Breast cancer awareness and barriers to symptomatic presentation among women from different ethnic groups in East London. Br J Cancer. 2011;105:1474-1479. [PMID: 21989188 PMCID: PMC3242523 DOI: 10.1038/bjc.2011.406]

Awareness of symptoms, anticipated barriers and delays to help-seeking among women at higher risk of breast cancer: A UK multicentre study

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.

Barriers to breast and cervical cancer screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom: evidence from a mixed-methods systematic review

BACKGROUND

Cancer is currently the leading cause of mortality globally, with new cancer cases estimated at 19.3 million and almost 10 million deaths in 2020. Specifically, breast and cervical cancer incidence and mortality prevalence among women of the minority group or marginalised populations in Europe have continued to be a public health concern due to the low uptake of cancer screening. Thus, this study utilised a mixed-method systematic review to identify barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom.

METHODS

Databases including PubMed, CINAHL, British Nursing Index, Web of Science, EMBASE, and Scopus databases, were systematically searched for studies on barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom published in English between January 2010 to July 2022. This mixed-method systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in reporting the included studies' results. The cluster mapping approach was used to identify and classify the barriers into themes.

RESULTS

Thirteen eligible studies were included in this current review. Seven of the thirteen studies used quantitative cross-sectional research design, while six used qualitative cross-sectional research design. These studies were conducted across the United Kingdom. Five themes were developed from the cluster mapping, and thirty-four sub-theme barriers to the uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom were identified. The developed themes in relation to the barriers include; socio-demographic characteristics, health service delivery, cultural, religious & language, the gap in knowledge & awareness, and emotional, sexual & family support.

CONCLUSION

The study concluded that barriers in socio-demographic characteristics, health service delivery, cultural, religious and language, the gap in knowledge & awareness, and emotional, sexual & family support were identified as non-uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom. Reducing or eliminating these barriers would improve the benefits of timely breast and cervical cancer screening in the United Kingdom.

Dynamic Biobanking for Advancing Breast Cancer Research

Longitudinal patient biospecimens and data advance breast cancer research through enabling precision medicine approaches for identifying risk, early diagnosis, improved disease management and targeted therapy. Cancer biobanks must evolve to provide not only access to high-quality annotated biospecimens and rich associated data, but also the tools required to harness these data. We present the Breast Cancer Now Tissue Bank centre at the Barts Cancer Institute as an exemplar of a dynamic biobanking ecosystem that hosts and links longitudinal biospecimens and multimodal data including electronic health records, genomic and imaging data, offered alongside integrated data sharing and analytics tools. We demonstrate how such an ecosystem can inform precision medicine efforts in breast cancer research.

Relationship between ethnicity and stage at diagnosis in England: a national analysis of six cancer sites

OBJECTIVES

Cancer stage at diagnosis is a determinant of treatment options and survival. Previous research has shown differences in barriers to presentation with cancer between ethnic groups. The completeness and quality of cancer stage and ethnicity data has improved markedly over recent years in England, allowing for comparison of stage distributions at diagnosis between ethnic groups. This study aimed to assess relationships between ethnic group and two outcomes: unknown stage cancer and late stage (stages 3 and 4) cancer, after adjustment for confounders.

DESIGN AND SETTING

A retrospective secondary data analysis using data from NHS Digital's National Cancer Registration and Analysis Service and Hospital Episode Statistics records from 2012 to 2016.

PARTICIPANTS

This study analysed newly diagnosed breast, colon, non-small cell lung cancer (NSCLC), ovary, prostate and uterine cancers in white British, Caribbean, African, Chinese and Asian patients aged 15-99 in England.

RESULTS

Caribbean, African and Asian women with breast or ovarian cancer, Caribbean and African women with uterine or colon cancer, Caribbean women with NSCLC and Caribbean men with colon cancer had increased odds of late-stage disease at diagnosis compared with the white British cohort. In contrast, Caribbean and African men with prostate cancer had decreased odds of late-stage cancer. Where stage was known, there were variations in late-stage cancer by ethnic group.

CONCLUSIONS

Low symptom awareness and barriers to presentation can cause delays, resulting in later stage diagnosis. Targeted intervention campaigns to help raise awareness of cancer signs and symptoms and the benefits of early diagnosis, along with removing barriers to appropriate referrals, could help to improve these inequalities.

