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Taleghani F, Kianpour M, Tabatabaiyan M. Barriers to Breast Self-examination among Iranian Women. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:108-112. [PMID: 30820221 PMCID: PMC6390439 DOI: 10.4103/ijnmr.ijnmr_94_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Breast cancer is a very common cancer in women which is diagnosable using inexpensive, accessible, and easy screening programs in the early stages of the disease. Culture, beliefs, and opinions of women affect adoption of screening techniques. Nursing professionals are supposed to be aware of such influencing factors. Therefore, this study was conducted to investigate barriers to breast self-examination (BSE) among women in Isfahan province. Materials and Methods During a cross-sectional descriptive and correlational study in 2017, 1509 women in rural and urban areas of Isfahan province were selected using multistage sampling method. Data were collected by visiting homes, using a questionnaire, and conducting interviews and were analyzed using descriptive and analytical statistics. Results The results showed that barriers consisted of lack of awareness about breast examination (p = 0.006), lack of awareness about BSE techniques (p < 0.001), and lack of training by personnel of healthcare centers (p = 0.016), which were significantly associated with residency areas (i.e., urban and rural areas). Moreover, women's educational level was significantly associated with 5 of 10 barriers and their occupation was significantly associated with 2 of 10 barriers to BSE. Conclusions Among the several factors that may affect BSE, a part of them in Isfahan women act as obstacle that they are moderated by some demographic factors such as residency areas, education level, and occupation. Therefore, nursing plans and interventions aimed at developing BSE should be tailored to suit the unique demographic characteristics of women.
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Affiliation(s)
- Fariba Taleghani
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Kianpour
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Tabatabaiyan
- Department of Surgery, Seyed Al-Shohada Hospital, Focal Point of Breast Cancer at Isfahan University of Medical Sciences, Isfahan, Iran
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Yedjou CG, Sims JN, Miele L, Noubissi F, Lowe L, Fonseca DD, Alo RA, Payton M, Tchounwou PB. Health and Racial Disparity in Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1152:31-49. [PMID: 31456178 PMCID: PMC6941147 DOI: 10.1007/978-3-030-20301-6_3] [Citation(s) in RCA: 220] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Breast cancer is the most common noncutaneous malignancy and the second most lethal form of cancer among women in the United States. It currently affects more than one in ten women worldwide. The chance for a female to be diagnosed with breast cancer during her lifetime has significantly increased from 1 in 11 women in 1975 to 1 in 8 women (Altekruse, SEER Cancer Statistics Review, 1975-2007. National Cancer Institute, Bethesda, 2010). This chance for a female of being diagnosed with cancer generally increases with age (Howlader et al, SEER Cancer Statistics Review, 1975-2010. National Cancer Institute, Bethesda, 2013). Fortunately, the mortality rate from breast cancer has decreased in recent years due to increased emphasis on early detection and more effective treatments in the White population. Although the mortality rates have declined in some ethnic populations, the overall cancer incidence among African American and Hispanic population has continued to grow. The goal of the work presented in this book chapter is to highlight similarities and differences in breast cancer morbidity and mortality rates among non-Hispanic white and non-Hispanic black populations. This book chapter also provides an overview of breast cancer, racial/ethnic disparities in breast cancer, breast cancer incidence and mortality rate linked to hereditary, major risk factors of breast cancer among minority population, breast cancer treatment, and health disparity. A considerable amount of breast cancer treatment research have been conducted, but with limited success for African Americans compared to other ethnic groups. Therefore, new strategies and approaches are needed to promote breast cancer prevention, improve survival rates, reduce breast cancer mortality, and ultimately improve the health outcomes of racial/ethnic minorities. In addition, it is vital that leaders and medical professionals from minority population groups be represented in decision-making in research so that racial disparity in breast cancer can be well-studied, fully addressed, and ultimately eliminated in breast cancer.
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Affiliation(s)
- Clement G Yedjou
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA.
| | - Jennifer N Sims
- Department of Epidemiology and Biostatistics, College of Public Service, Jackson State University, Jackson Medical Mall - Thad Cochran Center, Jackson, MS, USA
| | - Lucio Miele
- LSU Health Sciences Center, School of Medicine, Department of Genetics, New Orleans, LA, USA
| | - Felicite Noubissi
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA
| | - Leroy Lowe
- Getting to Know Cancer (NGO), Truro, NS, Canada
| | - Duber D Fonseca
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA
| | - Richard A Alo
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA
| | - Marinelle Payton
- Department of Epidemiology and Biostatistics, College of Public Service, Jackson State University, Jackson Medical Mall - Thad Cochran Center, Jackson, MS, USA
| | - Paul B Tchounwou
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA
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Al-Ajmi K, Lophatananon A, Yuille M, Ollier W, Muir KR. Review of non-clinical risk models to aid prevention of breast cancer. Cancer Causes Control 2018; 29:967-986. [PMID: 30178398 PMCID: PMC6182451 DOI: 10.1007/s10552-018-1072-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 08/10/2018] [Indexed: 12/29/2022]
Abstract
A disease risk model is a statistical method which assesses the probability that an individual will develop one or more diseases within a stated period of time. Such models take into account the presence or absence of specific epidemiological risk factors associated with the disease and thereby potentially identify individuals at higher risk. Such models are currently used clinically to identify people at higher risk, including identifying women who are at increased risk of developing breast cancer. Many genetic and non-genetic breast cancer risk models have been developed previously. We have evaluated existing non-genetic/non-clinical models for breast cancer that incorporate modifiable risk factors. This review focuses on risk models that can be used by women themselves in the community in the absence of clinical risk factors characterization. The inclusion of modifiable factors in these models means that they can be used to improve primary prevention and health education pertinent for breast cancer. Literature searches were conducted using PubMed, ScienceDirect and the Cochrane Database of Systematic Reviews. Fourteen studies were eligible for review with sample sizes ranging from 654 to 248,407 participants. All models reviewed had acceptable calibration measures, with expected/observed (E/O) ratios ranging from 0.79 to 1.17. However, discrimination measures were variable across studies with concordance statistics (C-statistics) ranging from 0.56 to 0.89. We conclude that breast cancer risk models that include modifiable risk factors have been well calibrated but have less ability to discriminate. The latter may be a consequence of the omission of some significant risk factors in the models or from applying models to studies with limited sample sizes. More importantly, external validation is missing for most of the models. Generalization across models is also problematic as some variables may not be considered applicable to some populations and each model performance is conditioned by particular population characteristics. In conclusion, it is clear that there is still a need to develop a more reliable model for estimating breast cancer risk which has a good calibration, ability to accurately discriminate high risk and with better generalizability across populations.
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Affiliation(s)
- Kawthar Al-Ajmi
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, The University of Manchester, Manchester, M139 PL UK
| | - Artitaya Lophatananon
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, The University of Manchester, Manchester, M139 PL UK
| | - Martin Yuille
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, The University of Manchester, Manchester, M139 PL UK
| | - William Ollier
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, The University of Manchester, Manchester, M139 PL UK
| | - Kenneth R. Muir
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, The University of Manchester, Manchester, M139 PL UK
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Buribekova R, Shukurbekova I, Ilnazarova S, Jamshevov N, Sadonshoeva G, Sayani S, Aminmuhammad A, Amersi F, Asaria S, Saleh M, Talib Z. Promoting Clinical Breast Evaluations in a Lower Middle-Income Country Setting: An Approach Toward Achieving a Sustainable Breast Health Program. J Glob Oncol 2018; 4:1-8. [PMID: 30241226 PMCID: PMC6223421 DOI: 10.1200/jgo.17.00103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To promote a systems-based approach for the early detection and downstaging of breast cancer at presentation in the remote mountainous region of Gorno Badakhshan Autonomous Oblast (GBAO), Tajikistan, by introducing breast cancer awareness into the community and training health care professionals in clinical breast evaluation (CBE). METHODS Through a public-private partnership between the Ministry of Health, the Aga Khan Health Services, Tajikistan, and the Aga Khan Health Board, we organized breast cancer screening in the community and trained family medicine doctors (FMDs) and family medicine nurses (FMNs) in CBE. We identified and trained CBE master trainers, who, in turn, systematically trained FMNs to conduct CBEs in each of the remote regional clinics. RESULTS Between 2014 and 2017, 47 FMDs (85% of all FMDs in GBAO), 166 FMNs (55% of all FMNs in GBAO), and six master trainers were trained. Of 3,556 women who were screened, abnormal CBEs were noted in 696 of them (20%). Of the last 1,101 CBEs that were performed by trainee FMNs, with secondary CBEs by master trainers, the rate of abnormal CBEs plateaued at 9%. A total of 18 women were diagnosed with breast cancer-2.6% of abnormal CBEs and 0.5% of all screened women. CONCLUSION A dual-pronged approach of community awareness and CBE training of health care professionals, supported by CBE master trainers, offers a sustainable approach for the early detection of breast pathology. We observed anecdotal evidence of clinical early-stage detection over time with improved CBE proficiency and community acceptance. Sustaining this program will require advocacy by health care providers and a responsive public policy to support the early detection and treatment of breast cancer across the region.
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Affiliation(s)
- Roziya Buribekova
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Irina Shukurbekova
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Surayo Ilnazarova
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Nekruz Jamshevov
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Guldarbogh Sadonshoeva
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Saleem Sayani
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Aliya Aminmuhammad
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Farin Amersi
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Sheemain Asaria
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Mansoor Saleh
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Zohray Talib
- Roziya Buribekova, Irina Shukurbekova, Surayo Ilnazarova, Nekruz Jamshevov, and Guldarbogh Sadonshoeva, Aga Khan Health Services, Dushanbe, Tajikistan; Saleem Sayani and Aliya Aminmuhammad, Aga Khan University; Farin Amersi, Sheemain Asaria, Mansoor Saleh, and Zohray Talib, Aga Khan Health Board, Karachi, Pakistan; Zohray Talib, George Washington University School of Medicine, Washington, DC; and Mansoor Saleh, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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Brand NR, Wasike R, Makhdomi K, Chauhan R, Moloo Z, Gakinya SM, Neugut AI, Zujewski JA, Sayed S. Sentinel Lymph Node Biopsy Pathology and 2-Year Postsurgical Recurrence of Breast Cancer in Kenyan Women. J Glob Oncol 2018; 4:1-7. [PMID: 30241138 PMCID: PMC6180780 DOI: 10.1200/jgo.17.00111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The goal of this study was to describe the pathologic findings and early follow-up experience of patients who underwent a sentinel lymph node biopsy (SLNB) at Aga Khan University Hospital (AKUH) between 2008 and 2017. PATIENTS AND METHODS We performed a retrospective analysis of women with breast cancer who underwent an SLNB at AKUH between 2008 and 2017. The SLNB was performed on patients with stage I and stage II breast cancer, and identification of the sentinel lymph node was made by radioactive tracer, blue dye, or both, per availability and surgeon preference. Demographic, surgical, and pathologic data, including immunohistochemistry of the surgical sample for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2, were abstracted from the patient records. Follow-up data were available for a subset of patients. RESULTS Between 2008 and 2017, six surgeons performed SLNBs on 138 women, 129 of whom had complete records and were included in the study. Thirty-one of 129 (24%) had a positive SLNB, including 10 of 73 (14%) with stage I and 21 of 56 (38%) with stage II disease. Seventy-eight patients (60%) received systemic adjuvant chemotherapy and 79 (62%) received radiation therapy, and of the 102 patients who were estrogen receptor positive, 86 (85%) received endocrine therapy. Seventy-nine patients were observed for > 2 years, and, of these, four (5.1%) had a regional recurrence. CONCLUSION The SLNB positivity rates were similar to those of high-income country (HIC) cohorts. However, preliminary data suggest that recurrence rates are elevated at AKUH as compared with those of HIC cohorts, perhaps because of a lower use of radiotherapy and chemotherapy at AKUH compared with HIC cohorts or because of differences in the characteristics of the primary tumor in patients at AKUH as compared with those in HICs.
