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Sun P, Yu C, Yin L, Chen Y, Sun Z, Zhang T, Shuai P, Zeng K, Yao X, Chen J, Liu Y, Wan Z. Global, regional, and national burden of female cancers in women of child-bearing age, 1990-2021: analysis of data from the global burden of disease study 2021. EClinicalMedicine 2024; 74:102713. [PMID: 39050105 PMCID: PMC11268131 DOI: 10.1016/j.eclinm.2024.102713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/27/2024] Open
Abstract
Background The global status of women's health is underestimated, particularly the burden on women of child-bearing age (WCBA). We aim to investigate the pattern and trend of female cancers among WCBA from 1990 to 2021. Methods We retrieved data from the Global Burden of Disease Study (GBD) 2021 on the incidence and disability-adjusted life-years (DALYs) of four major female cancers (breast, cervical, uterine, and ovarian cancer) among WCBA (15-49 years) in 204 countries and territories from 1990 to 2021. Estimated annual percentage changes (EAPC) in the age-standardised incidence and DALY rates of female cancers, by age and socio-demographic index (SDI), were calculated to quantify the temporal trends. Spearman correlation analysis was used to examine the correlation between age-standardised rates and SDI. Findings In 2021, an estimated 1,013,475 new cases of overall female cancers were reported globally, with a significant increase in age-standardised incidence rate (EAPC 0.16%), and a decrease in age-standardised DALY rate (-0.73%) from 1990 to 2021. Annual increase trends of age-standardised incidence rate were observed in all cancers, except for that in cervical cancer. Contrary, the age-standardised DALY rate decreased in all cancers. Breast and cervical cancers were prevalent among WCBA worldwide, followed by ovarian and uterine cancers, with regional disparities in the burden of four female cancers. In addition, the age-standardised incidence rates of breast, ovarian, and uterine cancers basically showed a consistent upward trend with increasing SDI, while both the age-standardised incidence and DALY rates in cervical cancer exhibited downward trends with SDI. Age-specific rates of female cancers increased with age in 2021, with the most significant changes observed in younger age groups, except for uterine cancer. Interpretation The rising global incidence of female cancers, coupled with regional variations in DALYs, underscores the urgent need for innovative prevention and healthcare strategies to mitigate the burden among WCBA worldwide. Funding This study was supported by the Science Foundation for Young Scholars of Sichuan Provincial People's Hospital (NO. 2022QN44 and NO. 2022QN18); the Key R&D Projects of Sichuan Provincial Department of Science and Technology (NO. 2023YFS0196); the National Natural Science Foundation of China (No. 82303701).
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Affiliation(s)
- Ping Sun
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chang Yu
- Preventive Medicine Clinic, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Limei Yin
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Chen
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Zhaochen Sun
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- School of Public Health, Southwest Medical University, Luzhou, China
| | - TingTing Zhang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Ping Shuai
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Kaihong Zeng
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoqin Yao
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jianyu Chen
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Yuping Liu
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhengwei Wan
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Yuan M, Zhu Y, Ren Y, Chen L, Dai X, Wang Y, Huang Y, Wang H. Global burden and attributable risk factors of breast cancer in young women: historical trends from 1990 to 2019 and forecasts to 2030 by sociodemographic index regions and countries. J Glob Health 2024; 14:04142. [PMID: 39026460 PMCID: PMC11258534 DOI: 10.7189/jogh.14.04142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Background Breast cancer in young women (BCY) is much less common but has significant health sequelae and societal costs. We aimed to evaluate the global and regional burden of breast cancer in women aged 15-39 years from 1990 to 2019. Methods We collected detailed data on breast cancer from the Global Burden of Disease Study 2019 (GBD 2019) Data Resources. The age-standardised incidence rate (ASIR), age-standardised mortality rate (ASMR), age-standardised disability-adjusted life years rate (ASDR), and estimated annual percentage change (EAPC) were used to assess the disease burden of BCY. The Bayesian Age-Period-Cohort model was used to forecast disease burden from 2020 to 2030. Results From 1990 to 2019, significant increases in ASIR were found for BCY (EAPC = 0.59, 95% confidence interval (CI) = 0.5 to 0.68), whereas decreases in ASMR (EAPC = -0.41, 95% CI = -0.53 to -0.3) and ASDR (EAPC = -0.35, 95% CI = -0.46 to -0.24). Across countries with varying sociodemographic indexes (SDI), all regions showed an upward trend in BCY morbidity, except for countries with a high SDI. While mortality and DALYs rates have decreased in countries with high, high-middle, and middle SDI, they have increased in countries with low-middle and low SDI. Countries with lower SDIs are projected to bear the greatest burden of BCY over the next decade, including both low and low-middle categories. Alcohol use was the main risk factor attributed to BCY deaths in most countries, while exposure to second hand smoke was the predominant risk factor for BCY deaths in middle and low-middle SDI countries. Conclusions The burden of breast cancer in young women is on the rise worldwide, and there are significant regional differences. Countries with a low-middle or low SDI face even more challenges, as they experienced a more significant and increasing BCY burden than countries with higher SDIs.
