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Chanakira EZ, Thomas CV, Balen J, Mandrik O. A systematic review of public health interventions to address breast cancer inequalities in low- and middle-income countries. Syst Rev 2024; 13:195. [PMID: 39054497 PMCID: PMC11271015 DOI: 10.1186/s13643-024-02620-2] [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: 07/17/2023] [Accepted: 07/18/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Breast cancer is the most diagnosed cancer in the world, with a worse prognosis documented in low- and middle-income countries. Inequalities pertaining to breast cancer outcomes are observed at within-country level, with demographics and socioeconomic status as major drivers. AIM This review aims to aggregate all available evidence from low- and middle-income countries on public health interventions that can be utilized to reduce breast cancer inequalities within the breast cancer continuum. METHODS The study was a systematic review and narrative synthesis of available literature, with the literature search conducted between September and October 2021. The search was re-run in September 2022 to update the review. PubMed, Scopus, Embase, African Index Medicus and LILACS were searched, based on predetermined criteria. Randomized controlled trials, cohort studies and quasi-experimental studies were included for review, while studies without an intervention and comparator group were excluded. The Joanna Briggs Institute family of checklists was used for quality assessment of the included studies. Data pertaining to study design, quality control and intervention effectiveness was extracted. RESULTS A total of 915 studies were identified for screening and 21 studies met the selection criteria. Only one study specifically evaluated the impact of an intervention on breast cancer inequalities. Diverse, multi-level interventions that can be utilized to address breast cancer inequalities through targeted application to disadvantaged subpopulations were identified. Educational interventions were found to be effective in improving screening rates, downstaging through early presentation as well as improving time to diagnosis. Interventions aimed at subsidizing or eliminating screening payments resulted in improved screening rates. Patient navigation was highlighted to be effective in improving outcomes throughout the breast cancer continuum. CONCLUSION Findings from the systematic review underline the importance of early detection in breast cancer management for low- and middle-income countries. This can be achieved through a variety of interventions, including population education, and addressing access barriers to public health services such as screening, particularly among under-served populations. This study provides a comprehensive database of public health interventions relevant to low- and middle-income countries that can be utilized for planning and decision-making purposes. Findings from the review highlight an important research gap in primary studies on interventions aimed at reducing breast cancer inequalities in low- and middle-income countries. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42021289643.
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Affiliation(s)
- Esther Z Chanakira
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK.
| | - Chloe V Thomas
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
| | - Julie Balen
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Olena Mandrik
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
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Songiso M, Nuñez O, Cabanes A, Mutale M, Munalula J, Pupwe G, Henry-Tillman R, Parham GP. Three-year survival of breast cancer patients attending a one-stop breast care clinic nested within a primary care health facility in sub-Saharan Africa-Zambia. Int J Cancer 2024; 155:261-269. [PMID: 38525795 PMCID: PMC11096003 DOI: 10.1002/ijc.34920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/26/2024]
Abstract
In Zambia, women with breast symptoms travel through multiple levels of the healthcare system before obtaining a definitive diagnosis. To eradicate this critical barrier to care, we nested a novel breast specialty service platform inside a large public-sector primary healthcare facility in Lusaka, Zambia to offer clinical breast examination, breast ultrasound, and ultrasound-guided core needle biopsy in a one-stop format, tightly linked to referral for treatment. The objective of the study was to determine the life expectancy and survival outcomes of a prospective cohort of women diagnosed with breast cancer who were attended to and followed up at the clinic. The effect of breast cancer stage on prognosis was determined by estimating stage-specific crude survival using the Kaplan-Meier method. Survival analysis was used to estimate mean lifespan according to age and stage at diagnosis. We enrolled 302 women with histologically confirmed breast cancer. The overall 3-year survival was 73%. An increase in patients presenting with early breast cancer and improvements in their survival were observed. Women with early-stage breast cancer had a lifespan similar to the general population, while loss of life expectancy was significant at more advanced stages of disease. Our findings suggest that implementing efficient breast care services at the primary care level can avert a substantial proportion of breast cancer-related deaths. The mitigating factor appears to be stage of disease at the time of diagnosis, the cause of which is multifactorial, with the most influential being delays in the referral process.
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Affiliation(s)
- Mutumba Songiso
- Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
- Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Olivier Nuñez
- National Center of Epidemiology (Pab,12) Instituto de Salud Carlos III Monforte de Lemos 5 28029 Madrid, Spain
| | | | - Mpimpa Mutale
- University of Lusaka, Department of Physiological Sciences, Lusaka, Zambia
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Mahanani MR, Valkov M, Agaeva A, Kaucher S, Pikalova LV, Grishchenko MY, Zhuikova LD, Jaehn P, Winkler V. Comparison of female breast cancer between Russia and Germany: A population-based study on time trends and stage at diagnosis. Cancer Epidemiol 2022; 80:102214. [PMID: 35841762 DOI: 10.1016/j.canep.2022.102214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/14/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES While a mammography-screening program (MSP) is being offered systematically in Germany since 2009, the dispanserizatsiya has been implemented in Russia since 2013. This study examined trends of stage at breast cancer diagnosis in two Russian regions and compared the results with the development in Germany. In addition, we aimed to gain further insights into the early detection of breast cancer in Russia. METHODS Incidence data from two cancer registries in Russia and 12 population-based cancer registries in Germany were used to analyse breast cancer incidence rates among women above age 30 over time. Further, we calculated rate ratios to compare the age group-specific incidence rates after the implementation of MSP in Germany (2010-2014) with the period before implementation (2003-2005) separately for each tumour stage and all stages combined. RESULTS During the study period from 2003 to 2014, age-standardised rates for breast cancer were 54.6 and 116.7 per 100,000 for Russia and Germany, respectively. The proportion of the T1 stage at diagnosis among Russian women aged 50 + is half than that in Germany. Nevertheless, we observed an increasing trend of early-stage alongside the reduction of advanced-stage incidence rates of breast cancer in Russia. CONCLUSIONS The observed trend in Russia may reflect overall positive changes in early detection of breast cancer, with actual proportion of T1 stage still far behind Germany. Advances in breast cancer screening efforts through the dispanserizatsiya may help to further reduce the breast cancer burden.
