
s
io
n c
r
it
e
r
ia
:
w
om
e
n w
ho a
r
e
:
‒
P
r
e
gna
nt
a
nd l
a
c
ta
ti
ng
.
‒
D
ia
gnos
e
d w
it
h br
e
a
s
t
c
a
nc
e
r
.
‒
U
nde
r
w
e
nt
br
e
a
s
t
s
c
r
e
e
ni
ng i
n t
he
l
a
s
t
6 m
ont
hs
.
‒
U
nde
r
w
e
nt
a
ny kind of
br
e
a
s
t
s
ur
ge
r
y i
n t
he
l
a
s
t
6 m
ont
hs
.
2.
7.
P
r
oc
e
d
u
r
e
f
or
d
at
a c
ol
le
c
t
io
n
T
he
br
e
a
s
t
e
xa
m
pr
oj
e
c
t
w
a
s
unde
r
ta
ke
n
a
s
a
p
a
r
t
of
th
e
gl
oba
l
gr
a
nt
f
undi
ng
by
th
e
R
ot
a
r
y
C
lu
b
of
M
a
dr
a
s
C
he
nn
a
pa
tn
a
f
or
th
e
e
a
r
ly
de
te
c
ti
on
of
br
e
a
s
t
le
s
io
ns
a
m
ong
w
om
e
n
a
ge
d
30
ye
a
r
s
a
nd
a
bove
unde
r
th
e
C
ha
ir
m
a
ns
hi
p
of
R
tn
.
D
r
.
S
.
A
ni
G
r
a
c
e
K
a
la
im
a
th
i.
T
he
in
a
ugur
a
ti
on
w
a
s
he
ld
a
t
V
H
S
-
M
.A
.
C
hi
da
m
ba
r
a
m
C
ol
le
ge
of
N
ur
s
in
g
on
01.02.2022
w
it
h
th
e
pr
e
s
e
nc
e
of
r
ot
a
r
ia
ns
f
r
om
R
ot
a
r
y
C
lu
b
of
M
a
dr
a
s
C
he
nna
pa
tn
a
,
tr
a
in
e
r
s
f
r
om
U
E
L
if
e
S
c
ie
nc
e
s
,
pr
in
c
ip
a
ls
a
nd
f
a
c
ul
ty
tr
a
in
e
e
s
(
2
f
a
c
ul
ty
f
r
om
e
a
c
h
c
ol
le
ge
)
f
r
om
f
ou
r
N
ur
s
in
g
I
ns
ti
tu
ti
ons
(
V
H
S
-
M
.A
.
C
hi
da
m
ba
r
a
m
C
ol
le
ge
of
N
ur
s
in
g,
S
r
e
e
B
a
la
ji
C
ol
le
ge
of
N
ur
s
in
g,
M
a
th
a
C
ol
le
ge
of
N
ur
s
in
g
a
nd
O
m
a
ya
l
A
c
hi
C
ol
le
ge
of
N
ur
s
in
g)
.
T
he
iB
r
e
a
s
tE
xa
m
S
c
a
n
K
it
w
a
s
ha
nde
d
ove
r
to
th
e
f
our
nur
s
in
g
in
s
ti
tu
ti
ons
,
a
nd
a
br
ie
f
in
tr
o
duc
ti
on
to
th
e
de
vi
c
e
w
a
s
gi
v
e
n.
T
he
tr
a
in
in
g
pr
ogr
a
m
w
a
s
c
onduc
t
e
d
a
t
f
our
n
ur
s
in
g
c
ol
le
ge
s
by
th
e
tr
a
in
e
r
s
f
r
om
U
E
L
if
e
S
c
ie
nc
e
s
on
th
e
1s
t
w
e
e
k
of
F
e
br
ua
r
y
2022.
T
he
iB
r
e
a
s
tE
xa
m
S
c
a
n
K
it
c
ons
is
te
d
of
a
n
iB
r
e
a
s
t
s
c
a
nne
r
,
on
e
A
ndr
oi
d
m
obi
le
phon
e
w
it
h
c
ha
r
ge
r
,
a
nd
s
e
ve
n
s
e
n
s
or
c
a
r
tr
id
ge
s
(
e
a
c
h
s
e
n
s
or
c
a
r
tr
id
ge
c
a
n
do
500
s
c
a
n
s
)
f
r
om
U
E
L
if
e
S
c
ie
nc
e
s
.
A
to
ta
l
of
3
,
500
s
c
a
ns
w
e
r
e
done
by
e
a
c
h
in
s
ti
tu
ti
on,
to
ta
li
ng
14,0
00
s
c
a
ns
ove
r
a
ll
.
T
he
r
e
f
r
e
s
he
r
tr
a
in
in
g
w
a
s
c
onduc
te
d
a
t
S
r
i
B
a
la
ji
C
ol
le
ge
of
N
ur
s
in
g
on
25.03.2022
,
f
ol
lo
w
e
d
by
th
e
th
ir
d
tr
a
in
in
g
a
t
M
.A
.