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Affiliation(s)
- Mengqi Yuan
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Yi Zhu
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Yitao Ren
- School of Health Services Management, Southern Medical University, Guangzhou, PR China
| | - Lijin Chen
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Yuying Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Yixiang Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Hongmei Wang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
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Abdel-Razeq H, Mansour A. Challenges and Opportunities in Breast Cancer Care in Low-Resourced Countries, Jordan as An Example. Cancers (Basel) 2024; 16:1751. [PMID: 38730701 PMCID: PMC11083275 DOI: 10.3390/cancers16091751] [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: 04/03/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Jordan is a relatively small country with a rapidly growing population and a challenged economy. Breast cancer is the most diagnosed cancer among women worldwide and also in Jordan. Though the age-standardized rate (ASR) of breast cancer incidence is still lower than that in Western societies, the number of newly diagnosed cases continues to increase, involving younger women, and new cases are usually detected at more advanced stages. Improvements in breast cancer care across the health care continuum, including early detection, prevention, treatment, and survivorship and palliative care, have become very visible, but may not match the magnitude of the problem. More organized, goal-oriented work is urgently needed to downstage the disease and improve awareness of, access to, and participation in early detection programs. The cost of recently introduced anti-cancer therapies poses a great challenge, but the impact of these therapies on treatment outcomes, including overall survival, is becoming very noticeable. Though the concept of a multidisciplinary approach to breast cancer treatment is often used at most health care facilities, its implementation in real practice varies significantly. The availability of breast reconstruction procedures, survivorship programs, germline genetic testing, counselling, and palliative care is improving, but these are not widely practiced. In this manuscript, we review the status of breast cancer in Jordan and highlight some of the existing challenges and opportunities.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman 11941, Jordan;
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Ginsburg O, Vanderpuye V, Beddoe AM, Bhoo-Pathy N, Bray F, Caduff C, Florez N, Fadhil I, Hammad N, Heidari S, Kataria I, Kumar S, Liebermann E, Moodley J, Mutebi M, Mukherji D, Nugent R, So WKW, Soto-Perez-de-Celis E, Unger-Saldaña K, Allman G, Bhimani J, Bourlon MT, Eala MAB, Hovmand PS, Kong YC, Menon S, Taylor CD, Soerjomataram I. Women, power, and cancer: a Lancet Commission. Lancet 2023; 402:2113-2166. [PMID: 37774725 DOI: 10.1016/s0140-6736(23)01701-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Nazik Hammad
- Department of Medicine, Division of Hematology-Oncology, St. Michael's Hospital, University of Toronto, Canada; Department of Oncology, Queens University, Kingston, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Somesh Kumar
- Jhpiego India, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Erica Liebermann
- University of Rhode Island College of Nursing, Providence, RI, USA
| | - Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Deborah Mukherji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Gavin Allman
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Jenna Bhimani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - María T Bourlon
- Department of Hemato-Oncology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Michelle A B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yek-Ching Kong
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sonia Menon
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Azadnajafabad S, Saeedi Moghaddam S, Mohammadi E, Rezaei N, Rashidi MM, Rezaei N, Mokdad AH, Naghavi M, Murray CJL, Larijani B, Farzadfar F. Burden of breast cancer and attributable risk factors in the North Africa and Middle East region, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Front Oncol 2023; 13:1132816. [PMID: 37593096 PMCID: PMC10431599 DOI: 10.3389/fonc.2023.1132816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/10/2023] [Indexed: 08/19/2023] Open
Abstract
Background Breast cancer (BC) is the most common cancer in women globally. The North Africa and Middle East (NAME) region is coping hard with the burden of BC. We aimed to present the latest epidemiology of BC and its risk factors in this region. Methods We retrieved the data on BC burden and risk factors from the Global Burden of Disease Study 2019 to describe BC status in the 21 countries of the NAME region from 1990 to 2019. We explored BC incidence, prevalence, deaths, disability-adjusted life years (DALYs), and attributable burden to seven risk factors of female BC, namely, alcohol use, diet high in red meat, low physical activity, smoking, secondhand smoke, high body mass index, and high fasting plasma glucose. Decomposition analysis on BC incidence trend was done to find out the contributing factors to this cancer's growth. Results In 2019, there were 835,576 (95% uncertainty interval: 741,968 to 944,851) female and 10,938 (9,030 to 13,256) male prevalent cases of BC in the NAME region. This number leads to 35,405 (30,676 to 40,571) deaths among female patients and 809 (654 to 1,002) deaths in male patients this year. BC was responsible for 1,222,835 (1,053,073 to 1,411,009) DALYs among female patients in 2019, with a greater proportion (94.9%) of burden in years of life lost (YLLs). The major contributor to female BC incidence increase in the past three decades was found to be increase in age-specific incidence rates of BC (227.5%), compared to population growth (73.8%) and aging (81.8%). The behavioral risk factors were responsible for majority of attributable female BC burden (DALYs: 106,026 [66,614 to 144,247]). High fasting plasma glucose was found to be the risk factor with the largest effect (DALYs: 84,912 [17,377 to 192,838]) on female BC burden. Conclusion The increasing incidence and burden of BC in the NAME region is remarkable, especially when considering limited resources in the developing countries of this region. Proper policies like expanding screening programs and careful resource management are needed to effectively manage BC burden.
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Affiliation(s)
- Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Christopher J. L. Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Hempel S, Ganz D, Saluja S, Bolshakova M, Kim T, Turvey C, Cordasco K, Basu A, Page T, Mahmood R, Motala A, Barnard J, Wong M, Fu N, Miake-Lye IM. Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ Open 2023; 13:e060232. [PMID: 37197809 DOI: 10.1136/bmjopen-2021-060232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE For large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy. DESIGN The modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys. SETTING The work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care. PARTICIPANTS The panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems. OUTCOME MEASURES The study planned to formulate a research agenda, implications for practice and recommendations for policy. RESULTS For research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals' needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients. CONCLUSIONS Recommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - David Ganz
- Geriatrics Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sonali Saluja
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Timothy Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn Turvey
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA
- Rural Health Resource Center, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - Kristina Cordasco
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aashna Basu
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Care in the Community Service, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Tonya Page
- Office of Community, Clinical Integration & Field Support, Veteran Affairs Central Office, Kentucky City, Kentucky, USA
| | - Reshma Mahmood
- Santa Maria and San Luis Obispo Community Outpatient Clinics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jenny Barnard
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle Wong
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ning Fu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, Guangdong, China
| | - Isomi M Miake-Lye
- VA West Los Angeles Evidence-based Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Kesici Z, Yilmaz V. Insurance-based disparities in breast cancer treatment pathways in a universal healthcare system: a qualitative study. BMC Health Serv Res 2023; 23:112. [PMID: 36732811 PMCID: PMC9894738 DOI: 10.1186/s12913-023-09108-0] [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: 09/30/2022] [Accepted: 01/25/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The influence of healthcare system factors on treatment pathways for breast cancer has been studied extensively in lower-middle-income countries (LMICs), but in upper-middle-income countries (UMICs), this area is understudied. This article focuses on the experiences of breast cancer patients in Türkiye, a UMIC with a universal healthcare system. It explores variations in treatment pathways based on the type of health insurance provider (private or state). METHODS The study uses an exploratory qualitative method based on in-depth interviews with 12 breast cancer patients. The inclusion criteria were Turkish nationality, female gender, and having received treatment from a private hospital within one year of the interview. A purposeful sampling strategy was employed to recruit patients who had either social health insurance only or who had private health insurance in addition to their social health insurance. A two-stage thematic analysis of the interview data was conducted. First, we examined whether the type of insurance provider makes a difference in treatment pathways; we then identified healthcare system factors that explain these differences. RESULTS The study revealed two distinct pathways to treatment. These differ in terms of financial protection, service coverage, and patients' sense of equity. Patients with private insurance reported easy access to timely and comprehensive treatment. Those without, however, had to navigate complicated routes to treatment; they generally had to resort to seeking treatment from more than one hospital. We found two healthcare system factors that explained the differences: a failure to fully enforce the mandates of the state's social health insurance in the private hospital sector and growing reliance on private insurance to gain access to essential services. CONCLUSIONS Based on data from the Turkish case, we conclude that healthcare system factors are indeed influential in shaping treatment pathways for breast cancer in UMICs with universal healthcare. These factors include a failure to fully enforce the mandates of the state's social health insurance programme in the private hospital sector and a growing reliance on private insurance to gain access to essential services. We note that this contrasts dramatically with the situation in LMICs, where the main factors are low-quality care and shortages of medical staff, medicines, and technologies.