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Affiliation(s)
- Melani R Mahanani
- Epidemiology of Transition, Heidelberg Institute of Global Health, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Mikhail Valkov
- Department of Radiology, Radiotherapy and Oncology, Northern State Medical University, Trotsky av. 51, Arkhangelsk, Russia
| | - Anna Agaeva
- Department of Radiology, Radiotherapy and Oncology, Northern State Medical University, Trotsky av. 51, Arkhangelsk, Russia
| | - Simone Kaucher
- Epidemiology of Transition, Heidelberg Institute of Global Health, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Lidia V Pikalova
- Population Cancer Register of the Tomsk Region, 634050 Tomsk, Russia
| | | | - Lilia D Zhuikova
- Cancer Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences (RAS), 634050 Tomsk, Russia
| | - Philipp Jaehn
- Brandenburg Medical School Theodor Fontane, Institute of Social Medicine and Epidemiology, 14770 Brandenburg an der Havel, Germany; Brandenburg Medical School Theodor Fontane, Faculty of Health Sciences Brandenburg, Karl-Liebknecht-Str. 24-25, 14467 Potsdam, Germany
| | - Volker Winkler
- Epidemiology of Transition, Heidelberg Institute of Global Health, University Hospital Heidelberg, 69120 Heidelberg, Germany.
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Rubio MA, Mosquera D, Blanco M, Montes F, Finck C, Duval M, Trillos C, Jaramillo AM, Rosas LG, King AC, Sarmiento OL. Cross-sector co-creation of a community-based physical activity program for breast cancer survivors in Colombia. Health Promot Int 2022; 37:6646635. [PMID: 35853152 DOI: 10.1093/heapro/daac073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Benefits of physical activity (PA) in breast cancer survivors (BCS) are well established. However, programs to promote PA among BCS tailored to real-world contexts within low- to middle-income countries are limited. Cross-sector co-creation can be key to effective and scalable programs for BCS in these countries. This study aimed to evaluate the networking process to engage multisector stakeholders in the co-creation of a PA program for Colombian BCS called My Body. We employed a mixed-methods design including semistructured interviews, workshops and a social network analysis of centrality measures to assess stakeholders' engagement, resources and skills enabling the collaborative work, challenges, outcomes and lessons learned. The descriptive analysis and the centrality measures of the network revealed that 19 cross-sector stakeholders engaged in the My Body collaborative network. Through ongoing communication and cooperation, My Body built relationships between the academic lead institutions (local and international), and local and national public, private and academic institutions working in public health, sports and recreation, social sciences and engineering fields. The outcomes included the co-creation of the community-based PA program for BCS, its implementation through cross-sector synergies, increased relationships and communications among stakeholders, and successful dissemination of evidence and project results to the collaboration partners and other relevant stakeholders and community members. The mixed-methods assessment enabled understanding of ways to advance cross-sector co-creation of health promotion programs. The findings can help to enable continued development of sustainable cross-sector co-creation processes aimed at advancing PA promotion.
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Affiliation(s)
- María Alejandra Rubio
- Department of Public Health, School of Medicine, Universidad de los Andes, Carrera 1 #18ª-12, Bogotá, Colombia
| | - Daniela Mosquera
- Department of Public Health, School of Medicine, Universidad de los Andes, Carrera 1 #18ª-12, Bogotá, Colombia
| | - Martha Blanco
- Department of Industrial Engineering, School of Engineering, Universidad de los Andes, Carrera 1 #18ª-12, Bogotá, Colombia
| | - Felipe Montes
- Department of Industrial Engineering, School of Engineering, Universidad de los Andes, Carrera 1 #18ª-12, Bogotá, Colombia
| | - Carolyn Finck
- Department of Psychology, Universidad de los Andes, Carrera 1 #18ª-12, Bogotá, Colombia
| | - Martin Duval
- Department of Public Health, School of Medicine, Universidad de los Andes, Carrera 1 #18ª-12, Bogotá, Colombia
| | - Catalina Trillos
- Department of Public Health, School of Medicine, Universidad de los Andes, Carrera 1 #18ª-12, Bogotá, Colombia
| | - Ana María Jaramillo
- Department of Industrial Engineering, School of Engineering, Universidad de los Andes, Carrera 1 #18ª-12, Bogotá, Colombia
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University School Medicine, Stanford, CA 94305, USA.,Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Abby C King
- Department of Epidemiology and Population Health, Stanford University School Medicine, Stanford, CA 94305, USA.,Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Olga L Sarmiento
- Department of Public Health, School of Medicine, Universidad de los Andes, Carrera 1 #18ª-12, Bogotá, Colombia
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Nnaji CA, Kuodi P, Walter FM, Moodley J. Effectiveness of interventions for improving timely diagnosis of breast and cervical cancers in low-income and middle-income countries: a systematic review. BMJ Open 2022; 12:e054501. [PMID: 35470184 PMCID: PMC9039388 DOI: 10.1136/bmjopen-2021-054501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVES To systematically synthesise available evidence on the nature and effectiveness of interventions for improving timely diagnosis of breast and cervical cancers in low and middle-income countries (LMICs). DESIGN A systematic review of published evidence. The review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses. DATA SOURCES A comprehensive search of published literature was conducted. In addition, relevant grey literature sources and bibliographical references of included studies were searched for potentially eligible evidence. STUDY SELECTION Studies published between January 2010 and November 2020 were eligible for inclusion. To be eligible, studies had to report on interventions/strategies targeted at women, the general public or healthcare workers, aimed at improving the timely diagnosis of breast and/or cervical cancers in LMIC settings. DATA EXTRACTION AND SYNTHESIS Literature search, screening, study selection, data extraction and quality appraisal were conducted by two independent reviewers. Evidence was synthesised and reported using a global taxonomy framework for early cancer diagnosis. RESULTS From the total of 10 593 records identified, 21 studies conducted across 20 LMICs were included in this review. Most of the included studies (16/21) focused primarily on interventions addressing breast cancers; two focused on cervical cancer while the rest examined multiple cancer types. Reported interventions targeted healthcare workers (12); women and adolescent girls (7) and both women and healthcare workers (3). Eight studies reported on interventions addressing access delays; seven focused on interventions addressing diagnostic delays; two reported on interventions targeted at addressing both access and diagnostic delays, and four studies assessed interventions addressing access, diagnostic and treatment delays. While most interventions were demonstrated to be feasible and effective, many of the reported outcome measures are of limited clinical relevance to diagnostic timeliness. CONCLUSIONS Though limited, evidence suggests that interventions aimed at addressing barriers to timely diagnosis of breast and cervical cancer are feasible in resource-limited contexts. Future interventions need to address clinically relevant measures to better assess efficacy of interventions. PROSPERO REGISTRATION NUMBER CRD42020177232.
