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Kim HY, Mullaert J, Tondreau A, Park B, Rouzier R. Development of a model to predict the age at breast cancer diagnosis in a global population. Sci Rep 2024; 14:13845. [PMID: 38879675 PMCID: PMC11180172 DOI: 10.1038/s41598-024-53108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/27/2024] [Indexed: 06/19/2024] Open
Abstract
Knowing the mean age at diagnosis of breast cancer (BC) in a country is important for setting up an efficient BC screening program. The aim of this study was to develop and validate a model to predict the mean age at diagnosis of BC at the country level. To develop the model, we used the CI5plus database from the IARC, which contains incidence data for 122 selected populations for a minimum of 15 consecutive years from 1993 to 2012 and data from the World Bank. The standard model was fitted with a generalized linear model with the age of the population, growth domestic product per capita (GDPPC) and fertility rate as fixed effects and continent as a random effect. The model was validated in registries of the Cancer Incidence in Five Continents that are not included in the CI5plus database (1st validation set: 1950-2012) and in the most recently released volume (2nd validation set: 2013-2017). The intercept of the model was 30.9 (27.8-34.1), and the regression coefficients for population age, GDPPC and fertility rate were 0.55 (95% CI: 0.53-0.58, p < 0.001), 0.46 (95% CI: 0.26-0.67, p < 0.001) and 1.62 (95% CI: 1.42-1.88, p < 0.001), respectively. The marginal R2 and conditional R2 were 0.22 and 0.81, respectively, suggesting that 81% percent of the variance in the mean age at diagnosis of BC was explained by the variance in population age, GDPPC and fertility rate through linear relationships. The model was highly accurate, as the correlations between the predicted age from the model and the observed mean age at diagnosis of BC were 0.64 and 0.89, respectively, and the mean relative error percentage errors were 5.2 and 3.1% for the 1st and 2nd validation sets, respectively. We developed a robust model based on population age and continent to predict the mean age at diagnosis of BC in populations. This tool could be used to implement BC screening in countries without prevention programs.
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Affiliation(s)
- Ha Young Kim
- Department of Health Sciences, College of Medicine, Hanyang University, Seoul, Korea
- Institut Curie, PSL Research University, INSERM, U900, Saint Cloud, France
| | - Jimmy Mullaert
- Institut Curie, PSL Research University, INSERM, U900, Saint Cloud, France
| | - Ambre Tondreau
- Institut Curie, PSL Research University, INSERM, U900, Saint Cloud, France
| | - Boyoung Park
- Department of Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Roman Rouzier
- Institut Curie, PSL Research University, INSERM, U900, Saint Cloud, France.
- Department of Surgery, Centre François Baclesse, Caen, France.
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Gbenonsi GY, Martini J, Mahieu C. An analytical framework for breast cancer public policies in Sub-Saharan Africa: results from a comprehensive literature review and an adapted policy Delphi. BMC Public Health 2024; 24:1535. [PMID: 38849808 PMCID: PMC11157826 DOI: 10.1186/s12889-024-18937-5] [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: 07/05/2023] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Breast cancer is the leading cause of death from cancer in women and is a major public health problem worldwide. Despite the lower incidence rates of breast cancer in resource-limited settings, especially sub-Saharan Africa, there is a higher mortality rate compared to high-resource countries where the disease has a higher incidence. This makes breast cancer the second deadliest cancer in African women. These poor results reflect the weakness in public health policies. The aim of this paper is to contribute to the effective control of breast cancer by designing a framework for a comprehensive and systemic analysis of these policies in Sub-Saharan Africa. METHODS This research is based on a literature review that adopted a systematic approach followed by a modified policy Delphi involving breast cancer experts in Sub-Saharan Africa. We included narrative reviews and systematic reviews/meta-analyses published between 2015 and 2022 as well as official documents in the analysis. We integrated the World Health Organization's health system building blocks with Walt and Gilson's policy analysis triangle to analyse the information collected and develop our analytical framework. RESULTS A total of 22 reviews and documents were included in the study. Sixteen breast cancer experts from Sub-Saharan Africa participated in the first Delphi round, and nine participated in the second round. The different components identified for a comprehensive and systemic analysis of effective breast cancer policies can be classified into policy content divided according to the health system building blocks and related policy processes; individual, organized national and international policy stakeholders; and policy contexts. CONCLUSION This study enabled the design of a framework suitable for the comprehensive and systemic analysis of breast cancer control policies in Sub-Saharan Africa. This framework can be used as a checklist for stakeholders to guide the planning, implementation and evaluation of policies and specific breast cancer control programmes at the national and facility levels.
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Affiliation(s)
- Gloria Yawavi Gbenonsi
- School of Public Health- Research centre for Social Approaches to Health, Université libre de Bruxelles, Brussels, Belgium.
| | - Jessica Martini
- School of Public Health- Research centre for Social Approaches to Health, Université libre de Bruxelles, Brussels, Belgium
- European Social Observatory (OSE), Brussels, Belgium
| | - Céline Mahieu
- School of Public Health- Research centre for Social Approaches to Health, Université libre de Bruxelles, Brussels, Belgium
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Subedi R, Houssami N, Nickson C, Nepal A, Campbell D, David M, Yu XQ. Factors influencing the time to diagnosis and treatment of breast cancer among women in low- and middle-income countries: A systematic review. Breast 2024; 75:103714. [PMID: 38522173 PMCID: PMC10973645 DOI: 10.1016/j.breast.2024.103714] [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: 01/03/2024] [Revised: 03/08/2024] [Accepted: 03/16/2024] [Indexed: 03/26/2024] Open
Abstract
PURPOSE Shorter time from symptoms recognition to diagnosis and timely treatment would be expected to improve the survival of patients with breast cancer (BC). This review identifies and summarizes evidence on time to diagnosis and treatment, and associated factors to inform an improved BC care pathways in Low- and Middle-Income Countries (LMICs). METHODS A systematic search was conducted in electronic databases including Medline, Embase, PsycINFO and Global Health, covering publications between January 1, 2010, and November 6, 2023. Inclusion criteria encompassed studies published in English from LMICs that reported on time from symptoms recognition to diagnosis and/or from diagnosis to treatment, as well as factors influencing these timelines. Study quality was assessed independently by two reviewers using a standard checklist. Pre-contact, post-contact and treatment intervals and delays in these intervals are presented. Barriers and facilitators for shorter time to diagnosis and treatment found by individual studies after adjusting with covariates are summarized. RESULTS The review identified 21 studies across 14 countries and found that BC cases took a longer time to diagnosis than to treatment. However, time to treatment also exceeded the World Health Organization (WHO) recommended period for optimal survival. There was inconsistency in terminology and benchmarks for defining delays in time intervals. Low socioeconomic status and place of residence emerged as frequent barriers, while initial contact with a private health facility or specialist was commonly reported as a facilitator for shorter time to diagnosis and treatment. CONCLUSIONS Guidelines or consensus recommendations are essential for defining the optimal time intervals to BC diagnosis and treatment. Our review supported WHO's Global Breast Cancer Initiative recommendations. Increasing public awareness, strengthening of healthcare professional's capacities, partial decentralization of diagnostic services and implementation of effective referral mechanisms are recommended to achieve a shorter time to diagnosis and treatment of BC in LMICs.