C
hi
da
m
ba
r
a
m
C
ol
le
ge
of
N
ur
s
in
g
on
17.06.2022
on
us
in
g
a
ne
w
e
r
ve
r
s
io
n
of
th
e
a
ppl
ic
a
ti
on.
A
f
te
r
due
tr
a
in
in
g
a
nd
pe
r
m
is
s
io
n
f
r
om
th
e
vi
ll
a
ge
le
a
de
r
s
/
c
ounc
il
or
s
,
th
e
r
e
s
e
a
r
c
he
r
s
unde
r
to
ok
th
e
pr
oj
e
c
t
w
it
h
in
f
or
m
e
d c
ons
e
nt
f
r
om
t
he
w
om
e
n.
T
he
in
ve
s
ti
g
a
to
r
br
ie
f
ly
in
tr
o
duc
e
d
th
e
m
s
e
lv
e
s
a
nd
th
e
s
c
r
e
e
ni
ng'
s
obj
e
c
ti
v
e
s
.
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n
or
de
r
to
ge
t
th
e
ir
c
oope
r
a
ti
on
d
ur
in
g
da
t
a
c
ol
l
e
c
t
io
n,
th
e
y
w
e
r
e
f
or
c
e
d
to
s
l
e
e
p
c
om
f
or
ta
b
ly
on
th
e
b
e
d
in
a
r
oom
w
it
h
good
ve
nt
il
a
ti
on, a
nd
s
e
c
r
e
c
y
a
bout
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e
da
t
a
w
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s
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r
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nt
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d. T
he
p
a
r
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ip
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nt
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pr
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de
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r
it
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n a
nd
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b
a
l
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f
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m
e
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pe
r
m
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io
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a
bout
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ir
de
s
ir
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to
pa
r
ti
c
ip
a
t
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th
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c
r
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f
te
r
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a
in
in
g
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e
c
on
s
e
nt
,
th
e
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nve
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ti
g
a
to
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f
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t
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ol
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te
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ogr
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p
hi
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va
r
i
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bl
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s
,
f
ol
lo
w
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by
br
e
a
s
t
s
c
r
e
e
ni
n
g
f
or
le
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io
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us
i
ng
a
b
r
e
a
s
t
e
xa
m
.
A
to
ta
l
of
13,988
w
om
e
n w
e
r
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s
c
r
e
e
n
e
d
;
h
ow
e
v
e
r
,
w
it
hi
n
one
ye
a
r
of
t
im
e
(
e
a
c
h
nur
s
in
g
c
ol
l
e
ge
3,50
0 s
c
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)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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J
A
dv A
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2252
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183
3.
R
E
S
U
L
T
A
N
D
D
I
S
C
U
S
S
I
O
N
T
he
goa
ls
of
th
e
r
e
s
e
a
r
c
h
gui
de
d
th
e
or
ga
ni
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bul
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na
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a
t
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th
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r
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s
io
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dr
a
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om
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he
de
s
c
r
ip
ti
ve
s
ta
ti
s
ti
c
a
l
a
na
ly
s
i
s
.
T
he
m
a
in
f
oc
u
s
of
th
is
s
tu
dy
w
a
s
to
s
c
r
e
e
n
br
e
a
s
t
le
s
io
n
s
us
in
g
iB
r
e
a
s
tE
xa
m
a
m
ong
w
om
e
n
a
t
s
e
le
c
te
d
a
r
e
a
s
,
th
e
r
e
s
ul
ts
of
th
e
s
c
r
e
e
ni
ng
r
e
ve
a
le
d
th
a
t
out
of
th
e
13
,
988
w
om
e
n
w
ho
w
e
r
e
s
c
r
e
e
ne
d,
6
,
525
(
46.66%
)
w
e
r
e
in
th
e
a
ge
gr
oup
of
30
-
40
ye
a
r
s
,
4
,
436
(
31.71%
)
w
e
r
e
be
twe
e
n
41
-
50
ye
a
r
s
a
nd
3
,
027
(
21.63
%
)
w
e
r
e
a
bove
50
ye
a
r
s
.
O
f
th
e
to
ta
l
w
om
e
n
s
c
r
e
e
ne
d,
13
,
933
ha
d
no
le
s
io
ns
,
a
nd
55
w
om
e
n
w
e
r
e
id
e
nt
if
ie
d
to
ha
ve
pos
it
iv
e
br
e
a
s
t
le
s
io
ns
;
of
th
e
s
e
,
5
w
e
r
e
c
onf
ir
m
e
d
to
ha
ve
b
r
e
a
s
t
c
a
nc
e
r
th
r
ough
M
a
m
m
ogr
a
m
di
a
gnos
is
.