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Affiliation(s)
- Chukwudi A Nnaji
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
- Cancer Research Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Paul Kuodi
- Department of Public Health, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Fiona M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Wolfson Institute of Population Health, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - Jennifer Moodley
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
- Cancer Research Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
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Díaz-Casas SE, Briceño-Morales X, Puerto-Horta LJ, Lehmann-Mosquera C, Orozco-Ospino MC, Guzmán-AbiSaab LH, Ángel-Aristizábal J, García-Mora M, Duarte-Torres CA, Mariño-Lozano IF, Briceño-Morales C, Sánchez-Pedraza R. OUP accepted manuscript. Oncologist 2022; 27:e142-e150. [PMID: 35641213 PMCID: PMC8895754 DOI: 10.1093/oncolo/oyab023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose About 10% of breast cancer (BC) is diagnosed in stage IV. This study sought to identify factors associated with time to progression (TTP) and overall survival (OS) in a cohort of patients diagnosed with de novo metastatic breast cancer (MBC), from a single cancer center in Colombia, given that information on this aspect is limited. Methodology An observational, analytical, and retrospective cohort study was carried out. Time to progression and OS rates were estimated using the Kaplan–Meier survival functions. Cox models were developed to assess association between time to progression and time to death, using a group of fixed variables. Results Overall, 175 patients were included in the study; 33.7% of patients had luminal B HER2-negative tumors, 49.7% had bone involvement, and 83.4% had multiple metastatic sites. Tumor biology and primary tumor surgery were the variables associated with TTP and OS. Patients with luminal A tumors had the lowest progression and mortality rates (10 per 100 patients/year (95% CI: 5.0-20.0) and 12.6 per 100 patients/year (95% CI: 6.9-22.7), respectively), and patients with triple-negative tumors had the highest progression and mortality rates (40 per 100 patients/year (95% CI: 23.2-68.8) and 44.1 per 100 patients/year (95% CI: 28.1-69.1), respectively). Across the cohort, the median TTP was 2.1 years (95% CI: 1.6; the upper limit cannot be reached) and the median OS was 2.4 years (95% CI: 2-4.3). Conclusions In this cohort, patients with luminal A tumors and those who underwent tumor surgery given that they presented clinical benefit (CB) after initial systemic treatment, had the lowest progression and mortality rates. Overall, OS was inferior to other series due to high tumor burden and difficulties in accessing and continuing oncological treatments.
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Affiliation(s)
- Sandra Esperanza Díaz-Casas
- Breast Unit, National Cancer Institute of Colombia, Bogotá, Colombia
- Corresponding author: Sandra Esperanza Díaz-Casas, Breast and Soft Tissue Unit, National Cancer Institute, Calle 1A #9-85, Bogotá, DC 110321, Colombia. Tel: +57 310 819 7384;
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Figueroa JD, Gray E, Pashayan N, Deandrea S, Karch A, Vale DB, Elder K, Procopio P, van Ravesteyn NT, Mutabi M, Canfell K, Nickson C. The impact of the Covid-19 pandemic on breast cancer early detection and screening. Prev Med 2021; 151:106585. [PMID: 34217412 PMCID: PMC8241687 DOI: 10.1016/j.ypmed.2021.106585] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic affects mortality and morbidity, with disruptions expected to continue for some time, with access to timely cancer-related services a concern. For breast cancer, early detection and treatment is key to improved survival and longer-term quality of life. Health services generally have been strained and in many settings with population breast mammography screening, efforts to diagnose and treat breast cancers earlier have been paused or have had reduced capacity. The resulting delays to diagnosis and treatment may lead to more intensive treatment requirements and, potentially, increased mortality. Modelled evaluations can support responses to the pandemic by estimating short- and long-term outcomes for various scenarios. Multiple calibrated and validated models exist for breast cancer screening, and some have been applied in 2020 to estimate the impact of breast screening disruptions and compare options for recovery, in a range of international settings. On behalf of the Covid and Cancer Modelling Consortium (CCGMC) Working Group 2 (Breast Cancer), we summarize and provide examples of such in a range of settings internationally, and propose priorities for future modelling exercises. International expert collaborations from the CCGMC Working Group 2 (Breast Cancer) will conduct analyses and modelling studies needed to inform key stakeholders recovery efforts in order to mitigate the impact of the pandemic on early diagnosis and treatment of breast cancer.
