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Siddique R, Thangavelu L, S R, Almalki WH, Kazmi I, Kumar A, Mahajan S, Kalra H, Alzarea SI, Pant K. lncRNAs and cyclin-dependent kinases: Unveiling their critical roles in cancer progression. Pathol Res Pract 2024; 258:155333. [PMID: 38723325 DOI: 10.1016/j.prp.2024.155333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024]
Abstract
Long non-coding RNAs (lncRNAs) are a diverse class of RNA molecules that do not code for proteins but play critical roles in gene regulation. One such role involves the modulation of cell cycle progression and proliferation through interactions with cyclin-dependent kinases (CDKs), key regulators of cell division. Dysregulation of CDK activity is a hallmark of cancer, contributing to uncontrolled cell growth and tumor formation. These lncRNA-CDK interactions are part of a complex network of molecular mechanisms underlying cancer pathogenesis, involving various signaling pathways and regulatory circuits. Understanding the interplay between lncRNAs, CDKs, and cancer biology holds promise for developing novel therapeutic strategies targeting these molecular targets for more effective cancer treatment. Furthermore, targeting CDKs, key cell cycle progression and proliferation regulators, offers another avenue for disrupting cancer pathways and overcoming drug resistance. This can open new possibilities for individualized treatment plans and focused therapeutic interventions.
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Affiliation(s)
- Raihan Siddique
- School of Pharmacy, Suresh Gyan Vihar University, Mahal Road, Jagatpura, Jaipur, India
| | - Lakshmi Thangavelu
- Center for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, India.
| | - RenukaJyothi S
- Department of Biotechnology and Genetics, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India
| | - Waleed Hassan Almalki
- Department of Pharmacology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, 21589, Jeddah, Saudi Arabia
| | - Ashwani Kumar
- Department of Pharmacy, Vivekananda Global University, Jaipur, Rajasthan 303012, India
| | - Shriya Mahajan
- Centre of Research Impact and Outcome, Chitkara University, Rajpura, Punjab 140417, India
| | - Hitesh Kalra
- Chitkara Centre for Research and Development, Chitkara University, Himachal Pradesh 174103, India
| | - Sami I Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, 72341, Sakaka, Al-Jouf, Saudi Arabia
| | - Kumud Pant
- Graphic Era (Deemed to be University), Clement Town, Dehradun 248002, India; Graphic Era Hill University, Clement Town, Dehradun 248002, India
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2
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Xiao Z, Li L. Breast cancer mortality in Chinese women and men from 1990 to 2019: Analysis of trends in risk factors. J Obstet Gynaecol Res 2024; 50:970-981. [PMID: 38561241 DOI: 10.1111/jog.15931] [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: 11/26/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE This study aimed to examine the relative risk of risk factor in male and female breast cancer (BC) deaths in China and analyzed the changing trends in BC mortality rates from 1990 to 2019. METHODS Open data from the Global Burden of Disease database from 1990 to 2019 were analyzed to assess the number of BC deaths and age-standardized mortality rates (ASMR) in China. The age-period-cohort model was employed to study age effects, period effects, cohort effects, as well as local drift and net drift of the data, determining the impact of changing risk factors on crude mortality rates and ASMR of BC. RESULTS In 2019, the number of BC deaths across all age groups in China increased by 130.38% compared to 1990, with an increase of 125.68% in females and 648.80% in males. The ASMR for BC and male BC increased in 2019, while female BC ASMR declined. Overall, alcohol consumption and smoking as risk factors contributed to increased mortality rates of BC with advancing age. Over the entire study period, the net drift of alcohol consumption in females for BC was 0.06% (95% confidence interval [CI]: -0.24% to 0.36%), while for smoking it was -0.64% (95% CI: -0.83% to -0.45%). For males, the net drift of alcohol consumption for BC was 6.75% (95% CI: 5.55% to 7.96%), and for smoking, it was 6.09% (95% CI: 2.66% to 9.64%). CONCLUSION Hence, improving awareness of BC-related risk factors and implementing prevention strategies are necessary to alleviate future BC burdens.
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Affiliation(s)
- Ziwei Xiao
- Hunan Normal University, Changsha, Hunan, China
| | - Lin Li
- Hunan Normal University, Changsha, Hunan, China
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3
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Goh SP, Ong SC, Chan JE. Economic evaluation of germline genetic testing for breast cancer in low- and middle-income countries: a systematic review. BMC Cancer 2024; 24:316. [PMID: 38454347 PMCID: PMC10919043 DOI: 10.1186/s12885-024-12038-7] [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: 11/09/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Breast cancer (BC) is the most common cancer affecting women globally. Genetic testing serves as a prevention and treatment strategy for managing BC. This study aims to systematically review economic evaluations and the quality of selected studies involving genetic screening strategies for BC in low and middle-income countries (LMICs). METHODS A search was performed to identify related articles that were published up to April 2023 on PubMed, Embase, CINAHL, Web of Science, and the Centre for Reviews and Dissemination. Only English-language LMIC studies were included. Synthesis of studies characteristics, methodological and data input variations, incremental cost-effectiveness ratios (ICERs), and reporting quality (Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist) were performed. RESULTS This review found five pertinent studies, mainly focusing on economic evaluations of germline genetic testing in upper-middle-income countries (Upper MICs) like Malaysia, China, and Brazil. Only one study covered multiple countries with varying incomes, including lower-middle-income nations (Lower MICs) like India. The ICERs values in various screening scenarios for early-stage BC, HER2 negative BC patients, and healthy women with clinical or family history criteria were ranging from USD 2214/QALY to USD 36,342/QALY. Multigene testing for all breast cancer patients with cascade testing was at USD 7729/QALY compared to BRCA alone. Most studies adhered to the CHEERS 2022 criteria, signifying high methodological quality. CONCLUSIONS Germline testing could be considered as cost-effective compared to no testing in Upper MICs (e.g., Malaysia, China, Brazil) but not in Lower MICs (e.g., India) based on the willingness-to-pay (WTP) threshold set by each respective study. Limitations prevent a definite conclusion about cost-effectiveness across LMICs. More high-quality studies are crucial for informed decision-making and improved healthcare practices in these regions.
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Affiliation(s)
- Sook Pin Goh
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
| | - Jue Ern Chan
- Pharmacy Department, Klinik Kesihatan Chemor Pejabat Kesihatan Daerah Kinta, Ipoh, Perak, Malaysia
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Mainaz M, Guthigar M, Naik P. Effectiveness of a Health Educational Program in Enhancing Breast Cancer Knowledge Among Women in Rural Karnataka, South India. Cureus 2024; 16:e56157. [PMID: 38618335 PMCID: PMC11015857 DOI: 10.7759/cureus.56157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION AND AIM Breast cancer is one of the significant causes of mortality in India, ranking second only to cervical cancer among women. Annually, the country has witnessed the detection of 200,000 new cases, with 60% identified in the early stages. This study aimed to assess the effectiveness of a health education intervention program designed to enhance knowledge about breast cancer among women in rural Karnataka. MATERIALS AND METHODS A descriptive study design was employed and a total of 320 women were selected through multi-stage sampling. The educational intervention involved a PowerPoint presentation by the investigator, which was followed by group discussions that culminated with plenary sessions for clarifying the doubts of respondents. At the end of every educational session, pre-designed, pre-tested, and validated questionnaires, comprising a mix of structured and semi-structured questions, were completed by the respondents as part of the post-test. Results: Among the participants, 44.7% were educated up to the primary level, a majority (64.1%) were employed, and most (90.3%) were married. Additionally, 56.9% reported a monthly income below 3000 Indian rupees (₹), with the majority (86.3%) falling below the poverty line (BPL) category. A statistically significant improvement (p = 0.0001) in knowledge related to breast health, breast self-examination, clinical breast examination, and mammography was observed in the post-intervention phase when compared to the pre-test. 86.2% of the respondents showed an increase in knowledge level about breast health (either from poor to moderate or from moderate to good) and the practice of breast self-examination increased from 4.7% (pre-test) to 60.3% (post-test). Conclusion: The study demonstrated a significant enhancement in women's knowledge levels after implementing the health education intervention program. These findings underscore the importance of health education strategies in raising awareness of lifestyle diseases, particularly breast cancer, among women.
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Affiliation(s)
- Mainaz Mainaz
- Department of Social Work, Yenepoya (Deemed to be University), Mangaluru, IND
| | | | - Poonam Naik
- Department of Community Medicine, Yenepoya Medical College, Mangaluru, IND
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Riano I, Velazquez AI, Viola L, Abuali I, Jimenez K, Abioye O, Florez N. State of Cancer Control in South America: Challenges and Advancement Strategies. Hematol Oncol Clin North Am 2024; 38:55-76. [PMID: 37353378 DOI: 10.1016/j.hoc.2023.05.013] [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] [Indexed: 06/25/2023]
Abstract
Cancer is a major public health problem in South America. The cancer mortality burden is increasing in the region due to its presentation at later stages, which is related to limited access to cancer care. This results in a noticeable inequity in provisions of cancer care including specialized screening programs, as well as cancer-related treatments such as personalized medicine, radiation therapy, palliative care, and survivorship services. Consequently, South America faces many challenges for cancer control, most of them deriving from a lack of funding and unequal distribution of resources and cancer services, affecting mostly the underserved populations in the region.
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Affiliation(s)
- Ivy Riano
- Division of Hematology and Oncology, Dartmouth Cancer Center, Geisel School of Medicine Dartmouth, One Medical Drive, Lebanon, NH 03766, USA.
| | - Ana I Velazquez
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA. https://twitter.com/AnaVManana
| | - Lucia Viola
- Fundación Neumológica Colombiana, Centro de Tratamiento e Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Cra. 13b #161 - 85, Bogotá, Colombia. https://twitter.com/LuciaViola9
| | - Inas Abuali
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. https://twitter.com/Inas_md
| | - Kathya Jimenez
- Universidad Evangelica de El Salvador, El Salvador. https://twitter.com/KathyaJimenezMD
| | - Oyepeju Abioye
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa. https://twitter.com/AbioyeOyepeju
| | - Narjust Florez
- Dana Farber Cancer Institute, Harvard School of Medicine, 450 Brookline Avenue - DA1230, Boston, MA 02215, USA. https://twitter.com/NarjustFlorezMD
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Kasgri KA, Abazari M, Badeleh SM, Badeleh KM, Peyman N. Comprehensive Review of Breast Cancer Consequences for the Patients and Their Coping Strategies: A Systematic Review. Cancer Control 2024; 31:10732748241249355. [PMID: 38767653 PMCID: PMC11107334 DOI: 10.1177/10732748241249355] [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: 09/22/2023] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Women with breast cancer usually face multiple short-term and long-term problems in dealing with their acute and chronic symptoms during and after cancer treatment. However, serious gaps remain in addressing these issues in clinical and public health practice. METHODS According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we conducted a systematic literature search from 2000-2021 in electronic databases, including Medline, PubMed, Embase, Scopus, Web of Knowledge, and Google Scholar databases using predefined keywords. RESULTS The review identified several significant and interconnected problems in breast cancer patient's treatment and supportive care. The results revealed that these issues are very common among breast cancer patients, and specific attention and serious measures are needed to address these problems. Despite implementing different protocols and programs for covering and addressing these problems, serious gaps still exist in supporting breast cancer patients during clinical and follow-up care. CONCLUSION Developing innovative and holistic approaches and programs based on the multifactorial assessment of symptoms are suggested for addressing and covering the multidimensional requirements of this population. Consequently, thorough evaluation, education, treatment, and referrals should be provided for the most common sequelae of these patients by including appropriate medication, exercise, counselling, occupational therapy, and complementary therapies. The present study provides a more comprehensive source of information about breast cancer patient's medical and supportive needs in comparison with individual studies on symptom experiences.
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Affiliation(s)
- Kobra A. Kasgri
- Department of Midwifery, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Morteza Abazari
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Safa M. Badeleh
- Department of Food and Drug Control, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Kosar M. Badeleh
- Department of Sciences, Islamic Azad University, Sari Branch, Sari, Iran
| | - Nooshin Peyman
- Department of Health Education and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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Yazdan M, Naghib SM, Mozafari MR. Liposomal Nano-Based Drug Delivery Systems for Breast Cancer Therapy: Recent Advances and Progresses. Anticancer Agents Med Chem 2024; 24:896-915. [PMID: 38529608 DOI: 10.2174/0118715206293653240322041047] [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: 11/18/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
Breast cancer is a highly prevalent disease on a global scale, with a 30% incidence rate among women and a 14% mortality rate. Developing countries bear a disproportionate share of the disease burden, while countries with greater technological advancements exhibit a higher incidence. A mere 7% of women under the age of 40 are diagnosed with breast cancer, and the prevalence of this ailment is significantly diminished among those aged 35 and younger. Chemotherapy, radiation therapy, and surgical intervention comprise the treatment protocol. However, the ongoing quest for a definitive cure for breast cancer continues. The propensity for cancer stem cells to metastasize and resistance to treatment constitute their Achilles' heel. The advancement of drug delivery techniques that target cancer cells specifically holds significant promise in terms of facilitating timely detection and effective intervention. Novel approaches to pharmaceutical delivery, including nanostructures and liposomes, may bring about substantial changes in the way breast cancer is managed. These systems offer a multitude of advantages, such as heightened bioavailability, enhanced solubility, targeted tumor destruction, and diminished adverse effects. The application of nano-drug delivery systems to administer anti-breast cancer medications is a significant subject of research. This article delves into the domain of breast cancer, conventional treatment methods, the incorporation of nanotechnology into managerial tactics, and strategic approaches aimed at tackling the disease at its core.