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Affiliation(s)
- Zeynep Kesici
- grid.11220.300000 0001 2253 9056Social Policy Forum Research Centre, Boğaziçi University, Istanbul, Türkiye
| | - Volkan Yilmaz
- grid.15596.3e0000000102380260School of Law and Government, Dublin City University, Dublin, Ireland
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8
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Afaya A, Laari TT, Seidu AA, Afaya RA, Daniels-Donkor SS, Yakong VN, Ahinkorah BO. Factors associated with the uptake of clinical breast examination among women of reproductive age in Lesotho: analysis of a national survey. BMC Cancer 2023; 23:114. [PMID: 36726101 PMCID: PMC9890772 DOI: 10.1186/s12885-023-10566-2] [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: 07/04/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In low-resource settings with weak health systems, the WHO recommends clinical breast examination (CBE) as the most cost-effective breast screening modality for women. Evidence shows that biennial CBE leads to significant downstaging of breast cancer in all women. Breast cancer is the second most common cancer among women in Lesotho with a weaker healthcare system and a low breast cancer screening rate. This study investigated the prevalence and factors associated with the uptake of CBE among women of reproductive age in Lesotho. METHODS This study used cross-sectional data from the 2014 Lesotho Demographic and Health Survey. A sample of 6584 reproductive-age women was included in this study. We conducted both descriptive and multivariable logistic regression analyses. The study results were presented in frequencies, percentages, and adjusted odds ratios (aOR) with their corresponding confidence intervals (CIs). RESULTS The prevalence of CBE uptake was 9.73% (95% CI: 8.91, 10.61). Women who were covered by health insurance (aOR = 2.31, 95% CI [1.37, 3.88]), those who were pregnant (aOR = 2.34, 95% CI [1.64, 3.35]), those who had one to three children (aOR = 1.81, 95% CI [1.29,2.52]), and women who frequently read newspapers or magazines (aOR = 1.33, 95% CI [1.02,1.72]) were more likely to undergo CBE than their counterparts. Women who were aware of breast cancer (aOR = 2.54, 95% CI [1.63,3.97]), those who have ever had breast self-examination (BSE) within the last 12 months prior to the study (aOR = 5.30, 95% CI [4.35,6.46]), and those who visited the health facility in the last 12 months prior to the study (aOR = 1.57, 95% CI [1.27,1.95]) were also more likely to undergo CBE than their counterparts. Women residing in the Qacha's-nek region (aOR = 0.42, 95% CI [0.26,0.67]) were less likely to undergo CBE than those in the Botha-bothe region. CONCLUSION The study found a low prevalence of CBE uptake among reproductive-age women in Lesotho. Factors associated with CBE uptake include health insurance coverage, being pregnant, those who had one to three children, exposure to media, breast cancer awareness, ever had BSE, and those who visited a health facility. To increase CBE uptake, these factors should be considered when designing cancer screening interventions and policies in order to help reduce the burden of breast cancer in Lesotho.
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Affiliation(s)
- Agani Afaya
- grid.15444.300000 0004 0470 5454Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722 Seoul, South Korea ,grid.449729.50000 0004 7707 5975Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Timothy Tienbia Laari
- Presbyterian Primary Health Care (PPHC), Bolgatanga, Ghana ,grid.9829.a0000000109466120Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abdul Aziz Seidu
- grid.1011.10000 0004 0474 1797College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Australia ,REMS Consult Ltd, Takoradi, Ghana ,grid.511546.20000 0004 0424 5478Centre for Gender and Advocacy, Takoradi Technical University, P. O. Box 256, Takoradi, Ghana
| | - Richard Adongo Afaya
- grid.442305.40000 0004 0441 5393Department of Midwifery and Women’s Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Silas Selorm Daniels-Donkor
- grid.8241.f0000 0004 0397 2876Department of Nursing, School of Health Sciences, University of Dundee, Scotland, United Kingdom
| | - Vida Nyagre Yakong
- grid.442305.40000 0004 0441 5393Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Bright Opoku Ahinkorah
- REMS Consult Ltd, Takoradi, Ghana ,grid.117476.20000 0004 1936 7611School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Racine L, D'Souza MS, Tinampay C. Effectiveness of breast cancer screening interventions in improving screening rates and preventive activities in Muslim refugee and immigrant women: A systematic review and meta-analysis. J Nurs Scholarsh 2023; 55:329-344. [PMID: 36199240 DOI: 10.1111/jnu.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/22/2022] [Accepted: 09/09/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To systematically assess the effectiveness of breast cancer (BC) interventions in improving breast self-examination (BSE), clinical breast examination (CBE), mammogram screening rates, and preventive activities in Muslim refugee and immigrant women. DESIGN Guided by the Health Belief Model, a mixed method systematic review and meta-analysis was performed using a sequential design. METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA), the Critical Appraisal Skill Program Checklists, and the Joanna Briggs Institute (JBI) methodology for systematic review and meta-analysis. A systematic search of English-language peer-reviewed articles was undertaken in multiple health and social sciences databases from January 1, 2015, to March 31, 2022. Randomized clinical trials and quasi-experimental studies focused on the uptake of BSE, CBE, and mammograms were selected. RESULTS Fourteen articles were included in the review. Most of the studies relied on quasi-experimental designs and were carried out in the United States of America. The qualitative analysis of BC screening interventions generated three themes: (1) education, (2) access-focused, and (3) cultural and faith-based. The meta-analysis included three randomized control trials and two quasi-experimental studies. The meta-analysis demonstrates the effectiveness of community-led cultural and faith-based interventions in facilitating the completion of CBE and mammography screening. Education on BC and patient navigator interventions are more effectively used in conjunction than standalone interventions, yet community-based cultural and faith-based interventions are the most effective. CONCLUSION This systematic and meta-analysis review provides evidence on the effectiveness of access-focused and cultural and faith-based interventions in improving BC screening in Muslim refugee and immigrant women. Future research should focus on designing and measuring the effectiveness of cultural and faith-based interventions to increase Muslim refugee and immigrant women's BC screening knowledge and practices. CLINICAL RELEVANCE This systematic and meta-analysis review demonstrates the need to explore Muslim refugee and immigrant women's cultural contexts for developing culturally sensitive BC screening interventions. Knowledge and practice of BC and religiosity intersect with financial, geographic, and linguistic barriers to decrease participation in screening and preventive activities in Muslim refugee and immigrant women.
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Affiliation(s)
- Louise Racine
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Melba Sheila D'Souza
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Cindy Tinampay
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Afaya A, Ramazanu S, Bolarinwa OA, Yakong VN, Afaya RA, Aboagye RG, Daniels-Donkor SS, Yahaya AR, Shin J, Dzomeku VM, Ayanore MA, Alhassan RK. Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review. BMC Health Serv Res 2022; 22:1601. [PMID: 36587198 PMCID: PMC9805268 DOI: 10.1186/s12913-022-08927-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 12/05/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. METHODS We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)'s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. CONCLUSION This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities.