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Affiliation(s)
- Nathan R. Brand
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Ronald Wasike
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Khalid Makhdomi
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Rajendra Chauhan
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Zahir Moloo
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Samuel M. Gakinya
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Alfred I. Neugut
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Jo Anne Zujewski
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Shahin Sayed
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
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El Saghir NS, El Tomb PA, Carlson RW. Breast Cancer Diagnosis and Treatment in Low- and Mid-Resource Settings: the Role of Resource-Stratified Clinical Practice Guidelines. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0287-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Anderson de Cuevas RM, Saini P, Roberts D, Beaver K, Chandrashekar M, Jain A, Kotas E, Tahir N, Ahmed S, Brown SL. A systematic review of barriers and enablers to South Asian women's attendance for asymptomatic screening of breast and cervical cancers in emigrant countries. BMJ Open 2018; 8:e020892. [PMID: 29982210 PMCID: PMC6042536 DOI: 10.1136/bmjopen-2017-020892] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The aim of this review was to identify the cultural, social, structural and behavioural factors that influence asymptomatic breast and cervical cancer screening attendance in South Asian populations, in order to improve uptake and propose priorities for further research. DESIGN A systematic review of the literature for inductive, comparative, prospective and intervention studies. We searched the following databases: MEDLINE/In-Process, Web of Science, EMBASE, SCOPUS, CENTRAL, CDSR, CINAHL, PsycINFO and PsycARTICLES from database inception to 23 January 2018. The review included studies on the cultural, social, structural and behavioural factors that influence asymptomatic breast and cervical cancer screening attendance and cervical smear testing (Papanicolaou test) in South Asian populations and those published in the English language. The framework analysis method was used and themes were drawn out following the thematic analysis method. SETTINGS Asymptomatic breast or cervical screening. PARTICIPANTS South Asian women, including Bangladeshi, Indian, Pakistani, Sri Lankan, Bhutanese, Maldivian and Nepali populations. RESULTS 51 included studies were published between 1991 and 2018. Sample sizes ranged from 25 to 38 733 and participants had a mean age of 18 to 83 years. Our review showed that South Asian women generally had lower screening rates than host country women. South Asian women had poorer knowledge of cancer and cancer prevention and experienced more barriers to screening. Cultural practices and assumptions influenced understandings of cancer and prevention, emphasising the importance of host country cultures and healthcare systems. CONCLUSIONS High-quality research on screening attendance is required using prospective designs, where objectively validated attendance is predicted from cultural understandings, beliefs, norms and practices, thus informing policy on targeting relevant public health messages to the South Asian communities about screening for cancer. PROSPERO REGISTRATION NUMBER CSD 42015025284.
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Affiliation(s)
| | - Pooja Saini
- NIHR Collaboration for Leadership in Applied Health Research and Care, University of Liverpool, Liverpool, UK
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
| | - Deborah Roberts
- Royal Liverpool and Broadgreen Hospital NHS Trust, Liverpool, UK
| | - Kinta Beaver
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | | | - Anil Jain
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
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Yip CH, Taib NA, Song CV, Pritam Singh RK, Agarwal G. Early Diagnosis of Breast Cancer in the Absence of Population-Based Mammographic Screening in Asia. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0279-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Phaswana-Mafuya N, Peltzer K. Breast and Cervical Cancer Screening Prevalence and Associated Factors among Women in the South African General
Population. Asian Pac J Cancer Prev 2018; 19:1465-1470. [PMID: 29936716 PMCID: PMC6103566 DOI: 10.22034/apjcp.2018.19.6.1465] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023] Open
Abstract
Purpose: The aims of the study were to estimate the prevalence of breast and cervical cancer screening among women in the South African general population and assess associated factors. Methods: Data from a national populationbased cross-sectional household survey in South Africa in 2012 for 10,831 women aged 30+ years were analysed using bivariate and multivariable logistic regression. The outcome variables were cervical cancer screening (Papanicolaou smear test) and breast cancer screening (mammography). Exposure variables were sociodemographic factors, lifestyle variables, and chronic conditions. Results: The prevalences of Papanicolaou (PAP) smear test and mammography participation were 52.0% and 13.4%, respectively. On multivariable logistic regression analysis, women with higher education, those who were non-black African, having medical aid and having chronic conditions were more likely to undergo a Pap smear test and mammography. Living in rural areas was related to a lower likelihood of receiving both types of screening. In addition, undertaking moderate or vigorous physical activity was associated with breast cancer screening. Conclusion: Screening for cervical cancer was relatively high but for breast cancer it was low, despite the latter being a major public health problem in South Africa. This may be attributed to the limited availability, affordability, and accessibility of breast cancer screening services among socio-economically disadvantaged individuals There are some socio-economic disparities in adopting both breast and cervical cancer screening guidelines that could be targeted by interventions.
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Affiliation(s)
- Nancy Phaswana-Mafuya
- HIV/AIDS/STIs and TB Research Programme, Human Sciences Research Council, Private Bag X41, Pretoria 0001, South Africa
- Department of Research & Innovation, University of Limpopo, Sovenga 0727, South Africa
- Office of the Deputy Vice Chancellor: Research & Engagement, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa.
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Burden of cancer in the Eastern Mediterranean Region, 2005-2015: findings from the Global Burden of Disease 2015 Study. Int J Public Health 2018; 63:151-164. [PMID: 28776254 PMCID: PMC5973975 DOI: 10.1007/s00038-017-0999-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/02/2017] [Accepted: 06/13/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To estimate incidence, mortality, and disability-adjusted life years (DALYs) caused by cancer in the Eastern Mediterranean Region (EMR) between 2005 and 2015. METHODS Vital registration system and cancer registry data from the EMR region were analyzed for 29 cancer groups in 22 EMR countries using the Global Burden of Disease Study 2015 methodology. RESULTS In 2015, cancer was responsible for 9.4% of all deaths and 5.1% of all DALYs. It accounted for 722,646 new cases, 379,093 deaths, and 11.7 million DALYs. Between 2005 and 2015, incident cases increased by 46%, deaths by 33%, and DALYs by 31%. The increase in cancer incidence was largely driven by population growth and population aging. Breast cancer, lung cancer, and leukemia were the most common cancers, while lung, breast, and stomach cancers caused most cancer deaths. CONCLUSIONS Cancer is responsible for a substantial disease burden in the EMR, which is increasing. There is an urgent need to expand cancer prevention, screening, and awareness programs in EMR countries as well as to improve diagnosis, treatment, and palliative care services.
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Ghartey FN, Watmough D, Debrah S, Morna M, Anyanful A. Breast-i Is an Effective and Reliable Adjunct Screening Tool for Detecting Early Tumour Related Angiogenesis of Breast Cancers in Low Resource Sub-Saharan Countries. Int J Breast Cancer 2018; 2018:2539056. [PMID: 29850258 PMCID: PMC5904814 DOI: 10.1155/2018/2539056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/19/2018] [Accepted: 03/05/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND What cheaper alternative breast screening procedures are available to younger women in addition to clinical breast examination (CBE) in Sub-Saharan countries? In 2009, we first described BreastLight for screening and reported high sensitivity at detecting breast cancer. Due to limitations of BreastLight, we have since 2014 been using the more technologically advanced Breast-i to screen 2204 women to find cheaper screening alternatives. METHODOLOGY First, the participant lies down for CBE and then, in a darkened room, Breast-i was placed underneath each breast and trained personnel confirm vein pattern and look out for dark spot(s) to ascertain the presence of suspicious angiogenic lesion(s). RESULTS CBE detected 153 palpable breast masses and Breast-i, which detects angiogenesis, confirmed 136. However, Breast-i detected 22 more cases of which 7 had angiogenesis but were not palpable and 15 were missed by CBE due to large breast size. Overall confirmed cases were 26, with Breast-i detecting 7 cases missed by CBE. Breast-i and CBE gave sensitivities of 92.3% and 73%, respectively. CONCLUSION Breast-i with its high sensitivity to angiogenesis, reliability, and affordability will be an effective adjunct detection device that can be used effectively to increase early detection in younger women, thereby increasing treatment success.
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Affiliation(s)
- Frank Naku Ghartey
- Department of Chemical Pathology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | - Samuel Debrah
- Department of Surgery, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Martin Morna
- Department of Surgery, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Akwasi Anyanful
- Department of Medical Biochemistry, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Futakuchi M, Nitanda T, Ando S, Matsumoto H, Yoshimoto E, Fukamachi K, Suzui M. Therapeutic and Preventive Effects of Osteoclastogenesis Inhibitory Factor on Osteolysis, Proliferation of Mammary Tumor Cell and Induction of Cancer Stem Cells in the Bone Microenvironment. Int J Mol Sci 2018; 19:ijms19030888. [PMID: 29547583 PMCID: PMC5877749 DOI: 10.3390/ijms19030888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/02/2018] [Accepted: 03/14/2018] [Indexed: 11/24/2022] Open
Abstract
Background: We examined the effects of recombinant human osteoclastogenesis inhibitory factor (hOCIF) on osteolysis, proliferation of mammary tumor cells, and induction of cancer stem cells (CSCs) in the tumor-bone and tumor-subcutaneous microenvironments (TB- and TS-microE). Methods: Mouse mammary tumor cells were transplanted onto the calvaria or into a subcutaneous lesion of female mice, creating a TB-microE and a TS-microE, and the mice were then treated with hOCIF. To investigate the preventive effects of hOCIF, mice were treated with hOCIF before tumor cell implantation onto the calvaria (Pre), after (Post), and both before and after (Whole). The number of CSCs and cytokine levels were evaluated by IHC and ELISA assay, respectively. Results: hOCIF suppressed osteolysis, and growth of mammary tumors in the TB-microE, but not in the TS-microE. In the Pre, Post, and Whole groups, hOCIF suppressed osteolysis, and cell proliferation. hOCIF increased mouse osteoprotegrin (mOPG) levels in vivo, which suppressed mammary tumor cell proliferation in vitro. These preventive effects were observed in the dose-dependent. hOCIF did not affect the induction of CSCs in either microenvironment. Conclusion: While receptor activator of NF-κB ligand (RANKL) targeting therapy may not affect the induction of CSCs, RANKL is a potential target for prevention as well as treatment of breast cancer bone metastasis.
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Affiliation(s)
- Mitsuru Futakuchi
- Department of Pathology, Nagasaki University Hospital, Nagasaki 851-8501, Japan.
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan.
