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Green SM, Lloyd KE, Smith SG. Awareness of symptoms, anticipated barriers and delays to help-seeking among women at higher risk of breast cancer: A UK multicentre study. Prev Med Rep 2023; 34:102220. [PMID: 37200677 PMCID: PMC10186484 DOI: 10.1016/j.pmedr.2023.102220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023] Open
Abstract
Women with a family history of breast cancer have an increased lifetime risk of the disease. Delay in symptom presentation can lead to poorer outcomes. Low awareness of breast cancer symptoms and help-seeking barriers have been associated with delay in presentation in the general population. Symptom awareness and help-seeking barriers among women at increased risk of breast cancer are unknown. We conducted analysis of survey data which included women with moderate and high risk of breast cancer from 20 secondary and tertiary care clinics in England (n = 408). Women completed a validated survey assessing breast cancer symptom awareness, barriers to help-seeking and anticipated delay in help-seeking. Women recognised an average of 9.1/11 breast cancer symptoms (SD = 2.1). Nipple rash was the least recognised symptom (51.0%). Women educated to at least degree level had higher awareness than those with lower education (β = 0.14, 95% CI 0.13, 0.99, p = 0.011). Women at lower socioeconomic status (SES) had lower awareness than those at higher SES (β = -0.13, 95% CI -1.09, -0.07, p = 0.027). Women reported several anticipated help-seeking barriers (mean = 4.0/11, SD = 2.8). Waiting to see if a symptom will pass was the most commonly reported barrier to help-seeking (71.5%). Most women (376/408; 92.2%) reported that they would seek medical help within 2 weeks of discovering a breast cancer symptom. Interventions to increase awareness of non-lump breast cancer symptoms and reduce help-seeking barriers are needed, with considerations of appropriate reading levels and modalities for women with lower education and SES.
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Affiliation(s)
| | | | - Samuel G. Smith
- Corresponding author at: Leeds Institute of Health Sciences, University of Leeds, LS2 9LU, UK.
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2
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Walsh S, O'Mahony M, Lehane E, Farrell D, Taggart L, Kelly L, Sahm L, Byrne A, Corrigan M, Caples M, Martin AM, Tabirca S, Corrigan MA, Hegarty J. Cancer and breast cancer awareness interventions in an intellectual disability context: A review of the literature. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:131-145. [PMID: 31104540 DOI: 10.1177/1744629519850999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Women with an intellectual disability (ID) have a similar risk of developing breast cancer as women in the general population yet present with later stage breast cancers, which have poorer outcomes. AIM To identify whether there is a need to develop a breast cancer awareness intervention for women with an ID. METHODS Interventions aimed at increasing cancer awareness and breast cancer awareness for people with an ID were identified and critically appraised. RESULTS Five interventions to increase cancer awareness or breast cancer awareness in people with an ID were identified. CONCLUSION The review highlighted the paucity of theoretically underpinned breast cancer awareness interventions specifically aimed at women with an ID. Facilitating breast cancer awareness for women with an ID could potentially lead to earlier presentation of potential symptoms of breast cancer, earlier treatment, better prognosis and ultimately, improved survival. This article establishes that there is a need for an intervention underpinned by theory to increase breast cancer awareness in women with an ID.
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Affiliation(s)
- S Walsh
- 8795University College Cork, Ireland
| | | | - E Lehane
- 8795University College Cork, Ireland
| | - D Farrell
- 8813Institute of Technology Tralee, Ireland
| | - L Taggart
- 2596Ulster University, Northern Ireland
| | - L Kelly
- 57983Cork Breast Research Centre-Cork University Hospital, Ireland
| | - L Sahm
- 8795University College Cork, Ireland
| | - A Byrne
- 63976Cope Foundation, Ireland
| | - M Corrigan
- St. John of God Hospitaller Ministries, Ireland
| | - M Caples
- 8795University College Cork, Ireland
| | | | - S Tabirca
- 8795University College Cork, Ireland
| | - M A Corrigan
- 57983Cork Breast Research Centre-Cork University Hospital, Ireland
| | - J Hegarty
- 8795University College Cork, Ireland
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3
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Lai J, Mak V, Bright CJ, Lyratzopoulos G, Elliss-Brookes L, Gildea C. Reviewing the impact of 11 national Be Clear on Cancer public awareness campaigns, England, 2012 to 2016: A synthesis of published evaluation results. Int J Cancer 2021; 148:1172-1182. [PMID: 32875560 DOI: 10.1002/ijc.33277] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 12/23/2022]
Abstract
The Be Clear on Cancer (BCoC) campaigns have run in England since 2010. They aim to raise awareness of possible cancer symptoms, encouraging people to consult a general practice with these symptoms. Our study provides an overview of the impact of 11 national campaigns, for bowel, lung, bladder and kidney, breast and oesophago-gastric cancers. We synthesised existing results for each campaign covering seven clinical metrics across the patient pathway from primary care attendances to one-year net survival. For each metric, "before" and "after" periods were compared to assess change potentially related to the campaign. Results show that primary care attendances for campaign-related symptoms increased for 9 of 10 campaigns and relevant urgent referrals for suspected cancer increased above general trends for 9 of 11 campaigns. Diagnostic tests increased for 6 of 11 campaigns. For 7 of 11 campaigns, there were increases in cancer diagnoses resulting from an urgent referral for suspected cancer. There were sustained periods where more cancers were diagnosed than expected for 8 of 10 campaigns, with higher than expected proportions diagnosed at an early stage for sustained periods for 4 of 10 campaigns. There was no impact on survival. In summary, there is evidence that the BCoC campaigns impact help-seeking by patients and referral patterns by general practitioners, with some impact on diagnosis (incidence and stage). There was no clear evidence of impact on survival.
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Affiliation(s)
- Jennifer Lai
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, London, UK
| | - Vivian Mak
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, London, UK
| | - Chloe J Bright
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, London, UK
| | - Georgios Lyratzopoulos
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, London, UK
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - Lucy Elliss-Brookes
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, London, UK
| | - Carolynn Gildea
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, London, UK
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4
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Exploring determinants of, and interventions for, delayed presentation of women with breast symptoms: A systematic review. Eur J Oncol Nurs 2020; 44:101677. [DOI: 10.1016/j.ejon.2019.101677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/08/2019] [Accepted: 10/12/2019] [Indexed: 12/24/2022]
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5
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Ashareef B, Yaseen W, Jawa W, Barnawe Y, Alshehri W, Alqethami H, Bukari W, Alqumaili O. Breast Cancer Awareness among Female School Teachers in Saudi Arabia: A Population Based Survey. Asian Pac J Cancer Prev 2020; 21:337-342. [PMID: 32102508 PMCID: PMC7332133 DOI: 10.31557/apjcp.2020.21.2.337] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Indexed: 12/05/2022] Open
Abstract
Introduction: Breast cancer (BC) is the most frequent malignancy in women and second leading cause of cancer related death worldwide. In Saudi Arabia, it is the ninth leading cause of death. Few studies have been conducted to address BC awareness in KSA in general and to our knowledge, this is the first to be conducted in the Makkah region. Aim: To assess the level of awareness, knowledge and attitude of Saudi female teachers towards BC, in primary intermediate and secondary schools within the Makkah region. Method and Materials: The study proposal was approved by the Research Ethical Committee in the faculty of medicine, at Umm Al-Qura University. A self-administered questionnaire on BC was designed and tested. The questionnaire consisted of 23 items and covered four domains (awareness about the etiology, knowledge about BC risk factors, symptoms, knowledge about diagnosis and treatment& attitude toward screening). A sample of 400 female school teachers (working in primary, intermediate and secondary schools) were selected by multistage, random sampling. A selection of forty schools, with a sample of 10 teachers from each, was chosen at random in Makkah. Proper permission was obtained from the authorities. the questionnaire was filled out by each participant. The collected data was statistically analyzed using SPSS version 21. Results: The results showed that knowledge and attitude about BC amongst the female teachers differed significantly by age and marital status. Those aged 46-55 (F=8.5, p>0.002) and those who are married (F=2.7, p>0.04) had more knowledge about BC than others. The majority of respondents had a limited level of knowledge and understanding of BC symptoms (Table 2). However, it also showed that the teachers are very enthusiastic to learn about BC, and its prevention. Most participants (40/%) reported that they had not performed any breast exams before. Conclusions and Recommendation: This study indicated that Saudi female teachers’ level of knowledge of BC is inadequate. Introducing and developing an effective health education program in female schools within KSA is recommended.