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Affiliation(s)
- Mostafa Yazdan
- Department of Nanotechnology, School of Advanced Technologies, Iran University of Science and Technology (IUST), Tehran, 1684613114, Iran
| | - Seyed Morteza Naghib
- Department of Nanotechnology, School of Advanced Technologies, Iran University of Science and Technology (IUST), Tehran, 1684613114, Iran
| | - M R Mozafari
- Australasian Nanoscience and Nanotechnology Initiative (ANNI), Monash University LPO, Clayton, VIC 3168, Australia
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Schoenhals S, Mali ME, Sutherland EK, Sorenson J, Dedey F, Nellermoe J, Flores-Huidobro Martinez A, Tounkara MD, Price RR, Brownson KE. Geospatial availability of breast cancer treatment modalities and hypothetical access improvement in Ghana: A nationwide survey. PLoS One 2023; 18:e0291454. [PMID: 37713441 PMCID: PMC10503733 DOI: 10.1371/journal.pone.0291454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
Breast cancer in Ghana is a growing public health problem with increasing incidence and poor outcomes. Lack of access to comprehensive treatment in Ghana may be a contributing factor to its high mortality. The purpose of this study was to evaluate the availability of treatments nationwide and systematically identify high yield areas for targeted expansion. We conducted a cross-sectional, nationwide hospital-based survey from November 2020-October 2021. Surveys were conducted in person with trained research assistants and described hospital availability of all breast cancer treatments and personnel. All individual treatment services were reported, and hospitals were further stratified into levels of multi-modal treatment modeled after the National Comprehensive Cancer Network (NCCN) Framework treatment recommendations for low-resource settings. Level 3 included Tamoxifen and surgery (mastectomy with axillary lymph node sampling); Level 2 included Level 3 plus radiation, aromatase inhibitors, lumpectomy, and sentinel lymph node biopsy; Level 1 included Level 2 plus Her2 therapy and breast reconstruction. Hospitals were identified that could expand to these service levels based on existing services, location and personnel. The distance of the total population from treatment services before and after hypothetical expansion was determined with a geospatial analysis. Of the 328 participating hospitals (95% response rate), 9 hospitals had Level 3 care, 0 had Level 2, and 2 had Level 1. Twelve hospitals could expand to Level 3, 1 could expand to Level 2, and 1 could expand to Level 1. With expansion, the population percentage within 75km of Level 1, 2 and 3 care would increase from 42% to 50%, 0 to 6% and 44% to 67%, respectively. Multi-modal breast cancer treatment is available in Ghana, but it is not accessible to most of the population. Leveraging the knowledge of current resources and population proximity provides an opportunity to identify high-yield areas for targeted expansion.
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Affiliation(s)
- Sarah Schoenhals
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Meghan E. Mali
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Edward K. Sutherland
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Ensign Global College, Kpong, Eastern Region, Ghana
| | - Justin Sorenson
- J.Willard Marriot Library, University of Utah, Salt Lake City, Utah, United States of America
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Greater Accra, Ghana
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Jonathan Nellermoe
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | | | - Mamadou D. Tounkara
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Raymond R. Price
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- General Surgery, Intermountain Medical Center, Murray, Utah, United States of America
| | - Kirstyn E. Brownson
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Surgery, Huntsman Cancer Institute at University of Utah, Salt Lake City, Utah, United States of America
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Jiang J, Jiang S, Ahumada-Canale A, Chen Z, Si L, Jiang Y, Yang L, Gu Y. Breast Cancer Screening Should Embrace Precision Medicine: Evidence by Reviewing Economic Evaluations in China. Adv Ther 2023; 40:1393-1417. [PMID: 36800077 PMCID: PMC10070309 DOI: 10.1007/s12325-023-02450-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Abstract
The cost-effectiveness of conventional population-based breast cancer screening strategies (e.g. mammography) has been found controversial, while evidence shows that genetic testing for early detection of pathogenic variants is cost-effective. We aimed to review the economic evaluations of breast cancer screening in China to provide an information summary for future research on this topic. We searched the literature to identify the economic evaluations that examined breast cancer screening and testing in China, supplemented by hand-searching the reference lists of the included studies. We finally included five studies satisfying our inclusion criteria. Four articles examined mammography while the rest investigated multigene testing. The existing breast cancer screening programmes were found to be cost-effective among urban Chinese women, but one study concluded that they might cause harm to women in rural areas. Contextual factors, such as data absence, urban-rural disparity, willingness-to-pay threshold, and model design, imposed barriers to cost-effectiveness analysis. Multigene testing was found to be cost-effective and has a promising population impact among all women with breast cancer in China. Future research should investigate the cost-effectiveness of screening and identifying breast cancer through precision medicine technologies, including genetic testing, genome sequencing, cascade testing, and the return of secondary findings.
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Affiliation(s)
- Jingjing Jiang
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Shan Jiang
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Antonio Ahumada-Canale
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
- Faculty of Humanities and Social Sciences, School of Economics, University of Nottingham Ningbo China, Ningbo, Zhejiang, China
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Li Yang
- School of Public Health, Peking University, Beijing, China.
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
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Abdallah A, Abdelwahab K, Awny S, Zuhdy M, Hamdy O, Atallah K, Elfeky A, Hegazy MAF, Metwally IH. Fungating and Ulcerating Breast Cancer: Wound Closure Algorithm, Complications, and Survival Trends. Indian J Surg Oncol 2023; 14:93-105. [PMID: 36891440 PMCID: PMC9986193 DOI: 10.1007/s13193-022-01602-x] [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: 03/25/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022] Open
Abstract
Fungating breast cancer severely affects patients' daily lives, and patient management poses major oncology challenges. To present 10-year outcomes of unique tumor presentation, suggesting a focused algorithm for surgical management and providing deep analysis for factors affecting survival and surgical outcomes. Eighty-two patients with fungating breast cancer were enrolled in the period from January 2010 to February 2020 in the Mansoura University Oncology Center database. Epidemiological and pathological characteristics, risk factors, different surgical treatment techniques, and surgical and oncological outcomes were reviewed. Preoperative systemic therapy was used in 41 patients, with the majority (77.8%) showing progressive response. Mastectomy was performed in 81 (98.8%) patients, with primary wound closure in 71 (86.6%), and wide local excision in a single patient (1.2%). Different reconstructive techniques in non-primary closure operations were used. Complications were reported in 33 (40.7%) patients, of which 16 (48.5%) were of Clavien-Dindo grade II category. Loco-regional recurrence occurred in 20.7% of patients. The mortality rate during follow-up was 31.7% (n = 26). Estimated mean overall survival (with 95% CI) was 55.96 (41.98-69.9) months; estimated mean loco-regional recurrence-free survival (with 95% CI) was 38.01 (24.6-51.4) months. Surgery is a cornerstone fungating breast cancer treatment option, but at the expense of high morbidity. Sophisticated reconstructive procedures may be indicated for wound closure. A suggested algorithm based on the center's experience of wound management in difficult mastectomy cases is displayed.
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Affiliation(s)
- Ahmed Abdallah
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Khaled Abdelwahab
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Shadi Awny
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Mohammad Zuhdy
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Omar Hamdy
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Khalid Atallah
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Abeer Elfeky
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Mohammed A. F. Hegazy
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
| | - Islam H. Metwally
- Surgical Oncology Department, Oncology Center, Mansoura University (OCMU), Mansoura, 35516 Egypt
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11
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Lv L, Zhao B, Kang J, Li S, Wu H. Trend of disease burden and risk factors of breast cancer in developing countries and territories, from 1990 to 2019: Results from the Global Burden of Disease Study 2019. Front Public Health 2023; 10:1078191. [PMID: 36726635 PMCID: PMC9884979 DOI: 10.3389/fpubh.2022.1078191] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023] Open
Abstract
Background The incidence, mortality, burden of disability-adjusted life years (DALYs), and attributable risk factors of breast cancer vary significantly by country or region, particularly between developing and developed countries. This study aimed to analyze breast cancer development trends in developing countries based on the influence of the different sociodemographic indices (SDIs) and World Bank (WB) income-level disease data from 1990 to 2019. Methods Data on the annual incidence, mortality, DALY, years of life lost (YLL) prematurely, years lived with disability (YLD), and age-standardized rate (ASR) of breast cancer from 1990 to 2019 in different countries and territories were obtained from the 2019 Global Burden of Disease (GBD) Study. A comparative risk assessment (CRA) framework was used to analyze the general risk factors. Results The global age-standardized incidence rate (ASIR) gradually increased from 21.44 per 100,000 population in 1990 to 24.17 per 100,000 population in 2019. It rose precipitously to 2.91- and 2.49-fold, respectively, for countries with middle SDIs and low-middle SDIs. The ASIR of breast cancer was increasing in the lower-middle-income levels in WB, with an estimated annual percentage change (EAPC) of 0.29 [95% uncertainty interval (UI): 0.20-0.37] and reduced income (EAPC of 0.59 [95% UI: 0.53-0.65]). The Solomon Islands and the United Arab Emirates observed the most significant increase in the magnitude of deaths from breast cancer cases. Compared to the death cases of 1990, percentage changes increased separately by 1,169 and 851%. Compared to developed areas, breast cancer-related deaths increased rapidly in developing regions, especially among the middle-aged and elderly groups. Meanwhile, the long-term burden of breast cancer was ever expanding. Of all the GBD regions, Oceania had the youngest age distribution. The deaths in the young and middle-aged groups accounted for 69% in 1990 and 72% in 2019. Percentage changes in deaths from the seven risk factors in low- to middle-SDI regions increased significantly over time across all age groups. However, a diet with high red meat and high body mass index (BMI) accounted for the most considerable increase in the magnitude. Conclusion Public health policy regarding breast cancer is fundamental in low- and medium-income countries. The development and adoption of cost-effective screening and therapeutic solutions, the mitigation of risk factors, and the establishment of a cancer infrastructure are essential.
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Affiliation(s)
- Linlin Lv
- Key Laboratory of Protein Modification and Disease, School of Bioengineering, Dalian University of Technology, Dalian, Liaoning, China,Department of Pharmacy, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Binggong Zhao
- Key Laboratory of Protein Modification and Disease, School of Bioengineering, Dalian University of Technology, Dalian, Liaoning, China
| | - Jie Kang
- Key Laboratory of Protein Modification and Disease, School of Bioengineering, Dalian University of Technology, Dalian, Liaoning, China
| | - Shujing Li
- Key Laboratory of Protein Modification and Disease, School of Bioengineering, Dalian University of Technology, Dalian, Liaoning, China
| | - Huijian Wu
- Key Laboratory of Protein Modification and Disease, School of Bioengineering, Dalian University of Technology, Dalian, Liaoning, China,*Correspondence: Huijian Wu ✉
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12
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Trieu PD(Y, Mello-Thoms CR, Barron ML, Lewis SJ. Look how far we have come: BREAST cancer detection education on the international stage. Front Oncol 2023; 12:1023714. [PMID: 36686760 PMCID: PMC9846523 DOI: 10.3389/fonc.2022.1023714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
The development of screening mammography over 30 years has remarkedly reduced breast cancer-associated mortality by 20%-30% through detection of small cancer lesions at early stages. Yet breast screening programmes may function differently in each nation depending on the incidence rate, national legislation, local health infrastructure and training opportunities including feedback on performance. Mammography has been the frontline breast cancer screening tool for several decades; however, it is estimated that there are 15% to 35% of cancers missed on screening which are owing to perceptual and decision-making errors by radiologists and other readers. Furthermore, mammography screening is not available in all countries and the increased speed in the number of new breast cancer cases among less developed countries exceeds that of the developed world in recent decades. Studies conducted through the BreastScreen Reader Assessment Strategy (BREAST) training tools for breast screening readers have documented benchmarking and significant variation in diagnostic performances in screening mammogram test sets in different countries. The performance of the radiologists from less well-established breast screening countries such as China, Mongolia and Vietnam were significant lower in detecting early-stage cancers than radiologists from developed countries such as Australia, USA, Singapore, Italy. Differences in breast features and cancer presentations, discrepancies in the level of experiences in reading screening mammograms, the availability of high-quality national breast screening program and breast image interpretation training courses between developed and less developed countries are likely to have impact on the variation of readers' performances. Hence dedicated education training programs with the ability to tailor to different reader cohorts and different population presentations are suggested to ameliorate challenges in exposure to a range of cancer cases and improve the interpretation skills of local radiologists. Findings from this review provide a good understanding of the radiologist' performances and their improvement using the education interventions, primarily the BREAST program, which has been deployed in a large range of developing and developed countries in the last decade. Self-testing and immediate feedback loops have been shown to have important implications for benchmarking and improving the diagnostic accuracy in radiology worldwide for better breast cancer control.
