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Dzidzornu E, Angmorterh SK, Aboagye S, Angaag NA, Agyemang PN, Edwin F. Communication Channels of Breast Cancer Screening Awareness Campaigns Among Women Presenting for Mammography in Ghana. J Am Coll Radiol 2024:S1546-1440(24)00359-4. [PMID: 38599362 DOI: 10.1016/j.jacr.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE The channels and content of communication play an integral role in creating breast cancer screening awareness. Although breast cancer screening awareness campaigns are increasing in Ghana, no study has been conducted to investigate the communication channels used by these campaigns. This study aimed to identify the most effective source of breast cancer screening awareness information among women presenting for mammography in Ghana. METHODS Ethical approval was sought before data collection. A cross-sectional quantitative approach was adopted for the study and involved 192 women who visited two mammography centers in October 2020 for mammography screening. A self-administered closed-ended questionnaire was used for data collection. Descriptive and inferential statistics were carried out using SPSS version 26. RESULTS A total of 192 responses were obtained. Of them, 72 (37.5%) participants had diploma/Higher National Diploma/degree education, with 105 (54.7%) of them being traders or nonprofessionals. All participants had heard of mammography screening and examination before this study. Mass media was the most common source of information on mammography screening (86 [44.8%]), of which radio was the highest subcategory (34 [39.5%]). Moreover, women presenting for mammography in Ghana demonstrated a high level of knowledge of breast cancer screening. DISCUSSION Mass media is the most common source of information on breast cancer screening awareness in Ghana and has the potential to positively impact sensitization programs by reaching out to more women. There is a need to engage the Ghanaian population using mass media and health facilities to maximize the impact of breast cancer screening awareness campaigns.
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Affiliation(s)
- Elizabeth Dzidzornu
- Department of Medical Imaging, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Seth Kwadjo Angmorterh
- Department of Medical Imaging, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana.
| | - Sonia Aboagye
- Department of Speech, Language & Hearing Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Nathaniel Awentiirin Angaag
- Department of Medical Imaging, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Patience Nyamekye Agyemang
- Department of Medical Imaging, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Frank Edwin
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
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Price MD, Rositch AF, Dedey F, Mali ME, Brownson KE, Nsaful J, Tounkara M, Price RR, Sutherland EK. Availability and Geographic Access to Hospital-Based Breast Cancer Diagnostic Services in Ghana. JCO Glob Oncol 2024; 10:e2300231. [PMID: 38330275 PMCID: PMC10860977 DOI: 10.1200/go.23.00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Breast cancer is the most frequent cancer and second most common cause of cancer-related death in Ghana. Early detection and access to diagnostic services are vital for early treatment initiation and improved survival. This study characterizes the geographic access to hospital-based breast cancer diagnostic services in Ghana as a framework for expansion. METHODS A cross-sectional hospital-based survey was completed in Ghana from November 2020 to October 2021. Early diagnostic services, as defined by the National Comprehensive Cancer Network (NCCN) Framework for Resource Stratification, was assessed at each hospital. Services were characterized as available >80% of the time in the previous year, <80%, or not available. ArcGIS was used to identify the proportion of the population within 20 and 45 km of services. RESULTS Most hospitals in Ghana participated in this survey (95%; 328 of 346). Of these, 12 met full NCCN Basic criteria >80% of the time, with 43% of the population living within 45 km. Ten of the 12 met full NCCN Core criteria, and none met full NCCN Enhanced criteria. An additional 12 hospitals were identified that provide the majority of NCCN Basic services but lack select services necessary to meet this criterion. Expansion of services in these hospitals could result in an additional 20% of the population having access to NCCN Basic-level early diagnostic services within 45 km. CONCLUSION Hospital-based services for breast cancer early diagnosis in Ghana are available but sparse. Many hospitals offer fragmented aspects of care, but only a limited number of hospitals offer the full NCCN Basic or Core level of care. Understanding current availability and geographical distribution of services provides a framework for potential targeted expansion of services.
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Affiliation(s)
- Matthew D. Price
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
| | - Anne F. Rositch
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Meghan E. Mali
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah, Salt Lake City, UT
| | - Kirstyn E. Brownson
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Mamadou Tounkara
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
| | - Raymond R. Price
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah, Salt Lake City, UT
- Intermountain Healthcare, Salt Lake City, UT
| | - Edward Kofi Sutherland
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Ensign Global College Ghana, Kpong, Ghana
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Holmes DM, Matatiyo A, Mpasa A, Huibers MHW, Manda G, Tomoka T, Mulenga M, Namazzi R, Mehta P, Zobeck M, Mzikamanda R, Chintagumpala M, Allen C, Nuchtern JG, Borgstein E, Aronson DC, Ozuah N, Nandi B, McAtee CL. Outcomes of Wilms tumor therapy in Lilongwe, Malawi, 2016-2021: Successes and ongoing research priorities. Pediatr Blood Cancer 2023; 70:e30242. [PMID: 36798020 PMCID: PMC10698850 DOI: 10.1002/pbc.30242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/07/2023] [Accepted: 01/18/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Wilms tumor therapy in low- and middle-income countries (LMICs) relies on treatment protocols adapted to resource limitations, but these protocols have rarely been evaluated in real-world settings. Such evaluations are necessary to identify high-impact research priorities for clinical and implementation trials in LMICs. The purpose of this study was to identify highest priority targets for future clinical and implementation trials in sub-Saharan Africa by assessing outcomes of a resource-adapted treatment protocol in Malawi. METHODS We conducted a retrospective cohort study of children treated for Wilms tumor with an adapted SIOP-backbone protocol in Lilongwe, Malawi between 2016 and 2021. Survival analysis assessed variables associated with poor outcome with high potential for future research and intervention. RESULTS We identified 136 patients, most commonly with stage III (n = 35; 25.7%) or IV disease (n = 35; 25.7%). Two-year event-free survival (EFS) was 54% for stage I/II, 51% for stage III, and 13% for stage IV. A single patient with stage V disease survived to 1 year. Treatment abandonment occurred in 36 (26.5%) patients. Radiotherapy was indicated for 55 (40.4%), among whom three received it. Of these 55 patients, 2-year EFS was 31%. Of 14 patients with persistent metastatic pulmonary disease at the time of nephrectomy, none survived to 2 years. Notable variables independently associated with survival were severe acute malnutrition (hazard ratio [HR]: 1.9), increasing tumor stage (HR: 1.5), and vena cava involvement (HR: 3.1). CONCLUSION High-impact targets for clinical and implementation trials in low-resource settings include treatment abandonment, late presentation, and approaches optimized for healthcare systems with persistently unavailable radiotherapy.
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Affiliation(s)
- David M Holmes
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Apatsa Matatiyo
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Atupele Mpasa
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
| | - Minke H W Huibers
- Department of Outreach, Princess Maxima Center, Utrecht, Netherlands
| | - Geoffrey Manda
- Global Health Institute, Department of Epidemiology and Social Medicine, University of Antwerp, Belgium
| | - Tamiwe Tomoka
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Maurice Mulenga
- Department of Pathology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Ruth Namazzi
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Parth Mehta
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Mark Zobeck
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Rizine Mzikamanda
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Carl Allen
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Jed G Nuchtern
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Eric Borgstein
- Department of Surgery, University of Malawi College of Medicine, Zomba, Malawi
| | - Daniel C Aronson
- Department of Surgery, University Children's Hospital Zürich, Zürich, Switzerland
| | - Nmazuo Ozuah
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Bip Nandi
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Casey L McAtee
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Boamah Mensah AB, Mensah KB, Aborigo RA, Bangalee V, Oosthuizen F, kugbey N, Clegg-Lamptey JN, Virnig B, Kulasingam S, Ncama BP. Breast cancer screening pathways in Ghana: applying an exploratory single case study methodology with cross-case analysis. Heliyon 2022; 8:e11413. [DOI: 10.1016/j.heliyon.2022.e11413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/24/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
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Dandadzi A, Chapman E, Chirenje ZM, Namukwaya E, Pini S, Nkhoma K, Allsop MJ. Patient experiences of living with cancer before interaction with palliative care services in Zimbabwe: A qualitative secondary data analysis. Eur J Cancer Care (Engl) 2022; 31:e13632. [PMID: 35712980 PMCID: PMC9542205 DOI: 10.1111/ecc.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/10/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Cancer patients in Zimbabwe typically access health services with advanced disease, limiting treatment choices and lessening the likelihood of positive treatment outcomes. We outline experiences of patients with advanced cancer prior to interaction with palliative care services to identify targets for future intervention development to enhance care delivery in Zimbabwe. METHODS Participants were purposively sampled adult patients with advanced cancer. We adopted a thematic approach to guide a qualitative secondary data analysis exploring factors influencing support sought by participants, external factors influencing decision making across the disease trajectory and the process for seeking and accessing palliative care. RESULTS Participants reported fragmented and uncoordinated care, from initial symptom experience and throughout disease progression. A recurring notion of disjuncture was present through participants' experiences of gaps, breaks and discontinuity across the disease trajectory. Each step had a beginning and end without clear routes for transition with movement between steps as a result of happenstance or informal encounters. CONCLUSION Targets for intervention development at the patient and family level exist that may reduce the disjuncture currently experienced between need and care provision. A holistic response that incorporates engagement with policy actors is critical to addressing prominent financial constraints for patients.