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Affiliation(s)
- Basem Ashareef
- Consultant General Surgery, Department of General Surgery, Alnoor Specialized Hospital, Makkah, Saudi Arabia
| | - Waed Yaseen
- Consultant General Surgery, Department of General Surgery, Alnoor Specialized Hospital, Makkah, Saudi Arabia
| | - Wed Jawa
- Department of Obstetric and Gynecology, Maternity and Children's Hospital, Makkah, Saudi Arabia
| | | | - Wejdan Alshehri
- Department of Obstetric and Gynecology, Armed Forces Hospital, Taif, Saudi Arabia
| | - Heba Alqethami
- Department of General Surgery, King Faisal General Hospital, Makkah, Saudi Arabia
| | - Walaa Bukari
- Department of Obstetric and Gynecology, Heraa General Hospital, Makkah, Saudi Arabia
| | - Osama Alqumaili
- Consultant General Surgery, Department of General Surgery, Alnoor Specialized Hospital, Makkah, Saudi Arabia
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6
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Kaushal A, McCormick K, Warburton F, Burton C, Ramirez AJ, Forbes LJ. Promoting breast cancer awareness in older women during the seasonal flu vaccination campaign. ACTA ACUST UNITED AC 2019; 28:43-49. [PMID: 30620659 DOI: 10.12968/bjon.2019.28.1.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: older women are at high risk of presenting with breast cancer when it has reached a late stage, which may be partly because of poor breast cancer awareness. AIM: the aim of this project was to implement and evaluate a new way of delivering the Promoting Early Presentation (PEP) Intervention during flu vaccination appointments in primary care. The PEP Intervention is a 1-minute intervention, accompanied by a booklet and delivered by primary care health professionals to provide older women with the knowledge, confidence and skills to present promptly on discovering symptoms of breast cancer. METHOD: health professionals delivered the PEP Intervention to older women at six general practices in south London. The authors measured changes in breast cancer awareness after the intervention and interviewed practice staff about their experiences of using it. FINDINGS: knowledge of breast symptoms and breast checking was greater in women aged 70 years and above after the implementation than before. Health professionals' found it acceptable and feasible to implement. CONCLUSION: this intervention is a novel way of increasing breast cancer awareness in older women, which could contribute to earlier presentation and diagnosis of breast cancer in the UK.
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Affiliation(s)
- Aradhna Kaushal
- Research Associate, Research Department of Behavioural Science and Health, University College London
| | - Katrina McCormick
- Retired Consultant Public Health, Public Health Community Directorate, London Borough of Lewisham
| | - Fiona Warburton
- Medical Statistician, Population and Patient Health, Dental Institute, King's College London
| | - Cathy Burton
- General Practitioner, Cancer Commissioning Team, North West London Commissioning Support Unit
| | | | - Lindsay J Forbes
- Senior Clinical Research Fellow, Centre for Health Services Studies, University of Kent. Senior Lecturer, Division of Cancer Studies, King's College London
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7
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Macdonald S, Cunningham Y, Patterson C, Robb K, Macleod U, Anker T, Hilton S. Mass media and risk factors for cancer: the under-representation of age. BMC Public Health 2018; 18:490. [PMID: 29695238 PMCID: PMC5918870 DOI: 10.1186/s12889-018-5341-9] [Citation(s) in RCA: 10] [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: 05/12/2017] [Accepted: 03/20/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Increasing age is a risk factor for developing cancer. Yet, older people commonly underestimate this risk, are less likely to be aware of the early symptoms, and are more likely to be diagnosed with advanced stage cancer. Mass media are a key influence on the public's understanding health issues, including cancer risk. This study investigates how news media have represented age and other risk factors in the most common cancers over time. METHODS Eight hundred articles about the four most common cancers (breast, prostate, lung and colorectal) published within eight UK national newspapers in 2003, 2004, 2013 and 2014 were identified using the Nexis database. Relevant manifest content of articles was coded quantitatively and subjected to descriptive statistical analysis in SPSS to identify patterns across the data. RESULTS Risk was presented in half of the articles but this was rarely discussed in any depth and around a quarter of all articles introduced more than one risk factor, irrespective of cancer site. Age was mentioned as a risk factor in approximately 12% of all articles and this varied by cancer site. Age was most frequently reported in relation to prostate cancer and least often in articles about lung cancer. Articles featuring personal narratives more frequently focused on younger people and this was more pronounced in non-celebrity stories; only 15% of non-celebrity narratives were about people over 60. Other common risks discussed were family history and genetics, smoking, diet, alcohol, and environmental factors. Family history and genetics together featured as the most common risk factors. Risk factor reporting varied by site and family history was most commonly associated with breast cancer, diet with bowel cancer and smoking with lung cancer. CONCLUSION Age and older adults were largely obscured in media representation of cancer and cancer experience. Indeed common risk factors in general were rarely discussed in any depth. Our findings will usefully inform the development of future cancer awareness campaigns and media guidelines. It is important that older adults appreciate their heightened risk, particularly in the context of help-seeking decisions.
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Affiliation(s)
- Sara Macdonald
- Institute of Health & Wellbeing, General Practice and Primary Care, 1 Horselethill Rd, Glasgow, G12 9LX Scotland
| | - Yvonne Cunningham
- Institute of Health & Wellbeing, General Practice and Primary Care, 1 Horselethill Rd, Glasgow, G12 9LX Scotland
| | - Chris Patterson
- Institute of Health & Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB Scotland
| | - Katie Robb
- Institute of Health & WellbeingMental Health & Wellbeing, Gartnavel Royal Hospital, Administration Building, 1st floor, 1055 Great Western Road, Glasgow, G12 0XH Scotland
| | - Una Macleod
- Hull York Medical School, Allam Medical Building, Univrsity of Hull, Hull, HU6 7RX UK
| | - Thomas Anker
- Adam Smith Business School, Gilbert Scott Building, University of Glasgow, Glasgow, G12 8QQ Scotland
| | - Shona Hilton
- Institute of Health & Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB Scotland
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8
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Croager EJ, Gray V, Pratt IS, Slevin T, Pettigrew S, Holman CD, Bulsara M, Emery J. Find Cancer Early: Evaluation of a Community Education Campaign to Increase Awareness of Cancer Signs and Symptoms in People in Regional Western Australians. Front Public Health 2018; 6:22. [PMID: 29473031 PMCID: PMC5809399 DOI: 10.3389/fpubh.2018.00022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/22/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Cancer outcomes for people living in rural and remote areas are worse than for those living in urban areas. Although access to and quality of cancer treatment are important determinants of outcomes, delayed presentation has been observed in rural patients. Methods Formative research with people from rural Western Australia (WA) led to the Find Cancer Early campaign. Find Cancer Early was delivered in three regions of WA, with two other regions acting as controls. Staff delivered the campaign using a community engagement approach, including promotion in local media. Television communications were not used to minimize contamination in the control regions. The campaign evaluation was undertaken at 20 months via a computer-assisted telephone interview (CATI) survey comparing campaign and control regions. The primary outcome variable was knowledge of cancer signs and symptoms. Results Recognition and recall of Find Cancer Early and symptom knowledge were higher in the campaign regions. More than a quarter of those who were aware of the campaign reported seeing the GP as a result of their exposure. Conclusion Despite limited use of mass media, Find Cancer Early successfully improved knowledge of cancer symptoms and possibly led to changes in behavior. Social marketing campaigns using community development can raise awareness and knowledge of a health issue in the absence of television advertising.