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Affiliation(s)
- Phuong Dung (Yun) Trieu
- Discipline of Medical Imaging Sciences, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Claudia R. Mello-Thoms
- Discipline of Medical Imaging Sciences, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Melissa L. Barron
- Discipline of Medical Imaging Sciences, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sarah J. Lewis
- Discipline of Medical Imaging Sciences, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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13
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Niyibizi BA, Muhizi E, Rangira D, Ndoli DA, Nzeyimana IN, Muvunyi J, Irakoze M, Kazindu M, Rugamba A, Uwimana K, Cao Y, Rugengamanzi E, de Dieu Kwizera J, Manirakiza AVC, Rubagumya F. Multidisciplinary approach to cancer care in Rwanda: the role of tumour board meetings. Ecancermedicalscience 2023; 17:1515. [PMID: 37113712 PMCID: PMC10129399 DOI: 10.3332/ecancer.2022.1515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Indexed: 04/29/2023] Open
Abstract
Introduction Cancer treatment is complex and necessitates a multidisciplinary approach. Tumour Board Meetings (TBMs) provide a multidisciplinary platform for health care providers to communicate about treatment plans for patients. TBMs improve patient care, treatment outcomes and, ultimately, patient satisfaction by facilitating information exchange and regular communication among all parties involved in a patient's treatment. This study describes the current status of case conference meetings in Rwanda including their structure, process and outcomes. Methods The study included four hospitals providing cancer care in Rwanda. Data gathered included patients' diagnosis, number of attendance and pre-TBM treatment plan, as well as changes made during TBMs, including diagnostic and management plan changes. Results From 128 meetings that took place at the time of the study, Rwanda Military Hospital hosted 45 (35%) meetings, King Faisal Hospital had 32 (25%), Butare University Teaching Hospital (CHUB) had 32 (25%) and Kigali University Teaching Hospital (CHUK) had 19 (15%). In all hospitals, General Surgery 69 (29%) was the leading speciality in presenting cases. The top three most presented disease site were head and neck 58 (24%), gastrointestinal 28 (16%) and cervix 28 (12%). Most (85% (202/239)) presented cases sought inputs from TBMs on management plan. On average, two oncologists, two general surgeons, one pathologist and one radiologist attended each meeting. Conclusion TBMs in Rwanda are increasingly getting recognised by clinicians. To influence the quality of cancer care provided to Rwandans, it is crucial to build on this enthusiasm and enhance TBMs conduct and efficiency.
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Affiliation(s)
| | - Eulade Muhizi
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Gynecology, Munini District Hospital, Nyabihu, Rwanda
| | - Daniella Rangira
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto M5T 3M7, Canada
| | - Diane A Ndoli
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
| | | | - Jackson Muvunyi
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
| | - Magnifique Irakoze
- Department of Gynecology, Kigali University Teaching Hospital, Kigali, Rwanda
| | - Madeleine Kazindu
- Rwanda Cancer Relief, Kigali, Rwanda
- School of Medicine, College of Medical and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Alex Rugamba
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Internal Medicine, Ruhango Provincial Hospital, Ruhango, Rwanda
| | - Khadidja Uwimana
- Rwanda Cancer Relief, Kigali, Rwanda
- School of Medicine, College of Medical and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Yuanzhen Cao
- Department of Internal Medicine, Dartmouth–Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Eulade Rugengamanzi
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Jean de Dieu Kwizera
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Internal Medicine, Gisenyi Hospital, Rubavu, Gisenyi, Rwanda
| | - Achille VC Manirakiza
- Rwanda Cancer Relief, Kigali, Rwanda
- Unit of Oncology, Department of Internal Medicine, King Faisal Hospital, Kigali, Rwanda
| | - Fidel Rubagumya
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
- School of Medicine, College of Medical and Health Sciences, University of Rwanda, Kigali, Rwanda
- Unit of Oncology, Department of Internal Medicine, King Faisal Hospital, Kigali, Rwanda
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Kolawole ID, Ong TP. Barriers to Early Presentation and Diagnosis of Breast Cancer in Nigerian Women. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00637-w] [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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15
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Agha AA, Onalu C, Chidebe R. Bridging the Gap: Investigating the Role of Social Workers in Supporting Metastatic Breast Cancer Patients in Nigeria. SOCIAL WORK IN PUBLIC HEALTH 2022; 37:244-257. [PMID: 34816769 DOI: 10.1080/19371918.2021.1999878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cancer is a disease common in every country around the globe with high incidences and deaths. Receiving a breast cancer diagnosis is often associated with a death sentence which makes the individual exhibit self-denial attributes, mixed negative emotions, depression, and anxiety. This study investigated the gap in supportive care and the role of social workers in the management of metastatic breast cancer patients in Nigeria. This study employed a qualitative method using Key Informant Interviews (KII). A total of 12 healthcare professionals in the area of medical social work, palliative care, and medical oncology were engaged in collecting the required information. The result revealed that social workers play significant roles in every aspect of the cancer care continuum - diagnosis, treatment, reintegration, or palliative care. Social workers help metastatic breast cancer patients in Nigeria, however, there are growing challenges to their roles. Most unskilled professionals often present themselves as social workers who do not meet professional standards or perform the best practice.
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Affiliation(s)
- Agha Ali Agha
- Department of Social Work, University of Nigera, Nsukka, Nigeria
| | - Chinyere Onalu
- Department of Social Work, University of Nigera, Nsukka, Nigeria
| | - Runcie Chidebe
- Project PINK BLUE - Health & Psychological Trust Centre, Nigeria
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16
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Pumpalova YS, Ayeni OA, Chen WC, Buccimazza I, Cačala S, Stopforth LW, Farrow HA, Mapanga W, Nietz S, Phakathi B, Joffe M, McCormack V, Jacobson JS, Crew KD, Neugut AI, Ruff P, Cubasch H, O’Neil DS. The Impact of Breast Cancer Treatment Delays on Survival Among South African Women. Oncologist 2022; 27:e233-e243. [PMID: 35274708 PMCID: PMC8914482 DOI: 10.1093/oncolo/oyab054] [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] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/09/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In high-income settings, delays from breast cancer (BC) diagnosis to initial treatment worsen overall survival (OS). We examined how time to BC treatment initiation (TTI) impacts OS in South Africa (SA). METHODS We evaluated women enrolled in the South African BC and HIV Outcomes study between July 1, 2015 and June 30, 2019, selecting women with stages I-III BC who received surgery and chemotherapy. We constructed a linear regression model estimating the impact of sociodemographic and clinical factors on TTI and separate multivariable Cox proportional hazard models by first treatment (surgery and neoadjuvant chemotherapy (NAC)) assessing the effect of TTI (in 30-day increments) on OS. RESULTS Of 1260 women, 45.6% had upfront surgery, 54.4% had NAC, and 19.5% initiated treatment >90 days after BC diagnosis. Compared to the surgery group, more women in the NAC group had stage III BC (34.8% vs 81.5%). Living further away from a hospital and having hormone receptor positive (vs negative) BC was associated with longer TTI (8 additional days per 100 km, P = .003 and 8 additional days, P = .01, respectively), while Ki67 proliferation index >20 and upfront surgery (vs NAC) was associated with shorter TTI (12 and 9 days earlier; P = .0001 and.007, respectively). Treatment initiation also differed among treating hospitals (P < .0001). Additional 30-day treatment delays were associated with worse survival in the surgery group (HR 1.11 [95%CI 1.003-1.22]), but not in the NAC group. CONCLUSIONS Delays in BC treatment initiation are common in SA public hospitals and are associated with worse survival among women treated with upfront surgery.
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Affiliation(s)
- Yoanna S Pumpalova
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Oluwatosin A Ayeni
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Wenlong Carl Chen
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ines Buccimazza
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sharon Cačala
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- Department of Specialized Surgery, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, Empangeni, University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa
| | - Laura W Stopforth
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Hayley A Farrow
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Witness Mapanga
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- Division of Medical Oncology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Nietz
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Boitumelo Phakathi
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maureen Joffe
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Valerie McCormack
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alfred I Neugut
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Paul Ruff
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Herbert Cubasch
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel S O’Neil
- Sylvester Comprehensive Cancer Center and Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
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Sarker R, Islam MS, Moonajilin MS, Rahman M, Gesesew HA, Ward PR. Effectiveness of educational intervention on breast cancer knowledge and breast self-examination among female university students in Bangladesh: a pre-post quasi-experimental study. BMC Cancer 2022; 22:199. [PMID: 35193526 PMCID: PMC8862195 DOI: 10.1186/s12885-022-09311-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer is a global health issue and a leading cause of death among women. Early detection through increased awareness and knowledge on breast cancer and breast cancer screening is thus crucial. The aim of the present study was to assess the effect of an educational intervention program on breast cancer knowledge and the practice of breast self-examination among young female students of a university in Bangladesh. METHODS A quasi-experimental (pre-post) study design was conducted at Jahangirnagar University in Bangladesh. Educational information on breast cancer and breast self-examination (BSE), demonstration of BSE procedure and leaflets were distributed among 400 female students after obtaining written informed consent. The stepwise procedures of BSE performance were demonstrated with images. Pre-intervention and 15 days post-intervention assessments were conducted to assess the changes in knowledge on breast cancer and practices of BSE. Mc-Nemar's tests and paired sampled t-tests were performed to investigate the differences between pre- and post-test stages. RESULTS A total of 400 female university students aged 18-26 years were included in the sample. Significant changes were found in knowledge and awareness about breast cancer and BSE practices after the educational intervention. The significant differences were measured in the mean scores of pre-test vs. post-test: breast cancer symptoms (2.99 ± 1.05 vs. 6.35 ± 1.15; p < 0.001), risk factors (3.35 ± 1.19 vs. 7.56 ± 1.04; p < 0.001), treatment (1.79 ± 0.90 vs. 4.63 ± 0.84; p < 0.001), prevention (3.82 ± 1.32 vs. 7.14 ± 1.03; p < 0.001), screening of breast cancer (1.82 ± 0.55 vs. 3.98 ± 0.71; p < 0.001) and process of BSE (1.57 ± 1.86 vs. 3.94 ± 0.93; p < 0.001). Likewise, a significant percentage of change in BSE practices was obtained between pre-test and post-test (21.3% vs. 33.8%; p < 0.001). CONCLUSIONS Study findings confirm that the study population had inadequate awareness and knowledge at baseline which was improved significantly after educational intervention. A nationwide roll-out with community-based interventions is recommended for the female population in both rural and urban areas.
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Affiliation(s)
- Rumpa Sarker
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Md Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh. .,Centre for Advanced Research Excellence in Public Health, Savar, Dhaka, Bangladesh.
| | - Mst Sabrina Moonajilin
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Mahmudur Rahman
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Hailay Abrha Gesesew
- Department of Epidemiology, School of Health Sciences, Mekelle University, Mekelle, Ethiopia.,Centre for Health Policy Research, Torrens University, Adelaide, SA, Australia
| | - Paul R Ward
- Centre for Health Policy Research, Torrens University, Adelaide, SA, Australia
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Radiation Therapy for Breast Cancer During the COVID-19 Pandemic in Low Resource Countries: Consensus Statement from the Iranian Society of Radiation Oncology. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm.116209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: COVID-19 pandemic has resulted in considerable overloading of health care systems in almost all regions of the world. Among different malignancies, breast cancer can be considered as a typical example of how the decision-making process for radiation treatment can be adapted to unusual situations. There exist several international guidelines in order to modify radiotherapy treatments during the COVID-19 pandemic, however, some of their recommendations are not applicable in regions with limited resources. In this manuscript, we provided guidance to deliver radiotherapy to patients with breast cancer during the COVID-19 pandemic based on our available nationwide resources. Evidence Acquisition: A team of expert radiation oncologists convened multidisciplinary and cross-institutional meetings and reviewed the major internationally published guidelines and relevant literature in the field of breast radiotherapy during the COVID-19 pandemic in order to establish recommendations for the safe application of radiation regimens based on the national limited resources. Results: Practical guidance in order to deliver radiotherapy to patients with breast cancer during the COVID-19 pandemic based on available nationwide resources was developed. Conclusions: Many of the international recommendations on the breast cancer radiotherapy during COVID-19 outbreak are not applicable in countries with limited resources. Therefore, modifying the guidelines based on the available resources is mandatory in order to achieve the best possible results.
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Tagiling N, Yahya MM, Wan Zain WZ, Wan Abdul Rahman WF, Mat Nawi N. Early Institutional Experience of Dual Tracer and Single-Photon Emission Computed-Tomography/Computed-Tomography Mapping for Sentinel Node Biopsy: A Report of Two Early-Stage Breast Cancer. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211057328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intraoperative sentinel lymph node mapping (SLNM) with methylene blue dye (MBD) tracer has been the recommended method to detect SLN in early-stage breast cancer patients in low-resource settings. However, the use of MBD alone is hampered by the high false-negative rate; thus, it requires coupling with other mapping methods if the appropriate infrastructure and services are available. In this article, we present two prospective cases detailing our initial experience using the gold-standard dual tracer technique (DTT: MBD and 99mTc-nanocolloid radioisotope) in combination with hybrid single-photon emission computed-tomography/computed-tomography (SPECT/CT) preoperative mapping for image-guided SLN biopsy (SLNB). Overall, both studies were successful in identifying the SLNs, which aided in mapping the possible anatomical spread of the disease.
