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Godbole SV, Nandy K, Gauniyal M, Nalawade P, Sane S, Koyande S, Toyama J, Hegde A, Virgo P, Bhatia K, Paranjape RS, Risbud AR, Mbulaiteye SM, Mitsuyasu RT. HIV and cancer registry linkage identifies a substantial burden of cancers in persons with HIV in India. Medicine (Baltimore) 2016; 95:e4850. [PMID: 27631245 PMCID: PMC5402588 DOI: 10.1097/md.0000000000004850] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We utilized computerized record-linkage methods to link HIV and cancer databases with limited unique identifiers in Pune, India, to determine feasibility of linkage and obtain preliminary estimates of cancer risk in persons living with HIV (PLHIV) as compared with the general population.Records of 32,575 PLHIV were linked to 31,754 Pune Cancer Registry records (1996-2008) using a probabilistic-matching algorithm. Cancer risk was estimated by calculating standardized incidence ratios (SIRs) in the early (4-27 months after HIV registration), late (28-60 months), and overall (4-60 months) incidence periods. Cancers diagnosed prior to or within 3 months of HIV registration were considered prevalent.Of 613 linked cancers to PLHIV, 188 were prevalent, 106 early incident, and 319 late incident. Incident cancers comprised 11.5% AIDS-defining cancers (ADCs), including cervical cancer and non-Hodgkin lymphoma (NHL), but not Kaposi sarcoma (KS), and 88.5% non-AIDS-defining cancers (NADCs). Risk for any incident cancer diagnosis in early, late, and combined periods was significantly elevated among PLHIV (SIRs: 5.6 [95% CI 4.6-6.8], 17.7 [95% CI 15.8-19.8], and 11.5 [95% CI 10-12.6], respectively). Cervical cancer risk was elevated in both incidence periods (SIRs: 9.6 [95% CI 4.8-17.2] and 22.6 [95% CI 14.3-33.9], respectively), while NHL risk was elevated only in the late incidence period (SIR: 18.0 [95% CI 9.8-30.20]). Risks for NADCs were dramatically elevated (SIR > 100) for eye-orbit, substantially (SIR > 20) for all-mouth, esophagus, breast, unspecified-leukemia, colon-rectum-anus, and other/unspecified cancers; moderately elevated (SIR > 10) for salivary gland, penis, nasopharynx, and brain-nervous system, and mildly elevated (SIR > 5) for stomach. Risks for 6 NADCs (small intestine, testis, lymphocytic leukemia, prostate, ovary, and melanoma) were not elevated and 5 cancers, including multiple myeloma not seen.Our study demonstrates the feasibility of using probabilistic record-linkage to study cancer/other comorbidities among PLHIV in India and provides preliminary population-based estimates of cancer risks in PLHIV in India. Our results, suggesting a potentially substantial burden and slightly different spectrum of cancers among PLHIV in India, support efforts to conduct multicenter linkage studies to obtain precise estimates and to monitor cancer risk in PLHIV in India.
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Affiliation(s)
- Sheela V. Godbole
- National AIDS Research Institute (ICMR), Pune, India
- Correspondence: Sheela V. Godbole, National AIDS Research Institute-ICMR, 73, G Block, MIDC Bhosari, Pune 411026, India (e-mail: , )
| | - Karabi Nandy
- School of Nursing and Department Of Biostatistics University of California, Los Angeles (UCLA), USA
| | | | | | - Suvarna Sane
- National AIDS Research Institute (ICMR), Pune, India
| | - Shravani Koyande
- Mumbai (Bombay) Cancer Registry, Indian Cancer Society, Mumbai, India
| | - Joy Toyama
- Department of Biostatistics, School of Public Health, University of California, Los Angeles (UCLA), USA
| | - Asha Hegde
- Maharashtra State AIDS Control Society, Mumbai, India
| | - Phil Virgo
- Computer Services Corporation, Rockville
| | - Kishor Bhatia
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | | | | | - Sam M. Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Ronald T. Mitsuyasu
- University of California, Centre for AIDS Research and Education, David Geffen School of Medicine, Los Angeles (UCLA), USA
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102
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Brennan ME. The role of clinical breast examination in cancer screening for women at average risk: A mini review. Maturitas 2016; 92:61-63. [PMID: 27621240 DOI: 10.1016/j.maturitas.2016.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/17/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Abstract
As the debate about the potential benefits and harms of screening mammography continues, it is timely to consider the role of clinical breast examination in screening for women at average risk of breast cancer. This article reviews the results from clinical trials and discusses the varied recommendations around the world. It concludes that the evidence does not support routine clinical breast examination for women participating in screening mammography programs, but there may be a benefit for women not do not have mammographic screening, especially in developing nations where health literacy and 'breast awareness' levels may be lower. This review provides information for clinicians to support women who are making decisions about the increasingly complex issue of breast cancer screening.
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103
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Huang Z, Wen W, Zheng Y, Gao YT, Wu C, Bao P, Wang C, Gu K, Peng P, Gong Y, Zhang M, Xiang Y, Zhong W, Jin F, Xiang YB, Shu XO, Beeghly-Fadiel A. Breast cancer incidence and mortality: trends over 40 years among women in Shanghai, China. Ann Oncol 2016; 27:1129-1134. [PMID: 27013394 PMCID: PMC4880061 DOI: 10.1093/annonc/mdw069] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/02/2015] [Accepted: 02/07/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Breast cancer incidence rates are increasing among Asian women, likely due to the changes in risk factors caused by globalization. Trends in breast cancer rates among Chinese women may differ from other Asian regions due to the implementation of a nationwide family planning program and resulting changes in women's reproductive practices. Appraisal of cancer trends can direct cancer control and public health planning, but relevant studies in China are scarce due to a lack of long-term data. We sought to evaluate secular time trends in breast cancer incidence and mortality using 40 years of cancer registry data for women in urban Shanghai. MATERIALS AND METHODS Data on invasive breast cancer incidence and mortality were collected by the Shanghai Cancer Registry. Age-standardized rates (ASRs) for incidence and mortality were calculated using the Segi/Doll 1960 world standard population. Age, period, and birth cohort effects were evaluated using age-period-cohort (APC) Poisson regression models. Overall linear trends, interpreted as the estimated annual percentage change (EAPC), were derived from the net drift in age-drift models. RESULTS A total of 53 885 breast cancer cases and 17 235 breast cancer-specific deaths were documented among women in urban Shanghai between 1 January 1973 and 31 December 2012. Breast cancer incidence and mortality ASRs increased by 141.2% and 26.6%, respectively. Significant age, cohort, and period effects were identified in both incidence and mortality APC models; cohort effects were pronounced. Overall, a substantial increase in breast cancer incidence (EAPC = 2.96%/year) and a moderate increase in breast cancer mortality (EAPC = 0.87%/year) was observed. A notable downward trend in mortality was identified among younger women born after 1960. CONCLUSIONS Forty years of cancer registry data document a tremendous increase in incidence and a slight increase in mortality for breast cancer among women in Shanghai. Effective, appropriate, and affordable breast cancer prevention and control strategies are urgently needed in China.