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Affiliation(s)
| | - Victoria Gray
- University of Western Australia, Perth, WA, Australia
| | - Iain Stephen Pratt
- Cancer Council Western Australia, Subiaco, WA, Australia.,Western Australian Cancer Prevention Research Unit, Curtin University, Perth, WA, Australia
| | - Terry Slevin
- Cancer Council Western Australia, Subiaco, WA, Australia.,Western Australian Cancer Prevention Research Unit, Curtin University, Perth, WA, Australia
| | - Simone Pettigrew
- Western Australian Cancer Prevention Research Unit, Curtin University, Perth, WA, Australia
| | | | - Max Bulsara
- University of Notre Dame Australia, Fremantle, WA, Australia
| | - Jon Emery
- University of Melbourne, Melbourne, VIC, Australia
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Davis SF, Enderby P, Harrop D, Hindle L. Mapping the contribution of Allied Health Professions to the wider public health workforce: a rapid review of evidence-based interventions. J Public Health (Oxf) 2018; 39:177-183. [PMID: 26989160 DOI: 10.1093/pubmed/fdw023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objectives The objective was to identify a selection of the best examples of the public health contributions by Allied Health Professionals (AHPs) in order to encourage a wider awareness and participation from that workforce to public health practice. Study design A mapping exercise was used to identify evidence-based interventions that could lead to health improvements across a population. Methods A rapid review was undertaken to identify evidence, followed by a survey of Allied Health Profession (AHP) practitioners and an expert panel consensus method to select the examples of AHP public health interventions. Results Nine evidence-based interventions are identified and selected as examples of current AHP good practice. These examples represent a contribution to public health and include screening interventions, secondary prevention and risk management. Conclusions This study contributes to a strategy for AHPs in public health by appraising the effectiveness and impact of some exemplar AHP practices that contribute to health improvement. There is a need for AHPs to measure the impact of their interventions and to demonstrate evidence of outcomes at population level.
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Affiliation(s)
- S Fowler Davis
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - P Enderby
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - D Harrop
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
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10
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Lamort-Bouché M, Sarnin P, Kok G, Rouat S, Péron J, Letrilliart L, Fassier JB. Interventions developed with the Intervention Mapping protocol in the field of cancer: A systematic review. Psychooncology 2018; 27:1138-1149. [PMID: 29247578 DOI: 10.1002/pon.4611] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/27/2017] [Accepted: 12/04/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The Intervention Mapping (IM) protocol provides a structured framework to develop, implement, and evaluate complex interventions. The main objective of this review was to identify and describe the content of the interventions developed in the field of cancer with the IM protocol. Secondary objectives were to assess their fidelity to the IM protocol and to review their theoretical frameworks. METHODS Medline, Web of Science, PsycINFO, PASCAL, FRANCIS, and BDSP databases were searched. All titles and abstracts were reviewed. A standardized extraction form was developed. All included studies were reviewed by 2 reviewers blinded to each other. RESULTS Sixteen studies were identified, and these reported 15 interventions. The objectives were to increase cancer screening participation (n = 7), early consultation (n = 1), and aftercare/quality of life among cancer survivors (n = 7). Six reported a complete participatory planning group, and 7 described a complete logic model of the problem. Ten studies described a complete logic model of change. The main theoretical frameworks used were the theory of planned behaviour (n = 8), the transtheoretical model (n = 6), the health belief model (n = 6), and the social cognitive theory (n = 6). The environment was rarely integrated in the interventions (n = 4). Five interventions were reported as effective. CONCLUSIONS Culturally relevant interventions were developed with the IM protocol that were effective to increase cancer screening and reduce social disparities, particularly when they were developed through a participative approach and integrated the environment. Stakeholders' involvement and the role of the environment were heterogeneously integrated in the interventions.
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Affiliation(s)
- Marion Lamort-Bouché
- UMRESTTE UMR T 9405, Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement, Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France.,Collège Universitaire de Médecine Générale, Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Philippe Sarnin
- Groupe de Recherche en Psychologie Sociale (GREPS-EA 4163), Univ Lyon, Université Lumière Lyon 2, Lyon, France
| | - Gerjo Kok
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Sabrina Rouat
- Groupe de Recherche en Psychologie Sociale (GREPS-EA 4163), Univ Lyon, Université Lumière Lyon 2, Lyon, France
| | - Julien Péron
- Laboratoire de Biométrie et Biologie Evolutive LBBE-UMR 5558, Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France.,Service d'Oncologie Médicale, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France
| | - Laurent Letrilliart
- Collège Universitaire de Médecine Générale, Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France.,Health Services and Performance Research (HESPER-EA 7425), Univ Lyon, Université Claude Bernard Lyon 1, Université Lyon 2, Lyon, France
| | - Jean-Baptiste Fassier
- UMRESTTE UMR T 9405, Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement, Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France.,Service de Médecine et Santé au Travail, Hospices Civils de Lyon, Lyon, France
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11
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Rouzbeh M, Namadian M, Shakibazadeh E, Hasani J, Rouzbeh R. The Effect of Group Counseling Using Ellis’s A-B-C Technique on Irrational Beliefs and Self-Efficacy About Breast Self-Awareness of Women Health Volunteers. J Transcult Nurs 2017; 29:346-353. [DOI: 10.1177/1043659617727833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: This preliminary pilot effort assessed the effect of group counseling using A-B-C technique on irrational beliefs and self-efficacy for women health volunteers (WHVs) in breast self-awareness. Design: In this randomized controlled trial, 40 WHVs from three health centers (Abhar, Iran) were randomly allocated into two groups. Method: Seven weekly group counseling sessions were held for the intervention group. Data about cancer fatalism belief, dissatisfaction of body, anxiety, and self-efficacy were collected through validated questionnaires 1 month before and 2 weeks after the intervention. Results: Mean scores of anxiety ( p = .036), body dissatisfaction ( p = .002), cancer fatalism belief ( p ≤ .0001), and self-efficacy ( p ≤ .0001) were improved in the intervention group compared with control group. Discussion/Conclusion: Group counseling using A-B-C technique was effective in improving irrational beliefs and self-efficacy of the WHVs about breast self-awareness. Implications for Practice: The findings may help in further development of strategies and cultural programs to improve health-related irrational beliefs.