- Department of Molecular Toxicology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan.
| | - Takao Nitanda
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan.
| | - Saeko Ando
- Department of Molecular Toxicology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan.
| | - Harutoshi Matsumoto
- Department of Molecular Toxicology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan.
| | - Eri Yoshimoto
- Department of Molecular Toxicology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan.
| | - Katsumi Fukamachi
- Department of Molecular Toxicology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan.
| | - Masumi Suzui
- Department of Molecular Toxicology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan.
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Trivedi T, Zheng Y, Fournier PGJ, Murthy S, John S, Schillo S, Dunstan CR, Mohammad KS, Zhou H, Seibel MJ, Guise TA. The vitamin D receptor is involved in the regulation of human breast cancer cell growth via a ligand-independent function in cytoplasm. Oncotarget 2018; 8:26687-26701. [PMID: 28460457 PMCID: PMC5432290 DOI: 10.18632/oncotarget.15803] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/15/2017] [Indexed: 12/31/2022] Open
Abstract
Vitamin D has pleiotropic effects on multiple tissues, including malignant tumors. Vitamin D inhibits breast cancer growth through activation of the vitamin D receptor (VDR) and via classical nuclear signaling pathways. Here, we demonstrate that the VDR can also function in the absence of its ligand to control behaviour of human breast cancer cells both outside and within the bone microenvironment. Stable shRNA expression was used to knock down VDR expression in MCF-7 cells, generating two VDR knockdown clonal lines. In ligand-free culture, knockdown of VDR in MCF-7 cells significantly reduced proliferation and increased apoptosis, suggesting that the VDR plays a ligand-independent role in cancer cell growth. Implantation of these VDR knockdown cells into the mammary fat pad of nude mice resulted in reduced tumor growth in vivo compared with controls. In the intra-tibial xenograft model, VDR knockdown greatly reduced the ability of the cells to form tumors in the bone microenvironment. The in vitro growth of VDR knockdown cells was rescued by the expression of a mutant form of VDR which is unable to translocate to the nucleus and hence accumulates in the cytoplasm. Thus, our data indicate that in the absence of ligand, the VDR promotes breast cancer growth both in vitro and in vivo and that cytoplasmic accumulation of VDR is sufficient to produce this effect in vitro. This new mechanism of VDR action in breast cancer cells contrasts the known anti-proliferative nuclear actions of the VDR-vitamin D ligand complex.
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Affiliation(s)
- Trupti Trivedi
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, Australia.,Division of Endocrinology, Department of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - Yu Zheng
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, Australia
| | - Pierrick G J Fournier
- Division of Endocrinology, Department of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA.,Biomedical Innovation Department, Scientific Research and High Education Center from Ensenada (CICESE), Ensenada, Baja California, Mexico
| | - Sreemala Murthy
- Division of Endocrinology, Department of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - Sutha John
- Division of Endocrinology, Department of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - Suzanne Schillo
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, Australia
| | - Colin R Dunstan
- Department of Biomedical Engineering, University of Sydney, Sydney, Australia
| | - Khalid S Mohammad
- Division of Endocrinology, Department of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - Hong Zhou
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, Australia
| | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, Australia.,Department of Endocrinology and Metabolism, Concord Hospital, Concord, Sydney, Australia
| | - Theresa A Guise
- Division of Endocrinology, Department of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
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Perceived barriers to early detection of breast cancer in Wakiso District, Uganda using a socioecological approach. Global Health 2018; 14:9. [PMID: 29361954 PMCID: PMC5781279 DOI: 10.1186/s12992-018-0326-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 01/09/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Early detection of breast cancer is known to improve its prognosis. However, women in most low and middle income countries, including Uganda, do not detect it early hence present at an advanced stage. This study investigated the perceived barriers to early detection of breast cancer in Wakiso district, Uganda using a multilevel approach focused through a socioecological framework. METHODS Using qualitative methods, participants were purposively selected to take part in the study. 5 semi-structured interviews were conducted among the community members while two focus groups were conducted amongst women's group and community health workers (CHWs) in Ssisa sub county, Wakiso district. In addition, 7 key informant interviews with health professionals, policy makers and public health researchers were carried out. RESULTS Findings from the study revealed that barriers to early detection of breast cancer are multifaceted and complex, cutting across individual, interpersonal, organizational, community and policy barriers. The major themes that emerged from the study included: knowledge, attitudes, beliefs and practices (KABP); health system and policy constraints; and structural barriers. Prominent barriers associated with KABP were low knowledge, apathy, fear and poor health seeking behaviours. Barriers within the health systems and policy arenas were mostly centred around competing health care burdens within the country, lack of a cancer policy and weak primary health care capacity in Wakiso district. Distance, poverty and limited access to media were identified as the most prominent structural barriers. CONCLUSION Barriers to early detection of breast cancer are complex and go beyond individual behaviours. These barriers interact across multiple levels of influence such as organizational, community and policy. The findings of this study could provide opportunities for investment in multi-level interventions.
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Rivera-Franco MM, Leon-Rodriguez E. Delays in Breast Cancer Detection and Treatment in Developing Countries. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2018; 12:1178223417752677. [PMID: 29434475 PMCID: PMC5802601 DOI: 10.1177/1178223417752677] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/18/2017] [Indexed: 01/07/2023]
Abstract
Breast cancer is the most common cancer in women in both developed and developing countries and the second most common cancer in the world. Developing countries are increasingly adopting a Western lifestyle, such as changes in diet and delayed first childbirth, lower parity, and shorter periods of breastfeeding, which are important determinants of a higher incidence of breast cancer among those regions. Low- and middle-income countries (LMICs) represent most of the countries with the highest mortality rates, ranging from 40% to 60%. Furthermore, developing countries account for scarce survival data, and the few data available coincide with the observed incidence and mortality differences. Five-year survival rates for breast cancer are much worse for LMICs countries such as Brazil, India, and Algeria in comparison with the United States and Sweden. Paucity of early detection programs explain these poor survival rates, which results in a high proportion of women presenting with late-stage disease, along with lack of adequate diagnosis and treatment facilities. Emphasis is urgently needed on health education, to promote early diagnosis of breast cancer, highlighting the importance of creating more public facilities that provide treatment, which are key components for the improvement in breast cancer care in developing countries.
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Affiliation(s)
- Monica M Rivera-Franco
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Eucario Leon-Rodriguez
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Resource-stratified implementation of a community-based breast cancer management programme in Peru. Lancet Oncol 2017; 18:e607-e617. [PMID: 28971827 DOI: 10.1016/s1470-2045(17)30592-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/26/2017] [Accepted: 02/09/2017] [Indexed: 11/24/2022]
Abstract
Breast cancer incidence and mortality rates continue to rise in Peru, with related deaths projected to increase from 1208 in 2012, to 2054 in 2030. Despite improvements in national cancer control plans, various barriers to positive breast cancer outcomes remain. Multiorganisational stakeholder collaboration is needed for the development of functional, sustainable early diagnosis, treatment and supportive care programmes with the potential to achieve measurable outcomes. In 2011, PATH, the Peruvian Ministry of Health, the National Cancer Institute in Lima, and the Regional Cancer Institute in Trujillo collaborated to establish the Community-based Program for Breast Health, the aim of which was to improve breast health-care delivery in Peru. A four-step, resource-stratified implementation strategy was used to establish an effective community-based triage programme and a practical early diagnosis scheme within existing multilevel health-care infrastructure. The phased implementation model was initially developed by the Breast Cancer Initiative 2·5: a group of health and non-governmental organisations who collaborate to improve breast cancer outcomes. To date, the Community-based Program for Breast Health has successfully implemented steps 1, 2, and 3 of the Breast Cancer Initiative 2·5 model in Peru, with reports of increased awareness of breast cancer among women, improved capacity for early diagnosis among health workers, and the creation of stronger and more functional linkages between the primary levels (ie, local or community) and higher levels (ie, district, region, and national) of health care. The Community-based Program for Breast Health is a successful example of stakeholder and collaborator involvement-both internal and external to Peru-in the design and implementation of resource-appropriate interventions to increase breast health-care capacity in a middle-income Latin American country.
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Espina C, McKenzie F, Dos-Santos-Silva I. Delayed presentation and diagnosis of breast cancer in African women: a systematic review. Ann Epidemiol 2017; 27:659-671.e7. [PMID: 29128086 PMCID: PMC5697496 DOI: 10.1016/j.annepidem.2017.09.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/24/2017] [Accepted: 09/01/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE Africa has low breast cancer incidence rates but high mortality rates from this disease due to poor survival. Delays in presentation and diagnosis are major determinants of breast cancer survival, but these have not been comprehensively investigated in Africa. METHODS MEDLINE, Embase, and Global Health were searched to identify studies reporting on delays in presentation and/or diagnosis of breast cancer published between January 1, 2000 and May 31, 2016. Data were synthesized in narrative, tabular, and graphical forms. Meta-analyses were not possible due to between-study differences in the way delays were reported. RESULTS Twenty-one studies were included in the review. Study-specific average times between symptom recognition and presentation to a health care provider ranged from less than 1 to 4 months in North Africa and from less than 3 to greater than 6 months in sub-Saharan Africa. Study-specific average times from presentation to diagnosis were less than 1 month in North Africa but ranged from less than 3 to greater than 6 months in sub-Saharan Africa. Reported reasons for these delays included patient-mediated (e.g., socioeconomic factors) and health system-mediated factors (e.g., referral pathways). CONCLUSIONS This systematic review revealed marked delays in presentation and diagnosis of breast cancer in Africa. Identification of their drivers is crucial to the development of appropriate control strategies in the continent.
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Affiliation(s)
- Carolina Espina
- International Agency for Research on Cancer (IARC), Lyon, France.
| | - Fiona McKenzie
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Dickerson LK, Rositch AF, Lucas S, Harvey SC. Pilot Educational Intervention and Feasibility Assessment of Breast Ultrasound in Rural South Africa. J Glob Oncol 2017; 3:502-508. [PMID: 29094089 PMCID: PMC5646899 DOI: 10.1200/jgo.2016.008086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Breast cancer is the leading cause of cancer death in women worldwide, with high mortality in low- and middle-income countries because of a lack of detection, diagnosis, and treatment. With mammography unavailable, ultrasound offers an alternative for downstaging. The literature reports successful training in various domains, but a focus on the breast is novel. We assessed the feasibility (knowledge acquisition, perceived usefulness, and self-efficacy) of breast ultrasound training for nonphysician providers. METHODS Training was implemented for 12 providers at Hlokomela Clinic in Hoedspruit, South Africa, over 3 weeks. Didactic presentations and example cases were followed by a presurvey and test (n = 12). All providers received hands-on training with nurses as models; five providers trained with patients. A post-test (n = 12) assessed knowledge acquisition and a postsurvey (n = 10) assessed perceived program usefulness and provider self-efficacy. RESULTS The pre- to post-test averages improved by 68% in total and in four competencies (foundational knowledge, descriptive categories, benign v malignant, and lesion identification). On the postsurvey, providers expressed that ultrasound could significantly influence breast cancer detection (9.1 out of 10), treatment (7.9 out of 10), and survival (8.7 out of 10) in their community and endorsed moderate confidence in their scanning (6.3 out of 10) and interpreting abilities (5.6 out of 10). CONCLUSION Our research supports the feasibility of breast ultrasound training as part of a breast education program in low- and middle-income countries. Pre- and post-test results and observed proficiency indicate that training nonphysician providers is achievable; postsurvey responses indicate program acceptance, community-based ownership, and provider self-efficacy with ultrasound. Future work may show that breast ultrasound is viable for early detection where mammography is unavailable.