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Affiliation(s)
- Nashrulhaq Tagiling
- Department of Nuclear Medicine, Radiotherapy and Oncology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Maya Mazuwin Yahya
- Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Breast Cancer Awareness and Research Unit (BESTARI), Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Wan Zainira Wan Zain
- Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Breast Cancer Awareness and Research Unit (BESTARI), Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Wan Faiziah Wan Abdul Rahman
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Norazlina Mat Nawi
- Department of Nuclear Medicine, Radiotherapy and Oncology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
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20
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El-Khayat SM, Abouegylah M, Abdallah D, Geweil AG, Elenbaby AM, Zahra OS. The effect of metformin when combined with neoadjuvant chemotherapy in breast cancer patients. Med Oncol 2021; 39:1. [PMID: 34739637 DOI: 10.1007/s12032-021-01599-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/15/2021] [Indexed: 12/29/2022]
Abstract
Metformin has been used to treat type 2 Diabetes Mellitus since long time. It has two proposed anti-neoplastic mechanisms, direct (insulin-independent) and indirect (insulin-dependent) actions. To assess the effect of Metformin on pathological response when combined with neoadjuvant chemotherapy in breast cancer. A prospective study included stage II, III non-diabetic breast cancer patients who received neoadjuvant chemotherapy in our center during the period from May 2017 to March 2019. 59 patients met our inclusion criteria and completed the study, 27 patients received 850 mg Metformin every 12 h with chemotherapy (group A), and 32 patients received chemotherapy without Metformin (group B). Pathological response was assessed by Chevallier classification and residual cancer burden score (RCB). Both groups were well balanced regarding baseline characteristics. The results of our study showed that the rate of pathological complete response (pCR) was 14.8% in group (A) vs. 6.3% in group (B) with a P value of 0.39. RCB class 3 was 40.7% in group (A) vs. 68.8% in group (B) which was statistically significant with a (P value of 0.031). Patients with triple-positive histology who had RCB class 3 were only (14.3%) in group (A) versus (60%) in group B. Patients with body mass index (BMI) ≥ 25 who had RCB 3 were 40% and 66.7% in group (A) and (B), respectively. Metformin may increase the pCR especially in patients with BMI ≥ 25 and patients with triple-positive histology, a larger phase III study is needed to confirm this finding.
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Affiliation(s)
- Shaimaa M El-Khayat
- Clinical Oncology Department, Medical Research Institute, Alexandria University, 169 El-hureya Street, Qism Bab Sharqi, Alexandria, Alexandria Governorate, Egypt.
| | - Mohamed Abouegylah
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Dina Abdallah
- Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Gaber Geweil
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - A M Elenbaby
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Omar Shebl Zahra
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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21
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Utilization and predictors of postmastectomy radiation receipt in an Oncology Center in Zimbabwe. Breast Cancer Res Treat 2021; 189:701-709. [PMID: 34387794 DOI: 10.1007/s10549-021-06338-w] [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: 05/20/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Few sub-Saharan African studies have ascertained utilization for postmastectomy radiation (PMRT) for breast cancer, the second most common cancer among African women. We estimated PMRT utilization and identified predictors of PMRT receipt in Zimbabwe. METHODS Retrospective patient cohort included non-metastatic breast cancer patients treated from 2014 to 2019. PMRT eligibility was assigned per NCCN guidelines. Patients receiving chemotherapy for non-metastatic disease were also included. The primary endpoint was receipt of PMRT, defined as chest wall with/without regional nodal radiation. Predictors of receiving PMRT were identified using logistic regression. Model performance was evaluated using the c statistic and Hosmer-Lemeshow test for goodness-of-fit. RESULTS 201 women with localized disease and median follow-up of 11.4 months (IQR 3.3-17.9) were analyzed. PMRT was indicated in 177 women and utilized in 59(33.3%). Insurance coverage, clinical nodal involvement, higher grade, positive margins, and hormone therapy receipt were associated with higher odds of PMRT receipt. In adjusted models, no hormone therapy (aOR 0.12, 95% CI 0.043, 0.35) and missing grade (aOR 0.07, 95% CI 0.01, 0.38) were associated with lower odds of PMRT receipt. The resulting c statistic was 0.84, with Hosmer-Lemeshow p-value of 0.93 indicating good model fit. CONCLUSION PMRT was utilized in 33% of those meeting NCCN criteria. Missing grade and no endocrine therapy receipt were associated with reduced likelihood of PMRT utilization. In addition to practice adjustments such as increasing hypofractionation and increasing patient access to standard oncologic testing at diagnosis could increase postmastectomy utilization.
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22
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Kadravello A, Tan SB, Ho GF, Kaur R, Yip CH. Exploring Unmet Needs from an Online Metastatic Breast Cancer Support Group: A Qualitative Study. ACTA ACUST UNITED AC 2021; 57:medicina57070693. [PMID: 34356974 PMCID: PMC8305467 DOI: 10.3390/medicina57070693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Abstract
Background and Objective: Despite the increasing treatment options for patients with metastatic breast cancer (MBC), unmet needs remain common, especially in low and middle-income countries where resources are limited and MBC patients face many challenges. They often join support groups to cope with their unmet needs. Currently, many MBC patients connect with each other via online support group in view of the constant availability of support and rapid information exchange. The objective of this study is to determine the unmet needs of women with MBC from an online support group. Material and Methods: Messages in an online support group of twenty-two MBC patients over a period of three years from August 2016 till August 2019 were thematically analyzed. Results: Three themes were generated, (1) unmet information needs (2) unmet financial needs (3) unmet support needs. Women needed information on side effects of treatment, new treatment options and availability of clinical trials. Although Malaysia has universal health care coverage, access to treatment remains a major challenge. When treatment was not available in the public hospitals, or waiting lists were too long, women were forced to seek treatment in private hospitals, incurring financial catastrophe. Insufficient private insurance and inadequate social security payments force many women to consider stopping treatment. Women felt that they were not getting support from their clinicians in the public sector, who were quick to stop active treatment and advise palliation. On the other hand, clinicians in the private sector advise expensive treatment beyond the financial capability of the patients. Women with families also face the challenge of managing their family and household in addition to coping with their illness. Conclusions: There is a need for healthcare professionals, policy makers, and civil society to better address the needs of MBC patients through patient-centered, multidisciplinary and multi-organizational collaboration.
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Affiliation(s)
- Aravinthan Kadravello
- Breast Cancer Welfare Association Malaysia, Petaling Jaya 46200, Malaysia; (A.K.); (R.K.)
| | - Seng-Beng Tan
- Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia; (S.-B.T.); (G.-F.H.)
| | - Gwo-Fuang Ho
- Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia; (S.-B.T.); (G.-F.H.)
| | - Ranjit Kaur
- Breast Cancer Welfare Association Malaysia, Petaling Jaya 46200, Malaysia; (A.K.); (R.K.)
| | - Cheng-Har Yip
- Breast Centre, Subang Jaya Medical Centre, Subang Jaya 47500, Malaysia
- Correspondence:
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23
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Erfani P, Bhangdia K, Stauber C, Mugunga JC, Pace LE, Fadelu T. Economic Evaluations of Breast Cancer Care in Low- and Middle-Income Countries: A Scoping Review. Oncologist 2021; 26:e1406-e1417. [PMID: 34050590 PMCID: PMC8342576 DOI: 10.1002/onco.13841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/23/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Understanding the cost of delivering breast cancer (BC) care in low- and middle-income countries (LMICs) is critical to guide effective care delivery strategies. This scoping review summarizes the scope of literature on the costs of BC care in LMICs and characterizes the methodological approaches of these economic evaluations. MATERIALS AND METHODS A systematic literature search was performed in five databases and gray literature up to March 2020. Studies were screened to identify original articles that included a cost outcome for BC diagnosis or treatment in an LMIC. Two independent reviewers assessed articles for eligibility. Data related to study characteristics and methodology were extracted. Study quality was assessed using the Drummond et al. checklist. RESULTS Ninety-one articles across 38 countries were included. The majority (73%) of studies were published between 2013 and 2020. Low-income countries (2%) and countries in Sub-Saharan Africa (9%) were grossly underrepresented. The majority of studies (60%) used a health care system perspective. Time horizon was not reported in 30 studies (33%). Of the 33 studies that estimated the cost of multiple steps in the BC care pathway, the majority (73%) were of high quality, but studies varied in their inclusion of nonmedical direct and indirect costs. CONCLUSION There has been substantial growth in the number of BC economic evaluations in LMICs in the past decade, but there remain limited data from low-income countries, especially those in Sub-Saharan Africa. BC economic evaluations should be prioritized in these countries. Use of existing frameworks for economic evaluations may help achieve comparable, transparent costing analyses. IMPLICATIONS FOR PRACTICE There has been substantial growth in the number of breast cancer economic evaluations in low- and middle-income countries (LMICs) in the past decade, but there remain limited data from low-income countries. Breast cancer economic evaluations should be prioritized in low-income countries and in Sub-Saharan Africa. Researchers should strive to use and report a costing perspective and time horizon that captures all costs relevant to the study objective, including those such as direct nonmedical and indirect costs. Use of existing frameworks for economic evaluations in LMICs may help achieve comparable, transparent costing analyses in order to guide breast cancer control strategies.
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Affiliation(s)
- Parsa Erfani
- Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kayleigh Bhangdia
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Jean Claude Mugunga
- Harvard Medical School, Boston, Massachusetts, USA.,Partners In Health, Boston, Massachusetts, USA
| | - Lydia E Pace
- Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Temidayo Fadelu
- Harvard Medical School, Boston, Massachusetts, USA.,Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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24
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Sharma R. Examination of incidence, mortality and disability-adjusted life years and risk factors of breast cancer in 49 Asian countries, 1990-2019: estimates from Global Burden of Disease Study 2019. Jpn J Clin Oncol 2021; 51:826-835. [PMID: 33621341 DOI: 10.1093/jjco/hyab004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study presents an up-to-date, comprehensive and comparative examination of breast cancer's temporal patterns in females in Asia in last three decades. METHODS The estimates of incidence, mortality, disability-adjusted-life-years and risk factors of breast cancer in females in 49 Asian countries were retrieved from Global Burden of Disease 2019 study. RESULTS In Asia, female breast cancer incidence grew from 245 045[226 259-265 260] in 1990 to 914 878[815 789-1025 502] in 2019 with age-standardized incidence rate rising from 21.2/100 000[19.6-22.9] to 35.9/100 000[32.0-40.2] between 1990 and 2019. The death counts more than doubled from 136 665[126 094-148 380] to 337 822[301 454-375 251]. The age-standardized mortality rate rose marginally between 1990 and 2019 (1990: 12.1[11.0-13.1]; 2019: 13.4[12.0-14.9]). In 2019, age-standardized incidence rate varied from 17.2/100 000[13.95-21.4] in Mongolia to 122.5[92.1-160.7] in Lebanon and the age-standardized mortality rate varied 4-fold from 8.0/100 000 [7.2-8.8] in South Korea to 51.9[39.0-69.8] in Pakistan. High body mass index (5.6%), high fasting plasma glucose (5.6%) and secondhand smoke (3.5%) were the main contributory risk factors to all-age disability-adjusted-life-years due to breast cancer in Asia. CONCLUSION With growing incidence, escalating dietary and behavioural risk factors and lower survival rates due to late-disease presentation in low- and medium-income countries of Asia, breast cancer has become a significant public health threat. Its rising burden calls for increasing breast cancer awareness, preventive measures, early-stage detection and cost-effective therapeutics in Asia.