T
he
w
om
e
n
w
e
r
e
r
e
f
e
r
r
e
d
to
K
il
pa
uk
M
e
di
c
a
l
C
ol
le
g
e
H
os
pi
ta
l,
R
a
ji
v
G
a
ndhi
M
e
di
c
a
l
C
ol
le
ge
H
os
pi
ta
l,
a
nd
P
e
nna
la
m
f
or
f
ur
th
e
r
m
a
na
ge
m
e
nt
f
or
c
onf
ir
m
a
to
r
y di
a
gnos
is
.
T
he
iB
r
e
a
s
tE
xa
m
ga
dge
t,
w
hi
c
h
a
ut
o
-
c
a
li
br
a
te
s
a
nd
m
a
y
im
pr
ove
r
e
c
ove
r
y
s
pe
c
if
ic
it
y,
w
a
s
m
a
de
a
c
c
e
s
s
ib
le
.
T
he
a
s
s
e
s
s
m
e
nt
of
f
a
ls
e
pos
it
iv
e
s
br
ought
on
by
th
e
iB
r
e
a
s
tE
xa
m
'
s
us
a
ge
m
us
t
b
e
out
w
e
ig
he
d
by
th
e
i
nc
r
e
a
s
e
d a
c
c
e
s
s
ib
il
it
y t
o br
e
a
s
t
e
xa
m
in
a
ti
on.
F
or
br
e
a
s
t
f
in
di
ng, t
he
iB
r
e
a
s
tE
xa
m
de
m
ons
tr
a
te
s
a
s
upe
r
io
r
s
e
ns
it
iv
it
y
t
o
C
B
E
.
I
n
a
c
om
m
uni
ty
c
ont
e
xt
,
th
e
iB
r
e
a
s
tE
xa
m
m
ig
ht
be
us
e
d
in
c
onj
unc
ti
on
w
it
h
c
li
ni
c
a
l
hi
s
to
r
y
a
nd
br
e
a
s
t
e
xa
m
in
a
ti
on
to
tr
ia
ge
pa
ti
e
nt
s
to
de
t
e
r
m
in
e
w
ho
ne
e
d
s
f
ur
th
e
r
di
a
gnos
ti
c
e
v
a
lu
a
ti
on.
W
e
di
s
c
ove
r
e
d
th
a
t
if
th
e
iB
r
e
a
s
tE
xa
m
a
nd
c
li
ni
c
a
l
br
e
a
s
t
e
xa
m
in
a
ti
on
w
e
r
e
a
ppl
ie
d
e
qua
ll
y,
s
e
n
s
it
iv
it
y
f
or
que
s
ti
ona
bl
e
m
a
s
s
e
s
w
oul
d
a
dva
nc
e
,
but
s
pe
c
if
ic
it
y
w
oul
d
dr
op.
F
ig
ur
e
3
e
xpl
a
in
s
di
s
tr
ib
ut
io
n
of
s
a
m
pl
e
s
a
c
c
or
di
ng
to
a
ge
.
F
ig
ur
e
4
de
s
c
r
ib
e
s
n
um
be
r
of
br
e
a
s
t
le
s
io
n
id
e
nt
if
ie
d
a
c
c
or
di
ng
to
a
ge
,
a
nd
F
ig
ur
e
5
in
d
i
c
a
te
s
th
e
num
be
r
of
c
onf
ir
m
e
d
pos
it
iv
e
s
a
c
c
or
di
ng
to
a
g
e
of
s
a
m
pl
e
s
.
T
he
ga
th
e
r
e
d
in
f
or
m
a
ti
on
w
a
s
a
r
r
a
nge
d,
ta
ll
ie
d,
a
nd
e
xa
m
in
e
d
in
a
c
c
or
da
nc
e
w
it
h
th
e
s
tu
d
y'
s
goa
ls
.
T
a
bl
e
1
di
s
pl
a
y
s
th
e
r
e
s
ul
ts
of
th
e
de
s
c
r
ip
ti
ve
s
ta
ti
s
ti
c
a
l
a
na
ly
s
i
s
.
F
ig
ur
e
3. D
is
tr
ib
ut
io
n of
s
a
m
pl
e
s
a
c
c
or
di
ng t
o a
ge
F
ig
ur
e
4. N
um
be
r
of
br
e
a
s
t
le
s
io
n i
de
nt
if
ie
d a
c
c
or
di
ng
to
a
ge
F
ig
ur
e
5.
N
um
be
r
of
c
onf
ir
m
e
d pos
it
iv
e
s
a
c
c
or
di
ng t
o a
ge
of
th
e
s
a
m
pl
e
s
T
a
bl
e
1
.
F
r
e
que
nc
y a
nd p
e
r
c
e
nt
a
ge
di
s
tr
ib
ut
io
n of
a
ge
of
w
om
e
n w
ho unde
r
w
e
nt
iB
r
e
a
s
t
s
c
r
e
e
ni
ng
-
N
=
13
,
988
A
ge
i
n ye
a
r
s
N
%
N
o. of
br
e
a
s
t
l
e
s
i
ons
i
de
nt
i
f
i
e
d
N
o. of
c
onf
i
r
m
e
d pos
i
t
i
ve
s
30
-
40
ye
a
rs
6
,
525
46.66
29
4
41
-
50
ye
a
r
s
4
,
436
31.71
17
1
A
bove
50
ye
a
r
s
3
,
027
21.63
9
0
T
ot
a
l
13
,
988
100
55
5
47%
32%
21%
N
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0
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s
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o
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5
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r
s
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
S
N
:
2252
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8814
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nt
J
A
dv A
ppl
S
c
i
,
V
ol
. 15, No. 1, M
a
r
c
h 2026
:
178
-
186
184
4.