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Affiliation(s)
- Agani Afaya
- grid.15444.300000 0004 0470 5454Mo-Im Nursing Research Institute, College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea ,grid.449729.50000 0004 7707 5975Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Sheena Ramazanu
- grid.4280.e0000 0001 2180 6431Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Obasanjo Afolabi Bolarinwa
- grid.127050.10000 0001 0249 951XDepartment of Global Public Health, Canterbury Christ Church University, Canterbury, UK
| | - Vida Nyagre Yakong
- grid.442305.40000 0004 0441 5393Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Richard Adongo Afaya
- grid.442305.40000 0004 0441 5393Department of Midwifery and Women’s Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Richard Gyan Aboagye
- grid.449729.50000 0004 7707 5975Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Silas Selorm Daniels-Donkor
- grid.8241.f0000 0004 0397 2876Department of Nursing, School of Health Sciences, University of Dundee, Scotland Dundee, UK
| | - Ahmed-Rufai Yahaya
- Hariri School of Nursing, American University of Beruit, Beirut, Lebanon ,grid.460777.50000 0004 0374 4427Department of Internal Medicine, Tamale Teaching Hospital, Tamale, Ghana
| | - Jinhee Shin
- grid.412965.d0000 0000 9153 9511Woosuk University, College of Nursing, Wanju, Republic of Korea
| | - Veronica Millicent Dzomeku
- grid.9829.a0000000109466120Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Martin Amogre Ayanore
- grid.449729.50000 0004 7707 5975Department of Health Policy Planning and Management, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Robert Kaba Alhassan
- grid.449729.50000 0004 7707 5975Centre for Health Policy and Implementation Research. Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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11
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Deneche I, Touzani R, Bouhnik AD, Rey D, Bendiane MK, Chirpaz E. Factors associated with mammography screening among Reunionese women : a cross-sectional study. Rev Epidemiol Sante Publique 2022; 70:117-122. [PMID: 35491336 DOI: 10.1016/j.respe.2022.03.122] [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: 08/23/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the factors associated with the uptake of mammography screening in Reunionese women aged 50-65 years. METHODS This study included all women aged 50 to 65 years participating in a population-based cross-sectional study "FOSFORE". Participants were recruited between March and June 2017 using two sampling frames. The first frame consisted of households with a landline telephone, with or without a mobile line, by first randomly generating a telephone number and then randomly selecting an individual from among all eligible women in the household. The second sampling frame was constituted of women with an exclusive mobile line, who were selected directly if they met the eligibility criteria. Data were weighted for age and socio-professional status to ensure representativeness at the Reunion Island level. Weighted logistic regression was used to calculate odds ratios while adjusting for confounders. RESULTS 417 women were included in the study; 63.8% were up to date with guidelines on mammography screening and 36.2% were not up to date. Four factors were significantly associated with mammography screening, with an adjusted odds ratio of 2.92 (95% CI 1.51-5.61) for not having an Active Solidarity Income, 1.98 (95% CI 1.22-3.23) for having a regular gynecological follow-up by a physician, 6.53 (95% CI 3.23-13.21) for performing a Pap smear test in the past two years, and 2.07 (95% CI 1.21-3.52) for having an adequate literacy level (HLQ3). CONCLUSION The findings of this study suggest that higher socio-economic status is an indicator of participation in mammography screening in La Réunion, and future educational and intervention programs should target women in deprived areas.
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Affiliation(s)
- Imene Deneche
- Cancer Registry of the Reunion Island, Reunion University Hospital Center, Saint Denis, La Réunion, France.
| | - Rajae Touzani
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Research Units for Social and Economic Sciences of Health and Medical Information Processing, ISSPAM, Equipe CANBIOS Labelled Ligue Contre le Cancer, Marseille, France; Institut Paoli-Calmettes, SESSTIM U1252, Marseille, France
| | - Anne Deborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Research Units for Social and Economic Sciences of Health and Medical Information Processing, ISSPAM, Equipe CANBIOS Labelled Ligue Contre le Cancer, Marseille, France
| | - Dominique Rey
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Research Units for Social and Economic Sciences of Health and Medical Information Processing, ISSPAM, Equipe CANBIOS Labelled Ligue Contre le Cancer, Marseille, France
| | - Marc Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Research Units for Social and Economic Sciences of Health and Medical Information Processing, ISSPAM, Equipe CANBIOS Labelled Ligue Contre le Cancer, Marseille, France
| | - Emmanuel Chirpaz
- Cancer Registry of the Reunion Island, Reunion University Hospital Center, Saint Denis, La Réunion, France; Methodological Support Unit, Reunion University Hospital Center, Saint Denis, La Réunion, France; Centre for Clinical Investigation (INSERM CIC1410), Saint Pierre, La Réunion, France
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Abstract
INTRODUCTION Several studies explored a relationship between religiousness and the utilisation of cancer screenings, as religious people may obtain an increased social network or could have certain personality traits that enhance screening use. To the best of our knowledge, there is no systematic review that sums up the evidence gained from research on that relationship. Thus, our review aims to appraise the findings of observational studies regarding that relationship. Its findings may be useful in addressing specific target groups to increase ineffectively the low cancer screening rates. METHODS AND ANALYSIS Employing a predefined search algorithm, three online databases (CINAHL, PsycInfo and PubMed) will be searched. In addition, the bibliographies of the studies included in our review will be searched through manually and independently by two reviewers. We are looking for observational studies (both cross-sectional and longitudinal) which examine the association between religion and cancer screening utilisation. However, studies regarding specific samples (as ethnic minorities or religious sects) will be excluded. We expect that the studies examine various dimensions of religion, such as religious attendance or religious intensity. We will extract data that describe methodology, sample characteristics and the findings concerning our object of investigation. Moreover, a quality assessment will be performed. Two reviewers will independently select the studies, extract the data and assess the studies' quality. Disagreements will be dissolved by discussion or by inclusion of a third party. The findings will be presented narratively in text and tables. If possible, a meta-analysis will be carried out. ETHICS AND DISSEMINATION As no primary data are collected, the approval from an ethics committee is not required. Our review will be published in a peer-reviewed, scientific journal. PROSPERO REGISTRATION NUMBER CRD42021229222.
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Affiliation(s)
- Benedikt Kretzler
- Department for Health Economics and Health Services Research, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department for Health Economics and Health Services Research, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Linéa Brandt
- Department for Health Economics and Health Services Research, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department for Health Economics and Health Services Research, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Schäfer AA, Santos LP, Miranda VIA, Tomasi CD, Soratto J, Quadra MR, Meller FO. Regional and social inequalities in mammography and Papanicolaou tests in Brazilian state capitals in 2019: a cross-sectional study. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2021; 30:e2021172. [PMID: 34816891 DOI: 10.1590/s1679-49742021000400016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/22/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess regional and social inequalities in mammography and Papanicolaou tests. METHODS This was a cross-sectional study with data from the 2019 Chronic Disease Risk and Protective Factors Surveillance Telephone Survey (Vigitel). The outcome variables were mammography and cytopathology test. The exposure variables were race/skin color, schooling and region of residence in Brazil. Absolute inequality measurements were presented using the slope index of inequality (SII) and equiplots. RESULTS 23,339 women were included in this study. Having a mammography was 5.2 percentage points higher in women with higher levels of education, while having a cytopathology test was 5.3 percentage points lower in women of Black race/skin color.Having mammography and cytopathology tests was 3.9 and 11.2 percentage points higher, respectively, in the Southern region. CONCLUSION Social and regional inequalities persist in Brazil and affect mainly women of Black race/skin color, with low education levels and living in the Northeast region of the country.