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Affiliation(s)
- Rajesh Sharma
- Assistant Professor, University School of Management and Entrepreneurship, Delhi Technological University, Delhi, India
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25
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Mathieu KM, YouYou TG, Hicks ML, Mutombo A, Anaclet MM, Sylvain MK, Pinder L, Hicks MM, Kanda L, Kanda M, Parham GP, Henry-Tillman R. Building a breast cancer detection and treatment platform in the Democratic Republic of the Congo by integrating training, service and infrastructure development. Ecancermedicalscience 2021; 15:1233. [PMID: 34221116 PMCID: PMC8225335 DOI: 10.3332/ecancer.2021.1233] [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: 11/18/2020] [Indexed: 11/06/2022] Open
Abstract
Background Breast cancer is a leading cause of cancer-related morbidity and mortality in sub-Saharan Africa, a global region where opportunities for breast care of any type are extremely limited due to insufficient infrastructure, a paucity of clinical services and vast shortages of trained human resources. Methods A team of Zambian and US gynaecologic and breast oncology experts and nurse-specialists made multiple visits (each lasting 5 working days) to the Democratic Republic of the Congo (DRC), over a 2-year period. During each of five week-long site visits, hands-on training of local Congolese health providers was conducted during which time they were taught clinical breast exam (CBE), breast and axillary ultrasound, ultrasound-guided core needle biopsy/fine needle aspiration (FNA) and breast surgery. Simultaneous with the training exercises, a new breast care clinic was established and operationalised, and existing surgical theatres were upgraded. All activities were implemented in a private sector health care facility - Biamba Marie Mutombo Hospital - in the capital city of Kinshasa. Results From April 2017 to August 2020, a total of 5,211 women were identified as having breast abnormalities on CBE. Ages ranged from 26 to 86 years; median age: 42.0 (±14.1) years. Ultrasound abnormalities were noted in 1,420 (27%) clients, of which 516 (36%) met the criteria (indeterminate cystic lesion, solid or suspicious masses) for ultrasound-guided core needle biopsy or FNA. Pathology reports were available for 368 (71%) of the 516 clients who underwent biopsy, of which 164 were malignant and 204 benign. The majority (88%) of the cancers were advanced (TNM stages 3 and 4). Surgical procedures consisted of 183 lumpectomies, 58 modified radical mastectomies and 45 axillary lymph node dissections. Clinical competency for diagnostic and surgical procedures was reached early in the course of the training programme. Conclusion By integrating onsite training with simultaneous investments in clinical service and infrastructure development, the barriers to breast cancer diagnosis and treatment were disrupted and a modern breast care service platform was established in a private sector health care facility in the DRC.
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Affiliation(s)
- Kabongo Mukuta Mathieu
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Tankoy Gombo YouYou
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Michael L Hicks
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.,Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia.,St Mary Mercy Cancer Center, 36475 Five Mile Rd, Livonia, MI 48154, USA.,St Joseph Mercy Oakland Cancer Center, 44405 Woodward Ave, Suite 202, Pontiac, MI 48341, USA.,McLaren Macomb Medical Center, 1000 Harrington Blvd, Mount Clemens, MI 48043, USA.,https://orcid.org/0000-0002-1819-155X
| | - Alex Mutombo
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mukanya Mpalata Anaclet
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mulumba Kapuku Sylvain
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Leeya Pinder
- Department of Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA.,https://orcid.org/0000-0002-8929-7810
| | - Maya M Hicks
- Howard University College of Medicine, 520 W St NW, Washington, DC 20059, USA.,https://orcid.org/0000-0002-1993-3367
| | - Louis Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Mirielle Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.,Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia.,https://orcid.org/0000-0002-1782-9523
| | - Ronda Henry-Tillman
- Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 West Markham St, Slot #725, Little Rock, AR 72205, USA
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26
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Erfani P, Bhangdia K, Mugunga JC, Pace LE, Fadelu T. Cost of breast cancer care in low- and middle-income countries: a scoping review protocol. JBI Evid Synth 2021; 19:2813-2828. [PMID: 33625067 PMCID: PMC8373996 DOI: 10.11124/jbies-20-00402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This review will describe the scope of the literature on the cost of breast cancer care in low- and middle-income countries and summate the methodological characteristics and approaches of these economic evaluations. INTRODUCTION In the past decade, there has been global momentum to improve capacity for breast cancer care in low- and middle-income countries, which have higher rates of breast cancer mortality compared to high-income countries. Understanding the cost of delivering breast cancer care in low- and middle-income countries is critical to guide effective cancer care delivery strategies and policy. INCLUSION CRITERIA Studies that estimate the cost of breast cancer diagnosis and treatment in low- and middle-income countries will be included. Studies not available in English will be excluded. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review guidelines will be utilized. The search strategy has been developed in consultation with a medical librarian and will be carried out on five electronic databases from their inception (MEDLINE, Embase, Web of Science, Global Health, WHO Global Index Medicus) as well as in gray literature sources. Two independent reviewers will review all abstracts and titles in the primary screen and full-text articles in the secondary screen. A third reviewer will adjudicate conflicts. One reviewer will perform data extraction. Study demographics, design, and methodological characteristics (such as costing perspective, time horizon, and included cost categories) will be summarized in narrative and tabular formats. The methodological quality of studies will be evaluated using a validated economic evaluation tool.
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Affiliation(s)
- Parsa Erfani
- Harvard Medical School, Boston, MA, USA,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Jean Claude Mugunga
- Harvard Medical School, Boston, MA, USA,Partners in Health, Boston, MA, USA,Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lydia E. Pace
- Harvard Medical School, Boston, MA, USA,Brigham and Women’s Hospital, Boston, MA, USA
| | - Temidayo Fadelu
- Harvard Medical School, Boston, MA, USA,Dana-Farber Cancer Institute, Boston, MA, USA
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27
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Čačala SR, Farrow H, Makhanya S, Couch DG, Joffe M, Stopforth L. The Value of Navigators in Breast Cancer Management in a South African Hospital. World J Surg 2021; 45:1316-1322. [PMID: 33462702 DOI: 10.1007/s00268-020-05931-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Specialist breast cancer nurses (BCNs) have improved the psychological care and follow-up rates of breast cancer (BC) patients. This study sought to determine if breast cancer research workers (BCRWs) as de facto BCNs impacted patients' adherence to treatment by comparing groups with and without these patient navigators; hence assessing our need for BCNs. METHODS Two groups BC patients booked for primary chemotherapy compared. Study group 1 (SG1): no BCRWs/BCNs. Study group 2 (SG2): BCRWs involvement. Assessment of numbers completing primary chemotherapy, undergoing surgery post-neoadjuvant chemotherapy and BCRWs interventions. RESULTS SG1: n = 281, 25-89y, mean 52.7y, Stage 4: 35.6%, Stage 3: 64.4%. SG2: n = 154, 21-85y, mean 52.6y, Stage 4: 47.4%, Stage 3: 43.3%, Stage 2: 9%. Primary chemotherapy not completed SG1: 40.2% (113) versus SG2: 13.5% (21); p < 0.00001. SG1: 88% not completing were lost to follow-up. Excluding peri-chemotherapy deaths and discontinuation: SG1: 37.1% did not complete chemotherapy versus SG2: 2.6%, p < 0.00001. SG2: BCRWs: 107 interventions for 58 (37.7%) patients. Therapeutic breast surgery SG1: 103/181 (56.9%) versus SG2: 66/81 (81.5%); p < 0.0001. SG1: main reasons for not having surgery: lost to follow-up during (n = 58) or after (n = 9) chemotherapy. Follow-up SG2: 12-43 months, mortality: 52% (80/154), no lost to follow-ups. SG1: No mortality data. CONCLUSIONS In our setting, BC patients often do not attend or complete treatments. In this study, BCRWs as de-facto BCNs were beneficial for BC patient care, improving chemotherapy compliance and therapeutic surgical interventions. This highlights the need for BCNs for the management of BC patients in South Africa.
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Affiliation(s)
- S R Čačala
- Department of Surgery, Ngwelezana Hospital, Empangeni, KZN, South Africa. .,Department of Surgery, University of KwaZulu-Natal, Durban, KZN, South Africa.
| | - H Farrow
- Department of Oncology, Grey's Hospital, Pietermaritzburg, KZN, South Africa.,Non Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
| | - S Makhanya
- Department of Oncology, Grey's Hospital, Pietermaritzburg, KZN, South Africa.,Non Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
| | - D G Couch
- Department of Surgery, Ngwelezana Hospital, Empangeni, KZN, South Africa
| | - M Joffe
- Non Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa.,MRC Developmental Pathways To Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa.,South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa
| | - L Stopforth
- Department of Oncology, Grey's Hospital, Pietermaritzburg, KZN, South Africa.,Discipline of Radiotherapy and Oncology, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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28
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Hunter N, Dempsey N, Tbaishat F, Jahanzeb M, Al-Sukhun S, Gralow JR. Resource-Stratified Guideline-Based Cancer Care Should Be a Priority: Historical Context and Examples of Success. Am Soc Clin Oncol Educ Book 2020; 40:1-10. [PMID: 32223670 DOI: 10.1200/edbk_279693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Low- and middle-income countries (LMICs) are shouldering most of the burden of the rapidly increasing cancer incidence and mortality worldwide, and this situation is projected to worsen in coming decades. Studies estimate that more than one million deaths could be prevented annually if all patients received high-quality care, but most LMICs lack the resources and infrastructure to adopt U.S. or European clinical oncology practice guidelines. Several organizations have developed resource-stratified guidelines (RSGs) to provide graduated and/or region-specific strategies for cancer diagnosis and treatment. The birth of these efforts traces to 2002, when the World Health Organization (WHO) called for tailoring cancer treatments to the level of available resources by country; the Breast Health Global Initiative (BHGI) formalized the first stratified guidelines for breast cancer shortly thereafter. Since then, multiple organizations including ASCO and the National Comprehensive Cancer Network (NCCN) have created guidelines customized for various cancer subtypes and regions. These RSGs offer roadmaps for policy makers, clinicians, and health care administrators in LMICs to design projects in implementation science that can gradually and strategically raise the quality of cancer care in their nation or region. Although the same resource limitations that complicate cancer care in these areas also pose barriers to data gathering and research, some countries have met the challenge and are improving cancer care using RSGs as a metric for success.
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Affiliation(s)
- Natasha Hunter
- Division of Oncology, University of Washington, Seattle, WA
| | | | - Fayez Tbaishat
- Department of Oncology, Al Bashir Hospital, Amman, Jordan
| | | | | | - Julie R Gralow
- Division of Oncology, University of Washington, Seattle, WA
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29
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Salisu WJ, Mirlashari J, Varaei S, Seylani K. Limited access to care for persons with breast cancer in Africa: A systematic review. Eur J Oncol Nurs 2020; 50:101867. [PMID: 33276292 DOI: 10.1016/j.ejon.2020.101867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE To systematically review the available evidence and examine the factors that may limit patients' access to breast cancer care in Africa. METHODS We searched six databases (Google Scholar, Web of Science, PubMed, EMBASE, CINAHL, and Scopus) for studies conducted among breast cancer patients in Africa, highlighting patient challenges and barriers to care or treatment. The search was limited to studies published in the English language and from January 2000 until August 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. There were no limitations to the methodological design of the included studies. RESULTS In total, 18,154 articles were retrieved through electronic search; twenty-five were eligible for inclusion after quality appraisal. We analyzed the data using the deductive content analysis approach. Three categories emerged as barriers to breast cancer care: Socio-economic challenges, Institutional shortfalls, and Distinctiveness. CONCLUSIONS The findings support that economic hardships, fear, and scarcity of cancer treatments/equipment are critical in limiting access to breast cancer care. Sustainable strategies aimed at scaling-up breast cancer care in the region are necessary. The results also highlight the need for reduced treatment cost and aggressive educational campaigns across healthcare facilities and the local communities.
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Affiliation(s)
- Waliu Jawula Salisu
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, 1419733171, Iran
| | - Jila Mirlashari
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, 1419733171, Iran; Women's Health Research Institute, Department of OBGYN, University of British Columbia, 4500 Oak Street, Vancouver, Canada
| | - Shokoh Varaei
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, 1419733171, Iran
| | - Khatereh Seylani
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, 1419733171, Iran.
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30
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Crown A, Choi JH, Cole-Price A, Horowitz E, Joseph KA. Optimizing care of breast cancer patients from low resource countries who immigrate to New York City: A case series from a large public hospital. Breast J 2020; 26:2203-2207. [PMID: 32951276 DOI: 10.1111/tbj.14036] [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: 08/03/2020] [Revised: 08/09/2020] [Accepted: 08/17/2020] [Indexed: 12/24/2022]
Abstract
Global disparities in breast cancer care become particularly evident when patients seek definitive care in the United States (USA) after receiving a breast cancer diagnosis and initiating care in low- and middle-income countries (LMICs). We performed a retrospective review of 26 patients with breast cancer who immigrated from LMICs and received care at Bellevue Hospital. Fifteen (58%) presented with advanced disease (stage III or IV), including 7 (27%). All 26 patients required diagnostic work-up in the USA, and all 19 (73.1%) patients with stage 0-III disease underwent surgical excision. Patients from LMICs frequently present with advanced disease and in varying stages of breast cancer treatment. Improving communication with previous providers and fostering a collaborative approach with the international community are essential to developing efficacious treatment plans and improving oncologic outcomes.