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Affiliation(s)
- Ranjeeta Subedi
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.
| | - Nehmat Houssami
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Carolyn Nickson
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Denise Campbell
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Michael David
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Xue Qin Yu
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
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Das U, Soren S, Kar N. Menstrual and reproductive factors associated with risk of breast cancer among Indian women: a cross sectional study from National Family Health Survey, 2019-21. Arch Public Health 2024; 82:55. [PMID: 38654339 DOI: 10.1186/s13690-024-01266-9] [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: 10/03/2023] [Accepted: 03/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The breast cancer is common cancer in women globally. The risk of breast cancer is strongly associated with women's menstrual and reproductive factors that have been established in different countries. Therefore present study was aim to explore the association between menstrual and reproductive factors and the risk of breast cancer screening in Indian women. METHODS The present study data has been used fifth round of the National Family Health Survey (NFHS-V) with 724,115 women in aged 15-49 in 2019-21. The self-reported ever screened of breast cancer for women aged 30-49 was the main outcome variable of the study. Logistic regression models were used to estimate odds ratios and 95% confidence intervals for breast cancer by menstrual and reproductive factors adjusted for potential confounders. RESULTS Late menarche (OR = 2.20, 95% CI: 1.48-3.28), irregular menstrual cycle (OR = 1.29, 95% CI: 1.08-3.53)), delay age at first birth (OR = 1.93, 95% CI: 1.11-3.04) and contraceptive pill used (OR = 1.11, 95% CI: 0.74-2.10) were significantly associated to increases the uptake of screening breast cancer. While, a higher number of birth (OR = 0.52, 95% CI: 0.10-1.03), and long duration of breast-feeding practice (OR = 0.75, 95% CI: 0.63-0.91) were reduced to participate for screening breast cancer. CONCLUSION The results of the study confirm the role of menstrual and reproductive factors in breast cancer in Indian women. Therefore, our findings are imperative for developing breast cancer prevention strategies and better preparedness. Creating awareness and providing knowledge on cancer could be key strategies for the reduction of breast cancer in Indian reproductive age group women.
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Affiliation(s)
- Ujjwal Das
- Dept. of Geography, Rajiv Gandhi University, Itanagar, Arunachal Pradesh, India.
- Dept of Geography, Fakir Mohan University, Balasore, Odisha, India.
| | - Sabita Soren
- Dept of Geography, Fakir Mohan University, Balasore, Odisha, India
| | - Nishamani Kar
- Professor Dept. of Geography, Rajiv Gandhi University, Itanagar, Arunachal Pradesh, India
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Martinez-Gutierrez J, Chima S, Boyd L, Sherwani A, Drosdowsky A, Karnchanachari N, Luong V, Reece JC, Emery J. Failure to follow up abnormal test results associated with cervical cancer in primary and ambulatory care: a systematic review. BMC Cancer 2023; 23:653. [PMID: 37438686 DOI: 10.1186/s12885-023-11082-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/17/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Cervical cancer is a preventable and treatable form of cancer yet continues to be the fourth most common cancer among women globally. Primary care is the first point of contact most patients have with health services and is where most cancer prevention and early detection occur. Inadequate follow-up of abnormal test results for cervical abnormalities in primary care can lead to suboptimal patient outcomes including higher mortality and decreased quality of life. AIMS To explore the magnitude of and factors associated with, inadequate follow-up of test results for cervical abnormalities in primary and ambulatory care. METHODS MEDLINE, Embase, Cochrane Library and CINAHL were searched for peer-reviewed literature from 2000-2022, excluding case-studies, grey literature, and systematic reviews. Studies were included if they reported on patients aged ≥ 18 years with no previous cancer diagnosis, in a primary care/ambulatory setting. Risk of bias was assessed using the Joanna Briggs Institute Critical appraisal checklists, appropriate to the study design. A segregated methodology was used to perform a narrative synthesis, maintaining the distinction between quantitative and qualitative research. RESULTS We included 27 publications reporting on 26 studies in our review; all were conducted in high-income countries. They included 265,041 participants from a variety of ambulatory settings such as family medicine, primary care, women's services, and colposcopy clinics. Rates of inadequate follow-up ranged from 4 to 75%. Studies reported 41 different factors associated with inadequate follow-up. Personal factors associated with inadequate follow-up included younger age, lower education, and socioeconomic status. Psychological factors were reported by only 3/26 studies and 2/3 found no significant association. System protective factors included the presence of a regular primary care provider and direct notification of abnormal test results. DISCUSSION This review describes inadequate follow-up of abnormal cervical abnormalities in primary care. Prevalence varied and the evidence about causal factors is unclear. Most interventions evaluated were effective in decreasing inadequate follow-up. Examples of effective interventions were appointment reminders via telephone, direct notification of laboratory results, and HPV self-sampling. Even though rates of cervical cancer have decreased over the years, there is a lack of information on factors affecting follow-up in primary care and ambulatory settings, particularly in low and middle-income countries. This information is crucial if we are to achieve WHO's interim targets by 2030, and hope to avert 62 million cervical cancer deaths by 2120. TRIAL REGISTRATION PROSPERO ID CRD42021250136.
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Affiliation(s)
- Javiera Martinez-Gutierrez
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia.