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Affiliation(s)
- Antônio Augusto Schäfer
- Universidade do Extremo Sul Catarinense, Programa de Pós-Graduação em Saúde Coletiva, Criciúma, SC, Brasil
| | | | | | - Cristiane Damiani Tomasi
- Universidade do Extremo Sul Catarinense, Programa de Pós-Graduação em Saúde Coletiva, Criciúma, SC, Brasil
| | - Jacks Soratto
- Universidade do Extremo Sul Catarinense, Programa de Pós-Graduação em Saúde Coletiva, Criciúma, SC, Brasil
| | - Micaela Rabelo Quadra
- Universidade do Extremo Sul Catarinense, Programa de Pós-Graduação em Saúde Coletiva, Criciúma, SC, Brasil
| | - Fernanda Oliveira Meller
- Universidade do Extremo Sul Catarinense, Programa de Pós-Graduação em Saúde Coletiva, Criciúma, SC, Brasil
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Hernández Vargas JA, Ramírez Barbosa PX, Valbuena-Garcia AM, Acuña-Merchán LA, González-Diaz JA, Lopes G. National Cancer Information System Within the Framework of Health Insurance in Colombia: A Real-World Data Approach to Evaluate Access to Cancer Care. JCO Glob Oncol 2021; 7:1329-1340. [PMID: 34473526 PMCID: PMC8425322 DOI: 10.1200/go.21.00155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The National Cancer Information System (NCIS) has been operating since 2014, including information reported by health care insurers and providers on people with cancer diagnosed and treated within the Colombian health system. Its main purpose is to identify barriers to an effective access to cancer diagnosis and treatment across the country. We aimed to describe the methodology, scope and results in terms of access to health services with real-world data provided by the NCIS. METHODS Reporting of all cases of cancer by insurers and providers is mandatory by law. Data gathered include demographic and clinical information about new and old cases of cancer who receive health services. Over the years, the reporting process has been automated and it is currently performed in real time. Data quality is ensured through a standardized data-monitoring process. Access to health services is monitored by quality measures defined by consensus. RESULTS Since 2015, prevalent cases of invasive cancer have increased from 163,776 to 331,021 in 2020 (increment of 102.12%). Regarding quality measures, the proportion of people staged at diagnosis has increased over the years, especially in breast cancer. Meanwhile, early diagnosis is still concerning for breast and prostate cancer. Time to diagnosis and treatment have not consistently reached the expected goals in breast, cervical, and prostate cancer, whereas they have shown a better level of compliance for stomach and colon and rectum tumors, still not reaching the highest performance. CONCLUSION The real-world information approach provided by the NCIS may be complementary for cancer control planning in Colombia, emphasizing better management processes of health insurers and providers by identifying barriers for timely access to health care.
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Affiliation(s)
| | | | | | | | | | - Gilberto Lopes
- Division of Medical Oncology at University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
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15
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Gbenonsi G, Boucham M, Belrhiti Z, Nejjari C, Huybrechts I, Khalis M. Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review. BMC Public Health 2021; 21:1325. [PMID: 34229634 PMCID: PMC8259007 DOI: 10.1186/s12889-021-11296-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/15/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer patients in sub-Saharan Africa experience long time intervals between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing treatment time intervals has not been widely investigated. This review aimed to identify existing information on health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region. METHODS PubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization's six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program Quality-Assessment Tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding. RESULTS From 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence diagnostic and treatment intervals in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost. CONCLUSION The present review shows that diagnostic and treatment intervals among women with breast cancer in sub-Saharan Africa are influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.
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Affiliation(s)
- Gloria Gbenonsi
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco.
| | - Mouna Boucham
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | | | - Chakib Nejjari
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | | | - Mohamed Khalis
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco
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Global Perspectives on Palliative Care for Cancer Patients: Not All Countries Are the Same. Curr Oncol Rep 2021; 23:60. [PMID: 33829323 PMCID: PMC8026388 DOI: 10.1007/s11912-021-01044-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/14/2022]
Abstract
Abstract Purpose of the Review The integration of cancer-related palliative care is essential to holistic, quality cancer care. While some similarities exist between countries, this manuscript will focus on five differences that impact palliative care for cancer patients including the epidemiology of cancer and related symptoms, cancer-specific integration into care, palliative care education, economic development of the country, and cultural and religious differences. Recent Findings The epidemiology of cancer varies around the world resulting in variable symptoms and the need for individualized approaches to palliative care. While palliative care is integrated in some countries, it is lacking in over half of the world, and specific integration into cancer care is virtually absent. Education and training are the key to expansion, and yet oncology-focused palliative care education is lacking or is not well-reported in the literature. To complicate this global lens even further are the economic disparities that exist. Low-to-middle-income countries (LMICs) are resource poor and have the fewest resources and least amount of integration, and yet patients with advanced cancer are over-represented in these countries. Essential to cancer-related palliative care is a tailored approach that addresses cultural and religious differences around the globe. Summary Palliative care is developing around the globe and yet palliative care specific for cancer patients is in its infancy. Cancer care professionals should (1) understand the epidemiologic differences that exist globally and the impact this has on palliative care, (2) integrate palliative care into the cancer care arena, (3) provide cancer-specific palliative education focused on the cancer trajectory from diagnosis through survivorship and end of life, (4) advocate for LMICs, which suffer from a lack of resources and services, and (5) understand cultural and religious differences that exist to provide holistic and sensitive cancer-related palliative care.
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Ataeinia B, Saeedi Moghaddam S, Shabani M, Gohari K, Sheidaei A, Rezaei N, Naderimagham S, Ghasemi E, Rouhifard Khalilabad M, Roshani S, Farzi Y, Farzadfar F. National and Subnational Incidence, Mortality, and Years of Life Lost Due to Breast Cancer in Iran: Trends and Age-Period-Cohort Analysis Since 1990. Front Oncol 2021; 11:561376. [PMID: 33842306 PMCID: PMC8027299 DOI: 10.3389/fonc.2021.561376] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 01/15/2021] [Indexed: 01/04/2023] Open
Abstract
Breast cancer is the most common cancer among women, causing considerable burden and mortality. Demographic and lifestyle transitions in low and low-middle income countries have given rise to its increased incidence. The successful management of cancer relies on evidence-based policies taking into account national epidemiologic settings. We aimed to report the national and subnational trends of breast cancer incidence, mortality, years of life lost (YLL) and mortality to incidence ratio (MIR) since 1990. As part of the National and Subnational Burden of Diseases project, we estimated incidence, mortality and YLL of breast cancer by sex, age, province, and year using a two-stage spatio-temporal model, based on the primary dataset of national cancer and death registry. MIR was calculated as a quality of care indicator. Age-period-cohort analysis was used to distinguish the effects of these three collinear factors. A significant threefold increase in age-specific incidence at national and subnational levels along with a twofold extension of provincial disparity was observed. Although mortality has slightly decreased since 2000, a positive mortality annual percent change was detected in patients aged 25-34 years, leading to raised YLLs. A significant declining pattern of MIR and lower provincial MIR disparity was observed. We observed a secular increase of breast cancer incidence. Further evaluation of risk factors and developing national screening policies is recommended. A descending pattern of mortality, YLL and MIR at national and subnational levels reflects improved quality of care, even though mortality among younger age groups should be specifically addressed.