C
O
N
C
L
U
S
I
O
N
T
he
m
a
in
f
oc
us
of
th
is
s
tu
dy
w
a
s
to
s
c
r
e
e
n
br
e
a
s
t
le
s
io
n
s
us
in
g
iB
r
e
a
s
tE
xa
m
a
m
ong
w
om
e
n
a
t
s
e
le
c
te
d
a
r
e
a
s
;
th
e
r
e
s
ul
t
s
of
th
e
s
c
r
e
e
ni
ng
r
e
ve
a
le
d
th
a
t
out
of
th
e
13
,
988
w
om
e
n
w
ho
w
e
r
e
s
c
r
e
e
ne
d,
6
,
525
(
46.66%
)
w
e
r
e
in
th
e
a
ge
gr
oup
of
30
-
40
ye
a
r
s
,
4
,
436
(
31.
71%
)
w
e
r
e
be
twe
e
n
41
-
50
ye
a
r
s
a
nd
3
,
027
(
21.63%
)
w
e
r
e
a
bove
50
ye
a
r
s
.
T
he
s
tu
dy
c
onc
lu
de
d
th
a
t
of
th
e
13
,
988
w
om
e
n,
13
,
933
ha
d
no
le
s
io
ns
,
a
nd
55
w
om
e
n
w
e
r
e
id
e
nt
if
ie
d
to
ha
v
e
pos
it
iv
e
br
e
a
s
t
le
s
io
n
s
.
O
ut
of
55
w
om
e
n
w
ho
ha
d
br
e
a
s
t
le
s
io
ns
,
5
w
e
r
e
c
onf
ir
m
e
d
to
ha
ve
b
r
e
a
s
t
c
a
n
c
e
r
th
r
ough
M
a
m
m
ogr
a
m
di
a
gnos
is
;
ot
he
r
w
om
e
n
h
a
d
f
ib
r
oa
de
nom
a
s
a
nd
w
e
r
e
tr
e
a
te
d
a
t
th
e
r
e
f
e
r
r
a
l
a
r
e
a
s
.
iB
r
e
a
s
tE
xa
m
w
a
s
e
a
s
y,
ha
nd
-
he
ld
e
qui
pm
e
nt
th
a
t
w
a
s
por
ta
bl
e
a
nd
u
s
e
d
by
nur
s
e
r
e
s
e
a
r
c
he
r
s
,
e
v
e
n
f
or
hous
e
hol
d
s
c
r
e
e
ni
ngs
w
h
e
r
e
w
om
e
n
c
oul
d
not
r
e
a
c
h
he
a
lt
h
c
e
nt
e
r
s
.
A
ls
o,
th
e
ut
il
iz
a
ti
on
a
nd
m
a
in
te
na
nc
e
of
th
e
e
qui
pm
e
nt
w
e
r
e
s
im
pl
e
.
T
hi
s
b
r
e
a
s
t
e
xa
m
c
a
n
be
u
s
e
d
a
s
a
pr
e
-
s
c
r
e
e
ni
ng
de
vi
c
e
by
nur
s
e
s
a
nd othe
r
he
a
lt
hc
a
r
e
pr
of
e
s
s
io
na
ls
i
n m
a
r
gi
na
li
z
e
d a
r
e
a
s
f
or
e
a
r
ly
de
te
c
ti
on of
br
e
a
s
t
le
s
io
ns
/c
a
nc
e
r
s
.
F
U
N
D
I
N
G
I
N
F
O
R
M
A
T
I
O
N
A
ut
hor
s
s
t
a
te
no f
un
di
ng i
nvol
v
e
d.
A
U
T
H
O
R
C
O
N
T
R
I
B
U
T
I
O
N
S
S
T
A
T
E
M
E
N
T
T
hi
s
jo
ur
na
l
us
e
s
th
e
C
ont
r
ib
ut
or
R
ol
e
s
T
a
xonomy
(
C
R
e
di
T
)
to
r
e
c
ogni
z
e
in
di
vi
dua
l
a
ut
hor
c
ont
r
ib
ut
io
ns
, r
e
duc
e
a
ut
hor
s
hi
p di
s
put
e
s
,
a
nd f
a
c
il
it
a
te
c
ol
la
bo
r
a
ti
on.