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Affiliation(s)
| | - Jonine D Figueroa
- Usher Institute, University of Edinburgh, UK; Institute of Genetics and Cancer, Cancer Research UK Edinburgh Centre, UK.
| | - Ewan Gray
- Institute of Genetics and Cancer, Cancer Research UK Edinburgh Centre, UK
| | - Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Silvia Deandrea
- Directorate General for Health, Lombardy Region, Milano, Italy
| | - Andre Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Germany
| | - Diama Bhadra Vale
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | | | - Pietro Procopio
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Australia; University of Melbourne, Australia
| | | | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Australia
| | - Carolyn Nickson
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Australia; University of Melbourne, Australia
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Walbaum B, Puschel K, Medina L, Merino T, Camus M, Razmilic D, Navarro ME, Dominguez F, Cordova-Delgado M, Pinto MP, Acevedo F, Sánchez C. Screen-detected breast cancer is associated with better prognosis and survival compared to self-detected/symptomatic cases in a Chilean cohort of female patients. Breast Cancer Res Treat 2021; 189:561-569. [PMID: 34244869 DOI: 10.1007/s10549-021-06317-1] [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: 03/12/2021] [Accepted: 06/26/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE The implementation of national breast cancer (BC) screening programs in Latin America has been rather inconsistent. Instead, most countries have opted for "opportunistic" mammogram screenings on the population at risk. Our study assessed and compared epidemiological, clinical factors, and survival rates associated with BC detected by screening (SDBC) or self-detected/symptomatic (non-SDBC) in Chilean female patients. METHODS Registry-based cohort study that included non-metastatic BC (stage I/II/III) patients diagnosed between 1993 and 2020, from a public hospital (PH) and a private university cancer center (PC). Epidemiological and clinical data were obtained from medical records. RESULTS A total of 4559 patients were included. Most patients (55%; n = 2507) came from PH and were diagnosed by signs/symptoms (non-SDBC; n = 3132, 68.6%); these patients displayed poorer overall (OS) and invasive disease-free survival (iDFS) compared to SDBC. Importantly, the proportion of stage I and "luminal" BC (HR + /HER2 -) were significantly higher in SDBC vs. non-SDBC. Finally, using a stage/subset-stratified age/insurance-adjusted model, we found that non-SDBC cases are at a higher risk of death (HR:1.75; p < 0.001). In contrast, patients with PC health insurance have a lower risk of death (HR: 0.60; p < 0.001). CONCLUSION We confirm previous studies that report better prognosis/survival on SDBC patients. This is probably due to a higher proportion of stage I and luminal-A cases versus non-SDBC. In turn, the survival benefit observed in patients with PC health insurance might be attributed to a larger proportion of SDBC. Our data support the implementation of a systematic BC screening program in Chile to improve patient prognosis and survival rates.
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Affiliation(s)
- Benjamin Walbaum
- Department of Hematology-Oncology, Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
| | - Klaus Puschel
- Department of Family Medicine, School of Medicine. Pontificia, Universidad Católica de Chile, Santiago, Chile
| | - Lidia Medina
- Centro de Cáncer, Red de Salud UC Christus. Pontificia, Universidad Católica de Chile, Santiago, Chile
| | - Tomas Merino
- Department of Hematology-Oncology, Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
| | - Mauricio Camus
- Department of Surgical Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Dravna Razmilic
- Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria Elena Navarro
- Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Dominguez
- Department of Surgical Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Miguel Cordova-Delgado
- Department of Hematology-Oncology, Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
| | - Mauricio P Pinto
- Department of Hematology-Oncology, Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
| | - Francisco Acevedo
- Department of Hematology-Oncology, Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile.
| | - César Sánchez
- Department of Hematology-Oncology, Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile.
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Henderson V, Tossas-Milligan K, Martinez E, Williams B, Torres P, Mannan N, Green L, Thompson B, Winn R, Watson KS. Implementation of an integrated framework for a breast cancer screening and navigation program for women from underresourced communities. Cancer 2021; 126 Suppl 10:2481-2493. [PMID: 32348565 DOI: 10.1002/cncr.32843] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/06/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Trends in breast cancer mortality in the United States are decreasing, but racial disparities persist. Using an implementation science framework to inform evidence-based breast cancer screening and navigation within federally qualified health centers (FQHCs) with community stakeholders can mitigate barriers to screening. METHODS Using an integrated theoretical framework of the Practical, Robust Implementation and Sustainability Model and the Social Ecological Model, the University of Illinois Cancer Center and Mile Square Health Centers (MSHC) FQHC developed a breast cancer screening and navigation program, known as the Mile Square Accessible Mammogram Outreach and Engagement (Mi-MAMO) program, to tackle breast cancer disparities in Chicago among underresourced communities. To increase access to screening, patient navigators conducted community outreach activities. Partnerships were forged with community-based organizations, health care systems, and insurers. Outcomes were monitored with standardized performance measures. RESULTS Between January and December 2017, 103 women received a screening mammogram at MSHC. To increase screening rates, Mi-MAMO was started in August 2017. Between January and December 2018, the number of women who received a screening mammogram increased to 567. From August 2017 to December 2018, 779 women received navigation to screening and/or diagnostic services through the Mi-MAMO program. The majority of women were uninsured (63.9%), and 95.5% were racial/ethnic minorities. Twenty-four percent (n = 185) completed diagnostic services, and 10 women received positive breast cancer diagnoses (mean age, 49.7 years); all successfully navigated to treatment. The Mi-MAMO program is ongoing. CONCLUSIONS Deploying an integrated framework for patient navigation programs can increase breast cancer screening utilization and awareness among underresourced populations at higher risk for breast cancer.