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Affiliation(s)
- Bahar Ataeinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Center for Precision Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsima Shabani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,International Hematology/Oncology of Pediatrics Experts (IHOPE), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Kimiya Gohari
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Naderimagham
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Rouhifard Khalilabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Roshani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Yang W, Wu X, Zhou F. Collagen Type X Alpha 1 (COL10A1) Contributes to Cell Proliferation, Migration, and Invasion by Targeting Prolyl 4-Hydroxylase Beta Polypeptide (P4HB) in Breast Cancer. Med Sci Monit 2021; 27:e928919. [PMID: 33637669 PMCID: PMC7927362 DOI: 10.12659/msm.928919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Breast cancer, a common malignant tumor, has been considered as the leading cause of cancer-related death in women. Collagen type X alpha 1 (COL10A1) is overexpressed in breast cancer. The current study was designed to determine the functional involvement and regulatory mechanism of COL10A1 on the growth and metastasis of breast cancer. Material/Methods COL10A1 and Prolyl 4-hydroxylase beta polypeptide (P4HB) expressions in normal tissues and tumor tissues of breast cancer patients were obtained from the GEPIA dataset. COL10A1 and P4HB levels in breast cancer cell lines were detected by real-time quantitative polymerase chain reaction (RT-qPCR) and western blot analysis. Furthermore, the interaction between COL10A1 and P4HB was confirmed by co-immunoprecipitation (Co-IP) assay. Cell Counting Kit-8 (CCK-8) and colony formation assay were applied to evaluate cell proliferation and clone-forming abilities of breast cancer cells. In addition, wound healing assay and transwell assay were performed to measure cell migration and invasion capabilities, respectively, in breast cancer. Results The GEPIA dataset presented overexpressed COL10A1 and P4HB in tumor tissues of breast cancer patients. COL10A1 and P4HB expression levels were greatly upregulated in breast cancer cell lines. In addition, COL10A1 could directly interact with P4HB. Functionally, overexpressed COL10A1 boosted the proliferation and metastasis of breast cancer cells and silenced COL10A1 impeded the progression of breast cancer. More importantly, knockdown of P4HB weakened the promoting effects of overexpressed COL10A1 on cell proliferation, migration, and invasion in breast cancer. Conclusions COL10A1 promotes the malignant progression of breast cancer by upregulating P4HB expression, indicating that COL10A1 functions as an oncogene in breast cancer.
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Affiliation(s)
- Weibin Yang
- Department of Laboratory Medicine, WuHan PuRen Hospital, Wuhan, Hubei, China (mainland)
| | - Xuan Wu
- Department of Laboratory Medicine, WuHan PuRen Hospital, Wuhan, Hubei, China (mainland)
| | - Fan Zhou
- Department of Laboratory Medicine, WuHan PuRen Hospital, Wuhan, Hubei, China (mainland)
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Lotter W, Diab AR, Haslam B, Kim JG, Grisot G, Wu E, Wu K, Onieva JO, Boyer Y, Boxerman JL, Wang M, Bandler M, Vijayaraghavan GR, Gregory Sorensen A. Robust breast cancer detection in mammography and digital breast tomosynthesis using an annotation-efficient deep learning approach. Nat Med 2021; 27:244-249. [PMID: 33432172 DOI: 10.1038/s41591-020-01174-9] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023]
Abstract
Breast cancer remains a global challenge, causing over 600,000 deaths in 2018 (ref. 1). To achieve earlier cancer detection, health organizations worldwide recommend screening mammography, which is estimated to decrease breast cancer mortality by 20-40% (refs. 2,3). Despite the clear value of screening mammography, significant false positive and false negative rates along with non-uniformities in expert reader availability leave opportunities for improving quality and access4,5. To address these limitations, there has been much recent interest in applying deep learning to mammography6-18, and these efforts have highlighted two key difficulties: obtaining large amounts of annotated training data and ensuring generalization across populations, acquisition equipment and modalities. Here we present an annotation-efficient deep learning approach that (1) achieves state-of-the-art performance in mammogram classification, (2) successfully extends to digital breast tomosynthesis (DBT; '3D mammography'), (3) detects cancers in clinically negative prior mammograms of patients with cancer, (4) generalizes well to a population with low screening rates and (5) outperforms five out of five full-time breast-imaging specialists with an average increase in sensitivity of 14%. By creating new 'maximum suspicion projection' (MSP) images from DBT data, our progressively trained, multiple-instance learning approach effectively trains on DBT exams using only breast-level labels while maintaining localization-based interpretability. Altogether, our results demonstrate promise towards software that can improve the accuracy of and access to screening mammography worldwide.
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Affiliation(s)
- William Lotter
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA.
| | | | - Bryan Haslam
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA
| | - Jiye G Kim
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA
| | - Giorgia Grisot
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA
| | - Eric Wu
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA.,Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Kevin Wu
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA.,Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | | | - Yun Boyer
- DeepHealth Inc., RadNet AI Solutions, Cambridge, MA, USA
| | - Jerrold L Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA.,Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI, USA
| | - Meiyun Wang
- Department of Medical Imaging, Henan Provincial People's Hospital, Zhengzhou, Henan, China
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20
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Elshami M, Bottcher B, Alkhatib M, Ismail I, Abu-Nemer K, Hana M, Qandeel A, Abdelwahed A, Yazji H, Abuamro H, Matar G, Alsahhar A, Abolamzi A, Baraka O, Elblbessy M, Samra T, Alshorbassi N, Elshami A. Perceived barriers to seeking cancer care in the Gaza Strip: a cross-sectional study. BMC Health Serv Res 2021; 21:28. [PMID: 33407426 PMCID: PMC7788935 DOI: 10.1186/s12913-020-06044-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Several factors might contribute to the delay to get cancer care including poor cancer awareness and having barriers to seeking help. This study described these barriers in Gaza and their association with recalling and recognizing cancer symptoms and risk factors. METHODS A cross-sectional study was conducted in Gaza. Adult visitors (≥18 years) to the largest three governmental hospitals and adolescent students (15-17 years) from ten high schools were recruited. A translated-into-Arabic version of the validated Cancer Awareness Measure (CAM) was used to collect data in face-to-face interviews. It described demographic data, barriers to seek cancer care as well as recall and recognition of cancer symptoms and risk factors. Responses were compared between adults and adolescents as well as males and females. RESULTS Of 3033 participants approached, 2886 completed the CAM (response rate= 95.2%). Among them, 1429 (49.5%) were adult (702 females; 49.1%) and 1457 (50.5%) were adolescent (781 females; 53.6%). The mean age± standard deviation (SD) of adult and adolescent participants was 33.7±11.7 years and 16.3±0.8 years, respectively. Emotional barriers were the most common barriers with 'feeling scared' as the most reported barrier (n=1512, 52.4%). Females and adolescents were more likely to report 'feeling scared' as a barrier than males and adults, respectively. Higher recall scores for cancer symptoms were associated with lower likelihood to report 'embarrassment', 'worry about wasting doctor's time' and 'difficulty arranging transport'. This was also seen for recalling risk factors, where 'embarrassment' and all practical barriers showed significant inverse associations with higher scores. In addition, greater recognition scores of cancer risk factors were inversely associated with reporting 'embarrassment' and 'feeling scared'. CONCLUSIONS The most commonly perceived barriers to seeking cancer care were 'feeling scared' and 'feeling worried about what the doctor might find', followed by practical and service barriers. Females and adolescents were more likely to report 'fear' as a barrier to seek medical advice. Having a higher recall of cancer symptoms and risk factors was inversely associated with reporting most barriers. To improve patient outcome, early presentation can be facilitated by targeting barriers specific to population groups.