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Affiliation(s)
- Z Huang
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - W Wen
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA
| | - Y Zheng
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China.
| | - Y T Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai
| | - C Wu
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - P Bao
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - C Wang
- Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - K Gu
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - P Peng
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Y Gong
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - M Zhang
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Y Xiang
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - W Zhong
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - F Jin
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai
| | - Y B Xiang
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai
| | - X O Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA
| | - A Beeghly-Fadiel
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA
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Hamashima C, Hamashima C C, Hattori M, Honjo S, Kasahara Y, Katayama T, Nakai M, Nakayama T, Morita T, Ohta K, Ohnuki K, Sagawa M, Saito H, Sasaki S, Shimada T, Sobue T, Suto A. The Japanese Guidelines for Breast Cancer Screening. Jpn J Clin Oncol 2016; 46:482-492. [PMID: 27207993 DOI: 10.1093/jjco/hyw008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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105
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Somashekhar SP, Vijay R, Ananthasivan R, Prasanna G. Noninvasive and Low-Cost Technique for Early Detection of Clinically Relevant Breast Lesions Using a Handheld Point-of-Care Medical Device (iBreastExam): Prospective Three-Arm Triple-Blinded Comparative Study. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0057-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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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107
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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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108
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Krishnan S, Sivaram S, Anderson BO, Basu P, Belinson JL, Bhatla N, D'Cruz A, Dhillon PK, Gupta PC, Joshi N, Jhulka PK, Kailash U, Kapambwe S, Katoch VM, Kaur P, Kaur T, Mathur P, Prakash A, Sankaranarayanan R, Selvam JM, Seth T, Shah KV, Shastri S, Siddiqi M, Srivastava A, Trimble E, Rajaraman P, Mehrotra R. Using implementation science to advance cancer prevention in India. Asian Pac J Cancer Prev 2016; 16:3639-44. [PMID: 25987015 DOI: 10.7314/apjcp.2015.16.9.3639] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Oral, cervical and breast cancers, which are either preventable and/or amenable to early detection and treatment, are the leading causes of cancer-related morbidity and mortality in India. In this paper, we describe implementation science research priorities to catalyze the prevention and control of these cancers in India. Research priorities were organized using a framework based on the implementation science literature and the World Health Organization's definition of health systems. They addressed both community-level as well as health systems-level issues. Community-level or "pull" priorities included the need to identify effective strategies to raise public awareness and understanding of cancer prevention, monitor knowledge levels, and address fear and stigma. Health systems-level or "push" and "infrastructure" priorities included dissemination of evidence- based practices, testing of point-of-care technologies for screening and diagnosis, identification of appropriate service delivery and financing models, and assessment of strategies to enhance the health workforce. Given the extent of available evidence, it is critical that cancer prevention and treatment efforts in India are accelerated. Implementation science research can generate critical insights and evidence to inform this acceleration.
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Affiliation(s)
- Suneeta Krishnan
- Women's Global Health Imperative, RTI, San Francisco, USA E-mail :
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109
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Murillo R, Díaz S, Perry F, Poveda C, Piñeros M, Sánchez O, Buitrago L, Gamboa O, Lozano T, Yu H, Wang C, Duggan C, Thomas DB, Anderson BO. Increased breast cancer screening and downstaging in Colombian women: A randomized trial of opportunistic breast-screening. Int J Cancer 2016; 138:705-13. [PMID: 26264446 PMCID: PMC4832278 DOI: 10.1002/ijc.29801] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/30/2015] [Accepted: 07/16/2015] [Indexed: 02/02/2023]
Abstract
The lack of breast cancer screening in low and middle-income countries results in later stage diagnosis and worsened outcomes for women. A cluster randomized trial was performed in Bogotá, Colombia between 2008 and 2012 to evaluate effects of opportunistic breast cancer screening. Thirteen clinics were randomized to an intervention arm and 13 to a control arm. Physicians in intervention clinics were instructed to perform clinical breast examination on all women aged 50-69 years attending clinics for non-breast health issues, and then refer them for mammographic screening. Physicians in control clinics were not explicitly instructed to perform breast screening or mammography referrals, but could do so if they thought it indicated ("usual care"). Women were followed for 2-years postrandomization. 7,436 women were enrolled and 7,419 (99.8%) screened in intervention clinics, versus 8,419 enrolled and 1,108 (13.1%) screened in control clinics. Incidence ratios (IR) of early, advanced and all breast cancers were 2.9 (95% CI 1.1-9.2), 1.0 (0.3-3.5) and 1.9 (0.9-4.1) in the first (screening) year of the trial, and the cumulative IR for all breast cancers converged to 1.4 (0.7-2.8) by the end of follow-up (Year 2). Eighteen (69.2%) of 26 women with early stage disease had breast conservation surgery (BCS) versus 6 (42.5%) of 14 women with late-stage disease (p = 0.02). Fifteen (68.2%) of 22 women with breast cancer in the intervention group had BCS versus nine (50.0%) of 18 women in the control group (p = 0.34). Well-designed opportunistic clinic-based breast cancer screening programs may be useful for early breast cancer detection in LMICs.
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Affiliation(s)
- Raúl Murillo
- Instituto Nacional De Cancerología De ColombiaBogotáColombia
- Prevention and Implementation GroupInternational Agency for Research on CancerLyonFrance
| | - Sandra Díaz
- Instituto Nacional De Cancerología De ColombiaBogotáColombia
| | - Fernando Perry
- Instituto Nacional De Cancerología De ColombiaBogotáColombia
| | - César Poveda
- Instituto Nacional De Cancerología De ColombiaBogotáColombia
| | - Marion Piñeros
- Instituto Nacional De Cancerología De ColombiaBogotáColombia
| | - Oswaldo Sánchez
- Instituto Nacional De Cancerología De ColombiaBogotáColombia
| | - Lina Buitrago
- Instituto Nacional De Cancerología De ColombiaBogotáColombia
| | - Oscar Gamboa
- Instituto Nacional De Cancerología De ColombiaBogotáColombia
| | - Teófilo Lozano
- Instituto Nacional De Cancerología De ColombiaBogotáColombia
| | - Hsiang Yu
- Institute of Statistics, National Tsing‐Hua UniversityHsin‐ChuTaiwan
| | - Ching‐Yun Wang
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWA
| | - Catherine Duggan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWA
| | - David B. Thomas
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWA
| | - Benjamin O. Anderson
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWA
- Departments of Surgery and Global Health MedicineUniversity of WashingtonSeattleWA
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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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Busakhala NW, Chite FA, Wachira J, Naanyu V, Kisuya JW, Keter A, Mwangi A, Njiru E, Chumba D, Lumarai L, Biwott P, Kiplimo I, Otieno G, Kigen G, Loehrer P, Inui T. Screening by Clinical Breast Examination in Western Kenya: Who Comes? J Glob Oncol 2016; 2:114-122. [PMID: 28717690 PMCID: PMC5495450 DOI: 10.1200/jgo.2015.000687] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose More than 80% of women with breast cancer in Kenya present to medical care with established late-stage disease. We sought to understand why women might not participate in breast cancer screening when it is offered by comparing the views of a cohort of those who attended a screening special event with those of community controls who did not attend. Methods All residents living close to three health centers in western Kenya were invited to participate in screening. Participants (attendees) underwent clinical breast examination by trained physician oncologists. In addition, women who consented were interviewed by using a modified Breast Cancer Awareness Module questionnaire. Nonattendees were interviewed in their homes the following day. Results A total of 1,511 attendees (1,238 women and 273 men) and 467 nonattendee women participated in the study. Compared with nonattendees, the women attendees were older, more often employed, knew that breast cancer presented as a lump, and were more likely to have previously felt a lump in a breast. In addition, they were more likely to report previously participating in screening activities, were more likely to have performed breast self-examination, and were less concerned about wasting a doctor’s time. Almost all those surveyed (attendees and nonattendees) expressed interest in future breast cancer screening opportunities. Conclusion The women who volunteer for breast cancer screening in western Kenya are more aware of breast cancer than those who do not volunteer. Screening recruitment should seek to close these knowledge gaps to increase participation.
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Affiliation(s)
- Naftali Wisindi Busakhala
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Fredrick Asirwa Chite
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Juddy Wachira
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Violet Naanyu
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Job Wapangana Kisuya
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Alfred Keter
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Ann Mwangi
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Evanjeline Njiru
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - David Chumba
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Lugaria Lumarai
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Penina Biwott
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Ivan Kiplimo
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Grieven Otieno
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Gabriel Kigen
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Patrick Loehrer
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
| | - Thomus Inui
- and Moi University School of Medicine; and Moi Teaching and Referral Hospital; and Academic Model Providing Access to Healthcare (AMPATH) Oncology; and AMPATH Statistics, Eldoret, Kenya; Indiana University Simon Cancer Center; and Regenstrief Institute, Indianapolis, IN
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Legendre G, Guilhen N, Nadeau C, Brossard A, Fauvet R. [Exploring a non-inflammatory clinical breast mass: Clinical practice guidelines]. ACTA ACUST UNITED AC 2015; 44:904-12. [PMID: 26541562 DOI: 10.1016/j.jgyn.2015.09.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of the study was to assess the diagnostic value of physical examination, radiologic explorations and percutaneous procedures of the breast in the exploration of a non-inflammatory palpable mass, in order to propose guidelines. METHOD A systematic literature review was conducted in the Medline and Cochrane library databases. International guidelines in French and English language were also consulted until April 30th 2015. RESULTS Physical examination of a non-inflammatory palpable breast mass is not sufficient to eliminate a breast cancer (LE2). Mammography alone has a sensitivity between 70 and 95% for the diagnosis of breast cancer (LE3). Echography alone has a sensitivity of 98 to 100% for the diagnosis of breast cancer (LE2). The core needle biopsy has a better sensitivity and specificity than the fine-needle aspiration for breast cancer diagnosis (LE2). The association of mammography and 2D echography presents excellent sensitivity and negative predictive value (close to 100 %) to exclude a breast cancer (LE3). A double evaluation using mammography and echography is recommended in the exploration of a non-inflammatory palpable breast mass (grade B).