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Affiliation(s)
- Adlight Dandadzi
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Emma Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Z Mike Chirenje
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | | | - Simon Pini
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Ngwa W, Addai BW, Adewole I, Ainsworth V, Alaro J, Alatise OI, Ali Z, Anderson BO, Anorlu R, Avery S, Barango P, Bih N, Booth CM, Brawley OW, Dangou JM, Denny L, Dent J, Elmore SNC, Elzawawy A, Gashumba D, Geel J, Graef K, Gupta S, Gueye SM, Hammad N, Hessissen L, Ilbawi AM, Kambugu J, Kozlakidis Z, Manga S, Maree L, Mohammed SI, Msadabwe S, Mutebi M, Nakaganda A, Ndlovu N, Ndoh K, Ndumbalo J, Ngoma M, Ngoma T, Ntizimira C, Rebbeck TR, Renner L, Romanoff A, Rubagumya F, Sayed S, Sud S, Simonds H, Sullivan R, Swanson W, Vanderpuye V, Wiafe B, Kerr D. Cancer in sub-Saharan Africa: a Lancet Oncology Commission. Lancet Oncol 2022; 23:e251-e312. [PMID: 35550267 PMCID: PMC9393090 DOI: 10.1016/s1470-2045(21)00720-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 01/13/2023]
Abstract
In sub-Saharan Africa (SSA), urgent action is needed to curb a growing crisis in cancer incidence and mortality. Without rapid interventions, data estimates show a major increase in cancer mortality from 520 348 in 2020 to about 1 million deaths per year by 2030. Here, we detail the state of cancer in SSA, recommend key actions on the basis of analysis, and highlight case studies and successful models that can be emulated, adapted, or improved across the region to reduce the growing cancer crises. Recommended actions begin with the need to develop or update national cancer control plans in each country. Plans must include childhood cancer plans, managing comorbidities such as HIV and malnutrition, a reliable and predictable supply of medication, and the provision of psychosocial, supportive, and palliative care. Plans should also engage traditional, complementary, and alternative medical practices employed by more than 80% of SSA populations and pathways to reduce missed diagnoses and late referrals. More substantial investment is needed in developing cancer registries and cancer diagnostics for core cancer tests. We show that investments in, and increased adoption of, some approaches used during the COVID-19 pandemic, such as hypofractionated radiotherapy and telehealth, can substantially increase access to cancer care in Africa, accelerate cancer prevention and control efforts, increase survival, and save billions of US dollars over the next decade. The involvement of African First Ladies in cancer prevention efforts represents one practical approach that should be amplified across SSA. Moreover, investments in workforce training are crucial to prevent millions of avoidable deaths by 2030. We present a framework that can be used to strategically plan cancer research enhancement in SSA, with investments in research that can produce a return on investment and help drive policy and effective collaborations. Expansion of universal health coverage to incorporate cancer into essential benefits packages is also vital. Implementation of the recommended actions in this Commission will be crucial for reducing the growing cancer crises in SSA and achieving political commitments to the UN Sustainable Development Goals to reduce premature mortality from non-communicable diseases by a third by 2030.
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Affiliation(s)
- Wilfred Ngwa
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Information and Sciences, ICT University, Yaoundé, Cameroon.
| | - Beatrice W Addai
- Breast Care International, Peace and Love Hospital, Kumasi, Ghana
| | - Isaac Adewole
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Victoria Ainsworth
- Department of Physics and Applied Physics, University of Massachusetts Lowell, Lowell, MA, USA
| | - James Alaro
- National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | | | - Zipporah Ali
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
| | - Benjamin O Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Non-communicable Diseases, WHO, Geneva, Switzerland
| | - Rose Anorlu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Stephen Avery
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Prebo Barango
- WHO, Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Noella Bih
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Otis W Brawley
- Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Lynette Denny
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa; South African Medical Research Council, Gynaecological Cancer Research Centre, Tygerberg, South Africa
| | | | - Shekinah N C Elmore
- Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ahmed Elzawawy
- Department of Clinical Oncology, Suez Canal University, Ismailia, Egypt
| | | | - Jennifer Geel
- Division of Paediatric Haematology and Oncology, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Katy Graef
- BIO Ventures for Global Health, Seattle, WA, USA
| | - Sumit Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Laila Hessissen
- Pediatric Oncology Department, Pediatric Teaching Hospital, Rabat, Morocco
| | - Andre M Ilbawi
- Department of Non-communicable Diseases, WHO, Geneva, Switzerland
| | - Joyce Kambugu
- Department of Pediatrics, Uganda Cancer Institute, Kampala, Uganda
| | - Zisis Kozlakidis
- Laboratory Services and Biobank Group, International Agency for Research on Cancer, WHO, Lyon, France
| | - Simon Manga
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Lize Maree
- Department of Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
| | - Sulma I Mohammed
- Department of Comparative Pathobiology, Center for Cancer Research, Purdue University, West Lafayette, IN, USA
| | - Susan Msadabwe
- Department of Radiation Therapy, Cancer Diseases Hospital, Lusaka, Zambia
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Ntokozo Ndlovu
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Kingsley Ndoh
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Twalib Ngoma
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Timothy R Rebbeck
- Dana-Farber Cancer Institute, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Lorna Renner
- Department of Paediatrics, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Anya Romanoff
- Department of Health System Design and Global Health, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Fidel Rubagumya
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda; University of Global Health Equity, Kigali, Rwanda
| | - Shahin Sayed
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Shivani Sud
- Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Hannah Simonds
- Division of Radiation Oncology, Tygerberg Hospital and University of Stellenbosch, Stellenbosch, South Africa
| | | | - William Swanson
- Department of Physics and Applied Physics, Dana-Farber Cancer Institute, University of Massachusetts Lowell, Lowell, MA, USA
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology, and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - David Kerr
- Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Sadoh AE, Osime C, Nwaneri DU, Ogboghodo BC, Eregie CO, Oviawe O. Improving knowledge about breast cancer and breast self examination in female Nigerian adolescents using peer education: a pre-post interventional study. BMC WOMENS HEALTH 2021; 21:328. [PMID: 34507568 PMCID: PMC8431890 DOI: 10.1186/s12905-021-01466-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/20/2021] [Indexed: 11/10/2022]
Abstract
Background Prevention of BC of which the cornerstone is creating awareness and early detection is important in adolescents and young women because of their worse outcomes. Early detection strategies such as mammography are currently beyond the reach of most women in sub-Saharan Africa.. Lack of awareness and late presentation contribute to the poor outcomes. Awareness creation among adolescents may result in modification of some risk factors for BC with adoption of healthy life styles including accessing early detection activities. This study determined the effect of peer education as a strategy to create awareness on BC and breast self examination (BSE) among in-school female adolescents in Benin City. Methods This was a pre-post interventional study carried out in October –December 2016 on female students of four secondary schools in Benin City. Pre-peer training, using a pre-tested self-administered questionnaire, knowledge about BC and BSE was assessed in about 30% of each school population. This was followed by training of 124 students selected from the schools (one student per class) as peer trainers. The peer trainers provided training on BC and BSE (the intervention) for their classmates. Within two weeks of peer training knowledge about BC and BSE was reassessed in 30% of each school population. Selection of students for assessment pre and post intervention was by systematic sampling. Correct knowledge was scored and presented as percentages. Chi square test, student t test and ANOVA were used to assess associations and test differences with level of significance set at p < 0.05. Results There were 1337 and 1201 students who responded to the pre and post-training questionnaires respectively. The mean BC knowledge score (20.61 ± 13.4) prior to training was low and it statistically significantly improved to 55.93 ± 10.86 following training p < 0.0001 Following peer training, statistically significant improvement (p 0.037- < 0.001) occurred in most knowledge domains apart from symptomatology. Pre-peer training 906(67.8%) students knew about BSE but only 67(4.8%). Significantly more students 1134(94.7%) knew about BSE following peer training. Conclusions Peer education strategy can be used to improve BC and BSE knowledge in adolescents. This strategy is low cost and could be very useful in low resource settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01466-3.