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Affiliation(s)
- Mahnaz Rouzbeh
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Masoumeh Namadian
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
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12
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Hendry M, Pasterfield D, Gollins S, Adams R, Evans M, Fiander A, Robling M, Campbell C, Bekkers MJ, Hiscock J, Nafees S, Rose J, Stanley M, Williams O, Makin M, Wilkinson C. Talking about human papillomavirus and cancer: development of consultation guides through lay and professional stakeholder coproduction using qualitative, quantitative and secondary data. BMJ Open 2017; 7:e015413. [PMID: 28652291 PMCID: PMC5734366 DOI: 10.1136/bmjopen-2016-015413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/11/2017] [Accepted: 04/27/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND High-risk human papillomaviruses (HPVs) cause all cervical cancer and the majority of vulvar, vaginal, anal, penile and oropharyngeal cancers. Although HPV is the most common sexually transmitted infection, public awareness of this is poor. In addition, many clinicians lack adequate knowledge or confidence to discuss sexual transmission and related sensitive issues. Complex science needs to be communicated in a clear, digestible, honest and salient way. Therefore, the aim of this study was to coproduce with patients who have cancer appropriate resources to guide these highly sensitive and difficult consultations. METHODS A matrix of evidence developed from a variety of sources, including a systematic review and telephone interviews with clinicians, supported the production of a draft list of approximately 100 potential educational messages. These were refined in face-to-face patient interviews using card-sorting techniques, and tested in cognitive debrief interviews to produce a ‘fast and frugal’ knowledge tool. RESULTS We developed three versions of a consultation guide, each comprising a clinician guidance sheet and patient information leaflet for gynaecological (cervical, vaginal, vulvar), anal or oropharyngeal cancers. That cancer could be caused by a sexually transmitted virus acquired many years previously was surprising to many and shocking to a few patients. However, they found the information clear, helpful and reassuring. Clinicians acknowledged a lack of confidence in explaining HPV, welcomed the clinician guidance sheets and considered printed information for patients particularly useful. CONCLUSION Because of the ‘shock factor’, clinicians will need to approach the discussion of HPV with sensitivity and take individual needs and preferences into account, but we provide a novel, rigorously developed and tested resource which should have broad applicability in the UK National Health Service and other health systems.
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Affiliation(s)
- Maggie Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Diana Pasterfield
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Simon Gollins
- North Wales Cancer Treatment Centre, Betsi Cadwaladr University Health Board, Rhyl, UK
| | - Richard Adams
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Mererid Evans
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Alison Fiander
- Leading Safe Choices Programme, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Michael Robling
- South East Wales Trials Unit, Cardiff University, Cardiff, UK
| | - Christine Campbell
- Department of Pathology, Usher Institute for Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | - Julia Hiscock
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Sadia Nafees
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Janice Rose
- PPI Primary Care Clinical Studies Group, National Cancer Research Institute, Gloucester, UK
| | | | - Olwen Williams
- Department of Genitourinary Medicine, Betsi Cadwaladr University Health Board, Wrexham, UK
| | - Matthew Makin
- Office of the Medical Director, The Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
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Anastasi N, Lusher J. The impact of breast cancer awareness interventions on breast screening uptake among women in the United Kingdom: A systematic review. J Health Psychol 2017; 24:113-124. [PMID: 28810435 DOI: 10.1177/1359105317697812] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The impact of breast screening awareness campaigns on mammography attendance among British women was explored. British Nursing Index, Medline, PsycINFO, Embase and Cumulative Index to Nursing and Allied Health were searched between October 2012 and February 2013. Searches identified research on breast cancer awareness interventions and breast self-examination. In total, 867 articles were identified and 14 met criteria for review. Breast cancer awareness interventions were found to increase the uptake of breast self-examination behaviours and increase the likelihood of breast cancer screening attendance. Predicting the impact of these interventions on survivability and general morbidity/mortality outcomes remains a challenge due to a shortage of suitably evaluated campaigns.
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O'Mahony M, Comber H, Fitzgerald T, Corrigan MA, Fitzgerald E, Grunfeld EA, Flynn MG, Hegarty J. Interventions for raising breast cancer awareness in women. Cochrane Database Syst Rev 2017; 2:CD011396. [PMID: 28185268 PMCID: PMC6464597 DOI: 10.1002/14651858.cd011396.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Breast cancer continues to be the most commonly diagnosed cancer in women globally. Early detection, diagnosis and treatment of breast cancer are key to better outcomes. Since many women will discover a breast cancer symptom themselves, it is important that they are breast cancer aware i.e. have the knowledge, skills and confidence to detect breast changes and present promptly to a healthcare professional. OBJECTIVES To assess the effectiveness of interventions for raising breast cancer awareness in women. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialised Register (searched 25 January 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 12) in the Cochrane Library (searched 27 January 2016), MEDLINE OvidSP (2008 to 27 January 2016), Embase (Embase.com, 2008 to 27 January 2016), the World Health Organization's International Clinical Trials Registry Platform (ICTRP) search portal and ClinicalTrials.gov (searched 27 Feburary 2016). We also searched the reference lists of identified articles and reviews and the grey literature for conference proceedings and published abstracts. No language restriction was applied. SELECTION CRITERIA Randomised controlled trials (RCTs) focusing on interventions for raising women's breast cancer awareness i.e. knowledge of potential breast cancer symptoms/changes and the confidence to look at and feel their breasts, using any means of delivery, i.e. one-to-one/group/mass media campaign(s). DATA COLLECTION AND ANALYSIS Two authors selected studies, independently extracted data and assessed risk of bias. We reported the odds ratio (OR) and 95% confidence intervals (CIs) for dichotomous outcomes and mean difference (MD) and standard deviation (SD) for continuous outcomes. Since it was not possible to combine data from included studies due to their heterogeneity, we present a narrative synthesis. We assessed the quality of evidence using GRADE methods. MAIN RESULTS We included two RCTs involving 997 women: one RCT (867 women) randomised women to receive either a written booklet and usual care (intervention group 1), a written booklet and usual care plus a verbal interaction with a radiographer or research psychologist (intervention group 2) or usual care (control group); and the second RCT (130 women) randomised women to either an educational programme (three sessions of 60 to 90 minutes) or no intervention (control group). Knowledge of breast cancer symptomsIn the first study, knowledge of non-lump symptoms increased in intervention group 1 compared to the control group at two years postintervention, but not significantly (OR 1.1, 95% CI 0.7 to 1.6; P = 0.66; 449 women; moderate-quality evidence). Similarly, at two years postintervention, knowledge of symptoms increased in the intervention group 2 compared to the control group but not significantly (OR 1.4, 95% CI 0.9 to 2.1; P = 0.11; 434 women; moderate-quality evidence). In the second study, women's awareness of breast cancer symptoms had increased one month post intervention in the educational group (MD 3.45, SD 5.11; 65 women; low-quality evidence) compared to the control group (MD -0.68, SD 5.93; 65 women; P < 0.001), where there was a decrease in awareness. Knowledge of age-related riskIn the first study, women's knowledge of age-related risk of breast cancer increased, but not significantly, in intervention group 1 compared to control at two years postintervention (OR 1.8; 95% CI 0.9 to 3.5; P < 0.08; 447 women; moderate-quality evidence). Women's knowledge of risk increased significantly in intervention group 2 compared to control at two years postintervention (OR 4.8, 95% CI 2.6 to 9.0; P < 0.001; 431 women; moderate-quality evidence). In the second study, women's perceived susceptibility (how at risk they considered themselves) to breast cancer had increased significantly one month post intervention in the educational group (MD 1.31, SD 3.57; 65 women; low-quality evidence) compared to the control group (MD -0.55, SD 3.31; 65 women; P = 0.005), where a decrease in perceived susceptibility was noted. Frequency of Breast CheckingIn the first study, no significant change was noted for intervention group 1 compared to control at two years postintervention (OR 1.1, 95% CI 0.8 to 1.6; P = 0.54; 457 women; moderate-quality evidence). Monthly breast checking increased, but not significantly, in intervention group 2 compared to control at two years postintervention (OR 1.3, 95% CI 0.9 to 1.9; P = 0.14; 445 women; moderate-quality evidence). In the second study, women's breast cancer preventive behaviours increased significantly one month post intervention in the educational group (MD 1.21, SD 2.54; 65 women; low-quality evidence) compared to the control group (MD 0.15, SD 2.94; 65 women; P < 0.045). Breast Cancer AwarenessWomen's overall breast cancer awareness did not change in intervention group 1 compared to control at two years postintervention (OR 1.8, 95% CI 0.6 to 5.30; P = 0.32; 435 women; moderate-quality evidence) while overall awareness increased in the intervention group 2 compared to control at two years postintervention (OR 8.1, 95% CI 2.7 to 25.0; P < 0.001; 420 women; moderate-quality evidence). In the second study, there was a significant increase in scores on the Health Belief Model (that included the constructs of awareness and perceived susceptibility) at one month postintervention in the educational group (mean 1.21, SD 2.54; 65 women) compared to the control group (mean 0.15, SD 2.94; 65 women; P = 0.045).Neither study reported outcomes relating to motivation to check their breasts, confidence to seek help, time from breast symptom discovery to presentation to a healthcare professional, intentions to seek help, quality of life, adverse effects of the interventions, stages of breast cancer, survival estimates or breast cancer mortality rates. AUTHORS' CONCLUSIONS Based on the results of two RCTs, a brief intervention has the potential to increase women's breast cancer awareness. However, findings of this review should be interpreted with caution, as GRADE assessment identified moderate-quality evidence in only one of the two studies reviewed. In addition, the included trials were heterogeneous in terms of the interventions, population studied and outcomes measured. Therefore, current evidence cannot be generalised to the wider context. Further studies including larger samples, validated outcome measures and longitudinal approaches are warranted.