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Affiliation(s)
- G Legendre
- Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 01, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris Sud, 94276 Le Kremlin-Bicêtre, France.
| | - N Guilhen
- Service de gynécologie-obstétrique, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France
| | - C Nadeau
- Service de gynécologie-obstétrique, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France
| | - A Brossard
- Service de gynécologie-obstétrique, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France
| | - R Fauvet
- Service de gynécologie-obstétrique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 09, France; Inserm U1199, unité « Biologie et thérapies innovantes des cancers localement agressifs » (BioTICLA), université de Caen Basse-Normandie, centre de lutte contre le cancer François-Baclesse, 14076 Caen cedex 05, France
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Islami F, Lortet-Tieulent J, Okello C, Adoubi I, Mbalawa CG, Ward EM, Parkin DM, Jemal A. Tumor size and stage of breast cancer in Côte d'Ivoire and Republic of Congo - Results from population-based cancer registries. Breast 2015; 24:713-7. [PMID: 26371692 DOI: 10.1016/j.breast.2015.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/07/2015] [Accepted: 08/26/2015] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Breast cancer is now the leading female cancer in sub-Saharan Africa, but there is relatively little information on breast cancer characteristics from this region. We studied, on a population basis, the size and stage of female breast cancer at diagnosis in Côte d'Ivoire and Republic of Congo. METHODS Data on tumor size and stage of breast cancer at diagnosis were collected by population-based cancer registries in Abidjan (the capital of Côte d'Ivoire; 141 cases) and Brazzaville (the capital of Republic of Congo; 139 cases) from a random group of female breast cancer cases that were diagnosed in 2008-2009 using the same protocol. RESULTS The majority of breast cancers in both countries were advanced cancers. In Côte d'Ivoire, 68% of tumors were ≥5 cm in diameter and 74% of cancers were stage III or IV at diagnosis; the corresponding proportions in Republic of Congo were 63% and 81%. CONCLUSION These results underscore the importance of increased awareness about early detection of breast cancer, as well as expansion of the capacity to provide appropriate diagnosis, treatment, and palliative care in sub-Saharan Africa.
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Affiliation(s)
- Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
| | - Joannie Lortet-Tieulent
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
| | - Catherine Okello
- African Cancer Registry Network, INCTR African Registry Programme, Oxford, United Kingdom
| | - Innocent Adoubi
- Service de Cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Cote d'Ivoire
| | - Charles Gombé Mbalawa
- Service de Carcinologie et Radiothérapie, Centre Hospitalier Universitaire de Brazzaville, Brazzaville, Congo
| | - Elizabeth M Ward
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
| | - D Maxwell Parkin
- African Cancer Registry Network, INCTR African Registry Programme, Oxford, United Kingdom; Clinical Trials Service Unit & Epidemiological Studies Unit, Nuffield Department of Public Health, University of Oxford, Oxford, United Kingdom.
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
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The association between scheduling a gynecologic clinical visit and clinical breast examination in Rio de Janeiro. Int J Gynaecol Obstet 2015; 131:289-92. [DOI: 10.1016/j.ijgo.2015.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 06/01/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022]
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Wong IOL, Lam WWT, Wong CN, Cowling BJ, Leung GM, Fielding R. Towards informed decisions on breast cancer screening: Development and pilot testing of a decision aid for Chinese women. PATIENT EDUCATION AND COUNSELING 2015; 98:961-969. [PMID: 25959986 DOI: 10.1016/j.pec.2015.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/08/2015] [Accepted: 04/18/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To pilot-test a novel, self-use breast cancer (BC) screening decision aid (DA) targeting Hong Kong (HK) Chinese women at average risk of BC. METHODS Women were recruited through a population-based telephone survey using random digit dialling between October 2013 and January 2014. Eligible participants completed our baseline survey and then received the DA by post. Participants (n=90) completed follow-up telephone interviews one month later. RESULTS Most participants thought that all/most DA content was presented clearly (86.7%), and was useful in helping women make screening-related decisions (88.9%). It also achieved its expected impact of improving informed decision-making and increasing shared-participation preference without increasing participants' anxiety levels. Participants showed a modest non-statistical increase in their screening knowledge scores. Older women rated the perceived severity of a BC diagnosis as significantly lower, and more educated women reported significantly lower perceived anxiety about the disease. CONCLUSION Our DA appears acceptable and feasible for self-use by HK Chinese women who need to make an informed decision about BC screening without increasing overall anxiety levels. PRACTICE IMPLICATIONS This study supports the potential of self-use DAs for cancer screening-related decision support in a Chinese population.
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Affiliation(s)
- Irene O L Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Wendy W T Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cheuk Nam Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Benjamin J Cowling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Richard Fielding
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Bobdey S, Balasubramanium G, Kumar A, Jain A. Cancer Screening: Should Cancer Screening be Essential Component of Primary Health Care in Developing Countries? Int J Prev Med 2015; 6:56. [PMID: 26236443 PMCID: PMC4505397 DOI: 10.4103/2008-7802.160053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 07/23/2014] [Indexed: 11/13/2022] Open
Abstract
Background: Cancer is a fatal disease and is on the rise across the globe. In India, breast, cervix and the oral cavity are the leading cancer sites, but, unfortunately, in-spite of availability of screening tools, there is no organized cancer screening program in India. The main objective of this study was to review the performance of various cancer screening modalities in a resource poor setting. Methods: MEDLINE and web of science electronic database was searched from January 1990 to December 2013, using keywords such as “breast cancer, cervical cancer, oral cancer and their corresponding mesh terms were also used in combination with Boolean operators OR, AND.” Two authors independently selected studies published in English and conducted in India. A total of 16 studies was found relevant and eligible for the review. The data on sensitivity and specificity of various screening tool was extracted and analyzed. Results: Most of the reported screening trails in India are on cervical cancer and few on breast and oral cancer screening. The pooled estimates of sensitivity and specificity of cervical cancer screening test such as visual inspection with acetic acid, magnified visual inspection with acetic acid, visual inspection with Lugol's iodine, cytology (Papanicolaou smear) and human papillomavirus deoxyribonucleic acid was found to be 68.76% and 84.02%, 63.27% and 85.43%, 81.86% and 87.03%, 63.25% and 93.17% and 75.04% and 91.66%, respectively. Sensitivity and specificity of clinical breast examination was found to be 94.30% and 94.30%, respectively. Oral cancer screening through visual inspection by trained health care worker was found to have 87.90% sensitivity and 92.05% specificity. Conclusions: Our study highlights the availability and success of visual screening tools in early detection and mortality reduction of major neoplasia in resource-poor health care settings and recommends implementation of oral and cervical cancer screening as part of assured primary health care package in developing countries.