N
am
e
o
f
A
u
t
h
or
C
M
So
Va
Fo
I
R
D
O
E
Vi
Su
P
Fu
S
a
m
ue
l
A
ni
G
r
a
c
e
K
a
la
im
a
th
i
✓
✓
✓
✓
✓
✓
✓
V
e
nka
te
s
a
n
H
e
m
a
va
th
y
✓
✓
✓
✓
✓
✓
S
a
m
ba
va
da
s
K
a
n
c
ha
na
✓
✓
✓
✓
✓
✓
✓
✓
R
a
dha
kr
is
hna
n S
udha
✓
✓
✓
✓
✓
✓
✓
P
e
r
um
a
T
a
m
il
a
r
a
s
i
✓
✓
✓
✓
✓
✓
C
:
C
onc
e
pt
ua
l
i
z
a
t
i
on
M
:
M
e
t
hodol
ogy
So
:
So
f
t
w
a
r
e
Va
:
Va
l
i
da
t
i
on
Fo
:
Fo
r
m
a
l
a
na
l
ys
i
s
I
:
I
nve
s
t
i
ga
t
i
on
R
:
R
e
s
our
c
e
s
D
:
D
a
t
a
C
ur
a
t
i
on
O
:
W
r
i
t
i
ng
-
O
r
i
gi
na
l
D
r
a
f
t
E
:
W
r
i
t
i
ng
-
R
e
vi
e
w
&
E
di
t
i
ng
Vi
:
Vi
s
ua
l
i
z
a
t
i
on
Su
:
Su
pe
r
vi
s
i
on
P
:
P
r
oj
e
c
t
a
dm
i
ni
s
t
r
a
t
i
on
Fu
:
Fu
ndi
ng a
c
qui
s
i
t
i
on
C
O
N
F
L
I
C
T
O
F
I
N
T
E
R
E
S
T
S
T
A
T
E
M
E
N
T
A
ut
hor
s
s
ta
te
no c
onf
li
c
t
of
i
nt
e
r
e
s
t.
D
A
T
A
A
V
A
I
L
A
B
I
L
I
T
Y
T
he
da
t
a
th
a
t
s
uppor
t
th
e
f
in
di
ngs
of
th
is
s
tu
dy
a
r
e
a
va
il
a
bl
e
f
r
om
th
e
c
or
r
e
s
ponding
a
ut
hor
,
[
S
A
G
K
]
, upon r
e
a
s
ona
bl
e
r
e
que
s
t.
R
E
F
E
R
E
N
C
E
S
[
1]
S
.
S
r
i
ni
va
s
a
n,
G
.
I
ndr
a
,
T
.
R
.
S
a
r
a
va
na
n,
S
.
M
ur
uga
n,
C
.
S
r
i
ni
va
s
a
n,
a
nd
M
.
M
ut
hul
e
ks
hm
i
,
“
R
e
vol
ut
i
oni
z
i
ng
s
ki
n
c
a
n
c
e
r
de
t
e
c
t
i
on
w
i
t
h
R
a
s
pbe
r
r
y
Pi
-
e
m
be
dde
d
A
N
N
t
e
c
hnol
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i
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a
n
a
ut
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e
d
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e
ni
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I
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ac
t
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,
“
T
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br
e
a
s
t
i
m
a
gi
ng
-
r
e
por
t
i
ng
a
nd
da
t
a
s
ys
t
e
m
(
B
I
-
R
A
D
S
)
m
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e
a
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y,”
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vi
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a
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l
ys
i
s
w
i
t
h
c
ox
pr
opor
t
i
ona
l
ha
z
a
r
ds
m
ode
l
i
n
pr
e
di
c
t
i
ng
p
a
t
i
e
nt
out
c
om
e
s
,”
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5t
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I
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e
r
nat
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C
onf
e
r
e
n
c
e
on
E
l
e
c
t
r
oni
c
s
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Sus
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ai
nabl
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C
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uni
c
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ut
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l
i
t
y
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a
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nd
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he
l
d
s
c
a
nne
r
f
or
br
e
a
s
t
c
a
nc
e
r
e
a
r
l
y
de
t
e
c
t
i
on
a
nd
pa
t
i
e
nt
t
r
i
a
ge
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G
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i
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,”
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i
ni
c
a
l
br
e
a
s
t
e
xa
m
i
n
a
t
i
on’
s
a
bnor
m
a
l
i
t
i
e
s
f
or
br
e
a
s
t
c
a
nc
e
r
s
c
r
e
e
ni
ng:
c
r
os
s
-
s
e
c
t
i
ona
l
s
t
udy,”
E
ur
ope
an
J
our
nal
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O
b
s
t
e
t
r
i
c
s
&
G
y
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c
c
ur
a
c
y
of
de
e
p
l
e
a
r
ni
ng
f
or
br
a
i
n
c
a
nc
e
r
di
a
gnos
i
s
us
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P
ol
ya
k
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uppe
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m
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z
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I
nt
e
r
nat
i
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J
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I
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A
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s
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e
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s
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e
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am
in
at
io
n f
or
s
c
r
e
e
ni
ng br
e
a
s
t
le
s
io
n
s
am
ong …
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Sam
ue
l
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ni
G
r
ac
e
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S
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I
l
a
m
pi
r
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a
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M
ur
uga
n,
“
I
oT
i
n
br
a
i
n
-
c
om
put
e
r
i
nt
e
r
f
a
c
e
s
f
or
e
na
bl
i
ng
c
om
m
uni
c
a
t
i
on
a