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Affiliation(s)
- Máirín O'Mahony
- University College CorkSchool of Nursing & Midwifery, Brookfield Health Sciences ComplexCollege RoadCorkIreland
| | - Harry Comber
- University College CorkCork Specialist Training Programme for General Practice3 BloomfieldCorkIreland
| | - Tony Fitzgerald
- University College CorkDepartment of Epidemiology and Public HealthBrookfield Health Sciences ComplexCorkIreland
| | - Mark A Corrigan
- Cork University HospitalDepartment of SurgeryWilton RoadCorkIreland
| | | | - Elizabeth A Grunfeld
- Coventry UniversityCentre for Technology Enabled Health Research (CTEHR)CoventryUKCV1 5FB
| | - Maura G Flynn
- University College CorkNursing and Midwifery, Boston Scientific Health Sciences Library, Brookfield Health Sciences ComplexCollege RoadCorkIreland
| | - Josephine Hegarty
- University College CorkSchool of Nursing & Midwifery, Brookfield Health Sciences ComplexCollege RoadCorkIreland
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Abstract
Much time, effort and investment goes into the diagnosis of symptomatic cancer, with the expectation that this approach brings clinical benefits. This investment of resources has been particularly noticeable in the UK, which has, for several years, appeared near the bottom of international league tables for cancer survival in economically developed countries. In this Review, we examine expedited diagnosis of cancer from four perspectives. The first relates to the potential for clinical benefits of expedited diagnosis of symptomatic cancer. Limited evidence from clinical trials is available, but the considerable observational evidence suggests benefits can be obtained from this approach. The second perspective considers how expedited diagnosis can be achieved. We concentrate on data from the UK, where extensive awareness campaigns have been conducted, and initiatives in the primary-care setting, including clinical decision support, have all occurred during a period of considerable national policy change. The third section considers the most appropriate patients for cancer investigations, and the possible community settings for identification of such patients; UK national guidance for selection of patients for investigation is discussed. Finally, the health economics of expedited diagnosis are reviewed, although few studies provide definitive evidence on this topic.
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Affiliation(s)
- Willie Hamilton
- University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK
| | - Fiona M Walter
- Department of Public Health &Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Greg Rubin
- School of Medicine, Pharmacy and Health, Wolfson Building, Queen's Campus, University of Durham, Stockton-on-Tees TS17 6BH, UK
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor University, Gwenfro Unit 5, Wrexham Technology Park, Wrexham LL13 7YP, UK
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Kaushal A, Ramirez AJ, Warburton F, Forster AS, Linsell L, Burgess C, Tucker L, Omar L, Forbes LJ. "Promoting Early Presentation" intervention sustains increased breast cancer awareness in older women for three years: A randomized controlled trial. J Med Screen 2016; 24:163-165. [PMID: 28756764 DOI: 10.1177/0969141316667408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective In a randomized controlled trial, the Promoting Early Presentation intervention increased older women's breast cancer awareness after two years. We investigated whether this increase was sustained at three years, and the effect on breast screening self-referral. Methods We randomly allocated 867 women attending their final invited breast screening appointment to the Promoting Early Presentation intervention or usual care. We examined breast cancer awareness after three years and breast screening self-referrals after four years. Results Women in the Promoting Early Presentation intervention arm had higher breast cancer awareness at three years than the usual care arm (odds ratio: 10.4; 95% confidence interval: 3.1 to 34.8). There were no differences in proportions self-referring for breast screening between arms, but statistical power was limited. Conclusion The Promoting Early Presentation intervention has a sustained effect on breast cancer awareness in older women. The effect on self-referral for breast screening is unclear.
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Affiliation(s)
- Aradhna Kaushal
- Promoting Early Presentation Group, King's College London, London, UK
| | - Amanda J Ramirez
- Promoting Early Presentation Group, King's College London, London, UK
| | - Fiona Warburton
- Promoting Early Presentation Group, King's College London, London, UK
| | - Alice S Forster
- Promoting Early Presentation Group, King's College London, London, UK
| | - Louise Linsell
- Promoting Early Presentation Group, King's College London, London, UK
| | - Caroline Burgess
- Promoting Early Presentation Group, King's College London, London, UK
| | - Lorraine Tucker
- Promoting Early Presentation Group, King's College London, London, UK
| | - Lynne Omar
- Promoting Early Presentation Group, King's College London, London, UK
| | - Lindsay Jl Forbes
- Promoting Early Presentation Group, King's College London, London, UK
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Hendry M, Pasterfield D, Adams R, Evans M, Fiander A, Robling M, Campbell C, Makin M, Gollins S, Hiscock J, Nafees S, Bekkers MJ, Rose J, Williams O, Stanley M, Wilkinson C. Talking about human papillomavirus and cancer: protocol for a patient-centred study to develop scripted consultations. BMJ Open 2016; 6:e011205. [PMID: 27113240 PMCID: PMC4853976 DOI: 10.1136/bmjopen-2016-011205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Persistent infection with sexually transmitted, high-risk human papillomavirus (HPV) types is the cause of all cervical cancers and some anogenital and oropharyngeal cancers. HPV is an extremely common asymptomatic infection but little known and poorly understood by the public. Patients with HPV-related cancers have new and challenging information needs due to the complex natural history of HPV and the stigma of sexual transmission. They may ask questions that are outside the remit of the traditional cancer consultation, and there is a lack of guidance on how to counsel them. This study aims to fulfil that need by developing and testing cancer site-specific scripted consultations. METHODS AND ANALYSIS A synthesis of findings generated from previous work, a systematic review of information-based interventions for patients with HPV-related cancers, and interviews with cancer clinicians will provide the evidence base underpinning provisional messages. These will be explored in three phases of face-to-face interviews with 75-90 purposively selected patients recruited in cancer clinics to: (1) select and prioritise the most salient messages, (2) phrase the messages appropriately in plain English and, (3) test their acceptability and usefulness. Phases 1 and 2 will draw on card-sorting methods used in website design. In phase three, we will create cancer site-specific versions of the script and test them using cognitive interviewing techniques. ETHICS AND DISSEMINATION The study has received ethical approval. Findings will be published in a peer-reviewed journal. The final product will be cancer-specific scripted consultations, most likely in the form of a two-sided information sheet with the most important messages to be conveyed in a consultation on one side, and frequently asked questions for later reading on the reverse. However, they will also be appropriate and readily adaptable to web-based uses.