- Department of Family Medicine. Pontificia, Universidad Católica de Chile, Santiago, Chile.
| | - Sophie Chima
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Lucy Boyd
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
- Melbourne School of Population and Global Health, Centre for Health Policy, The University of Melbourne, Melbourne, Australia
| | - Asma Sherwani
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Allison Drosdowsky
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Napin Karnchanachari
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Vivien Luong
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Jeanette C Reece
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
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Rauniyar SK, Hashizume M, Yoneoka D, Nomura S. Projection of morbidity and mortality due to breast cancer between 2020 and 2050 across 42 low- and middle-income countries. Heliyon 2023; 9:e16427. [PMID: 37274661 PMCID: PMC10238690 DOI: 10.1016/j.heliyon.2023.e16427] [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: 12/21/2022] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/06/2023] Open
Abstract
Objective Aim of the study is to predict trends in morbidity and mortality due to breast cancer in 42 LMICs between 2020 and 2050. Design and Setting: National level cross-sectional breast cancer related data between 1990 and 2019 were used. Recurrent Neural Network, Long-Short-Term Memory (RNN-LSTM) model was employed to forecast the trend in breast cancer burden. Main outcomes and measures Age standardized breast cancer incidence, mortality, and disability adjusted life years (DALYs) rates. Results By 2050, the age standardized breast cancer incidence rate is expected to increase in 38 LMICs with highest incidence rate in Namibia; 127.0 (78.0-176.0) followed by Nigeria 71.1 (53.9-88.3) and Papua New Guinea 70.6 (88.7-74.6). Similarly, the age standardized breast cancer mortality and DALYs rates in 2050 are expected to increase in 33 and 35 LMICs respectively. The highest mortality and DALYs rates in 2050 are expected to be 64.7 (42.6-86.7) in Namibia and 1543.6 (1463.1-1624.1) in Pakistan. The estimated annual percentage change (EAPC) is expected to increase uniformly in all the countries during the same period. Due to considerable variation in exposure risk, such as high plasma glucose level, high body mass index (BMI) and socio-demographic index (SDI), high regional disparity in burden of breast cancer is expected among the countries. Conclusion and Relevance: Breast cancer burden is expected to increase in most of the LMICs with high regional disparity by 2050. Our study's finding focuses on LMICs with high breast cancer burden that require tailored strategies and effective action plans to ensure prevention from catastrophic consequences in the future. Minimizing the exposure to behavioral and metabolic risk factors such as high plasma glucose, high BMI, along with tackling the issue of low fertility rate would be important in managing breast cancer burden in LMICs.
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Affiliation(s)
- Santosh Kumar Rauniyar
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Yoneoka
- Infectious Disease Surveillance Center, National Institute of Infectious Disease, Tokyo, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
| | - Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Policy and Management, School of Medicine, Keio University, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
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Fields BC, Morse RM, Ortega E, Waterfield K, Prieto BA, Oberhelman R, Paz-Soldán VA. "I wanted information": navigating breast Cancer and its treatment in Lima, Peru. BMC Womens Health 2023; 23:230. [PMID: 37143060 PMCID: PMC10161672 DOI: 10.1186/s12905-023-02321-3] [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: 06/28/2022] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Breast cancer impacts millions of people worldwide, and in Peru, breast cancer is the most common cause of cancer related death among women. Breast cancer treatment is physically and emotionally burdensome and challenging for patients. METHODS In-depth interviews were conducted with 14 female breast cancer patients and survivors in Lima, Peru. The interviews explored four main themes: the women's emotional experiences, coping mechanisms, resources available or needed, and advice for newly diagnosed breast cancer patients. RESULTS Respondents described a tremendous lack of informational support during and after diagnosis and treatment and requested more of this support from health professionals. Social support groups were helpful to participants; however, these forms of support were not available to all participants. Emotional and esteem support seemed amply received from family and friends, faith organizations, and fellow cancer patients. Participants experienced a range of emotions upon diagnosis and during treatment including fear, anxiety, difficulty accepting bodily changes, loneliness, and denial. CONCLUSION Breast cancer and its treatment can be a long, emotional journey; more extensive forms of informational support could help patients cope with this process.
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Affiliation(s)
- Brittany C Fields
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Rachel M Morse
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Emma Ortega
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Kristen Waterfield
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Bryn A Prieto
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Richard Oberhelman
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Valerie A Paz-Soldán
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA.
- Asociación Benéfica PRISMA, Lima, Peru.
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Mubarik S, Luo L, Iqbal M, Nawsherwan, Bai J, Yu C. More recent insights into the breast cancer burden across BRICS-Plus: Health consequences in key nations with emerging economies using the global burden of disease study 2019. Front Oncol 2023; 13:1100300. [PMID: 36761973 PMCID: PMC9902930 DOI: 10.3389/fonc.2023.1100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/04/2023] [Indexed: 01/26/2023] Open
Abstract
Background Brazil, Russia, India, China, South Africa, and 30 other Asian nations make up the BRICS-Plus, a group of developing countries that account for about half of the world's population and contribute significantly to the global illness burden. This study aimed to analyzed the epidemiological burden of female breast cancer (BC) across the BRICS-Plus from 1990 to 2019 and studied the associations with age, period, birth cohort and countries' sociodemographic index (SDI). Methods The BC mortality and incidence estimates came from the 2019 Global Burden of Disease Study. We estimated cohort and period effects in BC outcomes between 1990 and 2019 using age-period-cohort (APC) modeling. The maximum likelihood (ML) of the APC-model Poisson with log (Y) based on the natural-spline function was used to estimate the rate ratio (RR). We used annualized rate of change (AROC) to quantify change over the previous 30 years in BC across BRICS-Plus and compare it to the global. Results In 2019, there were about 1.98 million female BC cases (age-standardized rate of 45.86 [95% UI: 41.91, 49.76]) and 0.69 million deaths (age-standardized rate of 15.88 [95% UI: 14.66, 17.07]) around the globe. Among them, 45.4% of incident cases and 51.3% of deaths were attributed to the BRICS-Plus. China (41.1% cases and 26.5% deaths) and India (16.1% cases and 23.1% deaths) had the largest proportion of incident cases and deaths among the BRICS-Plus nations in 2019. Pakistan came in third with 5.6% cases and 8.8% deaths. Over the past three decades, from 1990 to 2019, the BRICS-Plus region's greatest AROC was seen in Lesotho (2.61%; 95%UI: 1.99-2.99). The birth cohort impacts on BC vary significantly among the BRICS-Plus nations. Overall, the risk of case-fatality rate tended to decline in all BRICS-Plus nations, notably in South Asian Association for Regional Cooperation (SAARC) and China-ASEAN Free Trade Area (China-ASEAN FTA) countries, and the drop in risk in the most recent cohort was lowest in China and the Maldives. Additionally, there was a substantial negative link between SDI and case fatality rate (r1990= -0.91, p<0.001; r2019= -0.89, p<0.001) in the BRICS-Plus in both 1990 and 2019, with the Eurasian Economic Union (EEU) nations having the highest case fatality rate. Conclusions The BC burden varies remarkably between different BRICS-Plus regions. Although the BRICS' efforts to regulate BC succeeded, the overall improvements lagged behind those in high-income Asia-Pacific nations. Every BRICS-Plus country should strengthen specific public health approaches and policies directed at different priority groups, according to BRIC-Plus and other high-burden nations.