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Affiliation(s)
- Saurabh Bobdey
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Ganesh Balasubramanium
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Abhinendra Kumar
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Aanchal Jain
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Rajaraman P, Anderson BO, Basu P, Belinson JL, Cruz AD, Dhillon PK, Gupta P, Jawahar TS, Joshi N, Kailash U, Kapambwe S, Katoch VM, Krishnan S, Panda D, Sankaranarayanan R, Selvam JM, Shah KV, Shastri S, Shridhar K, Siddiqi M, Sivaram S, Seth T, Srivastava A, Trimble E, Mehrotra R. Recommendations for screening and early detection of common cancers in India. Lancet Oncol 2015; 16:e352-61. [PMID: 26149887 DOI: 10.1016/s1470-2045(15)00078-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 12/16/2022]
Abstract
Cancers of the breast, uterine cervix, and lip or oral cavity are three of the most common malignancies in India. Together, they account for about 34% of more than 1 million individuals diagnosed with cancer in India each year. At each of these cancer sites, tumours are detectable at early stages when they are most likely to be cured with standard treatment protocols. Recognising the key role that effective early detection and screening programmes could have in reducing the cancer burden, the Indian Institute for Cytology and Preventive Oncology, in collaboration with the US National Cancer Institute Center for Global Health, held a workshop to summarise feasible options and relevant evidence for screening and early detection of common cancers in India. The evidence-based recommendations provided in this Review are intended to act as a guide for policy makers, clinicians, and public health practitioners who are developing and implementing strategies in cancer control for the three most common cancers in India.
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Affiliation(s)
- Preetha Rajaraman
- Center for Global Health, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA.
| | - Benjamin O Anderson
- Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA, USA
| | - Partha Basu
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Jerome L Belinson
- Preventive Oncology International and Department of Surgery, Women's Health Institute, Lerner School of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Anil D' Cruz
- Department of Head and Neck Services, Tata Memorial Hospital, Mumbai, India
| | - Preet K Dhillon
- Centre for Control of Chronic Conditions, Public Health Foundation of India, Gurgaon, India
| | - Prakash Gupta
- Healis-Sekhsaria Institute for Public Health, Navi Mumbai, India
| | | | - Niranjan Joshi
- Healthcare Technology Innovation Centre, IIT Madras Research Park, Chennai, India
| | - Uma Kailash
- Institute of Cytology and Preventive Oncology, Noida, India
| | - Sharon Kapambwe
- Africa Centre of Excellence for Women's Cancer Control, Centre for Infectious Disease Research, Lusaka, Zambia
| | | | - Suneeta Krishnan
- Women's Global Health Imperative, Research Triangle Institute International, San Francisco, CA, USA
| | - Dharitri Panda
- Institute of Cytology and Preventive Oncology, Noida, India
| | - R Sankaranarayanan
- Early Detection & Prevention Section and Screening Group, International Agency for Research on Cancer, Lyon, France
| | | | - Keerti V Shah
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Surendra Shastri
- Department of Preventive Oncology, Tata Memorial Center, Mumbai, India
| | - Krithiga Shridhar
- Centre for Control of Chronic Conditions, Public Health Foundation of India, Gurgaon, India
| | | | - Sudha Sivaram
- Center for Global Health, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Tulika Seth
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Edward Trimble
- Center for Global Health, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Ravi Mehrotra
- Institute of Cytology and Preventive Oncology, Noida, India
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Hamashima C, Ohta K, Kasahara Y, Katayama T, Nakayama T, Honjo S, Ohnuki K. A meta-analysis of mammographic screening with and without clinical breast examination. Cancer Sci 2015; 106:812-8. [PMID: 25959787 PMCID: PMC4520631 DOI: 10.1111/cas.12693] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/19/2015] [Accepted: 05/02/2015] [Indexed: 12/29/2022] Open
Abstract
Mammographic screening with clinical breast examination has been recommended in Japan since 2000. Although mammographic screening without clinical breast examination has not been recommended, its introduction is anticipated. The efficacies of mammographic screening with and without clinical breast examination were evaluated based on the results of randomized controlled trials. PubMed and other databases for studies published between 1985 and 2014 were searched. The study design was limited to randomized controlled trials to evaluate mortality reduction from breast cancer. Five studies were eligible for meta-analysis of mammographic screening without clinical breast examination. The relative risk for women aged 40-74 years was 0.75 (95% confidence interval, 0.67-0.83). Three studies evaluated the efficacy of mammographic screening with clinical breast examination. The relative risk for women aged 40-64 years was 0.87 (95% confidence interval, 0.77-0.98). The number needed to invite was always lower in mammographic screening without clinical breast examination than in mammographic screening with clinical breast examination. In both screening methods, the number needed to invite was higher in women aged 40-49 years than in women aged 50-70 years. These results suggest that mammographic screening without clinical breast examination can afford higher benefits to women aged 50 years and over. Although evidence of the efficacy of mammographic screening without clinical breast examination was confirmed based on the results of the randomized controlled trials, a Japanese study is needed to resolve local problems.
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Affiliation(s)
- Chisato Hamashima
- Cancer Screening Assessment and Management Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Koji Ohta
- Department of Surgery, Fukui Prefecture Hospital, Fukui, Japan
| | - Yoshio Kasahara
- Division of Breast Surgery, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Takafumi Katayama
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Tomio Nakayama
- Center of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Satoshi Honjo
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Koji Ohnuki
- Division of Breast Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
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Lauby-Secretan B, Scoccianti C, Loomis D, Benbrahim-Tallaa L, Bouvard V, Bianchini F, Straif K. Breast-cancer screening--viewpoint of the IARC Working Group. N Engl J Med 2015; 372:2353-8. [PMID: 26039523 DOI: 10.1056/nejmsr1504363] [Citation(s) in RCA: 515] [Impact Index Per Article: 57.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Béatrice Lauby-Secretan
- From the International Agency for Research on Cancer, Lyon, France (B.L.-S., C.S., D.L., L.B.-T., V.B., K.S.); and the German Cancer Research Center, Heidelberg, Germany (F.B.)
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Kim Y, Yoo KY, Goodman MT. Differences in Incidence, Mortality and Survival of Breast Cancer by Regions and Countries in Asia and Contributing Factors. Asian Pac J Cancer Prev 2015; 16:2857-70. [DOI: 10.7314/apjcp.2015.16.7.2857] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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121
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Bedi M, Devins GM. Cultural considerations for South Asian women with breast cancer. J Cancer Surviv 2015; 10:31-50. [DOI: 10.1007/s11764-015-0449-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 03/19/2015] [Indexed: 12/21/2022]
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Shridhar K, Dey S, Bhan CM, Bumb D, Govil J, Dhillon PK. Cancer detection rates in a population-based, opportunistic screening model, New Delhi, India. Asian Pac J Cancer Prev 2015; 16:1953-8. [PMID: 25773793 DOI: 10.7314/apjcp.2015.16.5.1953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In India, cancer accounts for 7.3% of DALY's, 14.3% of mortality with an age-standardized incident rate of 92.4/100,000 in men and 97.4/100,000 in women and yet there are no nationwide screening programs. MATERIALS AND METHODS We calculated age-standardized and age-truncated (30-69 years) detection rates for men and women who attended the Indian Cancer Society detection centre, New Delhi from 2011-12. All participants were registered with socio-demographic, medical, family and risk factors history questionnaires, administered clinical examinations to screen for breast, oral, gynecological and other cancers through a comprehensive physical examination and complete blood count. Patients with an abnormal clinical exam or blood result were referred to collaborating institutes for further investigations and follow-up. RESULTS A total of n=3503 were screened during 2011-12 (47.8% men, 51.6% women and 0.6% children <15 years) with a mean age of 47.8 yrs (±15.1 yrs); 80.5% were aged 30-69 years and 77.1% had at least a secondary education. Tobacco use was reported by 15.8%, alcohol consumption by 11.9% and family history of cancer by 9.9% of participants. Follow-up of suspicious cases yielded 45 incident cancers (51.1% in men, 48.9% in women), consisting of 55.5% head and neck (72.0% oral), 28.9% breast, 6.7% gynecological and 8.9% other cancer sites. The age-standardized detection rate for all cancer sites was 340.8/100,000 men and 329.8/100,000 women. CONCLUSIONS Cancer screening centres are an effective means of attracting high-risk persons in low-resource settings. Opportunistic screening is one feasible pathway to address the rising cancer burden in urban India through early detection.