nd
c
ont
r
ol
f
or
t
he
d
i
s
a
bl
e
d,”
i
n
2024
10t
h
I
nt
e
r
nat
i
onal
C
onf
e
r
e
nc
e
on
C
om
m
uni
c
at
i
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r
oc
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s
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s
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d
N
V
i
vo
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or
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di
c
t
i
ve
a
na
l
y
s
i
s
i
n
m
ovi
e
s
uc
c
e
s
s
a
nd
a
udi
e
nc
e
i
ns
i
ght
s
,”
I
nt
e
r
nat
i
onal
J
our
nal
of
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ndus
t
r
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al
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t
i
e
nt
he
a
l
t
h
m
oni
t
or
i
ng
i
n
de
m
e
nt
i
a
us
i
ng
k
-
ne
a
r
e
s
t
ne
i
ghbor
m
ode
l
,”
I
nt
e
r
nat
i
onal
J
our
nal
of
M
ode
r
n C
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put
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c
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r
,
pa
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:
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e
a
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t
a
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i
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U
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i
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ba
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r
r
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gi
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ul
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m
a
r
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nc
e
r
a
na
l
ys
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s
f
r
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t
he
s
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,
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ua
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ona
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t
r
a
i
ni
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i
n
c
l
i
ni
c
a
l
br
e
a
s
t
e
xa
m
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ur
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a
s
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c
a
nc
e
r
de
t
e
c
t
i
on
us
i
ng
m
a
c
hi
ne
l
e
a
r
ni
ng
a
l
gor
i
t
hm
s
,”
i
n
P
r
oc
e
e
di
ngs
of
t
he
1s
t
I
nt
e
r
nat
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C
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e
r
e
nc
e
on
F
r
ont
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r
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gi
t
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m
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ddl
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c
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a
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s
ur
ba
n
w
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a
c
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m
uni
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udyf
r
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a
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t
di
s
e
a
s
e
s
a
m
ong
f
e
m
a
l
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s
i
n
t
he
S
out
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-
W
e
s
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R
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A
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bi
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,”
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ul
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r
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nds
of
t
hr
e
e
m
a
j
or
gyne
c
ol
ogi
c
c
a
nc
e
r
s
bur
de
n
a
n
d
a
t
t
r
i
but
a
bl
e
r
i
s
k
f
a
c
t
or
s
f
r
om
1990
t
o
2019:
a
n
a
ge
pe
r
i
od
c
ohor
t
a
na
l
ys
i
s
,”
B
M
C
P
ub
l
i
c
H
e
al
t
h
,
vol
.
24,
no.
1,
M
a
y
2024,
doi
:
10.1186/
s
12889
-
024
-
18858
-
3.
[
21]
M
.
S
.
K
um
a
r
,
H
.
A
z
a
t
h,
A
.
K
.
V
e
l
m
ur
uga
n,
K
.
P
a
dm
a
na
b
a
n,
a
nd
M
.
S
ubbi
a
h,
“
P
r
e
di
c
t
i
on
of
a
l
z
he
i
m
e
r
’
s
di
s
e
a
s
e
u
s
i
ng
hybr
i
d
m
a
c
hi
ne
l
e
a
r
ni
ng t
e
c
hni
que
,”
i
n
A
I
P
C
onf
e
r
e
nc
e
P
r
oc
e
e
di
ngs
, 2023
, doi
:
10.10
63/
5.0110283.
[
22]
B
.
J
.
G
a
ne
s
h,
P
.
V
i
j
a
ya
n,
V
.
V
a
i
de
hi
,
S
.
M
ur
uga
n,
R
.
M
e
e
na
ks
hi
,
a
nd
M
.
R
a
j
m
oha
n,
“
S
V
M
-
ba
s
e
d
pr
e
di
c
t
i
ve
m
ode
l
i
ng
of
dr
ow
s
i
ne
s
s
i
n
hos
pi
t
a
l
s
t
a
f
f
f
or
oc
c
upa
t
i
ona
l
s
a
f
e
t
y
s
ol
ut
i
on
vi
a
I
o
T
i
nf
r
a
s
t
r
uc
t
ur
e
,”
i
n
2024
2nd
I
nt
e
r
nat
i
onal
C
onf
e
r
e
nc
e
on
C
om
put
e
r
, C
om
m
uni
c
at
i
on and C
ont
r
ol
(
I
C
4)
, F
e
b. 2024, pp. 1
–
5
, doi
:
10.1109/
I
C
457434.2024.10486429.
[
23]
K
.
P
a
dm
a
na
ba
n,
A
.
M
.