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Affiliation(s)
- Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Lisha Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Mujahid Iqbal
- Department of Psychology, School of Philosophy, Wuhan University, Wuhan, China
| | - Nawsherwan
- Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jianjun Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China,*Correspondence: Chuanhua Yu,
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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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Dhakal R, Noula M, Roupa Z, Yamasaki EN. A Scoping Review on the Status of Female Breast Cancer in Asia with a Special Focus on Nepal. BREAST CANCER: TARGETS AND THERAPY 2022; 14:229-246. [PMID: 36052152 PMCID: PMC9427118 DOI: 10.2147/bctt.s366530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/26/2022] [Indexed: 12/24/2022]
Abstract
This study aimed to provide updated evidence on the status of female breast cancer and cancer treatment facilities in Asia, with a special focus on Nepal. This review used search phrases that included, breast neoplasm or cancer, health status, epidemiology, breast cancer survivors, cancer care facilities, Asia, Nepal. Researchers examined databases from January 2011 to December 2020 (PubMed, PMC, Google Scholar, and the reference lists of included papers). Studies of any design and reviews, were included in the study, except for qualitative studies. The study findings are presented in a narrative synthesis format using Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews. An initial search resulted in 974 papers, and 896 were reviewed after being checked for duplication using the Zotero software. Accordingly, utilizing the inclusion and exclusion criteria, 188 publications were selected, and after review of titles and abstracts, an additional 98 papers were removed for different reasons. Finally, the study looked at 90 female breast cancer papers. Results showed that the number of cases of breast cancer is growing all around the world, including in Asia and Nepal. Age, early menarche, late menopause, nulliparity, positive family history, excessive fat consumption, alcohol, and smoking are all frequent risk factors for breast cancer found in Asian women. Breast self-examination, clinical breast examination, and mammography screening are common methods for detecting breast carcinoma. Chemotherapy, radiation, and modified mastectomy are commonly used options for treatment. The number of breast cancer survivors is growing throughout the world, indicating better clinical care. There is a paucity of survival data in many Asian countries, including Nepal. There is also a scarcity of health workforce specialized in cancer care and treatment, as well as a few health facilities that are available to treat cancer cases in many Asian countries, including Nepal.
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Affiliation(s)
- Rojana Dhakal
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Nursing, School of Health and Allied Sciences, Pokhara University, Kaski, Gandaki Province, Nepal
- Correspondence: Rojana Dhakal, Department of Nursing, School of Health and Allied Sciences, Pokhara University, Kaski, Gandaki Province, Nepal, Email ;
| | - Maria Noula
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Zoe Roupa
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Edna N Yamasaki
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Rattani SA, Dahlke S, Cameron B. Cancer Care in Pakistan: A Descriptive Case Study. Glob Qual Nurs Res 2022; 9:23333936221080988. [PMID: 35237708 PMCID: PMC8882939 DOI: 10.1177/23333936221080988] [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: 07/13/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 01/09/2023] Open
Abstract
In this descriptive case study, we aimed to understand the experiences of cancer diagnosis, treatment, and palliative care in Pakistan. The case was limited to a hospital for cancer and hospice care in Karachi, Pakistan. Data collection included interviews with patients who had a cancer diagnosis, family members, healthcare providers, and unstructured observations. Two themes of suffering and late diagnosis were developed to describe the experiences of people with cancer. Suffering occurred as a result of poverty, social ideas about cancer, and physical suffering. Late diagnosis happened because of cultural ideas about health, low health literacy, and healthcare challenges, although both themes are interconnected. The findings illuminate three key pathways that will improve cancer diagnosis and palliative care in Pakistan: specifically, the need to (a) educate healthcare providers about cancer and palliative care, (b) eradicate corruption in healthcare, and (c) develop policies for universal access to health.
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Affiliation(s)
- Salma A Rattani
- Aga Khan University, Faculty of Nursing, School of Nursing and Midwifery, Karachi, Pakistan
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12
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Global challenges and policy solutions in breast cancer control. Cancer Treat Rev 2022; 104:102339. [DOI: 10.1016/j.ctrv.2022.102339] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 02/08/2023]
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13
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Olaya-Galán NN, Salas-Cárdenas SP, Rodriguez-Sarmiento JL, Ibáñez-Pinilla M, Monroy R, Corredor-Figueroa AP, Rubiano W, de la Peña J, Shen H, Buehring GC, Patarroyo MA, Gutierrez MF. Risk factor for breast cancer development under exposure to bovine leukemia virus in Colombian women: A case-control study. PLoS One 2021; 16:e0257492. [PMID: 34547016 PMCID: PMC8454960 DOI: 10.1371/journal.pone.0257492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/02/2021] [Indexed: 11/19/2022] Open
Abstract
Viruses have been implicated in cancer development in both humans and animals. The role of viruses in cancer is typically to initiate cellular transformation through cellular DNA damage, although specific mechanisms remain unknown. Silent and long-term viral infections need to be present, in order to initiate cancer disease. In efforts to establish a causative role of viruses, first is needed to demonstrate the strength and consistency of associations in different populations. The aim of this study was to determine the association of bovine leukemia virus (BLV), a causative agent of leukemia in cattle, with breast cancer and its biomarkers used as prognosis of the severity of the disease (Ki67, HER2, hormonal receptors) in Colombian women. An unmatched, observational case-control study was conducted among women undergoing breast surgery between 2016-2018. Malignant samples (n = 75) were considered as cases and benign samples (n = 83) as controls. Nested-liquid PCR, in-situ PCR and immunohistochemistry were used for viral detection in blood and breast tissues. For the risk assessment, only BLV positive samples from breast tissues were included in the analysis. BLV was higher in cases group (61.3%) compared with controls (48.2%), with a statistically significant association between the virus and breast cancer in the unconditional logistic regression (adjusted-OR = 2.450,95%CI:1.088-5.517, p = 0.031). In this study, BLV was found in both blood and breast tissues of participants and an association between breast cancer and the virus was confirmed in Colombia, as an intermediate risk factor.