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Affiliation(s)
- Maggie Hendry
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Di Pasterfield
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | | | | | - Alison Fiander
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Michael Robling
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Christine Campbell
- Usher Institute for Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Matthew Makin
- The Pennine Acute Hospitals NHS Trust, Manchester UK
| | - Simon Gollins
- North Wales Cancer Treatment Centre, Betsi Cadwaladr University Health Board, Rhyl, UK
| | - Julia Hiscock
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Sadia Nafees
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Marie-Jet Bekkers
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Jan Rose
- Patient representative, Gloucester, UK
| | - Olwen Williams
- Department of Sexual Health, Betsi Cadwaladr University Health Board, Wrexham, UK
| | | | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
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Campbell J, Pyer M, Rogers S, Jones J, Ramirez AJ, Forbes LJL. Promoting early presentation of breast cancer in women over 70 years old in general practice. J Public Health (Oxf) 2015; 38:591-598. [PMID: 26359315 DOI: 10.1093/pubmed/fdv125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Delay in presentation contributes to poorer survival of older women with breast cancer. Research has shown the effectiveness of the promoting early presentation (PEP) intervention when delivered by radiographers in the NHS Breast Screening Programme. This paper investigates the effectiveness of the intervention when delivered by practice nurses in general practice. METHODS The Breast Cancer Awareness Measure was used to compare participants' awareness of breast cancer before, 1 month after and 12 months after the delivery of the PEP intervention. Five hundred and fifty-six women aged over 70 years took part, 308 of whom returned all three surveys. RESULTS The intervention was associated with increased awareness of non-lump breast symptoms and reported breast check frequency. There was a marked increase in breast cancer awareness which persisted for 12 months. Less than 5% of women were classified as 'breast cancer aware' before the intervention, rising to over 25% 1 month afterwards. This percentage dropped slightly after 1 year to just below 20%. CONCLUSION Delivery of the PEP intervention in general practice was very effective at raising the awareness of breast cancer among older women. Primary care settings are well placed to enhance the reach of this kind of intervention to at-risk women.
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Affiliation(s)
- J Campbell
- Institute of Health and Wellbeing, University of Northampton, Northampton NN2 7AL, UK
| | - M Pyer
- Institute of Health and Wellbeing, University of Northampton, Northampton NN2 7AL, UK
| | - S Rogers
- Clinical Lead for Applied Health Research, Northamptonshire Healthcare Foundation Trust, Northampton NN5 6UD, UK University of Leicester, Leicester LE1 6TP, UK
| | - J Jones
- Institute of Health and Wellbeing, University of Northampton, Northampton NN2 7AL, UK
| | - A J Ramirez
- Promoting Early Presentation Group, King's College London, London SE1 3QD, UK
| | - L J L Forbes
- Promoting Early Presentation Group, King's College London, London SE1 3QD, UK
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Rutherford MJ, Abel GA, Greenberg DC, Lambert PC, Lyratzopoulos G. The impact of eliminating age inequalities in stage at diagnosis on breast cancer survival for older women. Br J Cancer 2015; 112 Suppl 1:S124-8. [PMID: 25734394 PMCID: PMC4385985 DOI: 10.1038/bjc.2015.51] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Older women with breast cancer have poorer relative survival outcomes, but whether achieving earlier stage at diagnosis would translate to substantial reductions in mortality is uncertain. METHODS We analysed data on East of England women with breast cancer (2006-2010) aged 70+ years. We estimated survival for different stage-deprivation-age group strata using both the observed and a hypothetical stage distribution (assuming that all women aged 75+ years acquired the stage distribution of those aged 70-74 years). We subsequently estimated deaths that could be postponed beyond 5 years from diagnosis if women aged 75+ years had the hypothetical stage distribution. We projected findings to the English population using appropriate age and socioeconomic group weights. RESULTS For a typically sized annual cohort in the East of England, 27 deaths in women with breast cancer aged 75+ years can be postponed within 5 years from diagnosis if their stage distribution matched that of the women aged 70-74 years (4.8% of all 566 deaths within 5 years post diagnosis in this population). Under assumptions, we estimate that the respective number for England would be 280 deaths (5.0% of all deaths within 5 years post diagnosis in this population). CONCLUSIONS The findings support ongoing development of targeted campaigns aimed at encouraging prompt presentation in older women.
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnosis
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Cohort Studies
- England
- Female
- Health Status Disparities
- Healthcare Disparities
- Humans
- Socioeconomic Factors
- Survival Rate
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Affiliation(s)
- M J Rutherford
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH UK
| | - G A Abel
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - D C Greenberg
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
- National Cancer Registration Service, Public Health England, Eastern Office, Cambridge CB22 3AD, UK
| | - P C Lambert
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stocholm SE-171 77, Sweden
| | - G Lyratzopoulos
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, UCL, 1-19 Torrington Place, London WC1E 6BT, UK
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O'Mahony M, Comber H, Fitzgerald T, Corrigan M, Fitzgerald E, Grunfeld EA, Flynn MG, Hegarty J. Interventions for raising breast cancer awareness in women. Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd011396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Dey S. Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal. World J Clin Oncol 2014; 5:509-519. [PMID: 25114864 PMCID: PMC4127620 DOI: 10.5306/wjco.v5.i3.509] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/27/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
To review the present status of breast cancer (BC) screening/early detection in low- and middle-income countries (LMICs) and identify the way forward, an open focused search for articles was undertaken in PubMed, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on ResearchGate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer (BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. Notably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of mHealth for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.
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Risk factors for delay in symptomatic presentation: a survey of cancer patients. Br J Cancer 2014; 111:581-8. [PMID: 24918824 PMCID: PMC4119978 DOI: 10.1038/bjc.2014.304] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/02/2014] [Accepted: 05/11/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Delay in symptomatic presentation leading to advanced stage at diagnosis may contribute to poor cancer survival. To inform public health approaches to promoting early symptomatic presentation, we aimed to identify risk factors for delay in presentation across several cancers. METHODS We surveyed 2371 patients with 15 cancers about nature and duration of symptoms using a postal questionnaire. We calculated relative risks for delay in presentation (time from symptom onset to first presentation >3 months) by cancer, symptoms leading to diagnosis and reasons for putting off going to the doctor, controlling for age, sex and deprivation group. RESULTS Among 1999 cancer patients reporting symptoms, 21% delayed presentation for >3 months. Delay was associated with greater socioeconomic deprivation but not age or sex. Patients with prostate (44%) and rectal cancer (37%) were most likely to delay and patients with breast cancer least likely to delay (8%). Urinary difficulties, change of bowel habit, systemic symptoms (fatigue, weight loss and loss of appetite) and skin symptoms were all common and associated with delay. Overall, patients with bleeding symptoms were no more likely to delay presentation than patients who did not have bleeding symptoms. However, within the group of patients with bleeding symptoms, there were significant differences in risk of delay by source of bleeding: 35% of patients with rectal bleeding delayed presentation, but only 9% of patients with urinary bleeding. A lump was a common symptom but not associated with delay in presentation. Twenty-eight percent had not recognised their symptoms as serious and this was associated with a doubling in risk of delay. Embarrassment, worry about what the doctor might find, being too busy to go to the doctor and worry about wasting the doctor's time were also strong risk factors for delay, but were much less commonly reported (<6%). INTERPRETATION Approaches to promote early presentation should aim to increase awareness of the significance of cancer symptoms and should be designed to work for people of the lowest socioeconomic status. In particular, awareness that rectal bleeding is a possible symptom of cancer should be raised.