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Affiliation(s)
- Ayebo E Sadoh
- Institute Of Child Health, University Of Benin, PMB 1154, Benin City, Nigeria.
| | - Clement Osime
- Department of Surgery, University Of Benin, PMB 1154, Benin City, Nigeria
| | - Damian U Nwaneri
- Institute Of Child Health, University Of Benin, PMB 1154, Benin City, Nigeria
| | | | - Charles O Eregie
- Institute Of Child Health, University Of Benin, PMB 1154, Benin City, Nigeria
| | - Osawaru Oviawe
- Institute Of Child Health, University Of Benin, PMB 1154, Benin City, Nigeria
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Mburu W, Boamah Mensah AB, Virnig B, Amuasi JH, Awuah B, Porta CM, Osei-Bonsu E, Kulasingam S. Pathways to Breast Cancer Diagnosis and Treatment Among Women in Ghana: A Qualitative Study. WOMEN'S HEALTH REPORTS 2021; 2:234-244. [PMID: 34318293 PMCID: PMC8310750 DOI: 10.1089/whr.2020.0117] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 12/24/2022]
Abstract
Background: Breast cancer is the leading cause of cancer death among Ghanaian women and most women are identified once they develop symptoms. Women then must navigate a complex health care system to get diagnosed and receive orthodox medicine. We describe Ghanaian women's pathways of care from breast cancer-related symptom detection to treatment receipt. Methods: We conducted a qualitative study using an empirical phenomenological approach. We used a purposive sampling technique to recruit 31 women with breast cancer who were receiving treatment at Komfo Anokye Teaching Hospital in Kumasi, Ghana. They participated in semistructured in-depth interviews between November 2019 and March 2020. All interviews were transcribed verbatim and analyzed using a deductive coding approach. Results: Women navigate approximately nine steps from symptom detection to receiving orthodox breast cancer treatment. The breast cancer care pathway is not linear and women frequently move among different management approaches, including alternative therapy (faith healing and traditional herbal healing). All the women detected the symptoms themselves. Some of the women sought orthodox medicine due to information from the media. Conclusions: Alternative therapy providers play a critical role in the breast cancer diagnosis and care pathways in Ghana underscoring the need to formally integrate them into the health care system. Breast cancer awareness programs through the media and educational programs aimed at alternative therapy providers may reduce the time from symptom detection to receipt of orthodox medicine.
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Affiliation(s)
- Waruiru Mburu
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Beth Virnig
- Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA
| | - John H Amuasi
- Department of Global Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Baffour Awuah
- Ministry of Health, Accra, Ghana.,Department of Medical Oncology and Radiation, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Carolyn M Porta
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ernest Osei-Bonsu
- Department of Medical Oncology and Radiation, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Shalini Kulasingam
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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9
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Using Media to Promote Public Awareness of Early Detection of Kaposi's Sarcoma in Africa. JOURNAL OF ONCOLOGY 2020; 2020:3254820. [PMID: 32280342 PMCID: PMC7115145 DOI: 10.1155/2020/3254820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 01/17/2023]
Abstract
Background Despite its hallmark cutaneous presentation, most Kaposi's sarcoma (KS) in Africa is diagnosed too late for effective treatment. Early diagnosis will only be achievable if patients with KS present earlier for care. We hypothesized that public awareness about KS can be enhanced through exposure to common media. Methods We developed educational messages regarding early detection of KS for the general African public portraying a three-part theme: “Look” (regularly examine one's skin/mouth), “Show” (bring to the attention of a healthcare provider any skin/mouth changes), and “Test” (ask for a biopsy for definitive diagnosis). We packaged the messages in three common media forms (comic strips, radio, and video) and tested their effect on increasing KS awareness among adults attending markets in Uganda. Participants were randomized to a single exposure to one of the media and evaluated for change in KS-related knowledge and attitudes. Results Among 420 participants, media exposure resulted in increased ability to identify KS (from 0.95% pretest to 46% posttest); awareness that anyone is at risk for KS (29% to 50%); belief that they may be at risk (63% to 76%); and knowledge that definitive diagnosis requires biopsy (23% to 51%) (all p < 0.001). Most participants (96%) found the media culturally appropriate. Conclusion Exposure to media featuring a theme of “Look,” “Show,” and “Test” resulted in changes in knowledge and attitudes concerning KS among the general public in Uganda. High incidence and poor survival of KS in Africa are an impetus to further evaluate these media, which are freely available online.
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Qu LG, Brand NR, Chao A, Ilbawi AM. Interventions Addressing Barriers to Delayed Cancer Diagnosis in Low- and Middle-Income Countries: A Systematic Review. Oncologist 2020; 25:e1382-e1395. [PMID: 32125732 DOI: 10.1634/theoncologist.2019-0804] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Delays to cancer diagnosis exist, resulting in worse survival outcomes for many cancers. Interventions targeting delays and barriers to cancer diagnosis and treatment have been investigated, but mostly in high-income countries. We conducted a systematic literature review to identify and characterize the interventions studied across cancers, within low- and middle-income countries (LMICs). METHODS This systematic review forms part two of a wider study examining solutions to delays and barriers in cancer early diagnosis in LMICs. A comprehensive literature search was conducted on November 27, 2017, encompassing published studies from the preceding 15 years. We extracted study design, population, and intervention, and reported outcome measures from each study. Results were presented by target of interventions (general vs. health care professionals). A narrative synthesis was used to summarize intervention efficacy. RESULTS Of 10,193 abstracts returned, 25 were included, consisting of studies across World Health Organization geographical regions, examining breast, cervix, childhood, prostate, head and neck, and gastric cancers. Altogether, 11 intervention studies targeted the general population, 12 targeted health care professionals, and 2 targeted both. The majority (17/25) of studies reported interventions focusing on patient and diagnosis-related barriers early in the cancer care pathway. Most studies reported knowledge score as primary outcome measure (17/25); few (6/25) reported on clinically relevant measures such as reducing disease stage at presentation or diagnostic time interval. Effectiveness of interventions was demonstrated for some cancers only. CONCLUSION More interventions reporting clinically relevant measures and using standardized methods and outcomes are required to improve our ability to effectively improve cancer early diagnosis in LMICs. IMPLICATIONS FOR PRACTICE Prior to this study, the extent of intervention literature in cancer early diagnosis in low- and middle-income countries had not been characterized. This study aimed to outline and characterize interventions across all cancer types and across all countries. This systematic review demonstrated that interventions have been investigated targeting both the general population and health care professionals. Furthermore, this review demonstrates that the majority of studies report knowledge as an outcome measure, rather than clinically significant measures that improve cancer-related outcomes, such as delay intervals or downstaging of disease. Future interventions should address clinically relevant measures to better assess efficacy of interventions.
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Affiliation(s)
- Liang G Qu
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Victoria, Australia
| | - Nathan R Brand
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
- Vagelos College of Physicians and Surgeons at Columbia University, New York, New York, USA
| | - Ann Chao
- Center for Global Health, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
| | - André M Ilbawi
- Management of Noncommunicable Diseases Unit, Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
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11
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Exploring determinants of, and interventions for, delayed presentation of women with breast symptoms: A systematic review. Eur J Oncol Nurs 2020; 44:101677. [DOI: 10.1016/j.ejon.2019.101677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/08/2019] [Accepted: 10/12/2019] [Indexed: 12/24/2022]
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12
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Tillyard G, DeGennaro V. New Methodologies for Global Health Research: Improving the Knowledge, Attitude, and Practice Survey Model Through Participatory Research in Haiti. QUALITATIVE HEALTH RESEARCH 2019; 29:1277-1286. [PMID: 30565510 DOI: 10.1177/1049732318816675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Knowledge, attitude, and practice (KAP) survey models are a common tool used by researchers and global health practitioners to reveal insights necessary for health program design and implementation. We explore how an interdisciplinary team of medical practitioners, researchers, designers, and community members improved the KAP survey tool in Haiti by drawing on participatory research methods. The overall objective of the project was to build a new approach to investigating and meeting community health needs and specifically the challenges faced by women with breast and cervical cancer in Haiti. The research findings were used to design an education tool kit for health care providers as well as create a community-based engagement strategy to better connect people to cancer screening and treatment facilities. By infusing the KAP survey model with participatory approaches to knowledge production, the advisory board designed a survey tool that generated more relevant and in-depth knowledge with the community while maintaining the study's simplicity and complying with a time-limited budget.
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Affiliation(s)
- Grace Tillyard
- 1 Goldsmith's College, London, United Kingdom
- 2 Innovating Health International, Port-au-Prince, Haiti
| | - Vincent DeGennaro
- 2 Innovating Health International, Port-au-Prince, Haiti
- 3 University of Florida, Gainesville, Florida, USA
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13
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Bonsu AB, Ncama BP. Integration of breast cancer prevention and early detection into cancer palliative care model. PLoS One 2019; 14:e0212806. [PMID: 30893313 PMCID: PMC6426220 DOI: 10.1371/journal.pone.0212806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/08/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Breast cancer is common among Ghanaian women. Late stage presentation has been credited to knowledge deficit and lack of breast cancer prevention and early detection services for women. OBJECTIVE This study aimed to develop a model to facilitate the integration of breast cancer prevention and early detection into cancer palliative care. METHOD This study used synthesized concepts emerging from a single case study research. The case was a tertiary health care facility, embedded with sub-units of analysis. Mixed-method approach was used to collect data from 102 participants. The study examined the experiences and views of the participants on breast cancer and screening pathways in Ghana. Thematic analysis and descriptive statistics ware used to analyze the qualitative and quantitative data respectively. This was followed with a cross-case analysis across the sub-units of analysis. A theory development approach was further used towards the development of a model, following three steps: concept analysis, statement synthesis and theory synthesis. RESULTS Six key concepts synthesized from the data were used to develop the model: initiate and sustain breast cancer prevention and early detection program, collaboration of health professionals, patients, families and micro-communities, conducive environment of the health care facility and needed resources, actions, services, and lastly diffusing innovation into the community through agents. CONCLUSION A model has been developed based on the experiences shared by women diagnosed with advanced breast cancer, their first degree relatives, micro-communities as well as clinicians working in a palliative care setting. This model will aid clinicians to provide breast cancer education, teach breast self-examination and offer clinical breast examination to families and micro-communities of advanced breast cancer patients receiving supportive care in a resource-limited setting.