Adapting a breast cancer early presentation intervention for Black women: A focus group study with women of Black African and Black Caribbean descent in the United Kingdom

OBJECTIVE

Black women in the United Kingdom are more likely than White women to be diagnosed with advanced breast cancer and have lower survival rates. We consulted women of Black Caribbean and Black African descent in the United Kingdom on how the Promoting Early Presentation (PEP) booklet and intervention could be adapted for Black women to promote early presentation with breast cancer symptoms.

METHODS

Focus groups with 22 women of Black African and Black Caribbean descent, of whom five had been treated for breast cancer. The participants were recruited from a large UK breast cancer charity and community settings. Data were analysed using Framework Analysis.

RESULTS

Four themes summarised the participants' views on how the booklet and intervention could be adapted: Justify the focus on Black women, Black people do not talk about cancer, Make interventions inclusive and engaging, and Engage Black communities to deliver interventions.

CONCLUSION

Breast cancer behaviour change interventions need to be more inclusive, illustrate how breast cancer symptoms manifest on black skin, and emphasise that breast cancer is curable to increase awareness and reduce cancer fear. Researchers should involve Black communities in the design and delivery of interventions to address appropriately cultural barriers to early presentation.

Protocol for a feasibility study of a cancer symptom awareness campaign to support the rapid diagnostic centre referral pathway in a socioeconomically deprived area: Targeted Intensive Community-based campaign To Optimise Cancer awareness (TIC-TOC)

INTRODUCTION

Rapid diagnostic centres (RDCs) are being implemented across the UK to accelerate the assessment of vague suspected cancer symptoms. Targeted behavioural interventions are needed to augment RDCs that serve socioeconomically deprived populations who are disproportionately affected by cancer, have lower cancer symptom awareness and are less likely to seek help for cancer symptoms. The aim of this study is to assess the feasibility and acceptability of delivering and evaluating a community-based vague cancer symptom awareness intervention in an area of high socioeconomic deprivation.

METHODS AND ANALYSIS

Intervention materials and messages were coproduced with local stakeholders in Cwm Taf Morgannwg, Wales. Cancer champions will be trained to deliver intervention messages and distribute intervention materials using broadcast media (eg, local radio), printed media (eg, branded pharmacy bags, posters, leaflets), social media (eg, Facebook) and attending local community events. A cross-sectional questionnaire will include self-reported patient interval (time between noticing symptoms to contacting the general practitioner), cancer symptom recognition, cancer beliefs and barriers to presentation, awareness of campaign messages, healthcare resource use, generic quality of life and individual and area-level deprivation indicators. Consent rates and proportion of missing data for patient questionnaires (n=189) attending RDCs will be measured. Qualitative interviews and focus groups will assess intervention acceptability and barriers/facilitators to delivery.

ETHICS AND DISSEMINATION

Ethical approval for this study was given by the London-West London & GTAC Research Ethics (21/LO/0402). This project will inform a potential future controlled study to assess intervention effectiveness in reducing the patient interval for vague cancer symptoms. The results will be critical to informing national policy and practice regarding behavioural interventions to support RDCs in highly deprived populations.

'Wise up to cancer': Adapting a community based health intervention to increase UK South Asian women's uptake of cancer screening

UK South Asian women are less likely to engage with cancer screening than the general population and present later with more advanced disease. Tailored interventions are needed to address barriers to these women accessing screening services. 'Wise up to cancer' is a community-based health intervention designed to increase cancer screening uptake. It has been implemented within the general population and a study was undertaken to implement it within a South Asian female community. This paper explores one workstream of the wider 'Wise up to Cancer' study which involved working out how best to adapt the baseline questionnaire (the first part of the intervention) for South Asian women in an inner-city location in Northern England. The aim of this workstream was to evaluate what worked well when implementing the adapted 'Wise up to Cancer' with South Asian women. In 2018, we conducted qualitative semi-structured interviews and focus group with 14 key stakeholders; women who had received the intervention, health champions and community workers to explore their perspectives on how the adapted intervention worked within a South Asian female community. The interviews were audio recorded or (notes taken), data were transcribed verbatim and the dataset was thematically analysed. We found that training peers as community health champions to deliver the intervention to address language and cultural barriers increased participant engagement, was beneficial for the peers and supported participants who revealed difficult social issues they may not have otherwise discussed. Accessing women in established community groups, following planned activities such as English language classes worked but flexibility was needed to meet individual women's needs. Further research is needed to explore the impact of adapting 'Wise up to Cancer' for this community in terms of engaging with cancer screening.