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Affiliation(s)
- Lindsay K. Dickerson
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
| | - Anne F. Rositch
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
| | - Susan Lucas
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
| | - Susan C. Harvey
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
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Yılmaz M, Sayın Y, Cengiz HÖ. The Effects of Training on Knowledge and Beliefs About Breast Cancer and Early Diagnosis Methods Among Women. Eur J Breast Health 2017; 13:175-182. [PMID: 29082374 PMCID: PMC5648273 DOI: 10.5152/tjbh.2017.3255] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/04/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Breast cancer (BC) is the most common female malignancy in the world and Turkey. Its prevalence and mortality are surprisingly increasing at a rapid rate. The objective of this study was to determine the effectiveness of training sessions on women's knowledge of relevant risk factors of BC and screening methods, screening behaviors and health beliefs among of healthy women in Turkey. MATERIALS AND METHODS In this study, in order to establish the efficiency of BC training, a semi-empirical single group pre-test & post-test research model was used. The data were collected by using a self-administered questionnaire and by using the Turkish version of Champion's health belief model scale (CHBMS). The pre-test was performed before the training and after one week of the training, post-test was performed with a questionnaire having the same content. RESULTS In total, 244 women participated in the study. The average age of the women was 39.44 (SD=1.06) years. The mean total knowledge score increased significantly (p<.001) from 9.05 in the pre-test to 16.53 in the post-test. The results showed that both mean knowledge scores and CHBMS subscales scores of the women were increased significantly (p<.001) from the pre-test to the post-test. In multiple linear regression analysis, BC screening knowledge of women with susceptibility, benefit, self-efficacy and health motivation subscales of CHBMS, breast self-examination (BSE) practice and self-efficacy were also significant in the post-test; in the pre- and post-tests, a significant relationship among the level of education of women, susceptibility and seriousness was found (p<.001). CONCLUSION The study showed that the training program had profound effects on BC knowledge, screening behaviors and health beliefs of women.
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Affiliation(s)
- Meryem Yılmaz
- Division of Nursing, Department of Surgical Disease Nursing, Cumhuriyet University School of Health Sciences, Sivas, Turkey
| | - Yazile Sayın
- Division of Nursing, Department of Surgical Disease Nursing, Bezmialem Vakıf University School of Health Sciences, İstanbul, Turkey
| | - Hatice Öner Cengiz
- Department of Surgical Nursing, Ankara University School of Health Sciences, Ankara, Turkey
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Stamatovic L, Vasovic S, Trifunovic J, Boskov N, Gajic Z, Parezanovic A, Icevic M, Cirkovic A, Milic N. Factors influencing time to seeking medical advice and onset of treatment in women who are diagnosed with breast cancer in Serbia. Psychooncology 2017; 27:576-582. [PMID: 28857314 DOI: 10.1002/pon.4551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Streamlining the diagnosis is a key factor in improving the treatment outcomes for breast cancer. The aim of this study was to determine factors influencing time to seeking medical advice and treatment onset in women who are diagnosed with breast cancer in Serbia. METHODS The study was a multicenter, cross-sectional national survey, performed at 10 oncology centers in Serbia. Time intervals spent throughout the complex diagnostic pathway were evaluated using a validated questionnaire administered to women with breast cancer (n = 800). Total interval (TI) was determined using predefined time scales, including one referring to patient interval (PI), and several related to health care system interval (SI). RESULTS Mean PI, SI, and TI were 4.5, 9.2, and 12.9 weeks, respectively; 20% of patients had a PI>12 weeks. Based on the multivariate regression model, longer PI was associated with perceived lack of time and personal disregard or trivialization of detected symptoms and signs. Women who were supported by family members or friends and had at least a secondary level education tended to have a shorter PI. Longer PI was correlated with a longer SI, while regular self-examination, having been diagnosed by an oncologist, and living in a major city were associated with shorter SI. CONCLUSIONS Several factors, related to psychological, demographic, behavioral, and health system characteristics, determined both the time to seeking medical advice and treatment onset for breast cancer. These findings support review and refining of national strategies and policies to promote early detection, diagnosis, and treatment of breast cancer.
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Affiliation(s)
- L Stamatovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - S Vasovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - J Trifunovic
- Oncology Institute of Vojvodina, Novi Sad, Serbia
| | - N Boskov
- General Hospital Zrenjanin, Zrenjanin, Serbia
| | - Z Gajic
- General Hospital Kruševac, Kruševac, Serbia
| | | | | | - A Cirkovic
- Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia
| | - N Milic
- Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia.,Department for Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Amatya B, Khan F, Galea MP. Optimizing post-acute care in breast cancer survivors: a rehabilitation perspective. J Multidiscip Healthc 2017; 10:347-357. [PMID: 28919774 PMCID: PMC5587162 DOI: 10.2147/jmdh.s117362] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Breast cancer (BC) is the most common malignancy and a leading cause of morbidity and mortality in women worldwide. Therapeutic advances and improved survival rates of women with BC have implications for long-term impact on disability, psychological function and quality of life (QoL), which may be amenable to rehabilitation. The focus of rehabilitation is on managing disability, reducing sequelae and symptoms, and enhancing participation and societal reintegration, to achieve the highest possible independence and the best QoL. Rehabilitation interventions should be considered early for maintaining functional capacity and reducing the risk of losing important abilities or independence and should be individualized depending on disease phase, functional deficits, personal requirements and specific goals. A number of interventions have been trialled to support rehabilitation input for women with BC, which include physical therapy, psychological interventions (psychotherapy, cognitive behavioral training) and others. Multidisciplinary rehabilitation and uni-disciplinary interventions such as physical therapy have been shown to be beneficial in reducing disability, and improving participation and QoL. There is a need for comprehensive assessment of health domains in BC patients using a standardized framework and a common language for describing the impact of disease at different levels, using the International Classification of Functioning, Disability and Health core sets. This will provide more detailed information on the needs of these patients, so more efficient and targeted rehabilitation interventions can be provided.
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Affiliation(s)
- Bhasker Amatya
- Department of Rehabilitation Medicine, Royal Melbourne Hospital
- Australian Rehabilitation Research Centre, Royal Melbourne Hospital
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Fary Khan
- Department of Rehabilitation Medicine, Royal Melbourne Hospital
- Australian Rehabilitation Research Centre, Royal Melbourne Hospital
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Mary P Galea
- Department of Rehabilitation Medicine, Royal Melbourne Hospital
- Australian Rehabilitation Research Centre, Royal Melbourne Hospital
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
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Badal K, Rampersad F, Warner WA, Toriola AT, Mohammed H, Scheffel HA, Ali R, Moosoodeen M, Konduru S, Russel A, Haraksingh R. A situational analysis of breast cancer early detection services in Trinidad and Tobago. Cancer Causes Control 2017; 29:33-42. [DOI: 10.1007/s10552-017-0937-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023]
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Scheel JR, Molina Y, Anderson BO, Patrick DL, Nakigudde G, Gralow JR, Lehman CD, Thompson B. Breast Cancer Beliefs as Potential Targets for Breast Cancer Awareness Efforts to Decrease Late-Stage Presentation in Uganda. J Glob Oncol 2017; 4:1-9. [PMID: 30241166 PMCID: PMC6180808 DOI: 10.1200/jgo.2016.008748] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose To assess breast cancer beliefs in Uganda and determine whether these beliefs
are associated with factors potentially related to nonparticipation in early
detection. Methods A survey with open- and close-ended items was conducted in a community sample
of Ugandan women to assess their beliefs about breast cancer. Linear
regression was used to ascertain associations between breast cancer beliefs
and demographic factors potentially associated with early detection,
including socioeconomic factors, health care access, prior breast cancer
knowledge, and personal detection practices. Results Of the 401 Ugandan women surveyed, most had less than a primary school
education and received medical care at community health centers. Most women
either believed in or were unsure about cultural explanatory models for
developing breast cancer (> 82%), and the majority listed these
beliefs as the most important causes of breast cancer (69%). By comparison,
≤ 45% of women believed in scientific explanatory risks for
developing breast cancer. Although most believed that regular screening and
early detection would find breast cancer when it is easy to treat (88% and
80%, respectively), they simultaneously held fatalistic attitudes toward
their own detection efforts, including belief or uncertainty that a cure is
impossible once they could self-detect a lump (54%). Individual beliefs were
largely independent of demographic factors. Conclusion Misconceptions about breast cancer risks and benefits of early detection are
widespread in Uganda and must be addressed in future breast cancer awareness
efforts. Until screening programs exist, most breast cancer will be
self-detected. Unless addressed by future awareness efforts, the high
frequency of fatalistic attitudes held by women toward their own detection
efforts will continue to be deleterious to breast cancer early detection in
sub-Saharan countries like Uganda.
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Affiliation(s)
- John R Scheel
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Yamile Molina
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Benjamin O Anderson
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Donald L Patrick
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Gertrude Nakigudde
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Julie R Gralow
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Constance D Lehman
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Beti Thompson
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
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Duan W, Li S, Meng X, Sun Y, Jia C. Smoking and survival of breast cancer patients: A meta-analysis of cohort studies. Breast 2017; 33:117-124. [DOI: 10.1016/j.breast.2017.03.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/16/2017] [Accepted: 03/23/2017] [Indexed: 02/07/2023] Open
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DeGregorio G, Manga S, Kiyang E, Manjuh F, Bradford L, Cholli P, Wamai R, Ogembo R, Sando Z, Liu Y, Sheldon LK, Nulah K, Welty T, Welty E, Ogembo JG. Implementing a Fee-for-Service Cervical Cancer Screening and Treatment Program in Cameroon: Challenges and Opportunities. Oncologist 2017; 22:850-859. [PMID: 28536303 DOI: 10.1634/theoncologist.2016-0383] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/07/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Cervical cancer screening is one of the most effective cancer prevention strategies, but most women in Africa have never been screened. In 2007, the Cameroon Baptist Convention Health Services, a large faith-based health care system in Cameroon, initiated the Women's Health Program (WHP) to address this disparity. The WHP provides fee-for-service cervical cancer screening using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC), prioritizing care for women living with HIV/AIDS. They also provide clinical breast examination, family planning (FP) services, and treatment for reproductive tract infection (RTI). Here, we document the strengths and challenges of the WHP screening program and the unique aspects of the WHP model, including a fee-for-service payment system and the provision of other women's health services. METHODS We retrospectively reviewed WHP medical records from women who presented for cervical cancer screening from 2007-2014. RESULTS In 8 years, WHP nurses screened 44,979 women for cervical cancer. The number of women screened increased nearly every year. The WHP is sustained primarily on fees-for-service, with external funding totaling about $20,000 annually. In 2014, of 12,191 women screened for cervical cancer, 99% received clinical breast exams, 19% received FP services, and 4.7% received treatment for RTIs. We document successes, challenges, solutions implemented, and recommendations for optimizing this screening model. CONCLUSION The WHP's experience using a fee-for-service model for cervical cancer screening demonstrates that in Cameroon VIA-DC is acceptable, feasible, and scalable and can be nearly self-sustaining. Integrating other women's health services enabled women to address additional health care needs. IMPLICATION FOR PRACTICE The Cameroon Baptist Convention Health Services Women's Health Program successfully implemented a nurse-led, fee-for-service cervical cancer screening program using visual inspection with acetic acid-enhanced by digital cervicography in the setting of a large faith-based health care system in Cameroon. It is potentially replicable in many African countries, where faith-based organizations provide a large portion of health care. The cost-recovery model and concept of offering multiple services in a single clinic rather than stand-alone "silo" cervical cancer screening could provide a model for other low-and-middle-income countries planning to roll out a new, or make an existing, cervical cancer screening services accessible, comprehensive, and sustainable.