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Affiliation(s)
- Angelena Crown
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jee-Hye Choi
- Department of Surgery, Bellevue Hospital Medical Center, NYU Langone Medical Center, New York, NY, USA
| | - Ayana Cole-Price
- Department of Surgery, Bellevue Hospital Medical Center, NYU Langone Medical Center, New York, NY, USA
| | - Elizabeth Horowitz
- Department of Surgery, Bellevue Hospital Medical Center, NYU Langone Medical Center, New York, NY, USA
| | - Kathie-Ann Joseph
- Department of Surgery, Bellevue Hospital Medical Center, NYU Langone Medical Center, New York, NY, USA
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31
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Madigan LI, Dinh P, Graham JD. Neoadjuvant endocrine therapy in locally advanced estrogen or progesterone receptor-positive breast cancer: determining the optimal endocrine agent and treatment duration in postmenopausal women-a literature review and proposed guidelines. Breast Cancer Res 2020; 22:77. [PMID: 32690069 PMCID: PMC7370425 DOI: 10.1186/s13058-020-01314-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction For patients with locally advanced estrogen receptor or progesterone receptor-positive breast cancer, neoadjuvant endocrine therapy (NET) facilitates down-staging of the tumor and increased rates of breast-conserving surgery. However, NET remains under-utilized, and there are very limited clinical guidelines governing which therapeutic agent to use, or the optimal duration of treatment in postmenopausal women. This literature review aims to discuss the evidence surrounding (1) biomarkers for patient selection for NET, (2) the optimal neoadjuvant endocrine agent for postmenopausal women with locally advanced breast cancer, and (3) the optimal duration of NET. In addition, we make initial recommendations towards developing a clinical guideline for the prescribing of NET. Method A wide-ranging search of online electronic databases was conducted using a truncated PIC search strategy to identify articles that were relevant to these aims and revealed a number of key findings. Results Randomized trials have consistently demonstrated that aromatase inhibitors are more effective than tamoxifen, in terms of objective response rate and rate of BCS, and should be used as first-line NET. The three available aromatase inhibitors have so far been demonstrated to be biologically equivalent, with the choice of aromatase inhibitor not having been shown to affect clinical outcomes. There is increasing evidence for extending the duration of NET beyond 3 to 4 months, to at least 6 months or until maximal clinical response is achieved. While on-treatment levels of the proliferation marker Ki67 are predictive of long-term outcome, the choice of adjuvant therapy in patients who have received NET and then surgery is best guided by the preoperative endocrine prognostic index, or PEPI, which incorporates Ki67 with other clinical parameters. Conclusion This study reveals that in appropriately selected patients, NET can provide equivalent clinical benefit to neoadjuvant chemotherapy in the same cohort, if suitable treatments and durations are chosen. Our findings highlight the need for better defined biomarkers both for guiding patient selection and for measuring outcomes. Development of standard guidelines for the prescribing of NET has the potential to improve both clinical outcomes and quality of life in this patient cohort.
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Affiliation(s)
- Lauren I Madigan
- Sydney Medical School - Westmead, The University of Sydney, Sydney, Australia.,Present Address: South Eastern Sydney Local Health District, and St. George and Sutherland Clinical Schools, UNSW Medicine, Sydney, Australia
| | - Phuong Dinh
- Sydney Medical School - Westmead, The University of Sydney, Sydney, Australia.,Westmead Breast Cancer Institute, Westmead Hospital, Westmead, Australia
| | - J Dinny Graham
- Sydney Medical School - Westmead, The University of Sydney, Sydney, Australia. .,Westmead Breast Cancer Institute, Westmead Hospital, Westmead, Australia. .,The Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia.
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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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Deepa KV, Gadgil A, Löfgren J, Mehare S, Bhandarkar P, Roy N. Is quality of life after mastectomy comparable to that after breast conservation surgery? A 5-year follow up study from Mumbai, India. Qual Life Res 2020; 29:683-692. [PMID: 31712944 PMCID: PMC7028794 DOI: 10.1007/s11136-019-02351-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 11/03/2022]
Abstract
PURPOSE Breast cancer is the commonest cancer in women worldwide. Surgery is a central part of the treatment. Modified radical mastectomy (MRM) is often replaced by breast conserving therapy (BCT) in high-income countries. MRM is still the standard choice, in low- and middle-income countries (LMICs) as radiotherapy, a mandatory component of BCT is not widely available. It is important to understand whether quality of life (QOL) after MRM is comparable to that after BCT. This has not been studied well in LMICs. We present, 5-year follow-up of QOL scores in breast cancer patients from India. METHODS We interviewed women undergoing breast cancer surgery preoperatively, at 6 months after surgery, and at 1 year and 5 years, postoperatively. QOL scores were evaluated using FACT B questionnaire. Average QOL scores of women undergoing BCT were compared with those undergoing MRM. Total scores, domain scores and trends of scores over time were analyzed. RESULTS We interviewed 54 women with a mean age of 53 years (SD 9 ± years). QOL scores in all the women, dipped during the treatment period, in all subscales but improved thereafter and even surpassed the baseline in physical, emotional and breast-specific domains (p < 0.05) at 5 years. At the end of 5 years, there was no statistically significant difference between the MRM and BCT groups in any of the total or domain scores. CONCLUSION QOL scores in Indian women did not differ significantly between MRM and BCT in the long term. Both options are acceptable in the study setting.
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Affiliation(s)
- K V Deepa
- Department of Surgery, Manipal Hospital, New Delhi, India
| | - A Gadgil
- Department of Surgery, BARC Hospital, WHO Collaboration Center for Research in Surgical Care Delivery in LMIC, Mumbai, India
| | - Jenny Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - S Mehare
- WHO Collaboration Center for Research in Surgical Care Delivery in LMIC, Mumbai, India
| | - Prashant Bhandarkar
- BARC Hospital, WHO Collaboration Center for Research in Surgical Care Delivery in LMIC, Mumbai, India
| | - N Roy
- WHO Collaboration Center for Research in Surgical Care Delivery in LMIC, Mumbai, India.
- Public Health Systems, Karolinska Institute, Stockholm, Sweden.
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Wu Z, Liu Y, Li X, Song B, Ni C, Lin F. Factors associated with breast cancer screening participation among women in mainland China: a systematic review. BMJ Open 2019; 9:e028705. [PMID: 31455705 PMCID: PMC6720337 DOI: 10.1136/bmjopen-2018-028705] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Although detecting breast cancer at an early stage through screening has been clearly shown to be an effective strategy, the screening participation rate in China remains low. This systematic review sought to synthesise the current evidence to identify factors associated with breast cancer screening participation among women in mainland China. DESIGN This study was a systematic review. DATA SOURCES Studies were collected from PubMed, PsycINFO, CINAHL, EMBASE and three major Chinese databases, specially China National Knowledge Infrastructure, Chongqing VIP and Wanfang Data. ELIGIBILITY CRITERIA All included papers were original research studies with a longitudinal or cross-sectional study design that considered associated factors of breast cancer screening participation among women in mainland China. DATA EXTRACTION AND SYNTHESIS Study selection, data extraction and quality assessment were conducted independently by two reviewers, involving a third to help reach a consensus when necessary. Primary outcomes of interest included factors associated with breast cancer screening participation. RESULTS A total of 19 studies were included in this review. Based on these studies, geographical region, a personal history of breast disease, past screening behaviours for breast disease, physical examination and the availability of medical specialists/equipment for breast examination were consistently associated with participation in breast cancer screening, while residential area, ethnicity and attitude towards breast cancer screening appeared to be associated with participation in breast cancer screening. There were additionally some factors with even more limited evidence with which to ascertain their association with screening participation. CONCLUSIONS There exists a wide range of factors that influence breast cancer screening participation in mainland China. These findings could help to inform future research and policy efforts.
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Affiliation(s)
- Zijing Wu
- School of Nursing, China Medical University, Shenyang, China
| | - Yu Liu
- School of Nursing, China Medical University, Shenyang, China
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, China
| | - Bing Song
- School of Nursing, China Medical University, Shenyang, China
| | - Cuiping Ni
- School of Nursing, China Medical University, Shenyang, China
| | - Frances Lin
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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Gebremariam A, Addissie A, Worku A, Assefa M, Kantelhardt EJ, Jemal A. Perspectives of patients, family members, and health care providers on late diagnosis of breast cancer in Ethiopia: A qualitative study. PLoS One 2019; 14:e0220769. [PMID: 31369640 PMCID: PMC6675093 DOI: 10.1371/journal.pone.0220769] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/23/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Most women with breast cancer in Ethiopia are diagnosed at an advanced stage of the disease, but the reasons for this have not been systematically investigated. This study, therefore, aimed to explore the main reasons for diagnosis of advanced stage breast cancer from the perspective of patients, family members, and health care providers. METHODS A qualitative study with in-depth interviews was conducted with 23 selected participants at Tikur Anbessa Specialized Hospital, Oncology Clinic using a semi-structured interview guide. These participants were 13 breast cancer patients, 5 family members, and 5 health care providers. Data were transcribed into English, coded and analyzed using thematic analysis. RESULTS Awareness about the causes, risk, initial symptoms, early detection methods, and treatment of breast cancer were uncommon, and misconceptions about the disease prevailed among breast cancer patients and family members. There was a sense of hopelessness and uncertainty about the effectiveness of conventional medicine amongst patients and family members. Consequently, performing spiritual acts (using holy water) or seeking care from traditional healers recurred amongst the interviewees. Not taking initial symptoms of breast cancer seriously by the patients, reliance on traditional medicines, competing priorities, financial hardship, older age, fear of diagnosis of cancer, and weak health systems (e.g., delay in referral and long waiting period for consultation) were noted as the main contributors to late diagnosis. In contrast, persuasion by family members and friends, higher educational attainment, and prior experience of neighboring women with breast cancer were mentioned to be facilitators of early diagnosis of breast cancer. CONCLUSIONS The causes of late diagnosis of breast cancer in Ethiopia are multi-factorial and include individual, cultural, and health system factors. Interventions targeting these factors could alleviate the misconceptions and knowledge gap about breast cancer in the community, and shorten waiting time between symptom recognition and diagnosis of breast cancer.
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Affiliation(s)
- Alem Gebremariam
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia, United States of America
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Wilson BE, Jacob S, Yap ML, Ferlay J, Bray F, Barton MB. Estimates of global chemotherapy demands and corresponding physician workforce requirements for 2018 and 2040: a population-based study. Lancet Oncol 2019; 20:769-780. [PMID: 31078462 DOI: 10.1016/s1470-2045(19)30163-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND The incidence of cancer (excluding non-melanomatous skin cancers) is projected to rise from 17·0 million to 26·0 million between 2018 and 2040. A large proportion of these patients would be likely to derive benefit from chemotherapy, but no studies so far have quantified current and projected global chemotherapy demands. We aimed to estimate changes in national, regional, and global demands for first-course chemotherapy and the cancer physician workforce between 2018 and 2040 if all patients were treated according to best-practice evidence-based guidelines. METHODS Data for the incidence of 29 types of cancer in 183 countries in 2018, and projections of incidence in 2040, were obtained from GLOBOCAN 2018. Optimal chemotherapy utilisation from evidence-based guidelines was applied to these incidence data to generate the number of new patients requiring first-course chemotherapy in 2018 and 2040. We then estimated the corresponding cancer physician workforce required to deliver this chemotherapy (on the basis of physicians seeing 150 new patients requiring chemotherapy per year). We did sensitivity analyses to investigate how cancer stage at presentation affected chemotherapy demands. We also did sensitivity analyses to explore changes to workforce requirements if each physician was seeing 100 new patients requiring chemotherapy per year or 300 new patients requiring chemotherapy per year. FINDINGS Between 2018 and 2040, the number of patients requiring first-course chemotherapy annually will increase from 9·8 million to 15·0 million, a relative increase of 53%. The estimated proportion of patients needing chemotherapy who reside in low-income or middle-income countries was 63% (6 162 240 of 9 782 783) in 2018, and will be 67% (10 071 049 of 14 984 560) in 2040. The most common indications for chemotherapy worldwide in 2040 will be lung cancer (accounting for 2 455 137 [16·4%] of 14 984 560 cases eligible for chemotherapy), breast cancer (1 898 740 [12·7%]), and colorectal cancer (1 678 153 [11·1%]). We estimated that, in 2018, 65 000 cancer physicians were required worldwide to deliver optimal chemotherapy-a figure that we estimate will rise to 100 000 by 2040 (with estimates ranging from from 50 000 to 150 000, depending on workload). INTERPRETATION Strategic investments in chemotherapy service provision and cancer physicians are needed to meet the projected increased demand for chemotherapy in 2040. FUNDING None.
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Affiliation(s)
- Brooke E Wilson
- University of New South Wales, Sydney, NSW, Australia; Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, Australia.
| | - Susannah Jacob
- University of New South Wales, Sydney, NSW, Australia; Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Mei Ling Yap
- University of New South Wales, Sydney, NSW, Australia; Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; Macarthur Cancer Centre, Campbelltown Hospital, Campbelltown, NSW, Australia; School of Medicine, Western Sydney University, Campbelltown, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Michael B Barton
- University of New South Wales, Sydney, NSW, Australia; Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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Keatmanee C, Chaumrattanakul U, Kotani K, Makhanov SS. Initialization of active contours for segmentation of breast cancer via fusion of ultrasound, Doppler, and elasticity images. ULTRASONICS 2019; 94:438-453. [PMID: 29477236 DOI: 10.1016/j.ultras.2017.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 06/08/2023]
Abstract
Active contours (snakes) are an efficient method for segmentation of ultrasound (US) images of breast cancer. However, the method produces inaccurate results if the seeds are initialized improperly (far from the true boundaries and close to the false boundaries). Therefore, we propose a novel initialization method based on the fusion of a conventional US image with elasticity and Doppler images. The proposed fusion method (FM) has been tested against four state-of-the-art initialization methods on 90 ultrasound images from a database collected by the Thammasat University Hospital of Thailand. The ground truth was hand-drawn by three leading radiologists of the hospital. The reference methods are: center of divergence (CoD), force field segmentation (FFS), Poisson Inverse Gradient Vector Flow (PIG), and quasi-automated initialization (QAI). A variety of numerical tests proves the advantages of the FM. For the raw US images, the percentage of correctly initialized contours is: FM-94.2%, CoD-0%, FFS-0%, PIG-26.7%, QAI-42.2%. The percentage of correctly segmented tumors is FM-84.4%, CoD-0%, FFS-0%, PIG-16.67%, QAI-22.44%. For reduced field of view US images, the percentage of correctly initialized contours is: FM-94.2%, CoD-0%, FFS-0%, PIG-65.6%, QAI-67.8%. The correctly segmented tumors are FM-88.9%, CoD-0%, FFS-0%, PIG-48.9%, QAI-44.5%. The accuracy, in terms of the average Hausdorff distance, is respectively 2.29 pixels, 33.81, 34.71, 7.7, and 8.4, whereas in terms of the Jaccard index, it is 0.9, 0.18, 0.19, 0.63, and 0.48.