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Affiliation(s)
| | | | | | | | - Paola Torres
- University of Illinois Cancer Center, Chicago, Illinois
| | - Nasima Mannan
- University of Illinois Cancer Center, Chicago, Illinois
| | - Lauren Green
- University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Beti Thompson
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Robert Winn
- Virginia Commonwealth University Massey Cancer Center, Richmond, Virginia
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Spreafico FS, Cardoso-Filho C, Cabello C, Sarian LO, Zeferino LC, Vale DB. Breast Cancer in Men: Clinical and Pathological Analysis of 817 Cases. Am J Mens Health 2020; 14:1557988320908109. [PMID: 32618495 PMCID: PMC7492861 DOI: 10.1177/1557988320908109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 11/15/2022] Open
Abstract
The objective of the current study was to describe breast cancer cases in men according to age, stage, and histology, calculating risks compared to women. It is a retrospective cross-sectional study of all breast cancer cases of the Hospital Cancer Registry of São Paulo state, Brazil, 2000-2015. Variables were age, sex, stage, and histology. Absolute numbers and proportions, Mann-Whitney test and prevalence ratio with 95% confidence interval were used. The study included 93,737 cases, of which 817 were males. The mean age at diagnosis was 60.3 years in men and 56.2 years in women (p < .001). Stage II was the most common in both sexes (33.9% in men and 36.5% in women). Men had a higher frequency of stage III than women (PR 1.18, 95% CI 1.01-1.37). Stage 0 was significantly more common in women (PR 0.69, 95% CI 0.51-0.94). Ductal carcinoma and its variants were the most common histological types in both sexes (88.7% in men and 89.0% in women). Men had a higher frequency of rarer histological types such as papillary (PR 2.17, 95% CI 1.36-3.44) and sarcomas (PR 4.10, 95% CI 1.86-9.01). In conclusion, in men, breast cancer diagnosis occurred in more advanced ages and stages. Invasive ductal carcinoma was the primary histological type observed, although rarer types were more frequent.
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Affiliation(s)
| | | | - Cesar Cabello
- Obstetrics and Gynecology Department,
State University of Campinas, Brazil
| | - Luis Otávio Sarian
- Obstetrics and Gynecology Department,
State University of Campinas, Brazil
| | | | - Diama Bhadra Vale
- Obstetrics and Gynecology Department,
State University of Campinas, Brazil
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Khani Jeihooni A, Darvishi N, Harsini PA. The Effect of Educational Intervention Based on the Theory of Planned Behavior on Mammography Screening in Iranian Women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:264-273. [PMID: 30604386 DOI: 10.1007/s13187-018-1460-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mammography is the most special screening method for early diagnosis of breast cancer. The purpose of present research is investigating the effect of educational intervention based on theory of planned behavior on mammography screening of women in Fasa city, Fars province, Iran. In this quasi-experimental study, 400 subjects (200 subjects for experimental group and 200 subjects for control group) were selected in 2017-2018. Educational intervention for the experimental group included 8 educational sessions. A questionnaire used for evaluating demographic information and constructs of theory of planned behavior (knowledge, perceived behavioral control, subjective norms, and attitude) investigated mammography performance of women before and 6 months after intervention. Data were analyzed by using SPSS 22 through chi-square test, McNemar's test, and Wilcoxon-Mann-Whitney test at significance level of P < 0.05. The average age of subjects was 45.52 ± 6.76 years in the experimental group and 45.12 ± 6.64 years in the control group. Six months after intervention, the experimental group showed significant increase in knowledge, perceived behavioral control, subjective norms, and attitude compared to the control group and 174 people (78%) of the experimental group had intention for doing mammography and 148 people (74%) of the experimental group performed mammography. Also, 6 months after educational intervention, 38 people (19%) of the control group had intention for performing mammography and 14 people (7%) of the control group performed mammography.
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Affiliation(s)
- Ali Khani Jeihooni
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran.
- Fasa Ibn Sina square, Fasa University of Medical Sciences, Fasa, P.Code:7461686688, Iran.
| | - Niloofar Darvishi
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Pooyan Afzali Harsini
- Department of Public Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Pruitt LCC, Odedina S, Anetor I, Mumuni T, Oduntan H, Ademola A, Morhason-Bello IO, Ogundiran TO, Obajimi M, Ojengbede OA, Olopade OI. Breast Cancer Knowledge Assessment of Health Workers in Ibadan, Southwest Nigeria. JCO Glob Oncol 2020; 6:387-394. [PMID: 32125900 PMCID: PMC7126761 DOI: 10.1200/jgo.19.00260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Breast cancer is the most common cancer among women, and in low- to middle-income countries late-stage diagnosis contributes to significant mortality. Previous research at the University College Hospital, a tertiary hospital in Ibadan, Nigeria, on social factors contributing to late diagnosis revealed that many patients received inappropriate initial treatment. METHODS The level of breast cancer knowledge among health practitioners at various levels of the health system was assessed. We developed a tool tailored to local needs to assess knowledge of symptoms, risk factors, treatments, and cultural beliefs. The recruitment included doctors, nurses, and pharmacists in public hospitals, physicians and pharmacists in private practice, nurses and health care workers from primary health care centers, community birth attendants, and students in a health care field from state schools. RESULTS A total of 1,061 questionnaires were distributed, and 725 providers responded (68%). Seventy-eight percent were female, and > 90% were Yoruba, the dominant local ethnic group. The majority were Christian, and 18% were Muslim. Median knowledge score was 31 out of 56, and the differences in scores between health care worker types were statistically significant (P < .001). Nearly 60% of the participants believed breast cancer is always deadly. More than 40% of participants believed that keeping money in the bra causes breast cancer, and approximately 10% believed that breast cancer is caused by a spiritual attack. CONCLUSION Our questionnaire revealed that, even at the tertiary care level, significant gaps in knowledge exist, and knowledge of breast cancer is unacceptably low at the level of community providers. In addition to efforts aimed at strengthening health systems, greater knowledge among community health care workers has the potential to reduce delays in diagnosis for Nigerian patients with breast cancer.