Worldwide review with meta-analysis of women's awareness about breast cancer

OBJECTIVE

To summarize the awareness levels of breast cancer (BC) worldwide and investigate factors associated with BC awareness to determine differences in awareness between China and other countries.

METHODS

This systematic review followed the PRISMA guidelines and included 92 articles up to July, 2021. We calculated percentages for BC awareness levels and conducted subgroup analysis and cumulative meta-analysis.

RESULTS

A total 84% (95% confidence interval [95%CI]: 78-90%) of women knew about BC; however, only 51% (95%CI: 37-66%) and 40% (95%CI: 24-56%) of women were aware of BC symptoms and BC risk factors, respectively. The most commonly known BC symptom was breast lump (71%, 95%CI: 62-80%), and BC family history was the most well-known BC risk factor (61%, 95%CI: 54-69%). Subgroup analysis showed lower awareness levels among Chinese and Asian women than women from other countries. Cumulative meta-analysis showed no obvious progress in BC awareness levels over time. We investigated 15 awareness-related factors, the most frequent of which were education level (61.8%), occupation (29.4%), and age (26.5%).

CONCLUSION

BC awareness levels remain low. Improving BC awareness is critical, especially in developing countries.

PRACTICE IMPLICATIONS

Effective education programs are urgently needed to improve women's BC awareness.

Inequalities in cancer screening, prevention and service engagement between UK ethnic minority groups

More people in the UK are living with cancer than ever before. With an increasingly ethnically diverse population, greater emphasis must be placed on understanding factors influencing cancer outcomes. This review seeks to explore UK-specific variations in engagement with cancer services in minority ethnic groups and describe successful interventions. The authors wish to highlight that, despite improvement to engagement and education strategies, inequalities still persist and work to improve cancer outcomes across our communities still needs to be prioritised. There are many reasons why cancer healthcare inequities exist for minority communities, reported on a spectrum ranging from cultural beliefs and awareness, through to racism. Strategies that successfully enhanced engagement included language support; culturally-sensitive reminders; community-based health workers and targeted outreach. Focusing on the diverse city of Leicester the authors describe how healthcare providers, researchers and community champions have worked collectively, delivering targeted community-based strategies to improve awareness and access to cancer services.

Women's awareness of breast cancer symptoms: a national cross-sectional study from Palestine

Background

Early diagnosis is crucial to reduce the morbidity and mortality associated with breast cancer (BC). Awareness of BC symptoms plays a key role in this. This study aimed to evaluate the Palestinian women’s awareness of BC symptoms and determine factors associated with good awareness.

Methods

This was a national cross-sectional study conducted from July 2019 to March 2020 in Palestine. Convenience sampling was used to recruit adult women from hospitals, primary healthcare centers, and public spaces located in 11 governorates. A translated-into-Arabic version of the validated BC awareness measure was utilized for data collection. The awareness level was categorized based on the number of symptoms recognized into: poor (0 to 4), fair (5 to 9), and good (10 to 13).

Results

Of 6269 approached, 5434 participants completed the questionnaire (response rate = 86.7%). A total of 5257 questionnaires were included in the analysis: 2551 from the Gaza Strip and 2706 from the West Bank and Jerusalem (WBJ). Participants living in the WBJ were more likely to be older, have higher monthly income, and suffer from more chronic diseases than participants living in the Gaza Strip.

The most frequently identified BC symptom was ‘lump or thickening in the breast’ (n = 4887, 92.9%) followed by ‘lump or thickening under the armpit’ (n = 4394, 83.6%). The least frequently identified symptoms were ‘pulling in of the nipple’ (n = 2665, 50.7%) and ‘change in the position of the nipple’ (n = 2710, 51.6%).

A total of 2191 participants (41.7%) demonstrated good awareness of BC symptoms. Participants from the Gaza Strip were more likely than participants from the WBJ to have good awareness (47.0.0% vs. 36.7%). On the multivariable analysis, being ≥ 40 years, completing a post-secondary education, knowing someone with cancer, and visiting hospitals and primary healthcare centers were all associated with an increase in the likelihood of having good awareness. However, living in the WBJ was associated with a decrease in the likelihood of having good awareness.