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Affiliation(s)
- Krithiga Shridhar
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, India E-mail :
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Nikendei C, Diefenbacher K, Köhl-Hackert N, Lauber H, Huber J, Herrmann-Werner A, Herzog W, Schultz JH, Jünger J, Krautter M. Digital rectal examination skills: first training experiences, the motives and attitudes of standardized patients. BMC MEDICAL EDUCATION 2015; 15:7. [PMID: 25638247 PMCID: PMC4322856 DOI: 10.1186/s12909-015-0292-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 01/12/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Physical clinical examination is a core clinical competence of medical doctors. In this regard, digital rectal examination (DRE) plays a central role in the detection of abnormalities of the anus and rectum. However, studies in undergraduate medical students as well as newly graduated doctors show that they are insufficiently prepared for performing DRE. Training units with Standardized Patients (SP) represent one method to deliver DRE skills. As yet, however, it is little known about SPs' attitudes. METHODS This is a qualitative study using a grounded theory approach. Interviews were conducted with 4 standardized patients about their experiences before, during and after structured SP training to deliver DRE competencies to medical students. The resulting data were subjected to thematic content analysis. RESULTS Results show that SPs do not have any predominant motives for DRE program participation. They participate in the SP training sessions with relatively little prejudice and do not anticipate feeling highly vulnerable within teaching sessions with undergraduate medical students. CONCLUSIONS The current study examined SPs' motives, views, expectations and experiences regarding a DRE program during their first SP training experiences. The results enabled us to derive distinct action guidelines for the recruitment, informing and briefing of SPs who are willing to participate in a DRE program.
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Affiliation(s)
- Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Katja Diefenbacher
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Nadja Köhl-Hackert
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
| | - Heike Lauber
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Julia Huber
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Anne Herrmann-Werner
- Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Jana Jünger
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Medical Centre, Heidelberg, Germany.
| | - Markus Krautter
- Department of Nephrology, University of Heidelberg, INF 162, 69115, Heidelberg, Germany.
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Lee EH, Park B, Kim NS, Seo HJ, Ko KL, Min JW, Shin MH, Lee K, Lee S, Choi N, Hur MH, Kim DI, Kim MJ, Kim SY, Sunwoo S, Dang JY, Kim SY, Kim Y, Lee WC, Jeong J. The Korean guideline for breast cancer screening. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.5.408] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Eun Hye Lee
- Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Boyoung Park
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Nam-Soon Kim
- Health Policy Research Department, Korea Institute for Health and Social Affairs, Sejong, Korea
| | - Hyun-Ju Seo
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - Kyoung Lan Ko
- Department of Radiology, Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Jun Won Min
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Kiheon Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seeyoun Lee
- Department of Surgery, Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Nami Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University College of Medicine, Seoul, Korea
| | - Min Hee Hur
- Department of Surgery, Cheil General Hospital & Women's Healthcare Center, Dankook Universitiy College of Medicine, Seoul, Korea
| | - Dong Il Kim
- Department of Environmental and Occupational Medicine, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Yong Kim
- Department of Surgery, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Sung Sunwoo
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yeon Dang
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Soo Young Kim
- Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Won-Chul Lee
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Abstract
Less-developed-region countries (LDCs) are seeing a rapid rise in cancer incidence owing to changing lifestyles, infections, environmental carcinogens and increasing longevity. LDCs have poor resources to deal with cancers, leading to high mortality rates. Investment in nationally implementable and sustainable cancer prevention and screening strategies would be more appropriate for LDCs. This Science and Society article outlines the burden of preventable cancers in selected LDCs and discusses evidence on cost-effective and widely implementable prevention and screening strategies.
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Affiliation(s)
- Aditi Shastri
- Albert Einstein College of Medicine, Hematology-Oncology, 1300 Morris Park Avenue, Bronx, New York, New York 10461, USA
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127
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Zelle SG, Baltussen R, Otten JDM, Heijnsdijk EAM, van Schoor G, Broeders MJM. Predicting the stage shift as a result of breast cancer screening in low- and middle-income countries: a proof of concept. J Med Screen 2014; 22:8-19. [PMID: 25416699 DOI: 10.1177/0969141314559956] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To provide proof of concept for a simple model to estimate the stage shift as a result of breast cancer screening in low- and middle-income countries (LMICs). Stage shift is an essential early detection indicator and an important proxy for the performance and possible further impact of screening programmes. Our model could help LIMCs to choose appropriate control strategies. METHODS We assessed our model concept in three steps. First, we calculated the proportional performance rates (i.e. index number Z) based on 16 screening rounds of the Nijmegen Screening Program (384,884 screened women). Second, we used linear regression to assess the association between Z and the amount of stage shift observed in the programme. Third, we hypothesized how Z could be used to estimate the stage shift as a result of breast cancer screening in LMICs. RESULTS Stage shifts can be estimated by the proportional performance rates (Zs) using linear regression. Zs calculated for each screening round are highly associated with the observed stage shifts in the Nijmegen Screening Program (Pearson's R: 0.798, R square: 0.637). CONCLUSIONS Our model can predict the stage shifts in the Nijmegen Screening Program, and could be applied to settings with different characteristics, although it should not be straightforwardly used to estimate the impact on mortality. Further research should investigate the extrapolation of our model to other settings. As stage shift is an essential screening performance indicator, our model could provide important information on the performance of breast cancer screening programmes that LMICs consider implementing.
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Affiliation(s)
- Sten G Zelle
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Rob Baltussen
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Johannes D M Otten
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Guido van Schoor
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands Dutch reference centre for screening, Nijmegen, The Netherlands
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Dickens C, Duarte R, Zietsman A, Cubasch H, Kellett P, Schüz J, Kielkowski D, McCormack V. Racial comparison of receptor-defined breast cancer in Southern African women: subtype prevalence and age-incidence analysis of nationwide cancer registry data. Cancer Epidemiol Biomarkers Prev 2014; 23:2311-21. [PMID: 25143359 DOI: 10.1158/1055-9965.epi-14-0603] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Receptor-defined breast cancer proportions vary across Africa. They have important implications for survival prospects and research priorities. METHODS We studied estrogen receptor (ER), progesterone receptor (PR), and HER2 receptor statuses in two multiracial Southern African countries with routine diagnostic immunohistochemistry. A total of 12,361 women with histologically confirmed breast cancer diagnosed at age ≥20 years during (i) 2009-2011 from South Africa's national cancer registry (public sector) and (ii) 2011-2013 from Namibia's only cancer hospital were included. Crude, age, and age + laboratory-adjusted ORs of receptor status were analyzed using logistic regression, and age-incidence curves were analyzed using Poisson regression. RESULTS A total of 10,047 (81%) women had known ER status. Ranking of subtypes was consistent across races: ER(+)/PR(+)HER2(-) was most common (race-specific percentage range, 54.6%-64.8%), followed by triple-negative (17.4%-21.9%), ER(+)/PR(+)HER2(+) (9.6%-13.9%), and ER(-)PR(-)HER2(+) (7.8%-10.9%). Percentages in black versus white women were 33.8% [95% confidence (CI), 32.5-35.0] versus 26.0% (24.0-27.9) ER(-); 20.9% (19.7-22.1) versus 17.5% (15.4-19.6) triple-negative; and 10.7% (9.8-11.6) versus 7.8% (6.3-9.3) ER(-)PR(-)HER2(+). Indian/Asian and mixed-ancestry women had intermediate values. Age-incidence curves had similar shapes across races: rates increased by 12.7% per year (12.2-13.1) across ER subtypes under the age of 50 years, and thereafter slowed for ER(+) (1.95%) and plateaued for ER(-) disease (-0.1%). CONCLUSIONS ER(+) breast cancer dominates in all Southern African races, but black women have a modest excess of aggressive subtypes. IMPACT On the basis of the predominant receptor-defined breast tumors in Southern Africa, improving survival for the growing breast cancer burden should be achievable through earlier diagnosis and appropriate treatment.
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Affiliation(s)
- Caroline Dickens
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France. Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Raquel Duarte
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Patricia Kellett
- National Cancer Registry of South Africa, National Health and Laboratory Services, Johannesburg, South Africa
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Danuta Kielkowski
- National Cancer Registry of South Africa, National Health and Laboratory Services, Johannesburg, South Africa
| | - Valerie McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France.