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Affiliation(s)
- Liese C C Pruitt
- Center for Global Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Stella Odedina
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Imaria Anetor
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Tolulope Mumuni
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Helen Oduntan
- Department of Pharmacy, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Adeyinka Ademola
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Imran O Morhason-Bello
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Temidayo O Ogundiran
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Millicent Obajimi
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Oladosu A Ojengbede
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago, Chicago, IL
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Díaz S, Wiesner Ceballos C, Perry F, Poveda Suárez CA, Carvajal Ochoa AM, Bermúdez Rivera JM, Puerto Jiménez DN, Vergel Martíenez JC. Educación en Colombia para la detección temprana del cáncer de mama. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introducción. El cáncer de mama representa un problema de salud pública cada vez mayor en Colombia. La mayoría de los estudiantes de medicina y de los profesionales de la salud no reciben capacitación para la detección temprana del cáncer de mama.
Objetivo. Describir el proceso llevado a cabo por el Instituto Nacional de Cancerología de Colombia, para capacitar a los profesionales de la salud (médicos generales, ginecólogos, médicos familiares y enfermeras) en la detección temprana del cáncer de mama, mediante cursos presenciales y virtuales.
Resultados. Con las dos modalidades de cursos, 1.875 profesionales de la salud han sido capacitados, la mayoría de ellos mediante el curso virtual (n=1.294; 73,0 %). Asimismo, los médicos generales han sido los profesionales que más se han certificado mediante alguna de las dos modalidades del curso (n=919; 49,0 %).
Los dos cursos generan gran satisfacción en los participantes, con una tasa de certificación del 100 % en la modalidad presencial y del 73,0 % en la virtual.
Conclusiones. Es difícil medir el impacto de la capacitación profesional en el diagnóstico precoz del cáncer de mama, porque la mayoría de las regiones de Colombia no tienen registros de cáncer. Es probable que, con un tiempo mayor de seguimiento, se logre medir el impacto real de los cursos en la detección temprana del cáncer de mama y, por ende, en la mortalidad debida a la enfermedad.
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de Sanjose S, Tsu VD. Prevention of cervical and breast cancer mortality in low- and middle-income countries: a window of opportunity. Int J Womens Health 2019; 11:381-386. [PMID: 31308762 PMCID: PMC6617716 DOI: 10.2147/ijwh.s197115] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/16/2019] [Indexed: 02/02/2023] Open
Abstract
Breast and cervical cancer are the two most common women’s cancers worldwide. Countries have invested for decades in early detection programs for breast and cervical cancer through screening, community education, and opportunistic case detection by health professionals. However, effectiveness in low- and middle-income countries (LMICs) has been limited due to low coverage, insufficient laboratory capacities for diagnosis, health information systems (HIS) that are not designed to track patients or monitor program performance, barriers that inhibit women’s uptake of services, and inadequate treatment options. Even where some screening activities exist, there has not been sufficient attention to ensuring completion of appropriate diagnosis and treatment after women receive a positive screening test result or report symptoms suggesting cervical or breast cancer. Because of this failure to provide adequate follow-up care, these women miss the potential benefit from early detection and have a higher than average risk to develop cancer or progress to more advanced cancer stages that could have been avoided. There are several critical steps in a woman’s journey from good health to elevated cancer risk, then to cancer prevention or diagnosis, and finally to treatment. There is a window of opportunity that extends from the time a positive finding is identified—by a cervical or breast screening test or recognition of a breast abnormality—to the point when cervical precancer treatment is delivered or a treatment plan for diagnosed breast cancer is initiated. Building on existing health systems and adapting measurable, affordable, and culturally acceptable interventions can achieve a lasting impact. If women can successfully navigate this window of opportunity, they can avoid progression to cervical cancer or greatly reduce the need for invasive treatments for breast cancer and improve their chances for survival and improved quality of life. We propose several actions that can lead us on the path towards reduction of this cancer burden.
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Affiliation(s)
| | - Vivien D Tsu
- Sexual and Reproductive Health, PATH, Seattle, WA, USA
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Olaya JG, Cardozo JA, Díaz SE, Sánchez R, Sanjuán J. Tamización para cáncer de mama en el departamento del Huila, Colombia. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Murillo R, Robles C. Research Needs for Implementing Cancer Prevention and Early Detection in Developing Countries: From Scientists' to Implementers' Perspectives. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9607803. [PMID: 31205949 PMCID: PMC6530220 DOI: 10.1155/2019/9607803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/01/2019] [Accepted: 04/14/2019] [Indexed: 12/29/2022]
Abstract
Implementation of evidence-based cancer prevention and early detection in low- and middle-income countries (LMIC) is challenging. Limited and inappropriate introduction of novel alternatives results in an equity gap whereby low-income populations receive a lower benefit. Implementation research represents an opportunity to foster the adoption and expansion of evidence-based cancer control strategies; however, scientific development in high-income countries does not necessarily fulfill the particular needs of LMIC in the field. A review on the link between implementation research and practice, the tension between theory and pragmatism, the conflict around implementation research methods, and determinants of research priority definition was carried out by considering the perspective of cancer prevention and early detection implementers in LMIC. Basic principles and alternatives to overcome implementation research challenges in these settings are discussed.