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Affiliation(s)
- Geneva DeGregorio
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Simon Manga
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Edith Kiyang
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Florence Manjuh
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Leslie Bradford
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Preetam Cholli
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Rebecca Ogembo
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Zacharie Sando
- The Yaoundé Gyneco-Obstetrics and Pediatric Hospital, Yaoundé, Cameroon
| | - Yuxin Liu
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Kathleen Nulah
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Thomas Welty
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Edith Welty
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Javier Gordon Ogembo
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Beckman Research Institute of City of Hope, Duarte, California, USA
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Yedjou CG, Tchounwou PB, Payton M, Miele L, Fonseca DD, Lowe L, Alo RA. Assessing the Racial and Ethnic Disparities in Breast Cancer Mortality in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E486. [PMID: 28475137 PMCID: PMC5451937 DOI: 10.3390/ijerph14050486] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/22/2017] [Accepted: 04/26/2017] [Indexed: 01/01/2023]
Abstract
Breast cancer is the second leading cause of cancer related deaths among women aged 40-55 in the United States and currently affects more than one in ten women worldwide. It is also one of the most diagnosed cancers in women both in wealthy and poor countries. Fortunately, the mortality rate from breast cancer has decreased in recent years due to increased emphasis on early detection and more effective treatments in White population. Although the mortality rates have declined in some ethnic populations, the overall cancer incidence among African American and Hispanic populations has continued to grow. The goal of the present review article was to highlight similarities and differences in breast cancer morbidity and mortality rates primarily among African American women compared to White women in the United States. To reach our goal, we conducted a search of articles in journals with a primary focus on minority health, and authors who had published articles on racial/ethnic disparity related to breast cancer patients. A systematic search of original research was conducted using MEDLINE, PUBMED and Google Scholar databases. We found that racial/ethnic disparities in breast cancer may be attributed to a large number of clinical and non-clinical risk factors including lack of medical coverage, barriers to early detection and screening, more advanced stage of disease at diagnosis among minorities, and unequal access to improvements in cancer treatment. Many African American women have frequent unknown or unstaged breast cancers than White women. These risk factors may explain the differences in breast cancer treatment and survival rate between African American women and White women. New strategies and approaches are needed to promote breast cancer prevention, improve survival rate, reduce breast cancer mortality, and ultimately improve the health outcomes of racial/ethnic minorities.
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Affiliation(s)
- Clement G Yedjou
- Natural Chemotherapeutics Research Laboratory, Research Centers in Minority Institutio (RCMI)-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Box 18750, Jackson, MS 39217, USA.
| | - Paul B Tchounwou
- Natural Chemotherapeutics Research Laboratory, Research Centers in Minority Institutio (RCMI)-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Box 18750, Jackson, MS 39217, USA.
| | - Marinelle Payton
- Center of Excellence in Minority Health and Health Disparities, School of Public Health, Jackson State University, Jackson Medical Mall-Thad Cochran Center, 350 West Woodrow Wilson Avenue, Jackson, MS 39213, USA.
| | - Lucio Miele
- Department of Genetics, LSU Health Sciences Center, School of Medicine, 533 Bolivar Street, Room 657, New Orleans, LA 70112, USA.
| | - Duber D Fonseca
- Natural Chemotherapeutics Research Laboratory, Research Centers in Minority Institutio (RCMI)-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Box 18750, Jackson, MS 39217, USA.
| | - Leroy Lowe
- Lancaster Environment Centre, Lancaster University, Bailrigg, Lancaster LA1 4YW, UK.
| | - Richard A Alo
- Department of Civil and Environmental Engineering, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Box 18750, Jackson, MS 39217, USA.
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Maffuz-Aziz A, Labastida-Almendaro S, Espejo-Fonseca A, Rodríguez-Cuevas S. Características clinicopatológicas del cáncer de mama en una población de mujeres en México. CIR CIR 2017; 85:201-207. [DOI: 10.1016/j.circir.2016.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 08/14/2016] [Accepted: 08/15/2016] [Indexed: 12/25/2022]
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Scheel JR, Molina Y, Patrick DL, Anderson BO, Nakigudde G, Lehman CD, Thompson B. Breast Cancer Downstaging Practices and Breast Health Messaging Preferences Among a Community Sample of Urban and Rural Ugandan Women. J Glob Oncol 2017; 3:105-113. [PMID: 28503660 PMCID: PMC5424549 DOI: 10.1200/jgo.2015.001198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Among a community sample of Ugandan women, we provide information about breast cancer downstaging practices (breast self-examination, clinical breast examination [CBE]) and breast health messaging preferences across sociodemographic, health care access, and prior breast cancer exposure factors. METHODS Convenience-based sampling was conducted to recruit Ugandan women age 25 years and older to assess breast cancer downstaging practices as well as breast health messaging preferences to present early for a CBE in the theoretical scenario of self-detection of a palpable lump (breast health messaging preferences). RESULTS The 401 Ugandan women who participated in this survey were mostly poor with less than a primary school education. Of these women, 27% had engaged in breast self-examination, and 15% had undergone a CBE. Greater breast cancer downstaging practices were associated with an urban location, higher education, having a health center as a regular source of care, and receiving breast cancer education (P < .05). Women indicated a greater breast health messaging preference from their provider (66%). This preference was associated with a rural location, having a health center as a regular source of care, and receiving breast cancer education (P < .05). CONCLUSION Most Ugandan women do not participate in breast cancer downstaging practices despite receipt of breast cancer education. However, such education increases downstaging practices and preference for messaging from their providers. Therefore, efforts to downstage breast cancer in Uganda should simultaneously raise awareness in providers and support improved education efforts in the community.
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Affiliation(s)
- John R Scheel
- University of Washington; Seattle Cancer Care Alliance
| | | | | | - Benjamin O Anderson
- University of Washington; Fred Hutchinson Cancer Research Center, Seattle, WA
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Chigbu CO, Onyebuchi AK, Onyeka TC, Odugu BU, Dim CC. The impact of community health educators on uptake of cervical and breast cancer prevention services in Nigeria. Int J Gynaecol Obstet 2017; 137:319-324. [PMID: 28295268 DOI: 10.1002/ijgo.12150] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/25/2017] [Accepted: 03/08/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the impact of trained community health educators on the uptake of cervical and breast cancer screening, and HPV vaccination in rural communities in southeast Nigeria. METHODS A prospective population-based intervention study, with a before-and-after design, involved four randomly selected communities in southeast Nigeria from February 2014 to February 2016. Before the intervention, baseline data were collected on the uptake of cervical and breast cancer prevention services. The intervention was house-to-house education on cervical cancer and breast cancer prevention. Postintervention outcome measures included the uptake of cervical and breast cancer screening, and HPV vaccination within 6 months of intervention. RESULTS In total, 1327 women were enrolled. Before the intervention, 42 (3.2%) women had undergone cervical cancer screening; afterwards, 897 (67.6%) women had received screening (P<0.001). Clinical breast examination was performed for 59 (4.4%) women before and 897 (67.6%) after the intervention (P<0.001). Only 2 (0.9%) of 214 children eligible for HPV vaccination had received the vaccine before versus 71 (33.2%) after the intervention (P<0.001). CONCLUSION The use of community health educators for house-to-house cervical and breast cancer prevention education was associated with significant increases in the uptake of cervical cancer screening, clinical breast examination, and HPV vaccination.
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Affiliation(s)
- Chibuike O Chigbu
- Department of Obstetrics and Gynecology, University of Nigeria Nsukka, Nsukka, Nigeria
| | - Azubuike K Onyebuchi
- Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria
| | - Tonia C Onyeka
- Department of Anaesthesia, University of Nigeria Nsukka, Nsukka, Nigeria
| | - Boniface U Odugu
- Department of Obstetrics and Gynecology, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Cyril C Dim
- Department of Obstetrics and Gynecology, University of Nigeria Nsukka, Nsukka, Nigeria
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80
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Olayemi E, Asare EV, Benneh-Akwasi Kuma AA. Guidelines in lower-middle income countries. Br J Haematol 2017; 177:846-854. [PMID: 28295193 DOI: 10.1111/bjh.14583] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Guidelines include recommendations intended to optimize patient care; used appropriately, they make healthcare consistent and efficient. In most lower-middle income countries (LMICs), there is a paucity of well-designed guidelines; as a result, healthcare workers depend on guidelines developed in Higher Income Countries (HICs). However, local guidelines are more likely to be implemented because they are applicable to the specific environment; and consider factors such as availability of resources, specialized skills and local culture. If guidelines developed in HICs are to be implemented in LMICs, developers need to incorporate local experts in their development. Involvement of local stakeholders may improve the rates of implementation by identifying and removing barriers to implementation in LMICs. Another option is to encourage local experts to adapt them for use in LMICs; these guidelines may recommend strategies different from those used in HICs, but will be aimed at achieving the best practicable standard of care. Infrastructural deficits in LMICs could be improved by learning from and building on the successful response to the human immunodeficiency virus/acquired immunodeficiency syndrome pandemic through interactions between HICs and LMICs. Similarly, collaborations between postgraduate medical colleges in both HICs and LMICs may help specialist doctors training in LMICs develop skills required for guideline development and implementation.
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Affiliation(s)
- Edeghonghon Olayemi
- Department of Haematology, College of Health Sciences, University of Ghana, Accra, Ghana.,Ghana Institute of Clinical Genetics, Korle Bu, Accra, Ghana
| | - Eugenia V Asare
- Ghana Institute of Clinical Genetics, Korle Bu, Accra, Ghana
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Gadgil A, Sauvaget C, Roy N, Muwonge R, Kantharia S, Chakrabarty A, Bantwal K, Haldar I, Sankaranarayanan R. Cancer early detection program based on awareness and clinical breast examination: Interim results from an urban community in Mumbai, India. Breast 2017; 31:85-89. [DOI: 10.1016/j.breast.2016.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022] Open
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Olasehinde O, Boutin-Foster C, Alatise OI, Adisa AO, Lawal OO, Akinkuolie AA, Adesunkanmi ARK, Arije OO, Kingham TP. Developing a Breast Cancer Screening Program in Nigeria: Evaluating Current Practices, Perceptions, and Possible Barriers. J Glob Oncol 2017; 3:490-496. [PMID: 29094087 PMCID: PMC5646896 DOI: 10.1200/jgo.2016.007641] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In low- and middle-income countries like Nigeria, women present with advanced breast cancer at an earlier age. Given the limited resources, development of screening programs that parallel resource capabilities of low- and middle-income countries is imperative. The objective of this study was to evaluate the perceptions, practices, and barriers regarding clinical breast examination (CBE) screening in a low-income community in Nigeria. Materials and Methods A cross-sectional survey of women age 40 years or older in Ife, Nigeria, using multistaged sampling was performed. Information on sociodemographics, knowledge of breast cancer, screening practices, and willingness to participate in CBE screening was obtained using an interviewer-administered questionnaire. Results A total of 1,169 women whose ages ranged from 40 to 86 years (mean age, 47.7 years; standard deviation, 8.79 years) were interviewed. The majority of women (94%) knew about breast cancer, whereas 27.5% knew someone who had had breast cancer, the majority of whom (64.5%) had died of the disease. Of the 36% of women who had breast screening recommended to them, only 19.7% had an actual CBE. Of these, only 6% had it in the last year. The majority of women (65.4%) were willing to have regular CBEs and did not care about the sex of the examiner in most instances. Lack of perceived need was the reason cited by women unwilling to participate. Conclusion The majority of women were aware of breast cancer and knew it as a fatal disease. With the relatively encouraging number of those willing to be examined, a carefully designed CBE program coupled with advocacy to correct uneducated beliefs seems promising.