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Affiliation(s)
- Chadaporn Keatmanee
- Sirindhorn International Institute of Technology, Thammasat University, Pathum Thani, Thailand; Japan Advanced Institute of Science and Technology, Ishikawa, Japan
| | | | - Kazunori Kotani
- Japan Advanced Institute of Science and Technology, Ishikawa, Japan
| | - Stanislav S Makhanov
- Sirindhorn International Institute of Technology, Thammasat University, Pathum Thani, Thailand.
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Luangxay T, Virachith S, Hando K, Vilayvong S, Xaysomphet P, Arounlangsy P, Phongsavan K, Mieno MN, Honma N, Kitagawa M, Sawabe M. Subtypes of Breast Cancer in Lao P.D.R.: A Study in a Limited-Resource Setting. Asian Pac J Cancer Prev 2019; 20:589-594. [PMID: 30806064 PMCID: PMC6897003 DOI: 10.31557/apjcp.2019.20.2.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: The purpose of this study is to evaluate the prevalence of the immunohistochemical subtypes of breast cancer among Lao women by using immunohistochemistry (according to the St. Gallen 2017 guidelines) and to study their correlation to clinicopathological features in order to help guide better treatment plans for patients. Materials and methods: Formalin-fixed and paraffin embedded tissue blocks of 76 cases of primary invasive breast cancer were retrieved from the University of Health Sciences, Vientiane, Lao PDR, from 2013 to 2016. Patients’ information and previous histological reports were reviewed. Immunohistochemistry was done using antibodies against estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2/neu) and Ki-67 (MIB-1). Results: The mean age of the patients was 49 years, and the major histologic type was invasive ductal carcinoma, NOS (90.7%). The proportion of each subtype was hormone receptor-positive and HER2-negative, 44.7%; hormone receptor-positive and HER2-positive, 3.9%; hormone receptor-negative and HER2-positive, 13.2%; and triple-negative, 38.2%. ER was positive in 40.8% of the cases, while PR was positive in 47.4%. More than half of the cases were poorly differentiated cancer (65.8%), followed by moderately differentiated (34.2%). Tumors presented with pT2 (60.5%), followed by pT3 (25.0%) and pT4 (7.9%). Conclusion: Breast cancer among Lao women is characterized by a large percentage of the triple-negative subtype that is less susceptible to hormonal treatments. The empirical treatment with tamoxifen should be reconsidered since it would be less effective to these patients. More importantly, basic pathology services should be the first requirement in Lao PDR in order to provide adequate care.
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Affiliation(s)
- Thitsamay Luangxay
- Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Cancer Center, Mittaphab Hospital, Vientiane, Laos.
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Xu Y, Liu T, Daniels MJ, Kantor R, Mwangi A, Hogan JW. Classification using ensemble learning under weighted misclassification loss. Stat Med 2019; 38:2002-2012. [PMID: 30609090 DOI: 10.1002/sim.8082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/09/2018] [Accepted: 12/07/2018] [Indexed: 11/07/2022]
Abstract
Binary classification rules based on covariates typically depend on simple loss functions such as zero-one misclassification. Some cases may require more complex loss functions. For example, individual-level monitoring of HIV-infected individuals on antiretroviral therapy requires periodic assessment of treatment failure, defined as having a viral load (VL) value above a certain threshold. In some resource limited settings, VL tests may be limited by cost or technology, and diagnoses are based on other clinical markers. Depending on scenario, higher premium may be placed on avoiding false-positives, which brings greater cost and reduced treatment options. Here, the optimal rule is determined by minimizing a weighted misclassification loss/risk. We propose a method for finding and cross-validating optimal binary classification rules under weighted misclassification loss. We focus on rules comprising a prediction score and an associated threshold, where the score is derived using an ensemble learner. Simulations and examples show that our method, which derives the score and threshold jointly, more accurately estimates overall risk and has better operating characteristics compared with methods that derive the score first and the cutoff conditionally on the score especially for finite samples.
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Affiliation(s)
- Yizhen Xu
- Department of Biostatistics, Brown University, Providence, RI
| | - Tao Liu
- Department of Biostatistics, Brown University, Providence, RI
| | - Michael J Daniels
- Department of Statistics and Data Sciences, University of Texas at Austin, Austin, TX
| | - Rami Kantor
- Division of Infectious Diseases, Brown University, Providence, RI
| | - Ann Mwangi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Joseph W Hogan
- Department of Biostatistics, Brown University, Providence, RI.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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Clinicians’ experiences and perspectives of breast cancer and possible integration of breast cancer prevention and early detection into palliative care. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.100162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bonsu AB, Ncama BP. Evidence of promoting prevention and the early detection of breast cancer among women, a hospital-based education and screening interventions in low- and middle-income countries: a systematic review protocol. Syst Rev 2018; 7:234. [PMID: 30547842 PMCID: PMC6293627 DOI: 10.1186/s13643-018-0889-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 11/20/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Given the increasing burden of breast cancer in the low- and middle-income countries, cost-effective approaches are needed to improve the early detection of breast cancer in these continents. Global policies and guidelines are now placing much emphasis on promoting early detection of breast cancer through integrated education and screening interventions. The proposed systematic review aims to map evidence on hospital-based breast cancer education, breast self-examination, and clinical breast examination services for women in low- and middle-income countries. METHODS/DESIGN We will conduct a systematic review of peer-reviewed studies on hospital-based breast cancer prevention intervention (breast cancer education, breast self-examination, and clinical breast examination) for women in low- and middle-income countries. An electronic search will be conducted in the following electronic databases CINAHL Plus with full text (EBSCOhost), MEDLINE with full-text (EBSCOhost) PsychINFO (EBSCOhost), and PubMed. Articles will also be searched through the "Cited by" search and citations included in the reference list of included articles. A two-stage mapping approach will be conducted. The first stage will involve screening studies through assessing their titles. Also, we will screen abstracts of identified studies descriptively and by focus and methods as dictated by the inclusion and exclusion criteria. The second stage will include extraction of data from eligible studies. A parallel screening and data extraction will be conducted by two reviewers. The quality of included studies will be assessed using the mixed methods appraisal tool (MMAT). A narrative account of the data extracted from the included studies will be analyzed using the thematic analysis. DISCUSSION We hope to find relevant studies reporting evidence on promoting prevention and the early detection of breast cancer among women in a hospital-based education and screening interventions in low- and middle-income countries. The evidence obtained from the included studies when summarized will help guide future research. The study results will be disseminated electronically and in print. Also, it will be presented at conferences related to breast cancer. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered with PROSPERO, with registration number CRD42017077818.
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Affiliation(s)
- Adwoa Bemah Bonsu
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Private Mail bag, University Post Office, Kumasi, Ghana
| | - Busisiwe Purity Ncama
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
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Kreyer J, Ranft A, Timmermann B, Juergens H, Jung S, Wiebe K, Boelling T, Schuck A, Vieth V, Streitbuerger A, Hardes J, Heinemann M, Dirksen U. Impact of the Interdisciplinary Tumor Board of the Cooperative Ewing Sarcoma Study Group on local therapy and overall survival of Ewing sarcoma patients after induction therapy. Pediatr Blood Cancer 2018; 65:e27384. [PMID: 30084137 DOI: 10.1002/pbc.27384] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/18/2018] [Accepted: 07/06/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Interdisciplinary Tumor Board (ITB) of the Cooperative Ewing Sarcoma Study (CESS) Group was investigated to assess its impact on the overall survival (OAS) of Ewing sarcoma (EwS) patients. The ITB functions as a reference center for the international institutions participating in the clinical trials of the CESS group, but is also available internationally to patients who have not been treated within an appropriate clinical trial. The value of tumor boards in terms of benefit for the patients and the health care system in general is not well documented and is also the subject of controversial discussions. A review of the representative literature is included. METHODS Data were analyzed from 481 patients who had been registered into the European Ewing Tumor Working Initiative of National Groups (EURO E.W.I.N.G.-99) clinical trial via the CESS data center between 2006 and 2009; this included 331 patients with localized disease and another 150 individuals with metastases at diagnosis. Median follow-up time was 3.2 years. RESULTS Improved OAS was observed for patients with metastases who had received recommendations from the ITB compared with those who had not received recommendations. In patients with localized disease, a recommendation from the ITB had no influence on OAS. CONCLUSION As a reference center for a rare disease, recommendations from our ITB impacted local therapy and led to higher OAS in patients with metastatic disease. To our knowledge, this is the first analysis that examines the value of a reference tumor board on a rare disease.
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Affiliation(s)
- Justus Kreyer
- Department of Orthopaedic and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Ranft
- Department of Pediatrics III, West German Cancer Centre, German Cancer Research Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Beate Timmermann
- Particle Therapy Clinic at West German Proton Therapy Centre Essen, University Hospital, University of Duisburg-Essen, Essen, Germany
| | | | - Susanne Jung
- Oral and Maxillofacial Surgery Clinics, University Hospital Muenster, Muenster, Germany
| | - Karsten Wiebe
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Tobias Boelling
- Department Osnabrueck, Center for Radiotherapy Rheine-Osnabrueck, Osnabrueck, Germany
| | - Andreas Schuck
- Department of Radiotherapy and Radiation Oncology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - Volker Vieth
- Department of Clinical Radiology, Klinikum Ibbenbüren, Ibbenbüren, Germany
| | - Arne Streitbuerger
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jendrik Hardes
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Melina Heinemann
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Dirksen
- Department of Pediatrics III, West German Cancer Centre, German Cancer Research Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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El Saghir NS, El Tomb PA, Carlson RW. Breast Cancer Diagnosis and Treatment in Low- and Mid-Resource Settings: the Role of Resource-Stratified Clinical Practice Guidelines. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0287-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kisiangani J, Baliddawa J, Marinda P, Mabeya H, Choge JK, Adino EO, Khayeka-Wandabwa C. Determinants of breast cancer early detection for cues to expanded control and care: the lived experiences among women from Western Kenya. BMC WOMENS HEALTH 2018; 18:81. [PMID: 29859095 PMCID: PMC5984781 DOI: 10.1186/s12905-018-0571-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 05/18/2018] [Indexed: 01/24/2023]
Abstract
Background Estimately, 70–80% of cancer cases are diagnosed in late stages in Kenya with breast cancer being a common cause of mortality among women where late diagnosis is the major ubiquitous concern. Numerous studies have focused on epidemiological and health policy dynamics essentially underestimating the determining factors that shape people’s choices and cues to health care service uptake. The study sought to evaluate the knowledge, attitude and health seeking behavior towards breast cancer and its screening in a quest to explain why women present for prognosis and treatment when symptomatic pointers are in advanced stages, impeding primary prevention strategies. Methods Eight focus groups (6–10 members per group) and four key informant interviews were conducted among adult participants from rural and urban settings. Sessions were audio-recorded and transcribed. A thematic analysis of the data was based on the concepts of the health belief model. Data analysis was conducted using NVIVO10. Results Most women perceived breast cancer as a fatal disease and conveyed fear of having early screening. Rural women preferred self-prescribed medications and the use of alternative medicine for long periods before presenting for professional care on suspicion that the lump is cancerous. Accessibility to equipped health facilities, lack of information to establish effective follow-up treatment and low-income status were underscored as their major health seeking behavior barriers whereas, urban women identified marital status as their main barrier. Key informant interviews revealed that health communication programs emphasized more on communicable diseases. This could in part explain why there is a high rate of misconception and suspicion about breast cancer among rural and urban women in the study setting. Conclusions Creating breast cancer awareness alongside clear guidelines on accessing screening and treatment infrastructure is critical. It was evident, a diagnosis of breast cancer or lump brings unexpected confrontation with mortality; fear, pain, cultural barriers, emotional and financial distress. Without clear referral channels to enable those with suspicious lumps or early stage disease to get prompt diagnosis and treatment, then well-meaning awareness will not necessarily contribute to reducing morbidity and mortality. Electronic supplementary material The online version of this article (10.1186/s12905-018-0571-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joyce Kisiangani
- The Aquaya Institute, Nairobi, 00505, Kenya.,School of Public Health, Department of Epidemiology and disease control, Moi University, P.O. Box 3900, Eldoret, Kenya
| | - Joyce Baliddawa
- School of Public Health, Department of Epidemiology and disease control, Moi University, P.O. Box 3900, Eldoret, Kenya
| | - Pamela Marinda
- Department of Food Science and Nutrition, School of Agricultural Sciences, The University of Zambia, Lusaka, Zambia
| | - Hillary Mabeya
- Gynocare Fistula Centre, Eldoret Hospital Lane, P.O. BOX 2326-30100, Eldoret, Kenya
| | - Joseph K Choge
- University of Kabianga, P.O. Box 2030-20200, Kericho, Kenya
| | | | - Christopher Khayeka-Wandabwa
- School of Pharmaceutical Science and Technology (SPST), Health Science Platform, Tianjin University, 92 Weijin road, Nankai District, Tianjin, 300072, People's Republic of China. .,African Population and Health Research Center (APHRC), P .O. Box 10787-00100, Nairobi, Kenya.