S
.
K
um
a
r
,
H
.
A
z
a
t
h,
A
.
K
.
V
e
l
m
ur
uga
n,
a
nd
M
.
S
ub
bi
a
h,
“
H
ybr
i
d
da
t
a
m
i
ni
ng
t
e
c
hni
que
ba
s
e
d
br
e
a
s
t
c
a
nc
e
r
pr
e
di
c
t
i
on,”
A
I
P
C
onf
e
r
e
nc
e
P
r
oc
e
e
di
ng
s
, 2023, doi
:
10.1063/
5.0110216.
[
24]
A
.
A
f
a
ya
e
t
al
.
,
“
F
a
c
t
or
s
a
s
s
oc
i
a
t
e
d
w
i
t
h
t
he
upt
a
ke
of
c
l
i
ni
c
a
l
br
e
a
s
t
e
xa
m
i
na
t
i
on
a
m
ong
w
om
e
n
of
r
e
pr
oduc
t
i
ve
a
ge
i
n
L
e
s
ot
ho
:
a
na
l
ys
i
s
of
a
na
t
i
ona
l
s
ur
ve
y,
”
B
M
C
C
anc
e
r
, vol
. 23, no. 1, F
e
b. 2023, doi
:
10.1
186/
s
12885
-
023
-
10566
-
2.
[
25]
S
.
F
.
I
r
a
ndoos
t
e
t
al
.
,
“
F
a
c
t
or
s
r
e
l
a
t
e
d
w
i
t
h
br
e
a
s
t
s
e
l
f
-
e
xa
m
i
na
t
i
on
i
n
w
om
e
n:
a
c
r
os
s
-
s
e
c
t
i
ona
l
s
t
udy
i
n
T
e
hr
a
n
P
r
ovi
nc
e
,
I
r
a
n,”
M
e
di
c
al
Sc
i
e
nc
e
, vol
. 24, no. 101, pp. 190
–
200, 2020.
[
26]
H
.
H
e
e
na
e
t
al
.
,
“
K
now
l
e
dge
,
a
t
t
i
t
ude
s
,
a
nd
pr
a
c
t
i
c
e
s
r
e
l
a
t
e
d
t
o
br
e
a
s
t
c
a
nc
e
r
s
c
r
e
e
ni
ng
a
m
ong
f
e
m
a
l
e
he
a
l
t
h
c
a
r
e
pr
of
e
s
s
i
ona
l
s
:
a
c
r
os
s
s
e
c
t
i
ona
l
s
t
udy,”
B
M
C
W
om
e
n’
s
H
e
al
t
h
, vol
. 19, no. 1, 2019, doi
:
10.1186/
s
12905
-
019
-
0819
-
x.
[
27]
M
oni
c
a
a
nd
R
.
M
i
s
hr
a
,
“
A
n
e
pi
de
m
i
ol
ogi
c
a
l
s
t
udy
of
c
e
r
vi
c
a
l
a
nd
br
e
a
s
t
s
c
r
e
e
ni
ng
i
n
I
ndi
a
:
di
s
t
r
i
c
t
-
l
e
ve
l
a
na
l
y
s
i
s
,”
B
M
C
W
om
e
n’
s
H
e
al
t
h
, vol
. 20, no. 1, 2020, doi
:
10.1186/
s
12905
-
020
-
01083
-
6.
B
I
O
G
R
A
P
H
I
E
S
O
F
A
U
T
H
O
R
S
Dr.
Samuel
Ani
Grace
Kalaimathi
is
a
registrar
of
Tamil
N
a
du
Nurses
and
Midwives
Council,
an
ambitious
administrator
cum
achiever,
a
vi
brant,
visionary
leader,
lobbyist,
academic
ian,
spokespers
on,
hi
-
tech
nurse,
rational
and
posit
ive
t
hinker
who
dreams
of
reformation
in
the
field
of
nursing.
She
is
a
voice
of
the
voiceless,
a
voice
to
make
visible
the
nurses
and
nurse
practitioner
s,
and
she
strives
to
bring
the
nurs
e
practice
act
and
nurse
practitioners
to
India
to
render
cost
-
effective
and
care
-
effective
ca
re
for
the
public
at
the
gr
assroots
level.
Longing
to
set
up
the
Model
University
for
Nursi
ng
in
Tamil
N
adu,
she
lobbies
with
the
state
legislators
and
authorities.
She
is
an
irreplac
eable
asset
and
a
super
heroine
in
the
field
of
nur
sing
in
Tamil
N
adu.
She
has
authored
books
such
as
nurses
guide
to
neonatal
procedures
,
"
a
quick
ref
erence
to
child'
s
growth
and
develo
pment
for
nurses
,"
and
a
text
book
on
"
child
health
nursing
for
ANM
'
s"
in
Tamil
language.
Sh
e
is
also
the
founder
and
chief
editor
of
"
the
Journal
of
Nursing
Trendz
"
and
the
executive
edi
tor
of
"
TNNMC
Journal
of
Pediatric
Nursing"
.