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Affiliation(s)
- Nury N. Olaya-Galán
- PhD Program in Biomedical and Biological Sciences, Universidad del Rosario, Bogotá, Colombia
- Grupo de Enfermedades Infecciosas, Laboratorio de Virología, Departamento de Microbiología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sandra P. Salas-Cárdenas
- Grupo de Enfermedades Infecciosas, Laboratorio de Virología, Departamento de Microbiología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jorge L. Rodriguez-Sarmiento
- Department of Pathology, Hospital Universitario San Ignacio - Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Ricardo Monroy
- Hospital Universitario Mayor Méderi – Universidad del Rosario, Bogotá, Colombia
| | - Adriana P. Corredor-Figueroa
- Grupo de Enfermedades Infecciosas, Laboratorio de Virología, Departamento de Microbiología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Wilson Rubiano
- Hospital Universitario Mayor Méderi – Universidad del Rosario, Bogotá, Colombia
| | - Jairo de la Peña
- Hospital Universitario Mayor Méderi – Universidad del Rosario, Bogotá, Colombia
| | - HuaMin Shen
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Gertrude C. Buehring
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Manuel A. Patarroyo
- Molecular Biology and Immunology Department, Fundación Instituto de Inmunología de Colombia (FIDIC), Bogotá, Colombia
- Microbiology Department, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
- Health Sciences Division, Main Campus, Universidad Santo Tomás, Bogotá, Colombia
| | - Maria F. Gutierrez
- Grupo de Enfermedades Infecciosas, Laboratorio de Virología, Departamento de Microbiología, Pontificia Universidad Javeriana, Bogotá, Colombia
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14
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Negi J, Nambiar D. Intersectional social-economic inequalities in breast cancer screening in India: analysis of the National Family Health Survey. BMC WOMENS HEALTH 2021; 21:324. [PMID: 34493267 PMCID: PMC8424809 DOI: 10.1186/s12905-021-01464-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/14/2021] [Indexed: 11/23/2022]
Abstract
Background Breast cancer incidence rates are increasing in developing countries including India. With 1.3 million new cases of cancer been diagnosed annually, breast cancer is the most common women’s cancer in India. India’s National Family Health Survey (NFHS-4) data 2015–2016 shows that only 9.8% of women between the ages of 15 and 49 had ever undergone breast examination (BE). Further, access to screening and treatment is unequally distributed, with inequalities by socio-economic status. It is unclear, however, if socio-economic inequalities in breast examination are similar across population subgroups. Methods We compared BE coverage in population sub-groups categorised by place of residence, religion, caste/tribal groups, education levels, age, marital status, and employment status in their intersection with economic status in India. We analysed data for 699,686 women aged 15–49 using the NFHS-4 data set conducted during 2015–2016. Descriptive (mean, standard errors, and confidence intervals) of women undergoing BE disaggregated by dimensions of inequality (education, caste/tribal groups, religion, place of residence) and their intersections with wealth were computed with national weights using STATA 12. Chi-square tests were performed to assess the association between socio-demographic factors and breast screening. Additionally, the World Health Organisation’s Health Equity Assessment Toolkit Plus was used to compute summary measures of inequality: Slope index for inequality (SII) and Relative Concentration Indices (RCI) for each intersecting dimension. Results BE coverage was concentrated among wealthier groups regardless of other intersecting population subgroups. Wealth-related inequalities in BE coverage were most pronounced among Christians (SII; 20.6, 95% CI: 18.5–22.7), married (SII; 14.1, 95% CI: 13.8–14.4), employed (SII: 14.6, 95%CI: 13.9, 15.3), and rural women (SII; 10.8, 95% CI: 10.5–11.1). Overall, relative summary measures (RCI) were consistent with our absolute summary measures (SII). Conclusions Breast examination coverage in India is concentrated among wealthier populations across population groups defined by place of residence, religion, age, employment, and marital status. Apart from this national analysis, subnational analyses may also help identify strategies for programme rollout and ensure equity in women’s cancer screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01464-5.
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Affiliation(s)
- Jyotsna Negi
- Independent Consultant, 62 Stratford Rd, Kensington, California, 94707, USA.
| | - Devaki Nambiar
- The George Institute for Global Health, New Delhi, India.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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15
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Clanahan JM, Reddy S, Broach RB, Rositch AF, Anderson BO, Wileyto EP, Englander BS, Brooks AD. Clinical Utility of a Hand-Held Scanner for Breast Cancer Early Detection and Patient Triage. JCO Glob Oncol 2021; 6:27-34. [PMID: 32031433 PMCID: PMC6998011 DOI: 10.1200/jgo.19.00205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Globally, breast cancer represents the most common cause of cancer death among women. Early cancer diagnosis is difficult in low- and middle-income countries, most of which are unable to support population-based mammographic screening. Triage on the basis of clinical breast examination (CBE) alone can be difficult to implement. In contrast, piezo-electric palpation (intelligent Breast Exam [iBE]) may improve triage because it is portable, low cost, has a short learning curve, and provides electronic documentation for additional diagnostic workup. We compared iBE and CBE performance in a screening patient cohort from a Western mammography center. METHODS Women presenting for screening or diagnostic workup were enrolled and underwent iBE then CBE, followed by mammography. Mammography was classified as negative (BI-RADS 1 or 2) or positive (BI-RADS 3, 4, or 5). Measures of accuracy and κ score were calculated. RESULTS Between April 2015 and May 2017, 516 women were enrolled. Of these patients, 486 completed iBE, CBE, and mammography. There were 101 positive iBE results, 66 positive CBE results, and 35 positive mammograms. iBE and CBE demonstrated moderate agreement on categorization (κ = 0.53), but minimal agreement with mammography (κ = 0.08). iBE had a specificity of 80.3% and a negative predictive value of 94%. In this cohort, only five of 486 patients had a malignancy; iBE and CBE identified three of these five. The two cancers missed by both modalities were small—a 3-mm retro-areolar and a 1-cm axillary tail. CONCLUSION iBE performs comparably to CBE as a triage tool. Only minimal cancers detected through mammographic screening were missed on iBE. Ultimately, our data suggest that iBE and CBE can synergize as triage tools to significantly reduce the numbers of patients who need additional diagnostic imaging in resource-limited areas.