Conclusion

Less than half of women included in this study showed good awareness of BC symptoms. More targeted educational interventions are needed to promote Palestinian women’s awareness of BC symptoms to facilitate early diagnosis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13224-7.

Factors Influencing Total Delay of Breast Cancer in Northeast of China

Objectives

Delay in diagnosis and treatment, called total delay, could probably result in lower survival rates in breast cancer patients. This study aimed to investigate the factors associated with the comprehensive delay behaviors and to evaluate its effect on outcomes in patients with breast cancer in Dalian, a northeast city of China.

Methods

A retrospective chart review was conducted using a cancer registry dataset including 298 patients. The Kaplan–Meier survival analysis was used to identify the threshold of total delay, dividing the patients into a group with significant uncertainty and a group without substantial delay. The factors associated with the significant total delay were investigated from the potential candidates, like income level and marital status, by using the chi-squared test. The difference of the clinicopathologic characteristics between the patients grouped by the significant total delay, like tumor size and lymph node metastasis, was also investigated to find out the effect of the total delay.

Results

A total of 238 charts were used for analysis. The mean age was 57.3. The median of total delays was 3.75 months. Thirty days was identified as a threshold, more than which the total delay can lead to worse survival. Patients’ marital status (p = 0.010), income levels (p = 0.003), smoking status (p = 0.031), initial visiting hospital level (p = 0.005), self-health care (p = 0.001), and self-concern about initial symptom (p ≈ 0.000) were identified as the independent predictors of the total delay. Metastasis (p ≈ 0.000) was identified as the significant result relating to the significant total delay.

Conclusions

A total delay of more than 30 days predicts worse survival in breast cancer patients in Dalian. Several factors, like patients’ marital status and income levels, can be considered to be relevant to the significant total delay. We recommend that these factors be used to predict the potential patients with the significant total delay in the clinical practice.

Delay in the diagnosis and treatment of breast cancer in Vietnam

BACKGROUND

Delays in diagnosis and treatment from first noticeable breast cancer symptoms are associated with poor outcomes. Understanding the reasons and barriers for patients' delay in seeking medical care is critical to mitigating the problem.

METHODS

In-person surveys were conducted among 462 women, aged 18-79, with incident breast cancer cases, recruited from two cancer hospitals in North Vietnam. Delay, defined as the time interval between symptom recognition to the diagnosis and initiation of treatment equal to or exceeding 3 months, was categorized as follows: no delay (<3 months), moderate delay (3-8 months), and serious delay (≥9 months). Multivariable multinomial logistic regression was applied in data analyses.

RESULTS

Over one-quarter patients (31.5%) experienced moderate delays, and close to one-fifth (17.5%) experienced serious delays. Adjusted odds ratios and 95% confidence intervals for moderate and serious delays were 5.60 (3.00-10.47) and 4.25 (2.05-8.85) for financial and physical barriers, respectively. Moderate delay was positively associated with psychological barriers (5.55 [1.75-17.57]) and lack of proper knowledge (3.15 [1.47-6.74]). The associations of barriers with delays in diagnosis and treatment appeared stronger among women living in rural areas. A lack of proper knowledge was significantly associated with delay among young women (<45 years old) and those with high incomes, while psychological barriers were significantly associated with delay among older women (≥45 years old).

CONCLUSION

Delays in diagnosis and treatment are common among Vietnamese breast cancer patients and are affected by several noted barriers. Proper policy needs to be developed to address this public health issue.

Patient Delay in Breast Cancer Diagnosis in Two Hospitals in Karachi, Pakistan: Preventive and Life-Saving Measures Needed

PURPOSE

Patients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them.

METHODS

Four hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review.

RESULTS

The mean (standard deviation) age of patients with breast cancer was 48.0 (12.3) years. The mean (standard deviation) patient delay was 15.7 (25.9) months, with 55.2% of women detecting a breast lump but not seeking a medical consultation because of a lack of awareness about the significance of the lump. A total of 9.4% of the women decided to seek treatment initially using complementary and alternative medicine and traditional treatment; 9.4% of the women presented to a health care provider with a breast lump but no action was taken, and they were wrongly reassured about the lump without mammography or biopsy. For 26% of the women, the delay in presentation was caused by anxiety, fears and misconceptions regarding diagnosis and treatment, and other social factors including possible adverse effects on their relationship with their husband. Multivariable analysis showed a strong association of lower socioeconomic status (odds ratio [OR], 8.11 [95% CI, 2.46 to 26.69]) and late stage of breast cancer (OR, 4.83 [95% CI, 1.74 to 13.39]) with a patient delay of ≥ 3 months.