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Affiliation(s)
- Mohamedraed Elshami
- Harvard Medical School, Boston, MA, USA. .,Ministry of Health, Gaza, Palestine.
| | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Iyad Ismail
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Khitam Abu-Nemer
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Mustafa Hana
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Ahmed Qandeel
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Ahmed Abdelwahed
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Hamza Yazji
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Hisham Abuamro
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Ghadeer Matar
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Ahmed Alsahhar
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Ahmed Abolamzi
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Obay Baraka
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Tahani Samra
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Alaa Elshami
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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21
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Ataeinia B, Saeedi Moghaddam S, Shabani M, Gohari K, Sheidaei A, Rezaei N, Naderimagham S, Ghasemi E, Rouhifard Khalilabad M, Roshani S, Farzi Y, Farzadfar F. National and Subnational Incidence, Mortality, and Years of Life Lost Due to Breast Cancer in Iran: Trends and Age-Period-Cohort Analysis Since 1990. Front Oncol 2021. [PMID: 33842306 DOI: 10.3389/fonc.2021.561376/full] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Breast cancer is the most common cancer among women, causing considerable burden and mortality. Demographic and lifestyle transitions in low and low-middle income countries have given rise to its increased incidence. The successful management of cancer relies on evidence-based policies taking into account national epidemiologic settings. We aimed to report the national and subnational trends of breast cancer incidence, mortality, years of life lost (YLL) and mortality to incidence ratio (MIR) since 1990. As part of the National and Subnational Burden of Diseases project, we estimated incidence, mortality and YLL of breast cancer by sex, age, province, and year using a two-stage spatio-temporal model, based on the primary dataset of national cancer and death registry. MIR was calculated as a quality of care indicator. Age-period-cohort analysis was used to distinguish the effects of these three collinear factors. A significant threefold increase in age-specific incidence at national and subnational levels along with a twofold extension of provincial disparity was observed. Although mortality has slightly decreased since 2000, a positive mortality annual percent change was detected in patients aged 25-34 years, leading to raised YLLs. A significant declining pattern of MIR and lower provincial MIR disparity was observed. We observed a secular increase of breast cancer incidence. Further evaluation of risk factors and developing national screening policies is recommended. A descending pattern of mortality, YLL and MIR at national and subnational levels reflects improved quality of care, even though mortality among younger age groups should be specifically addressed.
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Affiliation(s)
- Bahar Ataeinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Center for Precision Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsima Shabani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- International Hematology/Oncology of Pediatrics Experts (IHOPE), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Kimiya Gohari
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Naderimagham
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Rouhifard Khalilabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Roshani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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22
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Assessing Knowledge and Perceptions of Colorectal Cancer Screening in Armenia. J Surg Res 2020; 257:616-624. [PMID: 32949994 DOI: 10.1016/j.jss.2020.08.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Armenia has a high incidence of and mortality from colorectal cancer (CRC). No organized screening programs for CRC exist in Armenia. This study seeks to evaluate knowledge of and attitudes toward CRC and screening programs in Armenia. METHODS Adults aged 40-64 y were administered a survey using convenience sampling throughout polyclinics in Yerevan city. Survey questions were based on the Health Belief Model and were translated and modified for local relevance. RESULTS A total of 368 surveys were completed. Eighty-four percent had knowledge of CRC, 91% believed that early detection leads to improved outcomes, but only 22% had knowledge of screening. Women were more likely to have knowledge of CRC (odds ratio 2.19, P < 0.05). Although 19% have personally worried about having CRC, only 7% admitted to discussing their worries with a provider and 76% were willing to undergo screening if recommended by their doctor. Seventy-eight percent of respondents would only undergo screening if free or less than ~$20 USD. CONCLUSIONS Self-reported knowledge of CRC is high, whereas knowledge of screening remains low in Armenia. There is a willingness to undergo screening if recommended by a health care professional; however, this willingness is cost-sensitive. Interventions aimed at (1) increasing awareness of the disease and screening tests, (2) improving physician counseling, and (3) reducing financial barriers to screening should be considered along with the implementation of a national screening program in Armenia.
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23
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Özkan İ, Taylan S. Barriers to women’s breast cancer screening behaviors in several countries: A meta-synthesis study. Health Care Women Int 2020; 42:1013-1043. [DOI: 10.1080/07399332.2020.1814777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- İlknur Özkan
- Kumluca Faculty of Health Sciences, İnternal Medicine Nursing Department, Akdeniz University, Kumluca, Antalya, Turkey
| | - Seçil Taylan
- Kumluca Faculty of Health Sciences, Surgical Nursing Department, Akdeniz University, Kumluca, Antalya, Turkey
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24
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Amponsah-Dacosta E, Kagina BM, Olivier J. Health systems constraints and facilitators of human papillomavirus immunization programmes in sub-Saharan Africa: a systematic review. Health Policy Plan 2020; 35:701-717. [PMID: 32538437 PMCID: PMC7294244 DOI: 10.1093/heapol/czaa017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 12/03/2022] Open
Abstract
Given the vast investments made in national immunization programmes (NIPs) and the significance of NIPs to public health, it is important to understand what influences the optimal performance of NIPs. It has been established that well-performing NIPs require enabling health systems. However, systematic evidence on how the performance of health systems impacts on NIPs is lacking, especially from sub-Saharan Africa. We conducted a qualitative systematic review to synthesize the available evidence on health systems constraints and facilitators of NIPs in sub-Saharan Africa, using human papillomavirus immunization programmes as a proxy. Fifty-four articles published between 2008 and 2018 were found to be eligible. Data extraction was guided by an analytical model on the interface between NIPs and health systems. A cross-cutting thematic analysis of the extracted data was performed. This systematic review provides evidence necessary for informing ongoing health systems strengthening initiatives in sub-Saharan Africa. There is evidence to suggest that NIPs in sub-Saharan Africa have surmounted significant health systems constraints and have achieved notable public health success. This success can be attributed to strong political endorsement for vaccines, clear governance structures and effective collaboration with global partners. Despite this, significant health systems constraints persist in service delivery, vaccine communication, community engagement, the capacity of the health workforce and sustainable financing. These constraints could derail further progress if not addressed through health systems strengthening efforts. There is a need to expand the research agenda to include the comprehensive evaluation of health systems constraints and facilitators of NIPs within sub-Saharan Africa.