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Affiliation(s)
- Julie M Clanahan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sanjana Reddy
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robyn B Broach
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Benjamin O Anderson
- Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Ari D Brooks
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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16
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O'Donovan J, Newcomb A, MacRae MC, Vieira D, Onyilofor C, Ginsburg O. Community health workers and early detection of breast cancer in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Glob Health 2021; 5:bmjgh-2020-002466. [PMID: 32409331 PMCID: PMC7228495 DOI: 10.1136/bmjgh-2020-002466] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer is the leading cause of female mortality in low-income and middle-income countries (LMICs). Early detection of breast cancer, either through screening or early diagnosis initiatives, led by community health workers (CHWs) has been proposed as a potential way to address the unjustly high mortality rates. We therefore document: (1) where and how CHWs are currently deployed in this role; (2) how CHWs are trained, including the content, duration and outcomes of training; and (3) the evidence on costs associated with deploying CHWs in breast cancer early detection. Methods We conducted a systematic scoping review and searched eight major databases, as well as the grey literature. We included original studies focusing on the role of CHWs to assist in breast cancer early detection in a country defined as a LMIC according to the World Bank. Findings 16 eligible studies were identified. Several roles were identified for CHWs including awareness raising and community education (n=13); history taking (n=7); performing clinical breast examination (n=9); making onward referrals (n=7); and assisting in patient navigation and follow-up (n=4). Details surrounding training programmes were poorly reported and no studies provided a formal cost analysis. Conclusions Despite the relative paucity of studies addressing the role of CHWs in breast cancer early detection, as well as the heterogeneity of existing studies, evidence suggests that CHWs can play a number of important roles in breast cancer early detection initiatives in LMICs. However, if they are to realise their full potential, they must be appropriately supported within the wider health system.
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Affiliation(s)
- James O'Donovan
- Department of Education, Oxford University, Oxford, Oxfordshire, UK .,Division of Research and Health Equity, Omni Med, Mukono, Uganda
| | - Ashley Newcomb
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York, USA
| | - MacKenzie Clark MacRae
- Division of Research and Health Equity, Omni Med, Mukono, Uganda.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Dorice Vieira
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York, USA
| | - Chinelo Onyilofor
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ophira Ginsburg
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York, USA
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17
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Aklilu S, Bain C, Bansil P, de Sanjose S, Dunstan JA, Castillo V, Tsu V, Contreras I, Balassanian R, Hayes Constant TK, Scheel JR. Evaluation of diagnostic ultrasound use in a breast cancer detection strategy in Northern Peru. PLoS One 2021; 16:e0252902. [PMID: 34115775 PMCID: PMC8195385 DOI: 10.1371/journal.pone.0252902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
To evaluate the diagnostic impact of point-of-care breast ultrasound by trained primary care physicians (PCPs) as part of a breast cancer detection program using clinical breast exam in an underserved region of Peru. Medical records and breast ultrasound images of symptomatic women presenting to the Breast Cancer Detection Model (BCDM) in Trujillo, Peru were collected from 2017–2018. Performance was measured against final outcomes derived from regional cancer center medical records, fine needle aspiration results, patient follow-up (sensitivity, specificity, positive, and negative predictive values), and by percent agreement with the retrospective, blinded interpretation of images by a fellowship-trained breast radiologist, and a Peruvian breast surgeon. The diagnostic impact of ultrasound, compared to clinical breast exam (CBE), was calculated for actual practice and for potential impact of two alternative reporting systems. Of the 171 women presenting for breast ultrasound, 23 had breast cancer (13.5%). Breast ultrasound used as a triage test (current practice) detected all cancer cases (including four cancers missed on confirmatory CBE). PCPs showed strong agreement with radiologist and surgeon readings regarding the final management of masses (85.4% and 80.4%, respectively). While the triage system yielded a similar number of biopsies as CBE alone, using the condensed and full BI-RADS systems would have reduced biopsies by 60% while identifying 87% of cancers immediately and deferring 13% to six-month follow-up. Point-of-care ultrasound performed by trained PCPs improves diagnostic accuracy for managing symptomatic women over CBE alone and enhances access. Greater use of BI-RADS to guide management would reduce the diagnostic burden substantially.
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Affiliation(s)
- Segen Aklilu
- Department of Radiology, University of Washington, Seattle, Washington, United States of America
| | - Carolyn Bain
- PATH, Seattle, Washington, United States of America
| | - Pooja Bansil
- PATH, Seattle, Washington, United States of America
| | | | | | | | - Vivien Tsu
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Ronald Balassanian
- Department of Pathology, University of California San Francisco, San Francisco, California, United States of America
| | | | - John R. Scheel
- Department of Radiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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18
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Rositch AF, Unger-Saldaña K, DeBoer RJ, Ng'ang'a A, Weiner BJ. The role of dissemination and implementation science in global breast cancer control programs: Frameworks, methods, and examples. Cancer 2021; 126 Suppl 10:2394-2404. [PMID: 32348574 DOI: 10.1002/cncr.32877] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/11/2020] [Accepted: 03/11/2020] [Indexed: 01/24/2023]
Abstract
Global disparities in breast cancer outcomes are attributable to a sizable gap between evidence and practice in breast cancer control and management. Dissemination and implementation science (D&IS) seeks to understand how to promote the systematic uptake of evidence-based interventions and/or practices into real-world contexts. D&IS methods are useful for selecting strategies to implement evidence-based interventions, adapting their implementation to new settings, and evaluating the implementation process as well as its outcomes to determine success and failure, and adjust accordingly. Process models, explanatory theories, and evaluation frameworks are used in D&IS to develop implementation strategies, identify implementation outcomes, and design studies to evaluate these outcomes. In breast cancer control and management, research has been translated into evidence-based, resource-stratified guidelines by the Breast Health Global Initiative and others. D&IS should be leveraged to optimize the implementation of these guidelines, and other evidence-based interventions, into practice across the breast cancer care continuum, from optimizing public education to promoting early detection, increasing guideline-concordant clinical practice among providers, and analyzing and addressing barriers and facilitators in health care systems. Stakeholder engagement through processes such as co-creation is critical. In this article, the authors have provided a primer on the contribution of D&IS to phased implementation of global breast cancer control programs, provided 2 case examples of ongoing D&IS research projects in Tanzania, and concluded with recommendations for best practices for researchers undertaking this work.