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Affiliation(s)
- Adwoa Bemah Bonsu
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Busisiwe Purity Ncama
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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14
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Black E, Richmond R. Improving early detection of breast cancer in sub-Saharan Africa: why mammography may not be the way forward. Global Health 2019; 15:3. [PMID: 30621753 PMCID: PMC6325810 DOI: 10.1186/s12992-018-0446-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/07/2018] [Indexed: 12/13/2022] Open
Abstract
Background and methods The prevention and control of breast cancer in sub-Saharan Africa (SSA) is an increasingly critical public health issue. Breast cancer is the most frequent female cancer in SSA and mortality rates from this disease are the highest globally. Breast cancer has traditionally been considered a disease of high-income countries, and programs for early detection have been developed and implemented in these settings. However, screening programs for breast cancer in SSA have been less effective than in high-income countries. This article reviews the literature on breast cancer in SSA, focusing on early detection practices. It then examines the case for and against mammography and other early detection approaches for breast cancer in SSA. Results Women with breast cancer in SSA are younger compared with high-income countries. Most women present with advanced disease and because treatment options are limited, have poor prognoses. Delay between symptom onset and healthcare seeking is common. Engagement with early detection practices such as mammography and breast examination is low and contributes to late stage at diagnosis. Discussion While early detection of breast cancer through screening has contributed to important reductions in mortality in many high-income countries, most countries in SSA have not been able to implement and sustain screening programs due to financial, logistical and sociocultural constraints. Mammography is widely used in high-income countries but has several limitations in SSA and is likely to have a higher harm-to-benefit ratio. Breast self-examination and clinical breast examination are alternative early detection methods which are more widely used by women in SSA compared with mammography, and are less resource intensive. An alternative approach to breast cancer screening programs for SSA is clinical downstaging, where the focus is on detecting breast cancer earlier in symptomatic women. Evidence demonstrates effectiveness of clinical downstaging among women presenting with late stage disease. Conclusions Approaches for early detection of breast cancer in SSA need to be context-specific. While screening programs with mammography have been effective in high-income countries, evidence suggests that other strategies might be equally important in reducing mortality from breast cancer, particularly in low-resource settings. There is a strong argument for further research into the feasability and acceptability of clinical downstaging for the control of breast cancer in SSA. Electronic supplementary material The online version of this article (10.1186/s12992-018-0446-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eleanor Black
- School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, 2052, Australia.
| | - Robyn Richmond
- School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, 2052, Australia
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15
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Bonsu AB, Ncama BP, Bonsu KO. Breast cancer knowledge, beliefs, attitudes and screening efforts by micro-community of advanced breast cancer patients in Ghana. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.100155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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16
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Clinicians’ experiences and perspectives of breast cancer and possible integration of breast cancer prevention and early detection into palliative care. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.100162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Wu TY, Lee J. Promoting Breast Cancer Awareness and Screening Practices for Early Detection in Low-Resource Settings. Eur J Breast Health 2018; 15:18-25. [PMID: 30816360 DOI: 10.5152/ejbh.2018.4305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/14/2018] [Indexed: 12/12/2022]
Abstract
Objective Breast cancer is the most common type of cancer among women in the Philippines. Philippines has one of the highest breast cancer mortality rate and the lowest mortality-to-incidence ratio in Asia. This study has three objectives: 1) explore Filipino women's knowledge, attitudes toward, and practices of breast cancer and cancer screening, 2) examine if an educational program increases women's intention to seek future breast cancer screening, and 3) examine associations between demographic variables and breast cancer screening practices. Materials and Methods A total of 944 women from two urban areas (Calasciao and Tacloban City) and one rural area (Sogood) of the Philippines participated in this cross-sectional study. Study participants attended an educational program and completed study questionnaires regarding demographics, knowledge about, and practices of breast self-exams, clinical breast exams and mammography as well as reported barriers toward future screening. Results The results showed a disparity between knowledge of routine breast cancer screening and actuals screening behaviors. Following breast health education and screening programs, participants reported greater intention to adhere to recommended breast cancer screening guidelines. The multivariate analyses showed that education level is a significant predictor for CBE and mammography uptake in current study. Conclusion This study has implications for breast cancer control among women in low-resources settings. Designing and implementing effective educational programs that increase women's awareness about breast cancer and promote screening uptake are important steps to reduce the burden affected by breast cancer among women in the Philippines and other South Asian low- to middle-income countries.
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Affiliation(s)
- Tsu-Yin Wu
- Department of Nursing, Eastern Michigan University School of Nursing, MI, USA
| | - Joohyun Lee
- Department of Mental Health Behavioral Sciences, James A. Haley VA Medical Center, Tempa, FL
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18
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McKenzie F, Zietsman A, Galukande M, Anele A, Adisa C, Parham G, Pinder L, Dos Santos Silva I, McCormack V. Breast cancer awareness in the sub-Saharan African ABC-DO cohort: African Breast Cancer-Disparities in Outcomes study. Cancer Causes Control 2018; 29:721-730. [PMID: 29980984 DOI: 10.1007/s10552-018-1047-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 06/02/2018] [Indexed: 10/28/2022]
Abstract
A greater understanding of the nature and drivers of poor breast cancer (BC) awareness in sub-Saharan Africa (SSA) will inform much needed awareness programmes. We aimed to assess the level and nature of BC awareness in the multi-country African Breast Cancer-Disparities in Outcome (ABC-DO) cohort of women newly diagnosed with BC during 2014-2017. Awareness indicators were assessed during a baseline interview at/near diagnosis. Logistic/ordinal regression was used to estimate odds ratios (OR) for indicators of BC awareness in relation to woman-level characteristics for individual settings and then meta-analyzed. In the 1,451 women included, almost all Namibian non-black women (n = 104) knew of BC and its curability, while in Namibian black and Zambian women, one in 7 (~ 15%) had not previously heard of BC and 25-40% did not know it was curable. In Uganda and Nigeria awareness was lowest: one in four women had no BC awareness, and 2 in 3 had no knowledge of its cure potential. Low educational level, unskilled employment, low socioeconomic position, rural residence, older age, being unmarried, and in some settings HIV-positivity, were associated with lower BC awareness-e.g., having unskilled employment was associated with not having heard of BC (summary OR 3.37; 95% confidence interval (CI) 2.17-5.23), believing that it is incurable (2.43; 1.81-3.26), and not recognizing a breast lump symptom (1.85; 1.41-2.43) but with between-setting variation (I2 > 68% for all). The findings provide evidence of the level and difference in BC awareness and beliefs across different settings, highlighting the urgent need for context-specific education programmes in the SSA region.
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Affiliation(s)
- Fiona McKenzie
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France.
| | | | | | | | - Charles Adisa
- Abia State University Teaching Hospital, Aba, Nigeria
| | | | | | - Isabel Dos Santos Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Valerie McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
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19
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McKenzie F, Zietsman A, Galukande M, Anele A, Adisa C, Parham G, Pinder L, Cubasch H, Joffe M, Kidaaga F, Lukande R, Offiah AU, Egejuru RO, Shibemba A, Schuz J, Anderson BO, dos Santos Silva I, McCormack V. Drivers of advanced stage at breast cancer diagnosis in the multicountry African breast cancer - disparities in outcomes (ABC-DO) study. Int J Cancer 2018; 142:1568-1579. [PMID: 29197068 PMCID: PMC5838525 DOI: 10.1002/ijc.31187] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 01/25/2023]
Abstract
Breast cancer (BC) survival rates in sub-Saharan Africa (SSA) are low in part due to advanced stage at diagnosis. As one component of a study of the entire journey of SSA women with BC, we aimed to identify shared and setting-specific drivers of advanced stage BC. Women newly diagnosed in the multicountry African Breast Cancer-Disparities in Outcomes (ABC-DO) study completed a baseline interview and their stage information was extracted from medical records. Ordinal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for advanced stage (I, II, III, IV) in relation to individual woman-level, referral and biological factors. A total of 1795 women were included from Nigeria, Uganda, Zambia, and the multiracial populations of Namibia and South Africa, 1091 of whom (61%) were stage III/IV. Stage was lower in women with greater BC knowledge (OR 0.77 (95% CI: 0.70, 0.85) per point on a 6 point scale). More advanced stage was associated with being black (4.00 (2.79, 5.74)), having attended
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Affiliation(s)
- Fiona McKenzie
- Section of Environment and RadiationInternational Agency for Research on CancerLyonFrance
| | | | | | | | | | | | | | - Herbert Cubasch
- University of the Witwatersrand, Chris Hani Baragwanath Academic HospitalJohannesburgSouth Africa
| | - Maureen Joffe
- University of the Witwatersrand, Chris Hani Baragwanath Academic HospitalJohannesburgSouth Africa
| | | | | | | | | | | | - Joachim Schuz
- Section of Environment and RadiationInternational Agency for Research on CancerLyonFrance
| | | | - Isabel dos Santos Silva
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Valerie McCormack
- Section of Environment and RadiationInternational Agency for Research on CancerLyonFrance
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20
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Mishra GS, Bhatt SH. Novel Program of Using Village Health Workers in Early Detection and Awareness of Head and Neck Cancers: Audit of a Community Screening Program. Indian J Otolaryngol Head Neck Surg 2017; 69:488-493. [PMID: 29238679 DOI: 10.1007/s12070-017-1231-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023] Open
Abstract
Head and neck cancers together (oral cavity, pharynx and larynx) are sixth commonest worldwide and are the commonest cancers in developing countries. The Cancer Project was started in Kheda/Anand, Gujarat, a harvest land of tobacco. The objective of this programme was to indoctrinate the most vulnerable and the least tended upon; the basics of head and neck cancers via the medium of their own kins. Voluntary village health workers were educated and trained to pick up the early signs of head and neck cancers. Oral self examination was taught to them and they went to peripheral villages to screen the population. They would refer suspicious cases to tertiary healthcare centre. The population was enlightened upon the basics of preventable measures, treatment options and rehabilitation facilities for head and neck cancer patients. Knowledge, attitude and practice analysis was done in the population which showed widespread disbelief and false practices. A population of 26,10,432 was surveyed in 1862 villages of which 10,522 (1.1%) individuals successfully quit the habit. The minimally educated workers referred 3309 suspicious individuals to higher centre of which 1890 (57.11%) tested positive for cancer. A lot of resource is put in research and development of rapid diagnosis and complete cure; however such a minimally costing program may help the most in primordial, primary and secondary level of prevention. Such programs should be advocated on the global platform on lines of Breast Self Examination.