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Demonstration of an algorithm to overcome health system-related barriers to timely diagnosis of breast diseases in rural Zambia. PLoS One 2018; 13:e0196985. [PMID: 29746541 PMCID: PMC5945023 DOI: 10.1371/journal.pone.0196985] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/24/2018] [Indexed: 01/07/2023] Open
Abstract
Background Long delays to diagnosis is a major cause of late presentation of breast diseases in sub-Saharan Africa. Aims We designed and implemented a single-visit breast care algorithm that overcomes health system-related barriers to timely diagnosis of breast diseases. Methods A multidisciplinary team of Zambian healthcare experts trained a team of mid- and high-level Zambian healthcare practitioners how to evaluate women for breast diseases, and train trainers to do likewise. Working collaboratively, the two teams then designed a clinical platform that provides multiple breast care services within a single visit. The service platform was implemented using a breast outreach camp format, during which breast self-awareness, psychosocial counseling, clinical breast examination, breast ultrasound, ultrasound-guided biopsy, imprint cytology of biopsy specimens and surgical treatment or referral, were offered within a single visit. Results Eleven hundred and twenty-nine (1129) women attended the camps for breast care. Mean age was 35.9 years. The majority were multiparous (79.4%), breast-fed (76.0%), and reported hormone use (50.4%). Abnormalities were detected on clinical breast examination in 122 (10.8%) women, 114 of whom required ultrasound. Of the 114 who underwent ultrasound, 48 had identifiable lesions and were evaluated with ultrasound-guided core needle biopsy (39) or fine-needle aspiration (9). The concordance between imprint cytology and histopathology was 100%, when breast specimens were classified as either benign or malignant. However, when specimens were classified by histopathologic subtype, the concordance between imprint cytology and histology was 85.7% for benign and 100% for malignant lesions. Six (6) women were diagnosed with invasive cancer. Eighteen (18) women with symptomatic breast lesions had next-day surgery. Significance Similar to its impact on cervical cancer prevention services, a single visit breast care algorithm has the potential to overcome health system-related barriers to timely diagnosis of breast diseases, including cancer, in rural African settings.
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Steiness HS, Villegas-Gold M, Parveen H, Ferdousy T, Ginsburg O. Barriers to care for women with breast cancer symptoms in rural Bangladesh. Health Care Women Int 2018; 39:536-554. [PMID: 29505392 DOI: 10.1080/07399332.2018.1446958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Breast cancer survival rates in lower-income countries like Bangladesh are approximately 50%, versus over 80% in high income countries. Anecdotal reports suggest that, beyond economic and health system barriers, sociocultural factors may influence a woman's care-seeking behavior and resultant early stage diagnoses. To understand these barriers, we conducted 63 interviews (43 women with breast cancer symptoms and 20 men) in Khulna, Bangladesh. We identified socio-cultural barriers like neglect and indifference toward women, women's lack of power to use resources, and reduced support from family due to stigma. Interventions must address these barriers and improve the status of women in Bangladesh.
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Affiliation(s)
- Heather Story Steiness
- a Human Evolution and Social Change, Arizona State University College of Liberal Arts and Sciences , St. Phoenix, Arizona , USA
| | - Michelle Villegas-Gold
- a Human Evolution and Social Change, Arizona State University College of Liberal Arts and Sciences , St. Phoenix, Arizona , USA
| | - Homaira Parveen
- a Human Evolution and Social Change, Arizona State University College of Liberal Arts and Sciences , St. Phoenix, Arizona , USA
| | | | - Ophira Ginsburg
- c Perlmutter Cancer Center, Section for Global Health , Department of Population Health, NYU Langone Health, New York , New York , USA
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Al-Sukhun S, de Lima Lopes G, Gospodarowicz M, Ginsburg O, Yu PP. Global Health Initiatives of the International Oncology Community. Am Soc Clin Oncol Educ Book 2017; 37:395-402. [PMID: 28561641 DOI: 10.1200/edbk_100008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cancer has become one of the leading causes of morbidity and mortality in low- and middle-income countries (LMICs), where 60% of the world's total new cases are diagnosed. The challenge for effective control of cancer is multifaceted. It mandates integration of effective cancer prevention, encouraging early detection, and utilization of resource-adapted therapeutic and supportive interventions. In the resource-constrained setting, it becomes challenging to deliver each service optimally, and efficient allocation of resources is the best way to improve the outcome. This concept was translated into action through development of resource-stratified guidelines, pioneered by the Breast Health Global Initiative (BHGI), and later adopted by most oncology societies in an attempt to help physicians deliver the best possible care in a limited-resource setting. Improving outcome entails collaboration between key stakeholders, including the pharmaceutical industry, local and national health authorities, the World Health Organization (WHO), and other nonprofit, patient-oriented organizations. Therefore, we started to observe global health initiatives-led by ASCO, the Union for International Cancer Control (UICC), and the WHO-to address these challenges at the international level. This article discusses some of these initiatives.
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Affiliation(s)
- Sana Al-Sukhun
- From the Al-Hayat Medical Center, Amman, Jordan; Sylvester Comprehensive Cancer Center and Miller School of Medicine, University of Miami, Miami, FL; University of Toronto, Cancer Care Ontario, Princess Margaret Cancer Centre, and University Health Network, Toronto, Canada; Laura and Isaac Perlmutter Cancer Center at NYU Langone Medical Center, New York, NY; Hartford Healthcare, Hartford, CT
| | - Gilberto de Lima Lopes
- From the Al-Hayat Medical Center, Amman, Jordan; Sylvester Comprehensive Cancer Center and Miller School of Medicine, University of Miami, Miami, FL; University of Toronto, Cancer Care Ontario, Princess Margaret Cancer Centre, and University Health Network, Toronto, Canada; Laura and Isaac Perlmutter Cancer Center at NYU Langone Medical Center, New York, NY; Hartford Healthcare, Hartford, CT
| | - Mary Gospodarowicz
- From the Al-Hayat Medical Center, Amman, Jordan; Sylvester Comprehensive Cancer Center and Miller School of Medicine, University of Miami, Miami, FL; University of Toronto, Cancer Care Ontario, Princess Margaret Cancer Centre, and University Health Network, Toronto, Canada; Laura and Isaac Perlmutter Cancer Center at NYU Langone Medical Center, New York, NY; Hartford Healthcare, Hartford, CT
| | - Ophira Ginsburg
- From the Al-Hayat Medical Center, Amman, Jordan; Sylvester Comprehensive Cancer Center and Miller School of Medicine, University of Miami, Miami, FL; University of Toronto, Cancer Care Ontario, Princess Margaret Cancer Centre, and University Health Network, Toronto, Canada; Laura and Isaac Perlmutter Cancer Center at NYU Langone Medical Center, New York, NY; Hartford Healthcare, Hartford, CT
| | - Peter Paul Yu
- From the Al-Hayat Medical Center, Amman, Jordan; Sylvester Comprehensive Cancer Center and Miller School of Medicine, University of Miami, Miami, FL; University of Toronto, Cancer Care Ontario, Princess Margaret Cancer Centre, and University Health Network, Toronto, Canada; Laura and Isaac Perlmutter Cancer Center at NYU Langone Medical Center, New York, NY; Hartford Healthcare, Hartford, CT
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Kohler RE, Gopal S, Lee CN, Weiner BJ, Reeve BB, Wheeler SB. Breast Cancer Knowledge, Behaviors, and Preferences in Malawi: Implications for Early Detection Interventions From a Discrete Choice Experiment. J Glob Oncol 2017; 3:480-489. [PMID: 29094086 PMCID: PMC5646878 DOI: 10.1200/jgo.2016.005371] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge. METHODS We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software. RESULTS Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE); few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both) was the most important attribute of an intervention, followed by the encounter setting and travel time. CONCLUSION Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women's preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position.
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Affiliation(s)
- Racquel E. Kohler
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Satish Gopal
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Clara N. Lee
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Bryan J. Weiner
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Bryce B. Reeve
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Stephanie B. Wheeler
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
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Dickerson LK, Rositch AF, Lucas S, Harvey SC. Pilot Educational Intervention and Feasibility Assessment of Breast Ultrasound in Rural South Africa. J Glob Oncol 2017; 3:502-508. [PMID: 29094089 PMCID: PMC5646899 DOI: 10.1200/jgo.2016.008086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Breast cancer is the leading cause of cancer death in women worldwide, with high mortality in low- and middle-income countries because of a lack of detection, diagnosis, and treatment. With mammography unavailable, ultrasound offers an alternative for downstaging. The literature reports successful training in various domains, but a focus on the breast is novel. We assessed the feasibility (knowledge acquisition, perceived usefulness, and self-efficacy) of breast ultrasound training for nonphysician providers. METHODS Training was implemented for 12 providers at Hlokomela Clinic in Hoedspruit, South Africa, over 3 weeks. Didactic presentations and example cases were followed by a presurvey and test (n = 12). All providers received hands-on training with nurses as models; five providers trained with patients. A post-test (n = 12) assessed knowledge acquisition and a postsurvey (n = 10) assessed perceived program usefulness and provider self-efficacy. RESULTS The pre- to post-test averages improved by 68% in total and in four competencies (foundational knowledge, descriptive categories, benign v malignant, and lesion identification). On the postsurvey, providers expressed that ultrasound could significantly influence breast cancer detection (9.1 out of 10), treatment (7.9 out of 10), and survival (8.7 out of 10) in their community and endorsed moderate confidence in their scanning (6.3 out of 10) and interpreting abilities (5.6 out of 10). CONCLUSION Our research supports the feasibility of breast ultrasound training as part of a breast education program in low- and middle-income countries. Pre- and post-test results and observed proficiency indicate that training nonphysician providers is achievable; postsurvey responses indicate program acceptance, community-based ownership, and provider self-efficacy with ultrasound. Future work may show that breast ultrasound is viable for early detection where mammography is unavailable.
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Affiliation(s)
- Lindsay K. Dickerson
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
| | - Anne F. Rositch
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
| | - Susan Lucas
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
| | - Susan C. Harvey
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
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Kangmennaang J, Mkandawire P, Luginaah I. Breast cancer screening among women in Namibia: explaining the effect of health insurance coverage and access to information on screening behaviours. Glob Health Promot 2017; 26:50-61. [PMID: 28944716 DOI: 10.1177/1757975917727017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Breast cancer contributes substantially to morbidity and mortality in Namibia as is the case in most countries in Sub-Saharan Africa (SSA). However, there is a dearth of nationally representative studies that examine the odds of screening for breast cancer in Namibia and SSA at large. This paper aims to fill this gap by examining the determinants of breast cancer screening guided by the Health Belief Model. METHODS We applied hierarchical binary logit regression models to explore the determinants of breast cancer screening using the 2013 Namibia Demography and Health Survey (NDHS). We accounted for the effect of unobserved heterogeneity that may affect breast cancer, testing behaviours among women cluster level. The NDHS is a nationally representative dataset that has recently started to collect information on cancer screening. RESULTS The results show that women who have health insurance coverage (odds ratio (OR) = 1.62, p ≤ 0.01), maintain contact with health professionals (OR = 1.47, p = 0.01), and who have secondary (OR = 1.38, p = 0.01) and higher (OR = 1.77, p ≤ 0.01) education were more likely to be screened for breast cancer. Factors that influence women's perception of their susceptibility to breast cancer such as birthing experience, age, region and place of residence were associated with screening in this context. CONCLUSIONS Overall, the health belief model predicted women's testing behaviours and also revealed the absence of relevant risk factors in the NDHS data that might influence screening. Overall, our results show that strategies for early diagnosis of breast cancer should be given major priority by cancer control boards as well as ministries of health in SSA. These strategies should centre on early screening and may involve reducing or eliminating barriers to health care, access to relevant health information and encouraging breast self-examination.
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Affiliation(s)
- Joseph Kangmennaang
- Department of Geography and Environment, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul Mkandawire
- Institute of Interdisciplinary Studies, Ottawa, Ontario, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, London, Ontario, Canada
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