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Affiliation(s)
- Raúl Murillo
- Centro Javeriano de Oncología – Hospital Universitario San Ignacio – Bogotá, Colombia
- Prevention and Implementation Group – International Agency for Research on Cancer – Lyon, France
| | - Claudia Robles
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme - Institut Catala d' Oncologia – Barcelona, Spain
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Birnbaum JK, Duggan C, Anderson BO, Etzioni R. Early detection and treatment strategies for breast cancer in low-income and upper middle-income countries: a modelling study. LANCET GLOBAL HEALTH 2019; 6:e885-e893. [PMID: 30012269 DOI: 10.1016/s2214-109x(18)30257-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Poor breast cancer survival in low-income and middle-income countries (LMICs) can be attributed to advanced-stage presentation and poor access to systemic therapy. We aimed to estimate the outcomes of different early detection strategies in combination with systemic chemotherapy and endocrine therapy in LMICs. METHODS We adapted a microsimulation model to project outcomes of three early detection strategies alone or in combination with three systemic treatment programmes beyond standard of care (programme A): programme B was endocrine therapy for all oestrogen-receptor (ER)-positive cases; programme C was programme B plus chemotherapy for ER-negative cases; programme D was programme C plus chemotherapy for advanced ER-positive cases. The main outcomes were reductions in breast cancer-related mortality and lives saved per 100 000 women relative to the standard of care for women aged 30-49 years in a low-income setting (East Africa; using incidence data and life tables from Uganda and data on tumour characteristics from various East African countries) and for women aged 50-69 years in a middle-income setting (Colombia). FINDINGS In the East African setting, relative mortality reductions were 8-41%, corresponding to 23 (95% uncertainty interval -12 to 49) to 114 (80 to 138) lives saved per 100 000 women over 10 years. In Colombia, mortality reductions were 7-25%, corresponding to 32 (-29 to 70) to 105 (61 to 141) lives saved per 100 000 women over 10 years. INTERPRETATION The best projected outcomes were in settings where access to both early detection and adjuvant therapy is improved. Even in the absence of mammographic screening, improvements in detection can provide substantial benefit in settings where advanced-stage presentation is common. FUNDING Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium Cancer Center Support Grant of the US National Institutes of Health.
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Affiliation(s)
- Jeanette K Birnbaum
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Benjamin O Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Surgery, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Statistics, University of Washington, Seattle, WA, USA.
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18
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Alba LH, Díaz S, Gamboa O, Poveda C, Henao A, Perry F, Duggan C, Gil F, Murillo R. Accuracy of mammography and clinical breast examination in the implementation of breast cancer screening programs in Colombia. Prev Med 2018; 115:19-25. [PMID: 30092313 DOI: 10.1016/j.ypmed.2018.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/30/2018] [Accepted: 08/04/2018] [Indexed: 10/28/2022]
Abstract
Most evidence on breast cancer screening accuracy derives from high income countries. We evaluated screening accuracy and factors related to program implementation in Bogota, Colombia. Between 2008 and 2012 participants underwent clinical breast examination (CBE) and mammography. Positive results underwent histological verification. Adherence to screening protocols was analyzed. Sensitivity, specificity, and predictive values were estimated and adjusted by overdiagnosis. Impact of alternative screening algorithms on follow-up was explored, including combined screening tests and modified coding systems for mammography. In total, 7436 women aged 50-69 were enrolled; 400 discontinued and 1003 non-compliant with screening protocols. 23 cancer cases were diagnosed. Mammography sensitivity and specificity were 78.3% (95%CI 77.3-99.3) and 99.4% (95%CI 99.2-99.6). CBE sensitivity was 39.1% (95%CI 37.9-40.3) and specificity 83.4% (95%CI 82.6-84.3). Parallel mammography and CBE showed the highest sensitivity (95.6%) and combined as serial tests the lowest (positive CBE followed by mammography 13.0%). A simplified coding system for mammography (recall/no-recall) had 6.3% of positive results and a minor reduction in specificity compared with standard mammography, but reported the best balance between recall rates and screening protocol compliance. Call-backs had high rates of loss-to-follow-up; thus, alternative screening algorithms might help increase screening compliance and follow-up in low and middle income countries, particularly in populations with poor screening history and low access to health services.
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Affiliation(s)
- Luz Helena Alba
- Department of Preventive and Social Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sandra Díaz
- Clínica de seno, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Oscar Gamboa
- Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - César Poveda
- Servicio de Imaginología, Instituto Nacional de Cancerología, Bogotá, Colombia; Facultad de Medicina, Universidad Nacional, Bogotá, Colombia
| | - Andrés Henao
- Radiología, Centro de Enfermedades Mamarias, Bogotá, Colombia
| | - Fernando Perry
- Clínica de seno, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Fabián Gil
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Raúl Murillo
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France; Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología, Bogotá, Colombia.
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Brand NR, Wasike R, Makhdomi K, Chauhan R, Moloo Z, Gakinya SM, Neugut AI, Zujewski JA, Sayed S. Sentinel Lymph Node Biopsy Pathology and 2-Year Postsurgical Recurrence of Breast Cancer in Kenyan Women. J Glob Oncol 2018; 4:1-7. [PMID: 30241138 PMCID: PMC6180780 DOI: 10.1200/jgo.17.00111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The goal of this study was to describe the pathologic findings and early follow-up experience of patients who underwent a sentinel lymph node biopsy (SLNB) at Aga Khan University Hospital (AKUH) between 2008 and 2017. PATIENTS AND METHODS We performed a retrospective analysis of women with breast cancer who underwent an SLNB at AKUH between 2008 and 2017. The SLNB was performed on patients with stage I and stage II breast cancer, and identification of the sentinel lymph node was made by radioactive tracer, blue dye, or both, per availability and surgeon preference. Demographic, surgical, and pathologic data, including immunohistochemistry of the surgical sample for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2, were abstracted from the patient records. Follow-up data were available for a subset of patients. RESULTS Between 2008 and 2017, six surgeons performed SLNBs on 138 women, 129 of whom had complete records and were included in the study. Thirty-one of 129 (24%) had a positive SLNB, including 10 of 73 (14%) with stage I and 21 of 56 (38%) with stage II disease. Seventy-eight patients (60%) received systemic adjuvant chemotherapy and 79 (62%) received radiation therapy, and of the 102 patients who were estrogen receptor positive, 86 (85%) received endocrine therapy. Seventy-nine patients were observed for > 2 years, and, of these, four (5.1%) had a regional recurrence. CONCLUSION The SLNB positivity rates were similar to those of high-income country (HIC) cohorts. However, preliminary data suggest that recurrence rates are elevated at AKUH as compared with those of HIC cohorts, perhaps because of a lower use of radiotherapy and chemotherapy at AKUH compared with HIC cohorts or because of differences in the characteristics of the primary tumor in patients at AKUH as compared with those in HICs.