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Affiliation(s)
- Girish S Mishra
- Department of Otorhinolaryngology and Head and Neck Surgery, ENT OPD # 214, Shri Krishna Hospital & Pramukh Swami Medical College, Karamsad, Anand, Gujarat 388325 India
| | - Sushen H Bhatt
- Department of Otorhinolaryngology and Head and Neck Surgery, ENT OPD # 214, Shri Krishna Hospital & Pramukh Swami Medical College, Karamsad, Anand, Gujarat 388325 India
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Gyedu A, Gaskill CE, Boakye G, Abdulai AR, Anderson BO, Stewart B. Differences in Perception of Breast Cancer Among Muslim and Christian Women in Ghana. J Glob Oncol 2017; 4:1-9. [PMID: 30241158 PMCID: PMC6180842 DOI: 10.1200/jgo.2017.009910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The burden of breast cancer continues to increase in low- and middle-income
countries (LMICs), where women present with more advanced disease and have
worse outcomes compared with women from high-income countries. In the
absence of breast cancer screening in LMICs, patients must rely on
self-detection for early breast cancer detection, followed by a prompt
clinical diagnostic work-up. Little is known about the influence of
religious beliefs on women’s perceptions and practices of breast
health. Methods A cross-sectional survey was administered to female members of Islamic and
Christian organizations in Ghana. Participants were asked about their
personal experience with breast concerns, knowledge of breast cancer,
performance of breast self-examination, and experience with clinical breast
exam. Results The survey was administered to 432 Muslim and 339 Christian women. Fewer
Muslim women knew someone with breast cancer (31% v 66%;
P < .001) or had previously identified a
concerning mass in their breast (16% v 65%;
P < .001). Both groups believed that new breast
masses should be evaluated at clinic (adjusted odds ratio [AOR], 1.08; 95%
CI, 0.58 to 2.01), but Muslim women were less likely to know that breast
cancer can be effectively treated (AOR, 0.34; 95% CI, 0.23 to 0.50). Muslim
women were less likely to have performed breast self-examination (AOR, 0.51;
95% CI, 0.29 to 0.88) or to have undergone clinical breast exam (AOR, 0.48;
95% CI, 0.27 to 0.84). Conclusion Muslim women were found to be less likely to participate in breast health
activities compared with Christian women, which highlights the need to
consider how religious customs within subpopulations might impact a
woman’s engagement in breast health activities. As breast awareness
initiatives are scaled up in Ghana and other LMICs, it is essential to
consider the unique perception and participation deficits of specific
groups.
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Affiliation(s)
- Adam Gyedu
- Adam Gyedu, Godfred Boakye, Abdul Rashid Abdulai, and Barclay Stewart, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; and Cameron E. Gaskill, Benjamin O. Anderson, and Barclay Stewart, University of Washington, Seattle, WA
| | - Cameron E Gaskill
- Adam Gyedu, Godfred Boakye, Abdul Rashid Abdulai, and Barclay Stewart, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; and Cameron E. Gaskill, Benjamin O. Anderson, and Barclay Stewart, University of Washington, Seattle, WA
| | - Godfred Boakye
- Adam Gyedu, Godfred Boakye, Abdul Rashid Abdulai, and Barclay Stewart, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; and Cameron E. Gaskill, Benjamin O. Anderson, and Barclay Stewart, University of Washington, Seattle, WA
| | - Abdul Rashid Abdulai
- Adam Gyedu, Godfred Boakye, Abdul Rashid Abdulai, and Barclay Stewart, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; and Cameron E. Gaskill, Benjamin O. Anderson, and Barclay Stewart, University of Washington, Seattle, WA
| | - Benjamin O Anderson
- Adam Gyedu, Godfred Boakye, Abdul Rashid Abdulai, and Barclay Stewart, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; and Cameron E. Gaskill, Benjamin O. Anderson, and Barclay Stewart, University of Washington, Seattle, WA
| | - Barclay Stewart
- Adam Gyedu, Godfred Boakye, Abdul Rashid Abdulai, and Barclay Stewart, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; and Cameron E. Gaskill, Benjamin O. Anderson, and Barclay Stewart, University of Washington, Seattle, WA
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Jedy-Agba E, McCormack V, Olaomi O, Badejo W, Yilkudi M, Yawe T, Ezeome E, Salu I, Miner E, Anosike I, Adebamowo SN, Achusi B, Dos-Santos-Silva I, Adebamowo C. Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors. Cancer Causes Control 2017; 28:685-697. [PMID: 28447308 PMCID: PMC5492222 DOI: 10.1007/s10552-017-0894-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/09/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Advanced stage at diagnosis is a common feature of breast cancer in Sub-Saharan Africa (SSA), contributing to poor survival rates. Understanding its determinants is key to preventing deaths from this cancer in SSA. METHODS Within the Nigerian Integrative Epidemiology of Breast Cancer Study, a multicentred case-control study on breast cancer, we studied factors affecting stage at diagnosis of cases, i.e. women diagnosed with histologically confirmed invasive breast cancer between January 2014 and July 2016 at six secondary and tertiary hospitals in Nigeria. Stage was assessed using clinical and imaging methods. Ordinal logistic regression was used to examine associations of sociodemographic, breast cancer awareness, health care access and clinical factors with odds of later stage (I, II, III or IV) at diagnosis. RESULTS A total of 316 women were included, with a mean age (SD) of 45.4 (11.4) years. Of these, 94.9% had stage information: 5 (1.7%), 92 (30.7%), 157 (52.4%) and 46 (15.3%) were diagnosed at stages I, II, III and IV, respectively. In multivariate analyses, lower educational level (odds ratio (OR) 2.35, 95% confidence interval: 1.04, 5.29), not believing in a cure for breast cancer (1.81: 1.09, 3.01), and living in a rural area (2.18: 1.05, 4.51) were strongly associated with later stage, whilst age at diagnosis, tumour grade and oestrogen receptor status were not. Being Muslim (vs. Christian) was associated with lower odds of later stage disease (0.46: 0.22, 0.94). CONCLUSION Our findings suggest that factors that are amenable to intervention concerning breast cancer awareness and health care access, rather than intrinsic tumour characteristics, are the strongest determinants of stage at diagnosis in Nigerian women.
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Affiliation(s)
- Elima Jedy-Agba
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Valerie McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | | | - Wunmi Badejo
- National Hospital Abuja, Nigeria, Abuja, Nigeria
| | - Monday Yilkudi
- University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - Terna Yawe
- University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | | | - Iliya Salu
- Asokoro District Hospital, Abuja, Nigeria
| | | | | | - Sally N Adebamowo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD, USA
| | | | - Isabel Dos-Santos-Silva
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clement Adebamowo
- Institute of Human Virology, University of Maryland and Marlene and Stewart Greenebaum Comprehensive Cancer Centre, Baltimore, MD, USA
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Scheel JR, Molina Y, Patrick DL, Anderson BO, Nakigudde G, Lehman CD, Thompson B. Breast Cancer Downstaging Practices and Breast Health Messaging Preferences Among a Community Sample of Urban and Rural Ugandan Women. J Glob Oncol 2017; 3:105-113. [PMID: 28503660 PMCID: PMC5424549 DOI: 10.1200/jgo.2015.001198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Among a community sample of Ugandan women, we provide information about breast cancer downstaging practices (breast self-examination, clinical breast examination [CBE]) and breast health messaging preferences across sociodemographic, health care access, and prior breast cancer exposure factors. METHODS Convenience-based sampling was conducted to recruit Ugandan women age 25 years and older to assess breast cancer downstaging practices as well as breast health messaging preferences to present early for a CBE in the theoretical scenario of self-detection of a palpable lump (breast health messaging preferences). RESULTS The 401 Ugandan women who participated in this survey were mostly poor with less than a primary school education. Of these women, 27% had engaged in breast self-examination, and 15% had undergone a CBE. Greater breast cancer downstaging practices were associated with an urban location, higher education, having a health center as a regular source of care, and receiving breast cancer education (P < .05). Women indicated a greater breast health messaging preference from their provider (66%). This preference was associated with a rural location, having a health center as a regular source of care, and receiving breast cancer education (P < .05). CONCLUSION Most Ugandan women do not participate in breast cancer downstaging practices despite receipt of breast cancer education. However, such education increases downstaging practices and preference for messaging from their providers. Therefore, efforts to downstage breast cancer in Uganda should simultaneously raise awareness in providers and support improved education efforts in the community.