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Forster AS, Forbes LJL, Abraham C, Warburton FG, Douglas E, Ramirez AJ. Promoting early presentation of breast cancer: a preliminary evaluation of a written intervention. Chronic Illn 2014; 10:18-30. [PMID: 23702787 DOI: 10.1177/1742395313484071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Older women are more likely to delay presentation with breast cancer, which contributes to poorer survival. We evaluated a written intervention that was designed to provide women with the knowledge, motivation, confidence and skills to present promptly with breast cancer symptoms. METHODS We assessed acceptability and understanding of the intervention by interviewing 43 women. We used their responses to refine the intervention. We tested the effect of the intervention on breast cancer awareness, confidence and intentions to check breasts and perceived barriers to help-seeking using a self-report questionnaire administered to 61 women prior to and one month after receiving the intervention. Quantitative data were analysed using the McNemar test. RESULTS Women were not made anxious by the intervention and understood its messages. At one month, a greater proportion of women knew that breast cancer risk increases with age, identified ≥5 non-lump symptoms and reported breast checking at least monthly in comparison to before the intervention was implemented. DISCUSSION The intervention does not induce anxiety, is understandable, and appears to increase breast cancer awareness. The results provide justification for a more rigorous trial to test efficacy.
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Affiliation(s)
- Alice S Forster
- 1Promoting Early Presentation Group, King's College London, UK
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Lyratzopoulos G, Greenberg DC, Rubin GP, Abel GA, Walter FM, Neal RD. Advanced stage diagnosis of cancer: who is at greater risk? Expert Rev Anticancer Ther 2014; 12:993-6. [DOI: 10.1586/era.12.77] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lyratzopoulos G, Abel G. Earlier diagnosis of breast cancer: focusing on symptomatic women. Nat Rev Clin Oncol 2013; 10:nrclinonc.2012.126-c1. [PMID: 23881030 DOI: 10.1038/nrclinonc.2012.126-c1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Yousuf SA, Al Amoudi SM, Nicolas W, Banjar HE, Salem SM. Do Saudi nurses in primary health care centres have breast cancer knowledge to promote breast cancer awareness? Asian Pac J Cancer Prev 2013; 13:4459-64. [PMID: 23167361 DOI: 10.7314/apjcp.2012.13.9.4459] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer is one of the leading causes of death among cancer patients in Saudi Arabia. It is known that nurses play a key role in promoting breast cancer awareness among women in any society. Nurses in primary health care centres (PHCC) have more direct contact with general population. This study aimed to investigate nurse knowledge of breast cancer and practice of early screening in PHCC in Jeddah city. METHODS A cross-sectional study was conducted using a self-administered questionnaire to assess the general knowledge of breast cancer, risk factors, and practice of 210 PHCC nurses. Data were analysed using SPSS v.16. RESULTS The mean age of the PHCC Nurses was 36.9 (SD ±8.6). Only 11% percent scored <50% of the total score for general epidemiological knowledge on breast cancer, about 35% scored <50% of the total score for breast cancer risk factors. Sixty seven percent scored >75% of the total score on breast cancer signs. Majority of nurses 62.8% practiced BSE, but only 4% practiced regularly every month. Some 28% practiced once per year. About 81% of the nurses had not had a clinical breast examination and only 14% had had a mammography. The results of the study failed to show any correlation between the knowledge scores with age, education, year of experience, family history of BC and marital status of the nurses. CONCLUSION The results from the study reflect that there is a need to provide continuing nursing education programmes for PHCC nurses to improve their breast cancer knowledge and practice.
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Affiliation(s)
- Shadia Abdullah Yousuf
- Public Health Nursing Department, Faculty of Nursing, Safa Salem Maternity and child Department, Faculty of Nursing, Hasna Banjar Nursing Administration, Jeddah, Saudi Arabia.
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28
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Rutherford MJ, Hinchliffe SR, Abel GA, Lyratzopoulos G, Lambert PC, Greenberg DC. How much of the deprivation gap in cancer survival can be explained by variation in stage at diagnosis: an example from breast cancer in the East of England. Int J Cancer 2013; 133:2192-200. [PMID: 23595777 DOI: 10.1002/ijc.28221] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/11/2013] [Indexed: 12/12/2022]
Abstract
Socioeconomic differences in cancer patient survival exist in many countries and across cancer sites. In our article, we estimated the number of deaths in women with breast cancer that could be avoided within 5 years from diagnosis if it were possible to eliminate socioeconomic differences in stage at diagnosis. We analysed data on East of England women with breast cancer (2006-2010). We estimated survival for different stage-age-deprivation strata using both the observed and a hypothetical stage distribution (assuming all women acquired the stage distribution of the most affluent women). Data were analysed on 20,738 women with complete stage information (92%). Affluent women were less likely to be diagnosed in advanced stage. Relative survival decreased with increasing level of deprivation. Eliminating differences in stage at diagnosis could be expected to nearly eliminate differences in relative survival for women in deprivation groups 3 and 4, but would only approximately halve the difference in relative survival for women in the most deprived group (5). This means, for a typical cohort of women diagnosed in a calendar year with breast cancer, eliminating deprivation differences in stage at diagnosis would prevent ∼40 deaths in the East of England from occurring within 5 years from diagnosis. Using appropriate weighting we estimated the respective number of avoidable deaths for the whole of England to be ∼450. The findings suggest that policies aimed at reducing inequalities in stage at diagnosis between women with breast cancer are important to reduce inequalities in breast cancer survival.
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Affiliation(s)
- M J Rutherford
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
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29
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Lyratzopoulos G, Abel GA, Brown CH, Rous BA, Vernon SA, Roland M, Greenberg DC. Socio-demographic inequalities in stage of cancer diagnosis: evidence from patients with female breast, lung, colon, rectal, prostate, renal, bladder, melanoma, ovarian and endometrial cancer. Ann Oncol 2012; 24:843-50. [PMID: 23149571 PMCID: PMC3574550 DOI: 10.1093/annonc/mds526] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Understanding socio-demographic inequalities in stage at diagnosis can inform priorities for cancer control. PATIENTS AND METHODS We analysed data on the stage at diagnosis of East of England patients diagnosed with any of 10 common cancers, 2006-2010. Stage information was available on 88 657 of 98 942 tumours (89.6%). RESULTS Substantial socio-demographic inequalities in advanced stage at diagnosis (i.e. stage III/IV) existed for seven cancers, but their magnitude and direction varied greatly by cancer: advanced stage at diagnosis was more likely for older patients with melanoma but less likely for older patients with lung cancer [odds ratios for 75-79 versus 65-69 1.60 (1.38-1.86) and 0.83 (0.77-0.89), respectively]. Deprived patients were more likely to be diagnosed in advanced stage for melanoma, prostate, endometrial and (female) breast cancer: odds ratios (most versus least deprived quintile) from 2.24 (1.66-3.03) for melanoma to 1.31 (1.15-1.49) for breast cancer. In England, elimination of socio-demographic inequalities in stage at diagnosis could decrease the number of patients with cancer diagnosed in advanced stage by ∼5600 annually. CONCLUSIONS There are substantial socio-demographic inequalities in stage at diagnosis for most cancers. Earlier detection interventions and policies can be targeted on patients at higher risk of advanced stage diagnosis.
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Affiliation(s)
- G Lyratzopoulos
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK.