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Affiliation(s)
- Olalekan Olasehinde
- , , , , , , and , Obafemi Awolowo University, Ile-Ife, Nigeria; , State University of New York, Downstate Medical Center, Brooklyn; and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carla Boutin-Foster
- , , , , , , and , Obafemi Awolowo University, Ile-Ife, Nigeria; , State University of New York, Downstate Medical Center, Brooklyn; and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Olusegun I Alatise
- , , , , , , and , Obafemi Awolowo University, Ile-Ife, Nigeria; , State University of New York, Downstate Medical Center, Brooklyn; and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Adewale O Adisa
- , , , , , , and , Obafemi Awolowo University, Ile-Ife, Nigeria; , State University of New York, Downstate Medical Center, Brooklyn; and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oladejo O Lawal
- , , , , , , and , Obafemi Awolowo University, Ile-Ife, Nigeria; , State University of New York, Downstate Medical Center, Brooklyn; and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Akinbolaji A Akinkuolie
- , , , , , , and , Obafemi Awolowo University, Ile-Ife, Nigeria; , State University of New York, Downstate Medical Center, Brooklyn; and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Abdul-Rasheed K Adesunkanmi
- , , , , , , and , Obafemi Awolowo University, Ile-Ife, Nigeria; , State University of New York, Downstate Medical Center, Brooklyn; and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Olujide O Arije
- , , , , , , and , Obafemi Awolowo University, Ile-Ife, Nigeria; , State University of New York, Downstate Medical Center, Brooklyn; and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thomas P Kingham
- , , , , , , and , Obafemi Awolowo University, Ile-Ife, Nigeria; , State University of New York, Downstate Medical Center, Brooklyn; and , Memorial Sloan Kettering Cancer Center, New York, NY
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Sayed S, Ngugi A, Ochieng P, Mwenda AS, Salam RA. Training health workers in clinical breast examination for early detection of breast cancer in low- and middle-income countries. Hippokratia 2017. [DOI: 10.1002/14651858.cd012515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Shahin Sayed
- Aga Khan University Hospital; Department of Pathology and Laboratory Medicine; 3rd Parklands Avenue P.O. Box 30270 Nairobi Kenya 00100
| | - Anthony Ngugi
- Aga Khan University (East Africa); Centre for Population Health Sciences, Faculty of Health Sciences; P O Box 30270 Nairobi Kenya 00100
| | - Powell Ochieng
- Aga Khan University; Department of Post Graduate Medical Education; 3rd Parklands Avenue Nairobi Kenya
| | - Aruyaru S Mwenda
- Aga Khan University Hospital; Department of Surgery; 3rd Parklands Avenue Nairobi Kenya 00100
| | - Rehana A Salam
- Aga Khan University Hospital; Division of Women and Child Health; Stadium Road PO Box 3500 Karachi Sind Pakistan 74800
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Yip CH. Challenges in the early detection of breast cancer in resource-poor settings. BREAST CANCER MANAGEMENT 2016. [DOI: 10.2217/bmt-2016-0026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Breast cancer is increasing in low- and middle-income countries (LMICs) compared with high-income countries, where presentation with later stages coupled with suboptimal treatment leads to a high mortality rate. An important strategy is to detect cancers at an early stage where cure is possible. Screening mammography requires resources that are not available in LMICs. Clinical breast examination and breast self-examination have not been shown to reduce mortality from breast cancer. Despite efforts to promote early detection, barriers to early detection in LMICs persist, and these barriers are not only due to poverty and illiteracy, but also due to psychosocial and cultural issues present in LMICs. Clearly, there are many challenges to early detection in LMICs that have to be addressed.
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Affiliation(s)
- Cheng-Har Yip
- Department of Surgery, Sime Darby Healthcare, Kuala Lumpur, Malaysia
- Department of Surgery, University Tunku Abdul Rahman, Kuala Lumpur, Malaysia
- Department of Surgery, University Malaya, Kuala Lumpur 50603, Malaysia
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Scheel JR, Peacock S, Orem J, Bugeza S, Muyinda Z, Porter PL, Wood WC, Comis RL, Lehman CD. Improving Breast Ultrasound Interpretation in Uganda Using a Condensed Breast Imaging Reporting and Data System. Acad Radiol 2016; 23:1271-7. [PMID: 27325412 DOI: 10.1016/j.acra.2016.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 05/31/2016] [Accepted: 05/31/2016] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to determine whether a 2-day educational course using a condensed Breast Imaging Reporting and Data System (condensed BI-RADS) improved the accuracy of Ugandan healthcare workers interpreting breast ultrasound. MATERIALS AND METHODS The target audience of this intervention was Ugandan healthcare workers involved in performing, interpreting, or acting on the results of breast ultrasound. The educational course consisted of a pretest knowledge assessment, a series of lectures on breast imaging interpretation and standardized reporting using a condensed BI-RADS, and a posttest knowledge assessment. Participants interpreted 53 different ultrasound test cases by selecting the finding type, descriptors for masses, and recommendations. We compared the percent correct on the pretest and posttest based on occupation and training level. RESULTS Sixty-one Ugandan healthcare workers participated in this study, including 13 radiologists, 13 other physicians, 12 technologists, and 23 midlevel providers. Most groups improved in identifying the finding type (P < 0.05). All occupations showed improved use of descriptive terms for the shape and internal echogenicity of masses (P < 0.05). Most groups showed significant improvement in recommendations for normal and benign findings with a corresponding reduction in biopsy recommendations. CONCLUSIONS Targeted breast ultrasound education using a condensed BI-RADS improved the interpretive performance of healthcare workers and was particularly successful in reducing the frequency of unnecessary biopsies for normal and benign findings. Multimodal educational efforts to improve accuracy and management of breast ultrasound findings may augment breast cancer early detection efforts in resource-limited settings.
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Affiliation(s)
- John R Scheel
- Department of Radiology, Seattle Cancer Care Alliance, University of Washington, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023.
| | - Sue Peacock
- Department of Medicine, Division of General Internal Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
| | | | - Samuel Bugeza
- Department of Radiology, Mulago Hospital, Kampala, Uganda
| | - Zeridah Muyinda
- Department of Radiology, Mulago Hospital, Association of Radiologists of Uganda, Kampala, Uganda
| | - Peggy L Porter
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Robert L Comis
- ECOG-ACRIN Cancer Research Group, Philadelphia, Pennsylvania
| | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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86
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Anderson BO, Duggan C. Resource-Stratified Guidelines for Cancer Management: Correction and Commentary. J Glob Oncol 2016; 3:84-88. [PMID: 28717747 PMCID: PMC5493239 DOI: 10.1200/jgo.2016.006213] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Benjamin O Anderson
- , Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; , Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Catherine Duggan
- , Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; , Fred Hutchinson Cancer Research Center, Seattle, WA
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87
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Gutnik L, Lee C, Msosa V, Moses A, Stanley C, Mzumara S, Liomba NG, Gopal S. Clinical breast examination screening by trained laywomen in Malawi integrated with other health services. J Surg Res 2016; 204:61-7. [PMID: 27451869 PMCID: PMC4963624 DOI: 10.1016/j.jss.2016.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/20/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Breast cancer awareness and early detection are limited in sub-Saharan Africa. Resource limitations make screening mammography or clinical breast examination (CBE) by physicians or nurses impractical in many settings. We aimed to assess feasibility and performance of CBE by laywomen in urban health clinics in Malawi. METHODS Four laywomen were trained to deliver breast cancer educational talks and conduct CBE. After training, screening was implemented in diverse urban health clinics. Eligible women were ≥30 y, with no prior breast cancer or breast surgery, and clinic attendance for reasons other than a breast concern. Women with abnormal CBE were referred to a study surgeon. All palpable masses confirmed by surgeon examination were pathologically sampled. Patients with abnormal screening CBE but normal surgeon examination underwent breast ultrasound confirmation. In addition, 50 randomly selected women with normal screening CBE underwent breast ultrasound, and 45 different women with normal CBE were randomly assigned to surgeon examination. RESULTS Among 1220 eligible women, 1000 (82%) agreed to CBE. Lack of time (69%) was the commonest reason for refusal. Educational talk attendance was associated with higher CBE participation (83% versus 77%, P = 0.012). Among 1000 women screened, 7% had abnormal CBE. Of 45 women with normal CBE randomized to physician examination, 43 had normal examinations and two had axillary lymphadenopathy not detected by CBE. Sixty of 67 women (90%) with abnormal CBE attended the referral visit. Of these, 29 (48%) had concordant abnormal physician examination. Thirty-one women (52%) had discordant normal physician examination, all of whom also had normal breast ultrasounds. Compared with physician examination, sensitivity for CBE by laywomen was 94% (confidence interval [CI] 79%-99%), specificity 58% (CI, 46%-70%), positive predictive value 48% (CI, 35%-62%), and negative predictive value 96% (CI, 85%-100%). Of 13 women who underwent recommended pathologic sampling of a breast lesion, two had cytologic dysplasia and all others benign results. CONCLUSIONS CBE uptake in Lilongwe clinics was high. CBE by laywomen compared favorably with physician examination and follow-up was good. Our intervention can serve as a model for wider implementation. Performance in rural areas, effects on cancer stage and mortality, and cost effectiveness require evaluation.