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Affiliation(s)
- John R Scheel
- University of Washington; Seattle Cancer Care Alliance
| | | | | | - Benjamin O Anderson
- University of Washington; Fred Hutchinson Cancer Research Center, Seattle, WA
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Thomas AS, Kidwell KM, Oppong JK, Adjei EK, Osei-Bonsu E, Boahene A, Jiggae E, Gyan K, Merajver SD. Breast Cancer in Ghana: Demonstrating the Need for Population-Based Cancer Registries in Low- and Middle-Income Countries. J Glob Oncol 2017; 3:765-772. [PMID: 29244986 PMCID: PMC5735963 DOI: 10.1200/jgo.2016.006098] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Breast cancer, the most common cancer worldwide, is the leading cause of
cancer mortality in Ghanaian women. Previous studies find Ghanaian women are
diagnosed at a younger age and at more advanced stages (III and IV), and
have tumors with characteristics similar to African American women. We
sought to remedy gaps in knowledge about breast cancer survival in Ghana and
its relation to demographic and biologic factors of the tumors at diagnosis
to assist in cancer control and registration planning. Methods Individuals with a breast cancer diagnosis who sought care at Komfo Anokye
Teaching Hospital from 2009 to 2014 were identified via medical records.
Follow-up telephone interviews were held to assess survival. Kaplan-Meier
plots and Cox proportional hazards models assessed survival associated with
clinical and demographic characteristics. Results A total of 223 patients completed follow-up and were analyzed. The median
survival was 3.8 years. Approximately 50% of patients were diagnosed with
grade 3 tumors, which significantly increased the risk of recurrence or
death (hazard ratio [HR] for grade 2 versus 1, 2.98; 95% CI, 1.26 to 7.02;
HR grade 3 v 1, 2.56; 95% CI, 1.08 to 6.07;
P = .04). No other variables were significantly
associated with survival. Conclusion Higher tumor grade was significantly associated with shorter survival,
indicating impact of aggressive biology at diagnosis on higher risk of
cancer spread and recurrence. Contrary to prevailing notions, telephone
numbers were not reliable for follow-up. Collecting additional contact
information will likely contribute to improvements in patient care and
tracking. A region-wide population-based active registry is important to
implement cancer control programs and improve survival in sub-Saharan
Africa.
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Affiliation(s)
- Abigail S Thomas
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Kelley M Kidwell
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Joseph K Oppong
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Ernest K Adjei
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Ernest Osei-Bonsu
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Angela Boahene
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Evelyn Jiggae
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Kofi Gyan
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Sofia D Merajver
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
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O'Mahony M, Comber H, Fitzgerald T, Corrigan MA, Fitzgerald E, Grunfeld EA, Flynn MG, Hegarty J. Interventions for raising breast cancer awareness in women. Cochrane Database Syst Rev 2017; 2:CD011396. [PMID: 28185268 PMCID: PMC6464597 DOI: 10.1002/14651858.cd011396.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Breast cancer continues to be the most commonly diagnosed cancer in women globally. Early detection, diagnosis and treatment of breast cancer are key to better outcomes. Since many women will discover a breast cancer symptom themselves, it is important that they are breast cancer aware i.e. have the knowledge, skills and confidence to detect breast changes and present promptly to a healthcare professional. OBJECTIVES To assess the effectiveness of interventions for raising breast cancer awareness in women. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialised Register (searched 25 January 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 12) in the Cochrane Library (searched 27 January 2016), MEDLINE OvidSP (2008 to 27 January 2016), Embase (Embase.com, 2008 to 27 January 2016), the World Health Organization's International Clinical Trials Registry Platform (ICTRP) search portal and ClinicalTrials.gov (searched 27 Feburary 2016). We also searched the reference lists of identified articles and reviews and the grey literature for conference proceedings and published abstracts. No language restriction was applied. SELECTION CRITERIA Randomised controlled trials (RCTs) focusing on interventions for raising women's breast cancer awareness i.e. knowledge of potential breast cancer symptoms/changes and the confidence to look at and feel their breasts, using any means of delivery, i.e. one-to-one/group/mass media campaign(s). DATA COLLECTION AND ANALYSIS Two authors selected studies, independently extracted data and assessed risk of bias. We reported the odds ratio (OR) and 95% confidence intervals (CIs) for dichotomous outcomes and mean difference (MD) and standard deviation (SD) for continuous outcomes. Since it was not possible to combine data from included studies due to their heterogeneity, we present a narrative synthesis. We assessed the quality of evidence using GRADE methods. MAIN RESULTS We included two RCTs involving 997 women: one RCT (867 women) randomised women to receive either a written booklet and usual care (intervention group 1), a written booklet and usual care plus a verbal interaction with a radiographer or research psychologist (intervention group 2) or usual care (control group); and the second RCT (130 women) randomised women to either an educational programme (three sessions of 60 to 90 minutes) or no intervention (control group). Knowledge of breast cancer symptomsIn the first study, knowledge of non-lump symptoms increased in intervention group 1 compared to the control group at two years postintervention, but not significantly (OR 1.1, 95% CI 0.7 to 1.6; P = 0.66; 449 women; moderate-quality evidence). Similarly, at two years postintervention, knowledge of symptoms increased in the intervention group 2 compared to the control group but not significantly (OR 1.4, 95% CI 0.9 to 2.1; P = 0.11; 434 women; moderate-quality evidence). In the second study, women's awareness of breast cancer symptoms had increased one month post intervention in the educational group (MD 3.45, SD 5.11; 65 women; low-quality evidence) compared to the control group (MD -0.68, SD 5.93; 65 women; P < 0.001), where there was a decrease in awareness. Knowledge of age-related riskIn the first study, women's knowledge of age-related risk of breast cancer increased, but not significantly, in intervention group 1 compared to control at two years postintervention (OR 1.8; 95% CI 0.9 to 3.5; P < 0.08; 447 women; moderate-quality evidence). Women's knowledge of risk increased significantly in intervention group 2 compared to control at two years postintervention (OR 4.8, 95% CI 2.6 to 9.0; P < 0.001; 431 women; moderate-quality evidence). In the second study, women's perceived susceptibility (how at risk they considered themselves) to breast cancer had increased significantly one month post intervention in the educational group (MD 1.31, SD 3.57; 65 women; low-quality evidence) compared to the control group (MD -0.55, SD 3.31; 65 women; P = 0.005), where a decrease in perceived susceptibility was noted. Frequency of Breast CheckingIn the first study, no significant change was noted for intervention group 1 compared to control at two years postintervention (OR 1.1, 95% CI 0.8 to 1.6; P = 0.54; 457 women; moderate-quality evidence). Monthly breast checking increased, but not significantly, in intervention group 2 compared to control at two years postintervention (OR 1.3, 95% CI 0.9 to 1.9; P = 0.14; 445 women; moderate-quality evidence). In the second study, women's breast cancer preventive behaviours increased significantly one month post intervention in the educational group (MD 1.21, SD 2.54; 65 women; low-quality evidence) compared to the control group (MD 0.15, SD 2.94; 65 women; P < 0.045). Breast Cancer AwarenessWomen's overall breast cancer awareness did not change in intervention group 1 compared to control at two years postintervention (OR 1.8, 95% CI 0.6 to 5.30; P = 0.32; 435 women; moderate-quality evidence) while overall awareness increased in the intervention group 2 compared to control at two years postintervention (OR 8.1, 95% CI 2.7 to 25.0; P < 0.001; 420 women; moderate-quality evidence). In the second study, there was a significant increase in scores on the Health Belief Model (that included the constructs of awareness and perceived susceptibility) at one month postintervention in the educational group (mean 1.21, SD 2.54; 65 women) compared to the control group (mean 0.15, SD 2.94; 65 women; P = 0.045).Neither study reported outcomes relating to motivation to check their breasts, confidence to seek help, time from breast symptom discovery to presentation to a healthcare professional, intentions to seek help, quality of life, adverse effects of the interventions, stages of breast cancer, survival estimates or breast cancer mortality rates. AUTHORS' CONCLUSIONS Based on the results of two RCTs, a brief intervention has the potential to increase women's breast cancer awareness. However, findings of this review should be interpreted with caution, as GRADE assessment identified moderate-quality evidence in only one of the two studies reviewed. In addition, the included trials were heterogeneous in terms of the interventions, population studied and outcomes measured. Therefore, current evidence cannot be generalised to the wider context. Further studies including larger samples, validated outcome measures and longitudinal approaches are warranted.