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Dickens C, Joffe M, Jacobson J, Venter F, Schüz J, Cubasch H, McCormack V. Stage at breast cancer diagnosis and distance from diagnostic hospital in a periurban setting: a South African public hospital case series of over 1,000 women. Int J Cancer 2014; 135:2173-82. [PMID: 24658866 PMCID: PMC4134722 DOI: 10.1002/ijc.28861] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/21/2014] [Accepted: 03/11/2014] [Indexed: 01/28/2023]
Abstract
Advanced stage at diagnosis contributes to low breast cancer survival rates in sub-Saharan Africa. Living far from health services is known to delay presentation, but the effect of residential distance to hospital, the radius at which this effect sets in and the women most affected have not been quantified. In a periurban South African setting, we examined the effect of a geographic information system (GIS)-measured straight-line distance, from a patient's residence to diagnostic hospital, on stage at diagnosis in 1,071 public-sector breast cancer patients diagnosed during 2006-2012. Generalized linear models were used to estimate risk ratios for late stage (stage III/IV vs. stage I/II) associated with distance, adjusting for year of diagnosis, age, race and socioeconomic indicators. Mean age of patients was 55 years, 90% were black African and diagnoses were at stages I (5%), II (41%), III (46%) and IV (8%). Sixty-two percent of patients with distances >20 km (n = 338) had a late stage at diagnosis compared to 50% with distances <20 km (n = 713, p = 0.02). Risk of late stage at diagnosis was 1.25-fold higher (95% CI: 1.09, 1.42) per 30 km. Effects were pronounced in an underrepresented group of patients over age 70. This positive stage-distance association held to 40 km, and plateaued or slightly reversed in patients (9%) living beyond this distance. Studies of woman and the societal and healthcare-level influences on these delays and on the late stage at diagnosis distribution are needed to inform interventions to improve diagnostic stage and breast cancer survival in this and similar settings.
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Affiliation(s)
- Caroline Dickens
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Johannesburg 2193, South Africa
| | - Maureen Joffe
- Wits Health Consortium, MRC/Wits Developmental Pathways to Health Research Unit, Faculty of Health Sciences, University of Witwatersrand
| | - Judith Jacobson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Francois Venter
- Information Management Directorate, Gauteng Provincial Department of Health, 37 Sauer Street, Bank of Lisbon, Marshall Town, Johannesburg, 2000, South Africa
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France
| | - Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Johannesburg 2193, South Africa
- Chris Hani Baragwanath Hospital Breast Clinic, Old Potch Road, Soweto, South Africa
| | - Valerie McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France
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130
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Singh D, Malila N, Pokhrel A, Anttila A. Association of symptoms and breast cancer in population-based mammography screening in Finland. Int J Cancer 2014; 136:E630-7. [PMID: 25160029 PMCID: PMC4312922 DOI: 10.1002/ijc.29170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/14/2014] [Accepted: 08/19/2014] [Indexed: 11/30/2022]
Abstract
The study purpose was to assess association of symptoms at screening visits with detection of breast cancer among women aged 50–69 years during the period 2006–2010. Altogether 1.2 million screening visits were made and symptoms (lump, retraction, secretion etc.) were reported either by women or radiographer. Breast cancer risk was calculated for each symptom separately using logistic regression [odds ratio (OR)] and 95% confidence intervals (CIs). Of the 1,198,410 screening visits symptoms were reported in 298,220 (25%) visits. Breast cancer detection rate for women with and without symptoms was 7.8 per 1,000 and 4.7 per 1,000 screening visits, respectively, whereas lump detected 32 cancers per 1,000 screens. Women with lump or retraction had an increased risk of breast cancer, OR = 6.47, 95% CI 5.89−7.09 and OR = 2.19, 95% CI 1.92–2.49, respectively. The sensitivity of symptoms in detecting breast carcinoma was 35.5% overall. Individual symptoms sensitivity and specificity ranged from, 0.66 to 14.8% and 87.4 to 99.7%, respectively. Of 5,541 invasive breast cancers, 1,993 (36%) reported symptoms at screen. Breast cancer risk among women with lump or retraction was higher in large size tumors (OR = 9.20, 95% CI 8.08–10.5) with poorly differentiated grades (OR = 5.91, 95% CI 5.03–6.94) and regional lymph nodes involvement (OR = 6.47, 95% CI 5.67–7.38). This study was done in a setting where breast tumors size is generally small, and symptoms sensitivity and specificity in diagnosing breast tumors were limited. Importance of breast cancer symptoms in the cancer prevention and control strategy needs to be evaluated also in other settings.
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Affiliation(s)
- Deependra Singh
- School of Health Sciences, University of Tampere, Tampere, Finland
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Tsu VD, Jeronimo J, Anderson BO. Why the time is right to tackle breast and cervical cancer in low-resource settings. Bull World Health Organ 2014; 91:683-90. [PMID: 24101784 DOI: 10.2471/blt.12.116020] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 05/29/2013] [Accepted: 05/30/2013] [Indexed: 01/04/2023] Open
Abstract
The health concerns of women in their mid-adult years - when the prime age of reproduction has passed - have been traditionally given little or no attention by health systems and donors, despite the heavy burden that diseases such as breast and cervical cancer impose on women and their families. The risk of sexually transmitted infections that accompanies sexual relations and the risk of death and morbidity associated with pregnancy have long been recognized and have stimulated major control efforts that are finally yielding positive results. Much less attention has been focused, however, on how experiences in early life can affect women's health in adulthood. Breast and cervical cancers kill more women than any other types of cancer in all parts of the developing world. In most of Asia and Latin America and some African countries, deaths from these two forms of cancer now outnumber pregnancy-related deaths. There are five compelling reasons for focusing on these cancers now to try to reverse these epidemiologic trends: (i) the burden of breast and cervical cancer is large and is growing; (ii) effective screening and treatment are available; (iii) research is generating new knowledge; (iv) there are opportunities for synergy with other health programmes; and (v) noncommunicable diseases are the focus of much current interest.
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Affiliation(s)
- Vivien Davis Tsu
- PATH, PO Box 900922, Seattle, WA 98109, United States of America (USA)
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Sreedevi A, Quereshi MA, Kurian B, Kamalamma L. Screening for Breast Cancer in a Low Middle Income Country: Predictors in a Rural Area of Kerala, India. Asian Pac J Cancer Prev 2014; 15:1919-24. [DOI: 10.7314/apjcp.2014.15.5.1919] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Asia accounts for 60% of the world population and half the global burden of cancer. The incidence of cancer cases is estimated to increase from 6.1 million in 2008 to 10.6 million in 2030, due to ageing and growing populations, lifestyle and socioeconomic changes. Striking variations in ethnicity, sociocultural practices, human development index, habits and dietary patterns are reflected in the burden and pattern of cancer in different regions. The existing and emerging cancer patterns and burden in different regions of Asia call for political recognition of cancer as an important public health problem and for balanced investments in public and professional awareness. Prevention as well as early detection of cancers leads to both better health outcomes and considerable savings in treatment costs. Cancer health services are still evolving, and require substantial investment to ensure equitable access to cancer care for all sections of the population. In this review, we discuss the changing burden of cancer in Asia, along with appropriate management strategies. Strategies should promote healthy ageing via healthy lifestyles, tobacco and alcohol control measures, hepatitis B virus (HBV) and human papillomavirus (HPV) vaccination, cancer screening services, and vertical investments in strengthening cancer healthcare infrastructure to improve equitable access to services.
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Affiliation(s)
| | - Kunnambath Ramadas
- Regional Cancer Centre, PO Box 2417, Trivandrum 695011, Kerala State, India
| | - You-lin Qiao
- Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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135
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Wang B, He M, Wang L, Engelgau MM, Zhao W, Wang L. Breast cancer screening among adult women in China, 2010. Prev Chronic Dis 2013; 10:E183. [PMID: 24199736 PMCID: PMC3820523 DOI: 10.5888/pcd10.130136] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Breast cancer is the most frequently diagnosed type of cancer among women in China. However, China does not have a national screening program or national screening guidelines. Little information on participation in breast cancer screening among Chinese women is available. Methods We used data from the 2010 China Chronic Disease and Risk Factor Surveillance System that included 53,513 women aged 18 years or older. Women were asked about breast cancer screening participation (any type of screening method), and we examined screening participation rates. We adjusted estimates and performed multivariable logistic regression to adjust for potential confounders. Results Overall, 21.7% (95% confidence interval [CI], 19.2%–24.2%) of respondents reported previous breast cancer screening. The participation rates were highest among women aged 30 to 39 years (30.7%; 95% CI, 26.9%–34.4%) and lowest among women 70 years or older (6.3%; 95% CI, 5.1%–7.6%). Compared with women living in the western region, women in the eastern region were 1.5 times more likely to be screened (adjusted odds ratio [OR], 1.5; 95% CI, 1.2–2.0). Compared with women without insurance, women with urban insurance were more likely to be screened (prevalence ratio = 2.6; 95% CI, 2.3–3.0) and be screened within the last 2 years (OR = 1.3; 95% CI, 1.0–1.7; P = .04). Conclusion Breast cancer screening participation rates among Chinese women were low and varied greatly by age, region, and insurance status. Comprehensive and prioritized strategies are needed to improve breast cancer screening participation among older women, those without medical insurance, and those living in the west.