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Affiliation(s)
- Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Rebecca J DeBoer
- Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Anne Ng'ang'a
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, Washington
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19
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Sood R, Masalu N, Connolly RM, Chao CA, Faustine L, Mbulwa C, Anderson BO, Rositch AF. Invasive breast Cancer treatment in Tanzania: landscape assessment to prepare for implementation of standardized treatment guidelines. BMC Cancer 2021; 21:527. [PMID: 33971839 PMCID: PMC8108449 DOI: 10.1186/s12885-021-08252-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Incidence of breast cancer continues to rise in low- and middle-income countries, with data from the East African country of Tanzania predicting an 82% increase in breast cancer from 2017 to 2030. We aimed to characterize treatment pathways, receipt of therapies, and identify high-value interventions to increase concordance with international guidelines and avert unnecessary breast cancer deaths. METHODS Primary data were extracted from medical charts of patients presenting to Bugando Medical Center, Tanzania, with breast concerns and suspected to have breast cancer. Clinicopathologic features were summarized with descriptive statistics. A Poisson model was utilized to estimate prevalence ratios for variables predicted to affect receipt of life-saving adjuvant therapies and completion of therapies. International and Tanzanian guidelines were compared to current care patterns in the domains of lymph node evaluation, metastases evaluation, histopathological diagnosis, and receptor testing to yield concordance scores and suggest future areas of focus. RESULTS We identified 164 patients treated for suspected breast cancer from April 2015-January 2019. Women were predominantly post-menopausal (43%) and without documented insurance (70%). Those with a confirmed histopathology diagnosis (69%) were 3 times more likely to receive adjuvant therapy (PrR [95% CI]: 3.0 [1.7-5.4]) and those documented to have insurance were 1.8 times more likely to complete adjuvant therapy (1.8 [1.0-3.2]). Out of 164 patients, 4% (n = 7) received concordant care based on the four evaluated management domains. The first most common reason for non-concordance was lack of hormone receptor testing as 91% (n = 144) of cases did not undergo this testing. The next reason was lack of lymph node evaluation (44% without axillary staging) followed by absence of abdominopelvic imaging in those with symptoms (35%) and lack of histopathological confirmation (31%). CONCLUSIONS Patient-specific clinical data from Tanzania show limitations of current breast cancer management including axillary staging, receipt of formal diagnosis, lack of predictive biomarker testing, and low rates of adjuvant therapy completion. These findings highlight the need to adapt and adopt interventions to increase concordance with guidelines including improving capacity for pathology, developing complete staging pathways, and ensuring completion of prescribed adjuvant therapies.
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Affiliation(s)
- Rupali Sood
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Office E6150, Baltimore, MD, 21205, USA
| | | | - Roisin M Connolly
- Cancer Research @ UCC, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Christina A Chao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Office E6150, Baltimore, MD, 21205, USA
| | | | | | - Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Office E6150, Baltimore, MD, 21205, USA.
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20
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Elghazawy H, Bakkach J, Zaghloul MS, Abusanad A, Hussein MM, Alorabi M, eldin NB, Helal T, Zaghloul TM, Venkatesulu BP, Elghazaly H, Al-Sukhun S. Implementation of breast cancer continuum of care in low- and middle-income countries during the COVID-19 pandemic. Future Oncol 2020; 16:2551-2567. [PMID: 32715776 PMCID: PMC7386379 DOI: 10.2217/fon-2020-0574] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/03/2020] [Indexed: 12/19/2022] Open
Abstract
Breast cancer is the most common malignancy among women worldwide. The current COVID-19 pandemic represents an unprecedented challenge leading to care disruption, which is more severe in low- and middle-income countries (LMIC) due to existing economic obstacles. This review presents the global perspective and preparedness plans for breast cancer continuum of care amid the COVID-19 outbreak and discusses challenges faced by LMIC in implementing these strategies. Prioritization and triage of breast cancer patients in a multidisciplinary team setting are of paramount importance. Deescalation of systemic and radiation therapy can be utilized safely in selected clinical scenarios. The presence of a framework and resource-adapted recommendations exploiting available evidence-based data with judicious personalized use of current resources is essential for breast cancer care in LMIC during the COVID-19 pandemic.
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Affiliation(s)
- Hagar Elghazawy
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Joaira Bakkach
- Biomedical Genomics & Oncogenetics Research Laboratory. Faculty of Sciences and Techniques of Tangier. Abdel Malek Essaadi University, Tangier 90000, Morocco
| | - Mohamed S Zaghloul
- Department of Radiotherapy, National Cancer Institute, Cairo University, Cairo 12622, Egypt
| | - Atlal Abusanad
- Department of Medicine, Oncology Division, King Abdulaziz University, Jeddah 23221, Saudi Arabia
| | - Mariam Mohamed Hussein
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Mohamed Alorabi
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Nermean Bahie eldin
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Thanaa Helal
- Department of Pathology, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Tarek M Zaghloul
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo 12622, Egypt
| | | | - Hesham Elghazaly
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Sana Al-Sukhun
- Al-Hyatt Oncology Center, Faculty of medicine, Jordan University, Amman 11183, Jordan
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21
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Chao CA, Huang L, Visvanathan K, Mwakatobe K, Masalu N, Rositch AF. Understanding women's perspectives on breast cancer is essential for cancer control: knowledge, risk awareness, and care-seeking in Mwanza, Tanzania. BMC Public Health 2020; 20:930. [PMID: 32539723 PMCID: PMC7296642 DOI: 10.1186/s12889-020-09010-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Breast Cancer is the most common cancer in women worldwide. Since 2008, Mwanza, Tanzania, has worked to provide comprehensive cancer services through its Zonal consultant hospital. New national guidelines focused on clinical breast exam requires that women be aware of and seek care for breast concerns. Therefore, this study aims to understand breast cancer awareness in Mwanza and describe women-level barriers, care-seeking behavior, and perspectives on breast cancer. METHODS A community-based survey was administered to conveniently sampled women aged 30 and older to assess women's perspectives on breast cancer and care-seeking behavior. RESULTS Among 1129 women with a median age of 37 (IQR: 31-44) years, 73% have heard of cancer and 10% have received breast health education. Women self-evaluated their knowledge of breast cancer (from 1-none to 10-extremely knowledgeable) with a median response of 3 (IQR: 1-4). Only 14% felt they knew any signs or symptoms of breast cancer. Encouragingly, 56% of women were fairly-to-very confident they would notice changes in their breasts, with 24% of women practicing self-breast examination and 21% reporting they had received a past breast exam. Overall, 74% said they would be somewhat-to-very likely to seek care if they noticed breast changes, with 96% noting severity of symptoms as a motivator. However, fear of losing a breast (40%) and fear of a poor diagnosis (38%) were most frequent barriers to care seeking. In assessing knowledge of risk factors, about 50% of women did not know any risk factors for breast cancer whereas 42% of women believed long term contraceptive use a risk factor. However, 37% and 35% of women did not think that family history or being older were risk factors, respectively. CONCLUSIONS The success of efforts to improve early diagnosis in a setting without population-based screening depends on women being aware of breast cancer signs and symptoms, risks, and ultimately seeking care for breast concerns. Fortunately, most women said they would seek care if they noticed a change in their breasts, but the low levels of cancer knowledge, symptoms, and common risk factors highlight the need for targeted community education and awareness campaigns.