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Affiliation(s)
- Máirín O'Mahony
- University College CorkSchool of Nursing & Midwifery, Brookfield Health Sciences ComplexCollege RoadCorkIreland
| | - Harry Comber
- University College CorkCork Specialist Training Programme for General Practice3 BloomfieldCorkIreland
| | - Tony Fitzgerald
- University College CorkDepartment of Epidemiology and Public HealthBrookfield Health Sciences ComplexCorkIreland
| | - Mark A Corrigan
- Cork University HospitalDepartment of SurgeryWilton RoadCorkIreland
| | | | - Elizabeth A Grunfeld
- Coventry UniversityCentre for Technology Enabled Health Research (CTEHR)CoventryUKCV1 5FB
| | - Maura G Flynn
- University College CorkNursing and Midwifery, Boston Scientific Health Sciences Library, Brookfield Health Sciences ComplexCollege RoadCorkIreland
| | - Josephine Hegarty
- University College CorkSchool of Nursing & Midwifery, Brookfield Health Sciences ComplexCollege RoadCorkIreland
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Kohler RE, Miller AR, Gutnik L, Lee CN, Gopal S. Experiences and perceptions regarding clinical breast exam screening by trained laywomen in Malawi. Cancer Causes Control 2017; 28:137-143. [PMID: 28097471 DOI: 10.1007/s10552-016-0844-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 12/20/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Despite the increasing burden, breast cancer control in sub-Saharan Africa is insufficient. Late diagnosis and lack of early detection and screening services contribute to high mortality. Clinical breast exam (CBE) screening can be valuable in low-income countries, including use of community health workers and non-health professionals to conduct exams. We assessed experiences of women who underwent CBE screening by trained laywomen in Lilongwe, Malawi, as part of a pilot program. METHODS The pilot study invited women attending urban health clinics to a breast cancer educational talk followed by CBE screening by trained laywomen. We purposively sampled participants from the pilot study and interviewed them about the screening experience and future cancer education programs and services. RESULTS Overall participants had positive experiences and were willing to undergo CBE screening by trained laywomen. Participants were motivated by the educational talk, shared newly acquired cancer knowledge with their social networks, and encouraged others to seek screening. Screened women suggested strategies for future interventions including combining breast and cervical cancer screening, using female providers, partnering with community leaders to increase uptake, and expanding services into the community. CONCLUSIONS Asymptomatic Malawian women accepted CBE screening by trained laywomen and considered breast cancer an important health issue. Women appreciated combined education and screening services and proposed further linkage of breast and cervical cancer screening. Based on our results, training laywomen to educate the public on breast cancer and conduct CBE is a feasible breast cancer control strategy in sub-Saharan Africa.
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Affiliation(s)
- Racquel E Kohler
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02115, USA.
| | - Anna R Miller
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27514, USA
| | - Lily Gutnik
- Department of Surgery, University of Utah, 30 North 1900 East, 3B 110 School of Medicine, Salt Lake City, UT, 84132, USA
| | - Clara N Lee
- Department of Surgery, University of North Carolina at Chapel Hill, 7041 Burnett-Womack, Chapel Hill, NC, 27599-7195, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Satish Gopal
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27514, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,UNC Project-Malawi, Lilongwe, Malawi
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Brinton L, Figueroa J, Adjei E, Ansong D, Biritwum R, Edusei L, Nyarko KM, Wiafe S, Yarney J, Addai BW, Awuah B, Clegg-Lamptey JN. Factors contributing to delays in diagnosis of breast cancers in Ghana, West Africa. Breast Cancer Res Treat 2016; 162:105-114. [PMID: 28025716 DOI: 10.1007/s10549-016-4088-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/15/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Late diagnoses and poor prognoses of breast cancer are common throughout Africa. METHODS To identify responsible factors, we utilized data from a population-based case-control study involving 1184 women with breast malignancies conducted in three hospitals in Accra and Kumasi, Ghana. Interviews focused on potential breast cancer risk factors as well as factors that might contribute to presentation delays. We calculated odds ratios (OR) and 95% confidence intervals (CI) comparing malignances with biopsy masses larger than 5 cm. (62.4% of the 1027 cases with measurable lesions) to smaller lesions. RESULTS In multivariate analyses, strong predictors of larger masses were limited education (OR 1.96, 95% CI 1.32-2.90 <primary vs. ≥senior secondary school), being separated/divorced or widowed (1.75, 1.18-2.60 and 2.25, 1.43-3.55, respectively, vs. currently married), delay in care seeking after onset of symptoms (2.64, 1.77-3.95 for ≥12 vs. ≤2 months), care having initially been sought from someone other than a doctor/nurse (1.86, 0.85-4.09), and frequent use of herbal medications/treatment (1.51, 0.95-2.43 for ≥3x/day usage vs. none). Particularly high risks associated with these factors were found among less educated women; for example, women with less than junior secondary schooling who delayed seeking care for breast symptoms for 6 months or longer were at nearly 4-times the risk of more educated women who promptly sought assistance. CONCLUSIONS Our findings suggest that additional communication, particularly among less educated women, could promote earlier breast cancer diagnoses. Involvement of individuals other than medical practitioners, including traditional healers, may be helpful in this process.
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Affiliation(s)
- Louise Brinton
- National Cancer Institute, 9609 Medical Center Drive, Room 7E-442, MSC 9776, Bethesda, MD, 20892-9776, USA.
| | - Jonine Figueroa
- National Cancer Institute, 9609 Medical Center Drive, Room 7E-442, MSC 9776, Bethesda, MD, 20892-9776, USA.,University of Edinburgh, Edinburgh, Scotland, UK
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Balouchi A, Shahdadi H, AlKhasawneh E, Abdollahimohammad A, Firouzkouhi M, Sarani H, Gorgij A. Rural Women's Awareness about Breast Cancer in Southeastern Iran: a Cross-Sectional Study. Asian Pac J Cancer Prev 2016; 17:1875-9. [DOI: 10.7314/apjcp.2016.17.4.1875] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Tetteh DA, Faulkner SL. Sociocultural factors and breast cancer in sub-Saharan Africa: implications for diagnosis and management. ACTA ACUST UNITED AC 2016; 12:147-56. [PMID: 26757491 DOI: 10.2217/whe.15.76] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The incidence of breast cancer is on the rise in sub-Saharan Africa (SSA) and efforts at early diagnosis have not been very successful because the public has scant knowledge about the disease, a large percentage of breast cancer cases are diagnosed late and mainly rural SSA women's practice of breast self-examination is poor. In this paper, we argue that an examination of the social and cultural contexts of SSA that influence breast cancer diagnosis and management in the region is needed. We discuss the implications of sociocultural factors, such as gender roles and spirituality, on breast cancer diagnosis and management in SSA.
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Affiliation(s)
- Dinah A Tetteh
- Bowling Green State University, School of Media & Communication, 302 West Hall, Bowling Green, OH 43403, USA
| | - Sandra L Faulkner
- Bowling Green State University, School of Media & Communication, 302 West Hall, Bowling Green, OH 43403, USA.,Bowling Green State University, Women's Gender & Sexuality Studies, 236 Shatzel Hall, Bowling Green, OH 43403, USA
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Kisuya J, Wachira J, Busakhala N, Naanyu V, Chite AF, Omenge O, Otieno G, Keter A, Mwangi A, Inui T. Impact of an educational intervention on breast cancer knowledge in western Kenya. HEALTH EDUCATION RESEARCH 2015; 30:786-796. [PMID: 26336906 DOI: 10.1093/her/cyv043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
Our objective was to assess the effectiveness of educational sessions that accompanied breast cancer screening events in three communities in western Kenya between October and November 2013. Five hundred and thirty-two women were recruited to complete a test of breast cancer-relevant knowledge and randomly allocated to 'pre-test' or 'post-test' groups that immediately preceded or followed participation in the educational sessions. The education was organized as a presentation by health professionals and focused mainly on causes of breast cancer, early and late cancer presentation signs, high-risk groups, screening methods to find early-stage breast cancer, self-breast exam procedures and treatment options for this disease. Participants were invited to ask questions and practice finding nodules in silicone breast models. The median age was 35 years (interquartile range: 28-45), and 86% had not undergone breast cancer screening previously. Many individual items in our test of knowledge showed statistically significant shifts to better-informed responses. When all items in the assessment questionnaire were scored as a 'test', on average there was a 2.80 point (95% CI: 2.38, 3.22) significant improvement in knowledge about breast cancer after the educational session. Our study provides evidence for the effectiveness of an educational strategy carefully tailored for women in these communities in Kenya.