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30
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Promoting early presentation of breast cancer in older women: implementing an evidence-based intervention in routine clinical practice. J Cancer Epidemiol 2012; 2012:835167. [PMID: 23213334 PMCID: PMC3505655 DOI: 10.1155/2012/835167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 10/10/2012] [Indexed: 01/07/2023] Open
Abstract
Background. Women over 70 with breast cancer have poorer one-year survival and present at a more advanced stage than younger women. Promoting early symptomatic presentation in older women may reduce stage cost effectively and is unlikely to lead to overdiagnosis. After examining efficacy in a randomised controlled trial, we piloted a brief health professional-delivered intervention to equip women to present promptly with breast symptoms, as an integral part of the final invited mammogram at age ~70, in the English National Health Service Breast Screening Programme. Methods. We trained mammographers, who then offered the intervention to older women in four breast screening services. We examined breast cancer awareness at baseline and one month in women receiving the intervention, and also in a service where the intervention was not offered. Results. We trained 27 mammographers to deliver the intervention confidently to a high standard. Breast cancer awareness increased 7-fold at one month in women receiving the intervention compared with 2-fold in the comparison service (odds ratio 15.2, 95% confidence interval 10.0 to 23.2). Conclusions. The PEP Intervention can be implemented in routine clinical practice with a potency similar to that achieved in a randomised controlled trial. It has the potential to reduce delay in diagnosis for breast cancer in older women.
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Burgess C, Teasdale E, Omar L, Tucker L, Ramirez AJ. Training radiographers to deliver an intervention to promote early presentation of breast cancer. Radiography (Lond) 2012. [DOI: 10.1016/j.radi.2012.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Variation in advanced stage at diagnosis of lung and female breast cancer in an English region 2006-2009. Br J Cancer 2012; 106:1068-75. [PMID: 22382691 PMCID: PMC3304409 DOI: 10.1038/bjc.2012.30] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Understanding variation in stage at diagnosis can inform interventions to improve the timeliness of diagnosis for patients with different cancers and characteristics. Methods: We analysed population-based data on 17 836 and 13 286 East of England residents diagnosed with (female) breast and lung cancer during 2006–2009, with stage information on 16 460 (92%) and 10 435 (79%) patients, respectively. Odds ratios (ORs) of advanced stage at diagnosis adjusted for patient and tumour characteristics were derived using logistic regression. Results: We present adjusted ORs of diagnosis in stages III/IV compared with diagnosis in stages I/II. For breast cancer, the frequency of advanced stage at diagnosis increased stepwise among old women (ORs: 1.21, 1.46, 1.68 and 1.78 for women aged 70–74, 75–79, 80–84 and ⩾85, respectively, compared with those aged 65–69 , P<0.001). In contrast, for lung cancer advanced stage at diagnosis was less frequent in old patients (ORs: 0.82, 0.74, 0.73 and 0.66, P<0.001). Advanced stage at diagnosis was more frequent in more deprived women with breast cancer (OR: 1.23 for most compared with least deprived, P=0.002), and in men with lung cancer (OR: 1.14, P=0.011). The observed patterns were robust to sensitivity analyses approaches for handling missing stage data under different assumptions. Conclusion: Interventions to help improve the timeliness of diagnosis of different cancers should be targeted at specific age groups.
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Lyratzopoulos G, Neal RD, Barbiere JM, Rubin GP, Abel GA. Variation in number of general practitioner consultations before hospital referral for cancer: findings from the 2010 National Cancer Patient Experience Survey in England. Lancet Oncol 2012; 13:353-65. [PMID: 22365494 DOI: 10.1016/s1470-2045(12)70041-4] [Citation(s) in RCA: 300] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Information from patient surveys can help to identify patient groups and cancers with the greatest potential for improvement in the experience and timeliness of cancer diagnosis. We aimed to examine variation in the number of pre-referral consultations with a general practitioner between patients with different cancers and sociodemographic characteristics. METHODS We analysed data from 41,299 patients with 24 different cancers who took part in the 2010 National Cancer Patient Experience Survey in England. We examined variation in the number of general practitioner consultations with cancer symptoms before hospital referral to diagnose cancer. Logistic regression was used to identify independent predictors of three or more pre-referral consultations, adjusting for cancer type, age, sex, deprivation quintile, and ethnic group. FINDINGS We identified wide variation between cancer types in the proportion of patients who had visited their general practitioner three or more times before hospital referral (7·4% [625 of 8408] for breast cancer and 10·1% [113 of 1124] for melanoma; 41·3% [193 of 467] for pancreatic cancer and 50·6% [939 of 1854] for multiple myeloma). In multivariable analysis, with patients with rectal cancer as the reference group, those with subsequent diagnosis of multiple myeloma (odds ratio [OR] 3·42, 95% CI 3·01-3·90), pancreatic cancer (2·35, 1·91-2·88), stomach cancer (1·96, 1·65-2·34), and lung cancer (1·68, 1·48-1·90) were more likely to have had three or more pre-referral consultations; conversely patients with subsequent diagnosis of breast cancer (0·19; 0·17-0·22), melanoma (0·34, 0·27-0·43), testicular cancer (0·47, 0·33-0·67), and endometrial cancer (0·59, 0·49-0·71) were more likely to have been referred to hospital after only one or two consultations. The probability of three or more pre-referral consultations was greater in young patients (OR for patients aged 16-24 years vs 65-74 years 2·12, 95% CI 1·63-2·75; p<0·0001), those from ethnic minorities (OR for Asian vs white 1·73, 1·45-2·08; p<0·0001; OR for black vs white 1·83, 1·51-2·23; p<0·0001), and women (OR for women vs men 1·28, 1·21-1·36; p<0·0001). We identified strong evidence of interactions between cancer type and age group and sex (p<0·0001 for both), and between age and ethnicity (p=0·0013). The model including these interactions showed a particularly strong sex effect for bladder cancer (OR for women vs men 2·31, 95% CI 1·98-2·69) and no apparent ethnic group differences in young patients aged 16-24 years, whilst the only cancers without an apparent age gradient were testicular cancer and mesothelioma. INTERPRETATION Our findings could help to prioritise and stratify early diagnosis initiatives and research, focusing on patients with cancers and sociodemographic characteristics with the largest potential for improvement. FUNDING None.
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Affiliation(s)
- Georgios Lyratzopoulos
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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Breast cancer awareness and barriers to symptomatic presentation among women from different ethnic groups in East London. Br J Cancer 2011; 105:1474-9. [PMID: 21989188 PMCID: PMC3242523 DOI: 10.1038/bjc.2011.406] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: During 2001 to 2005, 1-year breast cancer survival was low in ethnically diverse East London. We hypothesised that this was due to low breast cancer awareness and barriers to symptomatic presentation, leading to late stage at diagnosis in women from ethnic minorities. We examined ethnic differences in breast cancer awareness and barriers to symptomatic presentation in East London. Methods: We carried out a population-based survey of 1515 women aged 30+ using the Cancer Research UK Breast Cancer Awareness Measure. We analysed the data using logistic regression adjusting for age group and level of deprivation. Results: South Asian and black women had lower breast cancer awareness than white women. South Asian women, but not black women, reported more emotional barriers to seeking medical help than white women. White women were more likely than non-white women to report worry about wasting the doctor's time as a barrier to symptomatic presentation. Conclusion: Interventions to promote early presentation of breast cancer for South Asian and black women should promote knowledge of symptoms and skills to detect changes, and tackle emotional barriers to symptomatic presentation and for white women tackle the idea that going to the doctor to discuss a breast symptom will waste the doctor's time.
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