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Affiliation(s)
| | - Clara Lee
- UNC Project-Malawi, Lilongwe, Malawi; University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Vanessa Msosa
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Agnes Moses
- UNC Project-Malawi, Lilongwe, Malawi; University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina; Department of Medicine, Kamuzu Central Hospital, Lilongwe, Malawi; University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Suzgo Mzumara
- Department or Radiology, Kamuzu Central Hospital, Lilongwe, Malawi; University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi; University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina; University of Malawi College of Medicine, Blantyre, Malawi
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88
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Kashiwagi Y, Kakinohana S. Breast Cancer Knowledge and Preventive Behavior Among Filipino Women in a Rural Area: A Cross-Sectional Study. Nurs Midwifery Stud 2016. [DOI: 10.17795/nmsjournal34300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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89
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Akinkuolie AA, Etonyeaku AC, Olasehinde O, Arowolo OA, Babalola RN. Breast cancer patients' presentation for oncological treatment: a single centre study. Pan Afr Med J 2016; 24:63. [PMID: 27642404 PMCID: PMC5012757 DOI: 10.11604/pamj.2016.24.63.8432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/01/2016] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Breast cancer patients are presenting at advanced stages for oncological treatment in Nigeria and World Health Organization predicted developing countries' breast cancer incidence and mortality to increase by year 2020. METHODS Prospective observational hospital based study that enrolled breast cancer patients from catchment area of an oncology service hospital in Nigeria between 2007 and 2013. Patients' demographics, breast cancer burden and health care giver presentation variables were analysed for causal factors of seeking medical help and what determines commencement of effective oncological treatment. RESULTS Forty-six patients were enrolled, 19.6% of them presented primarily to oncologist while 80.4% presented secondarily for oncological treatment. There is a significant difference in presentation time for oncological treatment (t = -3.56, df = 42.90, p = 0.001) between primary (M =11.56 ± 5.21 weeks) and secondary presentation (M= 52.56 ± 10.27weeks). Tumor burden of those that presented secondarily were significantly more advanced (U = 78.5, p = 0.011) and, univariate analysis reveals that: patients' matrimonial setting, breast cancer awareness and mode of discovery of breast symptoms are patient related factors that determines their choice of health care providers and, determinant of effective oncological treatment is patient first contact health care provider. CONCLUSION Patients' bio-characteristics that determine their choice of health care provider should be incorporated into community breast cancer sensitization drives. Additionally, there is a need for a government agency assign the task of accrediting and defining scope of enterprise of health care institutions and their health care providers in our pluralist health system.
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90
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Pace LE, Shulman LN. Breast Cancer in Sub-Saharan Africa: Challenges and Opportunities to Reduce Mortality. Oncologist 2016; 21:739-44. [PMID: 27091419 DOI: 10.1634/theoncologist.2015-0429] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/26/2016] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED : The objective of this review is to describe existing data on breast cancer incidence and mortality in low- and middle-income countries (LMICs), in particular in sub-Saharan Africa; identify the limitations of these data; and review what is known about breast cancer control strategies in sub-Saharan African countries and other LMICs. Available estimates demonstrate that breast cancer incidence and mortality are rising in LMICs, including in Africa, although high-quality data from LMICs (and particularly from sub-Saharan Africa) are largely lacking. Case fatality rates from breast cancer appear to be substantially higher in LMICs than in high-income countries. Significant challenges exist to developing breast cancer control programs in LMICs, perhaps particularly in sub-Saharan Africa, and the most effective strategies for treatment and early detection in the context of limited resources are uncertain. High-quality research on breast cancer incidence and mortality and implementation research to guide effective breast cancer control strategies in LMICs are urgently needed. Enhanced investment in breast cancer research and treatment in LMICs should be a global public health priority. IMPLICATIONS FOR PRACTICE The numbers of new cases of breast cancer, and breast cancer deaths per year, in low- and middle-income countries are rising. Engagement by the international breast cancer community is critical to reduce global disparities in breast cancer outcomes. Cancer specialists and institutions in high-income countries can serve as key partners in training initiatives, clinical care, protocol and program development, and research. This article provides an overview of what is known about breast cancer incidence, mortality, and effective strategies for breast cancer control in sub-Saharan Africa and identifies key gaps in the literature. This information can help guide priorities for engagement by the global cancer community.
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Affiliation(s)
- Lydia E Pace
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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91
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Ahmadian M, Carmack S, Samah AA, Kreps G, Saidu MB. Psychosocial Predictors of Breast Self-Examination among Female Students in Malaysia: A Study to Assess the Roles of Body Image, Self-efficacy and Perceived Barriers. Asian Pac J Cancer Prev 2016; 17:1277-84. [DOI: 10.7314/apjcp.2016.17.3.1277] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pace LE, Dusengimana JMV, Hategekimana V, Habineza H, Bigirimana JB, Tapela N, Mutumbira C, Mpanumusingo E, Brock JE, Meserve E, Uwumugambi A, Dillon D, Keating NL, Shulman LN, Mpunga T. Benign and Malignant Breast Disease at Rwanda's First Public Cancer Referral Center. Oncologist 2016; 21:571-5. [PMID: 27009935 DOI: 10.1634/theoncologist.2015-0388] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/12/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Breast cancer incidence is rising in low- and middle-income countries. Understanding the distribution of breast disease seen in clinical practice in such settings can guide early detection efforts and clinical algorithms, as well as support future monitoring of cancer detection rates and stage. PATIENTS AND METHODS We conducted a retrospective medical record review of 353 patients who presented to Butaro Cancer Center of Excellence in Rwanda with an undiagnosed breast concern during the first 18 months of the cancer program. RESULTS Eighty-two percent of patients presented with a breast mass. Of these, 55% were diagnosed with breast cancer and 36% were diagnosed with benign disease. Cancer rates were highest among women 50 years and older. Among all patients diagnosed with breast cancer, 20% had stage I or II disease at diagnosis, 46% had locally advanced (stage III) disease, and 31% had metastatic disease. CONCLUSION After the launch of Rwanda's first public cancer referral center and breast clinic, cancer detection rates were high among patients presenting with an undiagnosed breast concern. These findings will provide initial data to allow monitoring of changes in the distribution of benign and malignant disease and of cancer stage as cancer awareness and services expand nationally. IMPLICATIONS FOR PRACTICE The numbers of cases and deaths from breast cancer are rising in low-income countries. In many of these settings, health care systems to address breast problems and efficiently refer patients with symptoms concerning for cancer are rudimentary. Understanding the distribution of breast disease seen in such settings can guide early detection efforts and clinical algorithms. This study describes the characteristics of patients who came with a breast concern to Rwanda's first public cancer referral center during its first 18 months. More than half of patients with a breast mass were diagnosed with cancer; most had late-stage disease. Monitoring changes in the types of breast disease and cancer stages seen in Rwanda will be critical as breast cancer awareness and services grow.
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Affiliation(s)
- Lydia E Pace
- Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Neo Tapela
- Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | - Jane E Brock
- Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Meserve
- Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | | | - Deborah Dillon
- Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy L Keating
- Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence N Shulman
- Harvard Medical School, Boston, Massachusetts, USA Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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From Community Laywomen to Breast Health Workers: A Pilot Training Model to Implement Clinical Breast Exam Screening in Malawi. PLoS One 2016; 11:e0151389. [PMID: 26959980 PMCID: PMC4784957 DOI: 10.1371/journal.pone.0151389] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Breast cancer burden is high in low-income countries. Inadequate early detection contributes to late diagnosis and increased mortality. We describe the training program for Malawi's first clinical breast exam (CBE) screening effort. METHODS Laywomen were recruited as Breast Health Workers (BHWs) with the help of local staff and breast cancer advocates. The four-week training consisted of lectures, online modules, role-playing, case discussions, CBE using simulators and patients, and practice presentations. Ministry of Health trainers taught health communication, promotion, and education skills. Breast cancer survivors shared their experiences. Clinicians taught breast cancer epidemiology, prevention, detection, and clinical care. Clinicians and research staff taught research ethics, informed consent, data collection, and professionalism. Breast cancer knowledge was measured using pre- and post-training surveys. Concordance between BHW and clinician CBE was assessed. Breast cancer talks by BHW were evaluated on a 5-point scale in 22 areas by 3 judges. RESULTS We interviewed 12 women, and 4 were selected as BHWs including 1 breast cancer survivor. Training was dynamic with modification based on trainee response and progress. A higher-than-anticipated level of comprehension and interest led to inclusion of additional topics like breast reconstruction. Pre-training knowledge increased from 49% to 91% correct (p<0.0001). Clinician and BHW CBE had 88% concordance (kappa 0.43). The mean rating of BHW educational talks was 4.4 (standard deviation 0.7). CONCLUSIONS Malawian laywomen successfully completed training and demonstrated competency to conduct CBE and deliver breast cancer educational talks. Knowledge increased after training, and concordance was high between BHW and clinician CBE.
