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This study described outcomes of a rural Pakistan community outreach model combining breast education, home CBE, and referral to confirm clinical abnormalities and improve breast cancer awareness. Health care workers and a gynecologist were trained, delivered home visits, assessed awareness with a standardized questionnaire, identified lesions, referred for examination and imaging, and conducted follow-up visits to address non-compliance reasons.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/implementation-of-a-clinical-breast-exam-and-referral-program-in-a-rural-district-of-pakistan/339310/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/implementation-of-a-clinical-breast-exam-and-referral-program-in-a-rural-district-of-pakistan/339310.png","ImageObject",300,407,{"name":92,"@type":93},"Aurora","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the main goal of the outreach program in rural Pakistan?","Question",{"text":112,"@type":113},"To evaluate outcomes of community breast education, home CBE, and referral aimed at early recognition of abnormalities and improved breast cancer awareness.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were health care workers and the gynecologist involved?",{"text":117,"@type":113},"Eight health care workers and a gynecologist received training on breast cancer knowledge and on delivering community awareness activities and conducting home CBE.",{"name":119,"@type":110,"acceptedAnswer":120},"What factors led to non-compliance with referral and imaging?",{"text":121,"@type":113},"Major reasons included lack of understanding of the risks and financial constraints, identified during follow-up home visits.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},339310,1790339622,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},4810365810221,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Martins et al. BMC Health Services Research (2024) 24:616 BMC Health Services Research  \n[https://doi.org/10.1186/s12913-024-11051-7](https://doi.org/10.1186/s12913-024-11051-7)  \nRESEARCH Open Access  \nImplementation of a clinical breast exam and referral program in a rural district of Pakistan  \nRussell Seth Martins 1†, Aiman Arif2†, SaharYameen2†, Shanila Noordin2†, Taleaa Masroor3, Shah Muhammad2, Mukhtiar Channa2, Sajid Bashir Soofi2 and Abida K. Sattar2,4*  \nAbstract  \nBackground The role of clinical breast examination (CBE) for early detection of breast cancer is extremely important in lower-middle-income countries (LMICs) where access to breast imaging is limited. Our study aimed to describe the outcomes of a community outreach breast education, home CBE and referral program for early recognition of breast abnormalities and improvement of breast cancer awareness in a rural district of Pakistan.  \nMethods Eight health care workers (HCW) and a gynecologist were educated on basic breast cancer knowledge and trained to create breast cancer awareness and conduct CBE in the community. They were then deployed in the Dadu district of Pakistan where they carried out home visits to perform CBE in the community. Breast cancer awareness was assessed in the community using a standardized questionnaire and standard educational intervention was performed. Clinically detectable breast lesions were identified during home CBE and women were referred to the study gynecologist to confirm the presence of clinical abnormalities. Those confirmed to have clinical abnormalities were referred for imaging. Follow-up home visits were carried out to assess reasons for non-compliance in patients who did not follow-through with the gynecologist appointment or prescribed imaging and re-enforce the need for follow-up.  \nResults Basic breast cancer knowledge of HCWs and study gynecologist improved post-intervention. HCWs conducted home CBE in 8757 women. Of these, 149 were warranted a CBE by a physician (to avoid missing an abnormality), while 20 were found to have a definitive lump by HCWs, all were referred to the study gynecologist (CBE checkpoint) . Only 50%(10/20) of those with a suspected lump complied with the referral to the gynecologist, where 90% concordance was found between their CBEs. Follow-up home visits were conducted in 119/169 non-compliant patients. Major reasons for non-compliance were a lack of understanding of the risks and financial constraints. A  \n\n| †Russell Seth Martins and Aiman Arif contributed equally to this work. |\n| --- |\n| †SaharYameen and Shanila Noordin contributed equally to this work. |\n\n*Correspondence: Abida K. Sattar [abida.sattar@aku.edu](abida.sattar@aku.edu)  \nFull list of author information is available at the end of the article  \n© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://creativecommons.org/l)icenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ([http://creativecommons.org/publicdomain/zero/1.0/](http://creativecommons.org/publicdomain/zero/1.0/)) applies to the data made available in this article, unless otherwise stated in a credit line to the data.  \nMartins et al. BMC Health Ser","cbCailGyxZHifdZm","https://ap.wps.com/l/cbCailGyxZHifdZm","pdf",1470612,"English","# Abstract\n## Background\n## Methods\n## Results\n## Conclusions\n# Introduction\n## Burden of breast cancer and need for early diagnosis\n## WHO emphasis on early diagnosis","[{\"question\":\"What was the main goal of the outreach program in rural Pakistan?\",\"answer\":\"To evaluate outcomes of community breast education, home CBE, and referral aimed at early recognition of abnormalities and improved breast cancer awareness.\"},{\"question\":\"How were health care workers and the gynecologist involved?\",\"answer\":\"Eight health care workers and a gynecologist received training on breast cancer knowledge and on delivering community awareness activities and conducting home CBE.\"},{\"question\":\"What factors led to non-compliance with referral and imaging?\",\"answer\":\"Major reasons included lack of understanding of the risks and financial constraints, identified during follow-up home visits.\"}]","Implementation of a clinical breast exam and referral program in a rural district of Pakistan | PDF",1790029399,25]