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Affiliation(s)
- Baohua Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
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136
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Burton C, Shi H, Ma Y. Simultaneous Detection of Six Urinary Pteridines and Creatinine by High-Performance Liquid Chromatography-Tandem Mass Spectrometry for Clinical Breast Cancer Detection. Anal Chem 2013; 85:11137-45. [DOI: 10.1021/ac403124a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Casey Burton
- Department of Chemistry and Center for Biomedical Science & Engineering, Missouri University of Science and Technology, 400 West 11th Street, Rolla, Missouri 65409, United States
| | - Honglan Shi
- Department of Chemistry and Center for Biomedical Science & Engineering, Missouri University of Science and Technology, 400 West 11th Street, Rolla, Missouri 65409, United States
| | - Yinfa Ma
- Department of Chemistry and Center for Biomedical Science & Engineering, Missouri University of Science and Technology, 400 West 11th Street, Rolla, Missouri 65409, United States
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137
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Yip CH, Taib NA. Challenges in the management of breast cancer in low- and middle-income countries. Future Oncol 2013; 8:1575-83. [PMID: 23231519 DOI: 10.2217/fon.12.141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The incidence of breast cancer is rising in low- and middle-income countries (LMICs) due to 'westernization' of risk factors for developing breast cancer. However, survival remains low because of barriers in early detection and optimal access to treatment, which are the two main determinants of breast cancer outcome. A multidisciplinary approach to treatment gives the best results. An accurate diagnosis is dependent on a reliable pathology service, which will provide an adequate pathology report with prognostic and predictor information to allow optimal oncological treatment. Stratification of clinical practice guidelines based on resource level will ensure that women will have access to treatment even in a low-resource setting. Advocacy and civil society play a role in galvanizing the political will required to meet the challenge of providing opportunities for breast cancer control in LMICs. Collaboration between high-income countries and LMICs could be a strategy in facing these challenges.
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Affiliation(s)
- Cheng-Har Yip
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Abstract
The clinical breast exam (CBE) is an important tool in the care of women. However, the utility of the screening CBE has been called into question. This article discusses the importance of the CBE as a physical diagnosis tool. Recommendations regarding screening with CBE are reviewed, and evidence surrounding breast cancer screening using CBE is briefly summarized. Clinicians should strive to provide high quality CBEs as part of the general clinical exam for women, particularly those who present with breast complaints, and for patients who choose to have CBE screening. In conclusion, there is a role for the CBE in the care of women, and clinicians should be proficient at performing these exams. Simulation teaching technologies are now available at Department of Veteran Affairs (VA) facilities to enable clinicians to improve their CBE skills.
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Affiliation(s)
- Teresa Bryan
- General Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham Veterans Affairs Medical Center, FOT 720 1720 2nd Ave South, Birmingham, AL 35294-3407 USA
| | - Erin Snyder
- General Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham Veterans Affairs Medical Center, FOT 720 1720 2nd Ave South, Birmingham, AL 35294-3407 USA
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Sankaranarayanan R, Alwan N, Denny L. How can we improve survival from breast cancer in developing countries? BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.13.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Rengaswamy Sankaranarayanan
- Early Detection & Prevention Section – Screening Group, International Agency for Research on Cancer (WHO-IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Nada Alwan
- Baghdad University Medical College, National Cancer Research Center, Iraqi National Cancer Research Program, Baghdad, Iraq
| | - Lynette Denny
- Department of Obstetrics & Gynaecology, University of Cape Town, H45 Old Main Building, Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa
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Brennan M, Houssami N. Thermography in breast cancer diagnosis, screening and risk assessment: systematic review. BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.13.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
SUMMARY Thermography uses the pattern of heat measured on the skin surface to image the breast. This review examines the evidence regarding thermography for breast cancer screening, diagnosis and risk prediction. A systematic literature search was conducted and qualitative and quantitative data were extracted and summarized. Seventeen studies (nonrandomized trials) met the inclusion criteria. Four studies reported thermography accuracy for screening (60,802 women): median sensitivity was 47% (range 25–70%) and the median false-positive rate was 31% (range 21–38%). Twelve studies reported thermography accuracy (9887 women) in the context of a known clinical or mammographic abnormality: median sensitivity was 59% (range 25–97%). Two studies found no association between abnormal thermography and an increased 5-year risk of developing breast cancer. The sensitivity of thermography in breast cancer detection is low and the evidence does not support thermography as an alternative to screening mammography or for the investigation of symptoms.
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Affiliation(s)
- Meagan Brennan
- Screening & Test Evaluation Program (STEP), Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Nehmat Houssami
- Screening & Test Evaluation Program (STEP), Sydney Medical School, University of Sydney, Sydney, Australia
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141
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Franceschi S, Wild CP. Meeting the global demands of epidemiologic transition - the indispensable role of cancer prevention. Mol Oncol 2013; 7:1-13. [PMID: 23218182 PMCID: PMC5528406 DOI: 10.1016/j.molonc.2012.10.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/22/2012] [Indexed: 12/29/2022] Open
Abstract
The number of new cancer cases each year is projected to rise worldwide by about 70% by 2030 due to demographic changes alone, with the largest increases in the lower-income countries. Wider adoption of specific aspects of westernized lifestyles would translate to still greater increases in certain cancer types. In many countries the burden of cancer and other non-communicable diseases will add to communicable diseases and malnutrition to impose a "double burden" on the poorest. These trends represent major challenges to health, poverty, sustainable development and equality. Prevention is, however, possible based on implementing existing knowledge about risk factors and the natural history of the disease. Both primary and secondary cancer prevention offer therefore many opportunities to combat the projected increases. Tobacco control, reductions in obesity and physical inactivity, reduced consumption of alcohol, vaccination against hepatitis B and human papilloma viruses, safe sex, avoidance of environmental and occupational carcinogens and excessive sun exposure as well as the early detection and screening for breast, cervix and colorectal cancers would all make significant contributions. At the same time, for a number of major cancers (e.g., colon, prostate, kidney, pancreas, brain, lympho-haematological malignancies) research is needed to identify as yet unknown risk factors whilst for existing prevention strategies additional work is needed on their implementation into health services. Finally, there is a remarkable opportunity for advances in understanding the molecular basis of carcinogenesis to provide new tools and insights into aetiology and prevention. It is only by complementing efforts to improve treatment with those aimed at prevention that the impending epidemic of this disease can be addressed.
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Affiliation(s)
- Silvia Franceschi
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Christopher P. Wild
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
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142
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Gadgil A, Roy N, Sankaranarayanan R, Muwonge R, Sauvaget C. Effect of comprehensive breast care on breast cancer outcomes: a community hospital based study from Mumbai, India. Asian Pac J Cancer Prev 2013; 13:1105-9. [PMID: 22799289 DOI: 10.7314/apjcp.2012.13.4.1105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Breast cancer is the second most common cancer in women in India and the disease burden is increasing annually. The lack of awareness initiatives, structured screening, and affordable treatment facilities continue to result in poor survival. We present a breast cancer survival scenario, in urban population in India, where standardised care is distributed equitably and free of charge through an employees' healthcare scheme. We studied 99 patients who were treated at our hospital during the period 2005 to 2010 and our follow-up rates were 95.95%. Patients received evidence-based standardised care in line with the tertiary cancer centre in Mumbai. One-, three- and five-year survival rates were calculated using Kaplan-Meier method. Socio-demographic, reproductive and tumor factors, relevant to survival, were analysed. Mortality hazard ratios (HR) were calculated using Cox proportional hazard method. Survival in this series was compared to that in registries across India and discrepancies were discussed. Patients mean age was 56 years, mean tumor size was 3.2 cms, 85% of the tumors belonged to T1 and T2 stages, and 45% of the patients belonged to the composite stages I and IIA. Overall 5-year survival was 74.9%. Patients who presented with large-sized tumors (HR 3.06; 95% CI 0.4-9.0), higher composite stage (HR 1.91; 0.55-6.58) and undergone mastectomy (HR 2.94; 0.63- 13.62) had a higher risk of mortality than women who had higher levels of education (HR 0.25; 0.05-1.16), although none of these results reached the significant statistical level. We observed 25% better survival compared to other Indian populations. Our results are comparable to those from the European Union and North America, owing to early presentation, equitable access to standardised free healthcare and complete follow-up ensured under the scheme. This emphasises that equitable and affordable delivery of standardised healthcare can translate into early presentation and better survival in India.