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Affiliation(s)
- Nathan R. Brand
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Ronald Wasike
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Khalid Makhdomi
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Rajendra Chauhan
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Zahir Moloo
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Samuel M. Gakinya
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Alfred I. Neugut
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Jo Anne Zujewski
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
| | - Shahin Sayed
- Nathan R. Brand and Alfred I. Neugut,
Columbia University, New York, NY; Ronald Wasike, Khalid
Makhdomi, Rajendra Chauhan, Zahir Moloo,
Samuel M. Gakinya, and Shahin Sayed, Aga Khan
University Hospital, Nairobi, Kenya; and Jo Anne Zujewski, Leidos
Biomedical Research, Frederick, MD
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Safizadeh H, Hafezpour S, Mangolian Shahrbabaki P. Health Damaged Context: Barriers to Breast Cancer Screening from Viewpoint of Iranian Health Volunteers. Asian Pac J Cancer Prev 2018; 19:1941-1949. [PMID: 30051677 PMCID: PMC6165652 DOI: 10.22034/apjcp.2018.19.7.1941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Breast cancer is common among cancer diseases and the second leading cause of death among women worldwide. The breast cancer-caused death is directly associated with diagnosis time of the disease. Screening is one of the major methods for health promotion in human societies. However, many women still refuse to do the periodic screening. The present study is aimed to analyze the experiences of health volunteers in order to understand the barriers to breast cancer screening among women at southeast of Iran. Methods Data collection was performed through focus groups. Using the purposive sampling method, 24 participants were selected and then were allocated to 6-member groups. The data were analysed using Lundman and Graneheim qualitative content analysis. Results The main theme of “Health Damage Context” was extracted with four main categories, including: family barriers, cultural and social barriers, personal barriers and organizational barriers. Conclusion Based on the results of the present study, there are numerous barriers to regular breast cancer screening, and for the same reasons, the willingness to screening is sometimes not satisfactory. Therefore, in case of the women’s referral to health centers, nurses and other health-care professionals should inform them about the role of different screening methods in early diagnosis and rapid treatment of breast cancer.
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Affiliation(s)
- Hossein Safizadeh
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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de Vries E, Buitrago G, Quitian H, Wiesner C, Castillo JS. Access to cancer care in Colombia, a middle-income country with universal health coverage. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2018.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Badal K, Rampersad F, Warner WA, Toriola AT, Mohammed H, Scheffel HA, Ali R, Moosoodeen M, Konduru S, Russel A, Haraksingh R. A situational analysis of breast cancer early detection services in Trinidad and Tobago. Cancer Causes Control 2017; 29:33-42. [DOI: 10.1007/s10552-017-0937-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023]
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Hazavehei SMM, Ezzati Rastegar K, Dogonchi M, Salimi N, Gheisvandi E. The Impact of Educational Intervention Programs to Promoting Mammography Screening: A Systematic Review. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2017. [DOI: 10.21859/jech-03018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Denny L, de Sanjose S, Mutebi M, Anderson BO, Kim J, Jeronimo J, Herrero R, Yeates K, Ginsburg O, Sankaranarayanan R. Interventions to close the divide for women with breast and cervical cancer between low-income and middle-income countries and high-income countries. Lancet 2017; 389:861-870. [PMID: 27814963 DOI: 10.1016/s0140-6736(16)31795-0] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 07/11/2016] [Accepted: 07/19/2016] [Indexed: 01/06/2023]
Abstract
Breast and cervical cancers are the commonest cancers diagnosed in women living in low-income and middle-income countries (LMICs), where opportunities for prevention, early detection, or both, are few. Yet several cost-effective interventions could be used to reduce the burden of these two cancers in resource-limited environments. Population- wide vaccination against human papillomavirus (HPV) linked to cervical screening, at least once, for adult women has the potential to reduce the incidence of cervical cancer substantially. Strategies such as visual inspection with acetic acid and testing for oncogenic HPV types could make prevention of cervical cancer programmatically feasible. These two cancers need not be viewed as inevitably fatal, and can be cured, particularly if detected and treated at an early stage. Investing in the health of girls and women is an investment in the development of nations and their futures. Here we explore ways to lessen the divide between LMICs and high-income countries for breast and cervical cancers.
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Affiliation(s)
- Lynette Denny
- Department of Obstetrics and Gynaecology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - Silvia de Sanjose
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Miriam Mutebi
- Department of Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Benjamin O Anderson
- Department of Surgery and Global Health Medicine, University of Washington, Division of Public Health Sciences, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jane Kim
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Jose Jeronimo
- Program for Appropriate Technology in Health (PATH), Seattle, WA, USA
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Ophira Ginsburg
- Institute of Cancer Policy, Women's College Research Institute, Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; WHO, Geneva, Switzerland
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Should low-income countries invest in breast cancer screening? Cancer Causes Control 2016; 27:1341-1345. [PMID: 27680017 DOI: 10.1007/s10552-016-0812-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
Abstract
With the increase in incidence and mortality of breast cancer in low-income countries (LICs), the question of whether LICs should promote breast cancer screening for early detection has gained tremendous importance. Because LICs have limited financial resources, the value of screening must be carefully considered before integrating screening programs into national healthcare system. Mammography-the most commonly used screening tool in developed countries-reduces breast cancer-specific mortality among women of age group 50-69, but the evidence is not so clear for younger women. Further, it does not reduce the overall mortality. Because the women in LICs tend to get breast cancer at younger age and are faced with various competing causes of mortality, LICs need to seriously evaluate whether mammographic screening presents a good value for the investment. Instead, we suggest a special module of clinical breast examination that could provide similar benefits at a very low cost. Nevertheless, we believe that LICs would obtain a much greater value for their investment if they promote primary prevention by tobacco cessation, healthier food and healthier lifestyle campaigns instead.
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