Based in lilongwe, malawi we trained laywomen on how to conduct clinical breast exam (CBE) and give breast cancer talks in health clinics. While patients were waiting to be seen. At the end of the clinic visit, eligible women were invited to undergo a screening CBE by a trained laywoman. Any abnormal exam was referred to study surgeon (PI) for further evaluation. A subset of normal screening CBE women were randomized to have screening ultrasound for sensitivity and specificity purposes. On surgeon exam, any palpable mass was further biopsied or underwent FNA. Any suspicious masses underwent excisional biopsy.