This
exceptional
nurse
has
been
honored
with
the
"
best
nurse
adminis
trator
"
award
from
the
Tamil
N
adu
Nurses
and
Midwives
Council,
"
best
teacher
"
award
from
the
T.N.
Dr.
M
.
G
.
R
.
Medical
University,
"
best
nursing
leadership"
award
from
"
education
today
"
magazine
,
and
"
best
non
-
medical
award
"
from
the
Indian
Medical
Association,
Tamil
N
adu
b
ranch.
She
,
the
revolutionary
with
in
credible
dedication
and
expertise,
visuali
zed
the
gradation
and
upliftm
ent
of
nurses
and
the
n
ursing
profession.
In
her
deeds,
she
strongly
believed
in
"
nothing
is
impossible
,"
and
she
is
the
best
example
of
"
i'
m
possible
"
. She can be contacted a
t email: registrartnc@
gmail.com
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
S
N
:
2252
-
8814
I
nt
J
A
dv A
ppl
S
c
i
,
V
ol
. 15, No. 1, M
a
r
c
h 2026
:
178
-
186
186
Dr.
Venkatesan
Hemavathy
is
a
p
rin
cipal/HOD
Department
of
Psychiatric
Nursing,
Sree
Balaji
College
of
Nursing,
Bharath
Institute
of
Higher
Education
and
Research,
Chennai,
India.
She
has
rich
experie
nce
of
more
than
27
years
of
tea
ching
and
resea
rch.
She
has
published
many
scientific
papers
in
National
and
International
Jo
urnals
and
has
organized
various
national
and
international
conf
erences,
seminars,
workshops,
and
webinars
.
She
is
the
chairperson
of the
cultural
commit
tee
, TNAI, Tamil
Nadu state Branc
h, and a
lifetime
member
of
ISPN,
NIMHANS,
Bengaluru.
She
has
won
the
Dr.
A.P.J.
Abdul
Kalam
Lifetime
Achievement
Annual
National
Award
for
Teaching,
Resea
rch,
a
nd
Publications
.
She
is
actively
associated
with
the
field
of
nursing
education
and
research
.
She
has
been
honored
with the "
best nurse administrator
"
award from the Tamil
N
adu Nurses
and Mid
wives C
ouncil,
Chennai,
Tamil Na
du. She c
an be c
ontacte
d at ema
il:
hemasbcn@
gmail.com.
Dr.
Sambavada
Kanchana
is
a
p
rincipal
at
Omayal
Achi
Colle
ge
of
Nursing,
Chennai.
She
has
published
many
papers
in
repute
d
journal
s
and
book
s
.
She
is
the
chief
editor
of
the
International
Centre
for
Collaborat
ive
Research
-
Journal
o
f
N
ursing
Research
(ICCR
-
JNR).
She
is
a
member
o
f
the
board
of
studies
for
research
at
t
he
Tamil
N
adu
Dr.
M.G.R.
Medical Univer
sity. She can be c
ontacted at e
mail: kanchana.
khan@
yahoo.co.in.
Dr.
Radhakrish
nan
Sudha
is
a
p
rincipal
at
M.
A.
Chidambara
m
College
and
School
of
Nursing,
VHS
Campus,
Taramani,
Chennai
-
113.
Governin
g
Council
Member
.
The
Tamil
Nadu
Dr.
M
.
G
.
R
.
Medical
University.
She
is
a
member
board
of
studies
-
nursing
at
the
T
amil
N
adu
Dr.
M
.
G
.
R
.
Medical
Unive
rsity.
Executive
e
ditor
in
Tamil
Nadu
Nurses
and
Midwives
Council
Journal
-
Pediatr
ic
Nursing
,
peer
reviewer
for
the
Nursing
Journal
of
India
,
SNA
Advisor
for
TNAI
Tamil
N
adu
State
Branch.
She
has
p
ublished
44
papers
and
3
books
,
namely
,
research
and
statistics
for
nurses
.
She
can
be
contacted
at
email:
sudhanatpagam@gmail.com.
Dr.
Perumal
Tamilarasi
is
a
principal
at
Madha
C
ollege
of
N
ursin
g
,
C
hennai.
A
pioneer
in
nursing
and
a
mentor
in
enhancing
nursing
research
in
vraious
field
of
nursing.
Conducted
numerous
resea
rch
studi
es
related
to
nursing.
She
has
pu
blished
many
papers
in
reputed
journal
s
and
books
.
She
is
the
e
xecutive
editorial
board
me
mber,
Journal
o
f
Medical
Surgica
l
Nursing
,
The
Tamil
Nadu
Dr.
M
.
G
.
R
.
Medical
Univer
sity
,
and
e
ditor
in
the
International
Journal
of
Cardiovascul
ar
Nursing.
She
can
be
contacted
at
email:
tamilperuma
l69@
gmail.com.
Evaluation Warning : The document was created with Spire.PDF for Python.