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Affiliation(s)
- Christina A Chao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Liuye Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kisa Mwakatobe
- Tanzania Breast Cancer Foundation, Dar es Salaam, Tanzania
| | - Nestory Masalu
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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22
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Ginsburg O, Yip CH, Brooks A, Cabanes A, Caleffi M, Dunstan Y. J, Gyawali B, McCormack V, de Anderson MM, Mehrotra R, Mohar A, Murillo R, Pace LE, Paskett ED, Romanoff A, Rositch AF, Scheel J, Schneidman M, Unger-Saldana K, Vanderpuye V, Wu TY, Yuma S, Dvaladze A, Duggan C, Anderson BO. Breast cancer early detection: A phased approach to implementation. Cancer 2020; 126 Suppl 10:2379-2393. [PMID: 32348566 PMCID: PMC7237065 DOI: 10.1002/cncr.32887] [Citation(s) in RCA: 199] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022]
Abstract
When breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered.
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Affiliation(s)
- Ophira Ginsburg
- Perlmutter Cancer Center, Section for Global Health, Division of Health and Behavior, Department of Population Health, New York University Langone Health, NY, USA
| | - Cheng-Har Yip
- University of Malaya, Kuala Lumpur, Malaysia
- Ramsay Sime Darby Health Care Kuala Lumpur, Malaysia
| | - Ari Brooks
- Dept. of Surgery, University of Pennsylvania, PA, USA
| | | | - Maira Caleffi
- Breast Center Hospital Moinhos de Vento Porto Alegre, Brazil
| | - Jorge Dunstan Y.
- Department of Breast, Skin and Soft Tissue Sarcomas Surgery Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Bishal Gyawali
- Department of Oncology, Department of Public Health Sciences and Division of Cancer Care and Epidemiology, Queen’s University, Kingston, Ontario, Canada
| | | | | | | | - Alejandro Mohar
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, UNAM, Mexico
| | - Raul Murillo
- Centro Javeriano de Oncología – Hospital Universitario San Ignacio. Colombia
- Facultad de Medicina – Pontificia Universidad Javeriana, Colombia
| | - Lydia E. Pace
- Division of Women’s Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Electra D. Paskett
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
| | - Anya Romanoff
- Department of Surgery, Division of Surgical Oncology, Breast Surgery, The Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA
| | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Scheel
- Dept. of Radiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington Seattle, WA, USA
| | - Miriam Schneidman
- Health, Nutrition and Population Global Practice, The World Bank Group
| | - Karla Unger-Saldana
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, UNAM, Mexico
| | - Verna Vanderpuye
- National Center for Oncology, Radiotherapy and Nuclear Medicine, Accra, Ghana
| | - Tsu-Yin Wu
- Center for Health Disparities Innovation and Studies, Eastern Michigan University, MI, USA
| | - Safina Yuma
- Dept. of Reproductive and Child Health, Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania
| | - Allison Dvaladze
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Catherine Duggan
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Benjamin O. Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Departments of Surgery and Global Health Medicine, University of Washington, Seattle, Washington, USA
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Dvaladze A, Kizub DA, Cabanes A, Nakigudde G, Aguilar B, Zujewski JA, Duggan C, Anderson BO, Pritam Singh RK, Gralow JR. Breast cancer patient advocacy: A qualitative study of the challenges and opportunities for civil society organizations in low-income and middle-income countries. Cancer 2020; 126 Suppl 10:2439-2447. [PMID: 32348570 DOI: 10.1002/cncr.32852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/12/2020] [Accepted: 03/01/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Breast cancer advocacy movements, driven by advocate-led civil society organizations (CSOs), have proven to be a powerful force for the advancement of cancer control in high-income countries (HICs). However, although patient advocacy movements are growing in low-income and middle-income countries (LMICs) in response to an increasing cancer burden, the experiences and needs of advocate-led breast cancer CSOs in LMICs is understudied. METHODS The authors conducted a qualitative study using in-depth interviews and focus group discussions with 98 participants representing 23 LMICs in Eastern Europe, Central Asia, East and Southern Africa, and Latin America. RESULTS Despite geographic, cultural, and socioeconomic differences, the common themes that emerged from the data across the 3 regions are strikingly similar: trust, knowledge gaps, stigma, sharing experiences, and sustainability. The authors identified common facilitators (training/education, relationship building/networking, third-party facilitators, and communication) and barriers (mistrust, stigma, organizational fragility, difficulty translating HIC strategies) to establishing trust, collaboration, and advancing cancer advocacy efforts. To the authors' knowledge, the current study is the first to describe the role that coalitions and regional networks play in advancing breast cancer advocacy in LMICs across multiple regions. CONCLUSIONS The findings of the current study corroborate the importance of investing in 3-way partnerships between CSOs, political leaders, and health experts. When provided with information that is evidence-based and resource appropriate, as well as opportunities to network, advocates are better equipped to achieve their goals. The authors propose that support for CSOs focuses on building trust through increasing opportunities for engagement, disseminating best practices and evidence-based information, and fostering the creation of platforms for partnerships and networks.
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Affiliation(s)
- Allison Dvaladze
- Department of Medicine, University of Washington, Seattle, Washington
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | - Bertha Aguilar
- Medical Foundation and Researchers in the Fight against Cancer (Fundacion MILC), Mexico City, Mexico
| | | | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Benjamin O Anderson
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Surgery, University of Washington, Seattle, Washington
| | - R K Pritam Singh
- Breast Cancer Welfare Association Malaysia, Petaling Jaya, Malaysia
| | - Julie R Gralow
- Department of Medicine, University of Washington, Seattle, Washington
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
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24
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Zuwasti U, Abbey G, Pollack E, Scheel J, Chong A. Breast Imaging in Global Health: Serving the Underserved. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00349-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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25
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Alawa J, Alhalabi F, Khoshnood K. Breast Cancer Management Among Refugees and Forcibly Displaced Populations: a Call to Action. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-00314-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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