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Affiliation(s)
- Anita Gadgil
- Bhabha Atomic Research Centre Hospital, Mumbai, India
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143
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Grosse Frie K, Ramadas K, Anju GA, Mathew BS, Muwonge R, Sauvaget CS, Thara ST, Sankaranarayanan R. Determinants of participation in a breast cancer screening trial in trivandrum district, India. Asian Pac J Cancer Prev 2013; 14:7301-7. [PMID: 24460292 DOI: 10.7314/apjcp.2013.14.12.7301] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Conspicuous differences in participation rates for breast self-examination (BSE), clinical breast examination (CBE), and referral for further investigations have been observed indicating involvement of a number of different factors. This study analysed determinants for participation in different levels of the breast cancer screening process in Indian females. MATERIALS AND METHODS An intervention group of 52,011 women was interviewed in a breast cancer screening trial in Trivandrum district, India. In order to assess demographic, socio-economic, reproductive, and cancer-related determinants of participation in BSE, CBE, and referral, uni- and multi-variate logistic regression was employed. RESULTS Of the interviewed women, 23.2% reported practicing BSE, 96.8% had attended CBE, and 49.1% of 2,880 screen-positives attended referral. Results showed an influence of various determinants on participation; women who were currently not married or who had no family history of cancer were significantly less likely to attend the screening process at any level. CONCLUSIONS Increasing awareness about breast cancer, early detection methods, and the advantages of early diagnoses among women, and their families, as well as health care workers offering social support, could help to increase participation over the entire screening process in India.
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Affiliation(s)
- Kirstin Grosse Frie
- Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France E-mail :
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144
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Soerjomataram I, Lortet-Tieulent J, Parkin DM, Ferlay J, Mathers C, Forman D, Bray F. Global burden of cancer in 2008: a systematic analysis of disability-adjusted life-years in 12 world regions. Lancet 2012; 380:1840-50. [PMID: 23079588 DOI: 10.1016/s0140-6736(12)60919-2] [Citation(s) in RCA: 417] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Country comparisons that consider the effect of fatal and non-fatal disease outcomes are needed for health-care planning. We calculated disability-adjusted life-years (DALYs) to estimate the global burden of cancer in 2008. METHODS We used population-based data, mostly from cancer registries, for incidence, mortality, life expectancy, disease duration, and age at onset and death, alongside proportions of patients who were treated and living with sequelae or regarded as cured, to calculate years of life lost (YLLs) and years lived with disability (YLDs). We used YLLs and YLDs to derive DALYs for 27 sites of cancers in 184 countries in 12 world regions. Estimates were grouped into four categories based on a country's human development index (HDI). We applied zero discounting and uniform age weighting, and age-standardised rates to enable cross-country and regional comparisons. FINDINGS Worldwide, an estimated 169·3 million years of healthy life were lost because of cancer in 2008. Colorectal, lung, breast, and prostate cancers were the main contributors to total DALYs in most world regions and caused 18-50% of the total cancer burden. We estimated an additional burden of 25% from infection-related cancers (liver, stomach, and cervical) in sub-Saharan Africa, and 27% in eastern Asia. We noted substantial global differences in the cancer profile of DALYs by country and region; however, YLLs were the most important component of DALYs in all countries and for all cancers, and contributed to more than 90% of the total burden. Nonetheless, low-resource settings had consistently higher YLLs (as a proportion of total DALYs) than did high-resource settings. INTERPRETATION Age-adjusted DALYs lost from cancer are substantial, irrespective of world region. The consistently larger proportions of YLLs in low HDI than in high HDI countries indicate substantial inequalities in prognosis after diagnosis, related to degree of human development. Therefore, radical improvement in cancer care is needed in low-resource countries. FUNDING Dutch Scientific Society, Erasmus University Rotterdam, and International Agency for research on Cancer.
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Affiliation(s)
- Isabelle Soerjomataram
- Section of Cancer Information, International Agency for Research on Cancer, Lyon, France.
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145
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Abstract
Breast cancer now represents the most common female malignancy in both the developing and developed world, and is the primary cause of death among women globally. Despite well-documented reductions in mortality from breast cancer during the past two decades, incidence rates continue to increase and do so more rapidly in countries that historically had low rates. This has emphasized the importance of survivorship issues and optimal management of disease chronicity. This article reviews current trends of incidence and mortality in both a western and global context, and considers pertinent changes in underlying etiological risk factors. The latter not only offer clues regarding changes in incidence patterns, but also provides rationale and guidance for strategies that could potentially reduce the burden of this disease. The relevance of lifestyle adjustments and screening interventions for primary and secondary prevention, respectively, are discussed with reference to different healthcare resource settings.
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Affiliation(s)
- John R Benson
- Cambridge Breast Unit, Addenbrookes Hospital, Hills Road, & University of Cambridge, Cambridge CB2 0QQ, UK.
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146
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Abstract
Noncommunicable diseases were estimated to claim more than 36 million lives worldwide in 2008. Major contributors to this burden were cardiovascular disease, cancer, chronic respiratory diseases, and diabetes. The United Nations General Assembly held a high-level meeting on noncommunicable diseases in September 2011 for heads of states and governments, conscious of the projected increases in disease incidence, particularly in low- and middle-income countries. This meeting followed the Special Session on HIV/AIDS in 2001, the only other high-level meeting to discuss a health topic and orient the global political agenda toward a growing threat to human development. Proposed strategies for control of noncommunicable diseases focused mainly on the shared risk factors of tobacco, harmful use of alcohol, physical inactivity, and unhealthy diet. However, for cancer, a broader response is required. Notably, the heterogeneity of cancer with respect to its geographical distribution, etiology, and pathology all demand a more nuanced, regional, or even local approach. Preparations for the meeting elicited enormous attention from governments and nongovernmental organizations, but the engagement of the research community was less evident. This commentary calls for the involvement of the cancer research community in response to the further action detailed in the United Nations Political Declaration emanating from the meeting, identifies a number of cancer-specific priorities, including vaccination against hepatitis B virus and human papillomavirus, cervical cancer screening, and early detection of breast cancer, and suggests areas where cancer research can provide the evidence base for cancer control, notably in improving the quality and coverage of cancer registration, elucidating cancer etiology, and evaluating interventions, including their implementation in low-resource health-care settings. Finally, the need for global cooperation in developing a research agenda for low- and middle-income countries is highlighted.
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Affiliation(s)
- Christopher Paul Wild
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
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Braun G, Führer A, Breitenstein E, Tariku W, Abdelbaghi O, Hauptmann S, Bogale S, Kantelhardt E. Cancer in Africa: AORTIC 8th International Cancer Conference 'Entering the 21st Century for Cancer Control in Africa' 30.11.-2.12.2011. ACTA ACUST UNITED AC 2012; 7:177-179. [PMID: 22740807 DOI: 10.1159/000188335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- G Braun
- Department of Gynecology, Martin-Luther-University Halle/Wittenberg, Germany
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149
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Sankaranarayanan R, Sauvaget C, Ramadas K, Ngoma T, Teguete I, Muwonge R, Naud P, Nessa A, Kuhaprema T, Qiao Y. Clinical trials of cancer screening in the developing world and their impact on cancer healthcare. Ann Oncol 2011; 22 Suppl 7:vii20-vii28. [DOI: 10.1093/annonc/mdr422] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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