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Affiliation(s)
- Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
- Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Benjamin M Kagina
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Jill Olivier
- Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
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25
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Al-Zalabani AH. Adaptation and validation of the Arabic version of self-efficacy scale for mammography. A report on psychometric properties. Saudi Med J 2020; 40:707-713. [PMID: 31287132 PMCID: PMC6757206 DOI: 10.15537/smj.2019.7.23938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objectives: To culturally adapt and validate a mammography-specific self-efficacy (MSSE) scale into Arabic for the Saudi Arabian context. Methods: A methodological study aimed at tool translation and adaptation conducted in primary healthcare centers in As Madinah, Saudi Arabia between March 2016 and May 2016. The MSSE scale was translated and adapted into Arabic using standard procedures. Content and face validity were investigated. Confirmatory factor analysis and reliability analysis were used to determine the scale’s psychometric properties. Results: The scale showed a good internal consistency (Cronbach’s alpha=0.88). The confirmatory factor analysis supported the scale’s single-factor structure and the goodness-of-fit indices confirmed the model’s good fit (comparative fit index=0.961, Tucker-Lewis index=0.943, root-mean-square error of approximation=0.076, and standardized root-mean-square residual=0.045). Women who had a mammogram in the last 2 years scored significantly higher on the scale (39±6.2) than women who had never received a mammogram (35.88±7.2; p=0.009). Conclusion: The study confirmed that the scale’s Arabic version has good psychometric properties, using reliability analysis, confirmatory factor analysis, and extreme groups validation. The scale is likely to be useful for evaluating interventional studies aimed at improving mammography screening participation rates.
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Affiliation(s)
- Abdulmohsen Hamdan Al-Zalabani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia. E-mail.
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Impact of community-based educational intervention on breast cancer and its screening awareness among Arab women in the United Arab Emirates. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2019.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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27
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Relationship between Mammographic Density and Age in the United Arab Emirates Population. JOURNAL OF ONCOLOGY 2019; 2019:7351350. [PMID: 31467543 PMCID: PMC6701291 DOI: 10.1155/2019/7351350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/27/2019] [Accepted: 07/14/2019] [Indexed: 12/12/2022]
Abstract
Objective Higher breast density is a strong, independent risk factor for breast cancer. Breast density varies by age, ethnicity, and geographic area although dense breast tissue has been associated with younger age and premenopausal status. The relationship between breast density and age in women in the United Arab Emirates (UAE) has not been determined. This study evaluated breast density in the UAE population and its relationship with age. Methods Women participating in the national cancer screening program from August 2015 to May 2018 who underwent screening mammography were included. Breast parenchymal density was classified according to the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) from category a (almost entirely fatty) through d (extremely dense). Subjects were divided into six age groups, and the association between age and breast density was evaluated. Results Of the 4911 women included, 1604 (32.7%), 2149 (43.8%), 1055 (21.5%), and 103 (2.1%) were classified as having categories a–d breast density, respectively. A significant negative correlation was observed between age and breast density category (p < 0.001). Women of mean age 44 ± 7 years had the highest breast density, whereas those of mean age 56 ± 14 years had the lowest breast density. Comparisons of Emirati women with Lebanese and Western women showed that breast density was lower in Emirati women than in the other populations. Conclusions To our knowledge, this is the first study to evaluate the relationship between mammographic breast density and age in UAE women. As in other populations, age was inversely related to breast density, but the proportion of Emirati women with dense breasts was lower than in other populations. Because this study lacked demographic, clinical, and histopathological data, further evaluation is required.
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Zechmann S, Di Gangi S, Kaplan V, Meier R, Rosemann T, Valeri F, Senn O. Time trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study. PLoS One 2019; 14:e0217879. [PMID: 31194773 PMCID: PMC6565361 DOI: 10.1371/journal.pone.0217879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/20/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Following years of controversy regarding screening for prostate cancer using prostate-specific antigen, evidence evolves towards a more restrained and preference-based use. This study reports the impact of landmark trials and updated recommendations on the incidence rate of prostate cancer screening by Swiss general practitioners. Methods We performed a retrospective analysis of primary care data, separated in 3 time periods based on dates of publications of important prostate-specific antigen screening recommendations. 1: 2010-mid 2012 including 2 updates; 2: mid 2012-mid 2014 including a Smarter Medicine recommendation; 3: mid-2014—mid-2017 maintenance period. Period 2 including the Smarter Medicine recommendation was defined as reference period. We further assessed the influence of patient’s age and the number of prostate-specific-antigen (PSA) tests, by the patient and within each time period, on the mean PSA concentration. Uni- and multivariable analyses were used as needed. Results 36,800 men aged 55 to 75 years were included. 14.6% had ≥ 2 chronic conditions, 11.7% had ≥ 1 prostate-specific antigen test, (mean 2.60 ng/ml [SD 12.3]). 113,921 patient-years were covered. Data derived from 221 general practitioners, 33.5% of GP were women, mean age was 49.4 years (SD 10.0), 67.9% used prostate-specific antigen testing. Adjusted incidence rate-ratio (95%-CI) dropped significantly over time periods: Reference Period 2: incidence rate-ratio 1.00; Period 1: incidence rate-ratio 1.74 (1.59–1.90); Period 3: incidence rate-ratio 0.61 (0.56–0.67). A higher number of chronic conditions and a patient age between 60–69 years were significantly associated with higher screening rate. Increasing numbers of PSA testing per patient, as well as increasing age, were independently and significantly associated with an increase in the PSA value. Conclusion Swiss general practitioners adapted screening behavior as early as evidence of a limited health benefit evolved, while using a risk-adapted approach whenever performing multiple testing. Updated recommendations might have helped to maintain this decrease. Further recommendations and campaigns should aimed at older patients with multimorbidity, to sustain a further decline in prostate-specific antigen screening practices.
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Affiliation(s)
- Stefan Zechmann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
- * E-mail:
| | - Stefania Di Gangi
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Vladimir Kaplan
- Department of Internal Medicine, Hospital Muri, Muri, Switzerland
| | - Rahel Meier
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
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Shirzadi S, Allahverdipour H, Sharma M, Hasankhani H. Perceived Barriers to Mammography Adoption among Women in Iran: A Qualitative Study. Korean J Fam Med 2019; 41:20-27. [PMID: 30803223 PMCID: PMC6987031 DOI: 10.4082/kjfm.18.0054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/19/2018] [Indexed: 01/14/2023] Open
Abstract
Background Breast cancer is the most commonly diagnosed tumorous cancer and the second leading cause of cancer-related deaths among women worldwide. This study aimed to qualitatively explore the barriers to mammography adoption among Iranian women. Methods This study is a qualitative component of a large research project on exploratory sequential mixed method design, utilizing conventional content analysis. In total, 24 participants were selected from among women who had participated in the first phase of the study. Data were collected through in-depth, semi-structured interviews. Results Five main themes were extracted, consisting of unawareness of mammography, fear control, priority of mammography needs, inadequate competency of mammography centers, and a sense of losing family support. Conclusion Different perceived barriers within various levels (individual, intrapersonal, health systems, and community) play influential roles in women’s decisions to participate in breast cancer screening program, which indicates the cultural aspect of perceived barriers in different communities and countries. The study provides the basis for intervention planning in this regard.
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Affiliation(s)
- Shayesteh Shirzadi
- Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Allahverdipour
- Research Center of Psychiatry and Behavioral Sciences, Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Manoj Sharma
- Department of Behavioral & Environmental Health, School of Public Health, Jackson State University, MS, USA
| | - Hadi Hasankhani
- Department of Nursing, Qualitative Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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