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Zehtab N, Jafari M, Barooni M, Nakhaee N, Goudarzi R, Zadeh MHL. Cost-Effectiveness Analysis of Breast Cancer Screening in Rural Iran. Asian Pac J Cancer Prev 2016; 17:609-14. [DOI: 10.7314/apjcp.2016.17.2.609] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gutnik LA, Matanje-Mwagomba B, Msosa V, Mzumara S, Khondowe B, Moses A, Kohler RE, Carey LA, Lee CN, Gopal S. Breast Cancer Screening in Low- and Middle-Income Countries: A Perspective From Malawi. J Glob Oncol 2016; 2:4-8. [PMID: 28717676 PMCID: PMC5497737 DOI: 10.1200/jgo.2015.000430] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Lily A. Gutnik
- Lily A. Gutnik, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Lily A. Gutnik, Blandina Khondowe, Agnes Moses, and Satish Gopal, UNC–Project Malawi; Beatrice Matanje-Mwagomba, Malawi Ministry of Health; Vanessa Msosa and Suzgo Mzumara, Kamuzu Central Hospital, Lilongwe; Suzgo Mzumara and Agnes Moses, University of Malawi College of Medicine, Blantyre, Malawi; Racquel E. Kohler, Gillings School of Global Public Health; Lisa A. Carey, Clara N. Lee, and Satish Gopal, Lineberger Comprehensive Cancer Center; and Satish Gopal, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Beatrice Matanje-Mwagomba
- Lily A. Gutnik, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Lily A. Gutnik, Blandina Khondowe, Agnes Moses, and Satish Gopal, UNC–Project Malawi; Beatrice Matanje-Mwagomba, Malawi Ministry of Health; Vanessa Msosa and Suzgo Mzumara, Kamuzu Central Hospital, Lilongwe; Suzgo Mzumara and Agnes Moses, University of Malawi College of Medicine, Blantyre, Malawi; Racquel E. Kohler, Gillings School of Global Public Health; Lisa A. Carey, Clara N. Lee, and Satish Gopal, Lineberger Comprehensive Cancer Center; and Satish Gopal, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Vanessa Msosa
- Lily A. Gutnik, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Lily A. Gutnik, Blandina Khondowe, Agnes Moses, and Satish Gopal, UNC–Project Malawi; Beatrice Matanje-Mwagomba, Malawi Ministry of Health; Vanessa Msosa and Suzgo Mzumara, Kamuzu Central Hospital, Lilongwe; Suzgo Mzumara and Agnes Moses, University of Malawi College of Medicine, Blantyre, Malawi; Racquel E. Kohler, Gillings School of Global Public Health; Lisa A. Carey, Clara N. Lee, and Satish Gopal, Lineberger Comprehensive Cancer Center; and Satish Gopal, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Suzgo Mzumara
- Lily A. Gutnik, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Lily A. Gutnik, Blandina Khondowe, Agnes Moses, and Satish Gopal, UNC–Project Malawi; Beatrice Matanje-Mwagomba, Malawi Ministry of Health; Vanessa Msosa and Suzgo Mzumara, Kamuzu Central Hospital, Lilongwe; Suzgo Mzumara and Agnes Moses, University of Malawi College of Medicine, Blantyre, Malawi; Racquel E. Kohler, Gillings School of Global Public Health; Lisa A. Carey, Clara N. Lee, and Satish Gopal, Lineberger Comprehensive Cancer Center; and Satish Gopal, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Blandina Khondowe
- Lily A. Gutnik, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Lily A. Gutnik, Blandina Khondowe, Agnes Moses, and Satish Gopal, UNC–Project Malawi; Beatrice Matanje-Mwagomba, Malawi Ministry of Health; Vanessa Msosa and Suzgo Mzumara, Kamuzu Central Hospital, Lilongwe; Suzgo Mzumara and Agnes Moses, University of Malawi College of Medicine, Blantyre, Malawi; Racquel E. Kohler, Gillings School of Global Public Health; Lisa A. Carey, Clara N. Lee, and Satish Gopal, Lineberger Comprehensive Cancer Center; and Satish Gopal, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Agnes Moses
- Lily A. Gutnik, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Lily A. Gutnik, Blandina Khondowe, Agnes Moses, and Satish Gopal, UNC–Project Malawi; Beatrice Matanje-Mwagomba, Malawi Ministry of Health; Vanessa Msosa and Suzgo Mzumara, Kamuzu Central Hospital, Lilongwe; Suzgo Mzumara and Agnes Moses, University of Malawi College of Medicine, Blantyre, Malawi; Racquel E. Kohler, Gillings School of Global Public Health; Lisa A. Carey, Clara N. Lee, and Satish Gopal, Lineberger Comprehensive Cancer Center; and Satish Gopal, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Racquel E. Kohler
- Lily A. Gutnik, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Lily A. Gutnik, Blandina Khondowe, Agnes Moses, and Satish Gopal, UNC–Project Malawi; Beatrice Matanje-Mwagomba, Malawi Ministry of Health; Vanessa Msosa and Suzgo Mzumara, Kamuzu Central Hospital, Lilongwe; Suzgo Mzumara and Agnes Moses, University of Malawi College of Medicine, Blantyre, Malawi; Racquel E. Kohler, Gillings School of Global Public Health; Lisa A. Carey, Clara N. Lee, and Satish Gopal, Lineberger Comprehensive Cancer Center; and Satish Gopal, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lisa A. Carey
- Lily A. Gutnik, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Lily A. Gutnik, Blandina Khondowe, Agnes Moses, and Satish Gopal, UNC–Project Malawi; Beatrice Matanje-Mwagomba, Malawi Ministry of Health; Vanessa Msosa and Suzgo Mzumara, Kamuzu Central Hospital, Lilongwe; Suzgo Mzumara and Agnes Moses, University of Malawi College of Medicine, Blantyre, Malawi; Racquel E. Kohler, Gillings School of Global Public Health; Lisa A. Carey, Clara N. Lee, and Satish Gopal, Lineberger Comprehensive Cancer Center; and Satish Gopal, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Clara N. Lee
- Lily A. Gutnik, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Lily A. Gutnik, Blandina Khondowe, Agnes Moses, and Satish Gopal, UNC–Project Malawi; Beatrice Matanje-Mwagomba, Malawi Ministry of Health; Vanessa Msosa and Suzgo Mzumara, Kamuzu Central Hospital, Lilongwe; Suzgo Mzumara and Agnes Moses, University of Malawi College of Medicine, Blantyre, Malawi; Racquel E. Kohler, Gillings School of Global Public Health; Lisa A. Carey, Clara N. Lee, and Satish Gopal, Lineberger Comprehensive Cancer Center; and Satish Gopal, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Satish Gopal
- Lily A. Gutnik, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Lily A. Gutnik, Blandina Khondowe, Agnes Moses, and Satish Gopal, UNC–Project Malawi; Beatrice Matanje-Mwagomba, Malawi Ministry of Health; Vanessa Msosa and Suzgo Mzumara, Kamuzu Central Hospital, Lilongwe; Suzgo Mzumara and Agnes Moses, University of Malawi College of Medicine, Blantyre, Malawi; Racquel E. Kohler, Gillings School of Global Public Health; Lisa A. Carey, Clara N. Lee, and Satish Gopal, Lineberger Comprehensive Cancer Center; and Satish Gopal, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Islam RM, Bell RJ, Billah B, Hossain MB, Davis SR. Awareness of breast cancer and barriers to breast screening uptake in Bangladesh: A population based survey. Maturitas 2016; 84:68-74. [DOI: 10.1016/j.maturitas.2015.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/02/2015] [Accepted: 11/03/2015] [Indexed: 11/24/2022]
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Ilbawi AM, Anderson BO. Cancer in global health: how do prevention and early detection strategies relate? Sci Transl Med 2015; 7:278cm1. [PMID: 25761886 DOI: 10.1126/scitranslmed.3008853] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
National cancer control plans are needed to stem the rapidly rising global cancer burden. Prevention and early detection are complementary but distinct strategies for cancer control. Some cancers are prevented through behavior and/or environmental modifications that reduce cancer risk, whereas other cancers are more amenable to treatment when they are successfully diagnosed at early stages. Prevention and early detection strategies should be prioritized on the basis of country-specific cancer demographics, modifiable risk factor distribution, and existing treatment resource availability. Following an individualized plan integrating prevention and early detection strategies, deficits can be targeted to strengthen national health systems for cancer control.
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Affiliation(s)
- André M Ilbawi
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
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Li J, Shao Z. Mammography screening in less developed countries. SPRINGERPLUS 2015; 4:615. [PMID: 26543750 PMCID: PMC4627993 DOI: 10.1186/s40064-015-1394-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/05/2015] [Indexed: 12/29/2022]
Abstract
Less developed countries (LDCs) are struggling with an increasing burden of breast cancer. It is important to identify what interventions might be most effective and feasible in reducing overall breast cancer mortality in a resource constrained settings. Mammography screening (MS) utilized in developed countries cannot be equally applied to LDCs. We provide a summary of the status of existing and past MS program attempts in LDCs, and try to determine the prerequisites under which any developing country is ready to benefit from a MS program. We make the case for a “mixed” portfolio of tools to reduce breast cancer mortality with MS reserved only for those sub-populations that meet the criteria. We hope our review will provide a background for policy makers to apply rigorous criteria before attempting to implement costly MS program and before judiciously evaluating additional competed programs in their countries.
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Affiliation(s)
- JunJie Li
- Department of Breast Surgery, Shanghai Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - ZhiMin Shao
- Department of Breast Surgery, Shanghai Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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Lopes LV, Miguel F, Freitas H, Tavares A, Pangui S, Castro C, Lacerda GF, Longatto-Filho A, Weiderpass E, Santos LL. Stage at presentation of breast cancer in Luanda, Angola - a retrospective study. BMC Health Serv Res 2015; 15:471. [PMID: 26471845 PMCID: PMC4608221 DOI: 10.1186/s12913-015-1092-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 09/21/2015] [Indexed: 11/21/2022] Open
Abstract
Background It is expected that, by 2020, 15 million new cases of cancer will occur every year in the world, one million of them in Africa. Knowledge of cancer trends in African countries is far from adequate, and improvements in cancer prevention efforts are urgently needed. The aim of this study was to characterize breast cancer clinically and pathologically at presentation in Luanda, Angola; we additionally provide quality information that will be useful for breast cancer care planning in the country. Methods Data on breast cancer cases were retrieved from the Angolan Institute of Cancer Control, from 2006 to 2014. For women diagnosed in 2009 (5-years of follow-up), demographic, clinical and pathological information, at presentation, was collected, namely age at diagnosis, parity, methods used for pathological diagnoses, tumor pathological characteristics, stage of disease and treatment. Descriptive statistics were performed. Results The median age of women diagnosed with breast cancer in 2009 was 47 years old (range 25–89). The most frequent clinical presentation was breast swelling with axillary lymph nodes metastasis (44.9 %), followed by a mass larger than 5 cm (14.2 %) and lump (12.9 %). Invasive ductal carcinoma was the main histologic type (81.8 %). Only 10.1 % of cancer cases had a well differentiated histological grade. Cancers were diagnosed mostly at advanced stages (66.7 % in stage III and 11.1 % in stage IV). Discussion In this study, breast cancer was diagnosed at a very advanced stage. Although it reports data from a single cancer center in Luanda, Angola it reinforces the need for early diagnosis and increasing awareness. According to the main challenges related to breast cancer diagnosis and treatment herein presented, we propose a realistic framework that would allow for the implementation of a breast cancer care program, built under a strong network based on cooperation, teaching, audit, good practices and the organization of health services. Conclusion Angola needs urgently a program for early diagnosis of breast cancer.
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Affiliation(s)
| | | | - Helga Freitas
- National Public Health Department, Ministry of Health, Luanda, Angola.
| | | | | | - Clara Castro
- Department of Epidemiology, Portuguese Oncology Institute of Porto, Porto, Portugal.
| | | | - Adhemar Longatto-Filho
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. .,Laboratory of Medical Investigation (LIM 14), Faculty of Medicine, São Paulo State University, São Paulo, Brazil. .,Molecular Oncology Research Center "Centro de Pesquisa em Oncologia Molecular" (CPOM), Barretos, Brazil.
| | - Elisabete Weiderpass
- Cancer Registry of Norway, Oslo, Norway. .,Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway. .,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. .,Department of Genetic Epidemiology, Folkhälsan Research Center, Samfundet Folkhälsan, Helsinki, Finland.
| | - Lúcio Lara Santos
- Angolan Institute of Cancer Control, Luanda, Angola. .,ONCOCIR - Education and Care in Oncology, Luanda, Angola. .,Experimental Pathology and Therapeutics Research Center, Portuguese Oncology Institute of Porto, Porto, Portugal.
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Hasan TN, Shah SA, Hassan MR, Safian N, Azhar ZI, Syed Abdul Rahim SS, Ghazi HF. Poor Knowledge and Practice Towards Breast Cancer among Women in Baghdad City, Iraq. Asian Pac J Cancer Prev 2015; 16:6669-72. [PMID: 26434892 DOI: 10.7314/apjcp.2015.16.15.6669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer is one of the most common cancers among females worldwide. The aim of this study was to assess the knowledge and practice about breast cancer and its related factors among women in Baghdad city, Iraq. MATERIALS AND METHODS A cross-sectional study was conducted among 508 women aged 18 to 55 years from four non-governmental organizations (NGO) in Baghdad city, Iraq. A self-administered questionnaire on breast cancer knowledge and practice was distributed to participants during weekly activity of the NGO. RESULTS A total of 61.2% of the respondents had poor knowledge, only 30.3% performed breast self-examination (BSE) and 41.8% said that they did not know the technique to perform BSE. Associations between knowledge and marital status and age were significant. For practice, working status, education, age and family income were significant. After controlling for cofounders, the most important contributing factors for poor knowledge among respondents were marital status and not performing BSE, with adjusted odds ratio of 1.6 and 1.8 respectively. CONCLUSIONS Breast cancer knowledge and practice of BSE are poor among women in Baghdad city, Iraq. More promotion regarding breast cancer signs and symptoms and also how to perform BSE should be conducted using media such as television and internet as these constituted the main sources of information for most women in our study.
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Affiliation(s)
- Tiba Nezar Hasan
- Department of Community Health, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia E-mail :
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