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Affiliation(s)
- J Kisuya
- Academic Model Providing Access to Healthcare (AMPATH) Oncology Institute, P.O Box 4606, Eldoret, Kenya,
| | - J Wachira
- Academic Model Providing Access to Healthcare (AMPATH) Oncology Institute, P.O Box 4606, Eldoret, Kenya
| | - N Busakhala
- Academic Model Providing Access to Healthcare (AMPATH) Oncology Institute, P.O Box 4606, Eldoret, Kenya, Department of Pharmacology
| | - V Naanyu
- Academic Model Providing Access to Healthcare (AMPATH) Oncology Institute, P.O Box 4606, Eldoret, Kenya, Department of Behavioral Sciences
| | - A F Chite
- Academic Model Providing Access to Healthcare (AMPATH) Oncology Institute, P.O Box 4606, Eldoret, Kenya, Department of Medicine and
| | - O Omenge
- Academic Model Providing Access to Healthcare (AMPATH) Oncology Institute, P.O Box 4606, Eldoret, Kenya, Department of Obstetrics and Gynecology, College of Health Sciences, Moi University School of Medicine, Eldoret, Kenya and
| | - G Otieno
- Academic Model Providing Access to Healthcare (AMPATH) Oncology Institute, P.O Box 4606, Eldoret, Kenya
| | - A Keter
- Academic Model Providing Access to Healthcare (AMPATH) Oncology Institute, P.O Box 4606, Eldoret, Kenya
| | - A Mwangi
- Academic Model Providing Access to Healthcare (AMPATH) Oncology Institute, P.O Box 4606, Eldoret, Kenya, Department of Behavioral Sciences
| | - T Inui
- Academic Model Providing Access to Healthcare (AMPATH) Oncology Institute, P.O Box 4606, Eldoret, Kenya, Department of Medicine and Department of Medicine, Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, IN, USA
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Luyeye Mvila G, Postema S, Marchal G, Van Limbergen E, Verdonck F, Matthijs G, Devriendt K, Michils G, Van Ongeval C. From the set-up of a screening program of breast cancer patients to the identification of the first BRCA mutation in the DR Congo. BMC Public Health 2014. [PMID: 25070656 DOI: 10.1186/1471-2458-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Breast cancer incidence in African population is low compared to western countries but the mortality rate is higher and the disease presents at a younger age and at a more advanced stage. The World Health Organisation and the Breast Health Global Initiative concluded that in low and middle income countries early breast cancer detection can be achieved by informing women on symptoms of breast cancer, on the practice of breast self-examination and clinical breast examination by trained health care workers. Based on these recommendations, we set up a breast cancer awareness campaign in Kinshasa, Democratic Republic of Congo (DRC). This paper describes the strategy that was established and the results that were achieved. METHODS A breast cancer awareness campaign was started in 2010 and data were collected until the end of 2012. Clinicians (expert group) trained nurses and health care workers (awareness groups) on clinical, technical and social aspects of breast cancer. Different channels were used to inform women about the campaign and clinical data (on medical and family history) were collected. The participating women were investigated with clinical breast examination by the awareness group. Women in whom a palpable mass was detected were referred to the hospital: they received a mammography and ultrasound and--in case of suspicious findings--additionally a core needle biopsy. In case of a positive family history, a blood sample was taken for genetic investigation. RESULTS In total, 4,315 women participated, resulting in 1,113 radiological breast examinations, performed in the General Hospital of Kinshasa of which 101 turned out to be malignant lesions. Fifty six percent of the women with breast cancer were less than 50 years old and 75% (65/87) were stage III tumors. A BRCA gene mutation was identified in a family with a severe history of breast cancer. CONCLUSIONS Even without financial support, it was possible to start an awareness campaign for breast cancer in Kinshasa. This campaign increased the awareness on cancer of the women in Kinshasa. The results demonstrate that this campaign had an immediate impact on patients and their families.
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Affiliation(s)
- Gertrude Luyeye Mvila
- Kinshasa General Hospital, Kasavubu University, University of Lubumbashi, Lubumbashi, DR, Congo.
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Luyeye Mvila G, Postema S, Marchal G, Van Limbergen E, Verdonck F, Matthijs G, Devriendt K, Michils G, Van Ongeval C. From the set-up of a screening program of breast cancer patients to the identification of the first BRCA mutation in the DR Congo. BMC Public Health 2014; 14:759. [PMID: 25070656 PMCID: PMC4133620 DOI: 10.1186/1471-2458-14-759] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 07/03/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Breast cancer incidence in African population is low compared to western countries but the mortality rate is higher and the disease presents at a younger age and at a more advanced stage. The World Health Organisation and the Breast Health Global Initiative concluded that in low and middle income countries early breast cancer detection can be achieved by informing women on symptoms of breast cancer, on the practice of breast self-examination and clinical breast examination by trained health care workers. Based on these recommendations, we set up a breast cancer awareness campaign in Kinshasa, Democratic Republic of Congo (DRC). This paper describes the strategy that was established and the results that were achieved. METHODS A breast cancer awareness campaign was started in 2010 and data were collected until the end of 2012. Clinicians (expert group) trained nurses and health care workers (awareness groups) on clinical, technical and social aspects of breast cancer. Different channels were used to inform women about the campaign and clinical data (on medical and family history) were collected. The participating women were investigated with clinical breast examination by the awareness group. Women in whom a palpable mass was detected were referred to the hospital: they received a mammography and ultrasound and--in case of suspicious findings--additionally a core needle biopsy. In case of a positive family history, a blood sample was taken for genetic investigation. RESULTS In total, 4,315 women participated, resulting in 1,113 radiological breast examinations, performed in the General Hospital of Kinshasa of which 101 turned out to be malignant lesions. Fifty six percent of the women with breast cancer were less than 50 years old and 75% (65/87) were stage III tumors. A BRCA gene mutation was identified in a family with a severe history of breast cancer. CONCLUSIONS Even without financial support, it was possible to start an awareness campaign for breast cancer in Kinshasa. This campaign increased the awareness on cancer of the women in Kinshasa. The results demonstrate that this campaign had an immediate impact on patients and their families.
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Affiliation(s)
- Gertrude Luyeye Mvila
- />Kinshasa General Hospital, Kasavubu University, University of Lubumbashi, Lubumbashi, DR Congo
- />Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Sandra Postema
- />Department of Radiology, UZ Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Guy Marchal
- />Department of Radiology, UZ Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Erik Van Limbergen
- />Leuven University Centre for Cancer Prevention (LUCK), Leuven, Belgium
| | | | - Gert Matthijs
- />Center for Human Genetics, UZ Leuven and Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Koen Devriendt
- />Center for Human Genetics, UZ Leuven and Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Genevieve Michils
- />Center for Human Genetics, UZ Leuven and Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Chantal Van Ongeval
- />Department of Radiology, UZ Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
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Sait KH, Anfinan NM, Eldeek B, Al-Ahmadi J, Al-Attas M, Sait HK, Basalamah HA, Al-Ama N, El Sayed ME. Perception of Patients with Cancer towards Support Management Services and Use of Complementary Alternative Medicine - a Single Institution Hospital-Based Study in Saudi Arabia. Asian Pac J Cancer Prev 2014; 15:2547-54. [DOI: 10.7314/apjcp.2014.15.6.2547] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ranasinghe HM, Ranasinghe N, Rodrigo C, Seneviratne RDA, Rajapakse S. Awareness of breast cancer among adolescent girls in Colombo, Sri Lanka: a school based study. BMC Public Health 2013; 13:1209. [PMID: 24359310 PMCID: PMC3906911 DOI: 10.1186/1471-2458-13-1209] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 12/17/2013] [Indexed: 11/16/2022] Open
Abstract
Background Breast cancer is the commonest cancer in women worldwide. Although programmes promoting breast cancer awareness are being carried out throughout Sri Lanka, few have targeted school students. We conducted this study to assess the knowledge, attitudes and practices regarding breast cancer with reference to screening, services available, breast self-examination, and sources of information, among adolescent schoolgirls in the Colombo District of Sri Lanka. Methods The knowledge, attitudes and practices related to breast cancer were assessed among 859 adolescent girls in schools within the Colombo District, using a self-administered questionnaire. Classes and students were selected using multi-stage stratified cluster sampling. Results Of the total sample, approximately 60% of respondents identified ‘history of breast lump’, ‘family history of breast cancer’ & ‘exposure to irradiation’ as risk factors for breast cancer. Although most were aware that the presence of a breast lump was an important warning sign, awareness of other warning signs was poor. Only 35.6% identified mammogram as an effective screening method. One third of the sample maintained that they are unaware of symptoms, diagnostics and treatment of breast cancer. Of those who were aware, 90.6% named surgery as a treatment option for breast cancer, 79.4% were unaware that chemotherapy is used. Of the total sample, 17.1% knew how to perform breast self-examination, and only 9.4% were aware of currently available breast cancer screening services. Knowledge was significantly better among students who had a relative with breast cancer. Conclusions There were significant deficiencies in knowledge, attitudes and practices on breast cancer in the study population. In particular, knowledge on breast self examination was poor. There is a need for awareness programs aimed specifically at this important target group.
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Affiliation(s)
| | | | | | | | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo 08, Sri Lanka.
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