CONCLUSION

Patient delay is a serious problem in Pakistan. There is an urgent need for intensive and comprehensive breast cancer education that addresses the myths and misconceptions related to breast cancer.

Feasibility of a community-based cancer awareness initiative: views of those delivering and managing the intervention

Aim

Many people delay presenting to health services with cancer symptoms due to lack of awareness, particularly in areas of high socio-economic deprivation. A three-year community-based intervention was launched in Northwest England to improve public awareness of cancer symptoms. In this study, we aimed to evaluate this intervention by exploring the views of those involved in its management and delivery.

Methods

Ten semi-structured interviews were conducted with volunteers as well as members of the project management and steering group. Interviews were analysed qualitatively using thematic analysis.

Results

Participants felt they succeeded in raising awareness, influencing behaviour, connecting with local communities and engaging with vulnerable people. Participants perceived some weaknesses in the delivery of the intervention, including limited engagement of stakeholders, particularly general practitioners (GPs), and socially excluded groups.

Conclusions

Future public health interventions should pay particular attention to engagement of socially excluded individuals who do not interact with community events or groups, and to the engagement of stakeholders in early planning stages of the intervention. This should involve a specific GP engagement plan.

Global Perceptions of Women on Breast Cancer and Barriers to Screening

PURPOSE OF REVIEW

Breast cancer (BC) is a public health dilemma across the globe and a leading cause of mortality for women. Approximately 2.1 million newly diagnosed female BC cases occurred in 2018, comprising nearly 1 in 4 cancer cases among women. When BC is recognized in its early stages, successful treatment results can be achieved. Therefore, screening for BC is of paramount significance and routine screening mammography has been shown to be effective in reducing mortality from BC. Despite being considered a global health issue, national screening programmes are offered only in developed countries and BC is still often diagnosed in advanced stages.

RECENT FINDINGS

Disparities in screening exist not only between different countries but also between local and immigrant populations within a particular country. Low screening is attributed to low public awareness as well as numerous social, psychological, and geographical barriers to screening. This review addresses (a) the differences in BC awareness and screening across the globe, (b) the most important barriers and facilitators to screening, and (c) the potential role of health education programmes to increase BC awareness and promote BC screening programmes with the ultimate goal to achieve earlier stage diagnosis of BC.

What can be done to encourage women from Black, Asian and minority ethnic backgrounds to attend breast screening? A qualitative synthesis of barriers and facilitators

OBJECTIVE

The objective of the study is to identify the barriers to UK Black, Asian and Minority Ethnic (BAME) women attending breast screening and subsequently, support the growing evidence base providing solutions to the public health problem of ethnic variation within screening attendance.

STUDY DESIGN

A systematic review and thematic analysis of UK-based, qualitative studies concerning BAME women.

METHODS

The methodology of this review is based on Cochrane guidelines. A search strategy was applied to Embase, PubMed and Medline. Predefined inclusion and exclusion criteria yielded 8 final articles which were appraised and thematically analysed.

RESULTS

The main findings of the review revealed three overarching themes: knowledge-related, access-related and cultural-related factors. The emphasis of the importance of knowledge was highlighted by all studies identifying a lack of knowledge as a key barrier to screening attendance.

CONCLUSIONS

BAME women have disproportionally lower breast screening attendance and a lack of knowledge is an essential barrier to overcome when addressing this health inequality.

Opportunities and Barriers to Breast Cancer Screening in a Rural Community in Coastal Karnataka, India: A Qualitative Analysis

Background:

Breast cancer is reported to be the most common cancer among women in India with a high mortality to incidence ratio. Late presentation, driven by lack of awareness and limited accessibility to health services are some of the stated reasons for this. Given this context, this qualitative study was carried out to understand the perception of rural women towards the disease and factors that influenced utilization of available screening services among them.

Methods:

Forty-four rural women aged 20-60 years from a coastal province in southern India participated in four Focus Group Discussions (FGDs) that were conducted to understand their perception, attitudes and barriers towards breast cancer screening. Participants were identified from the community through purposive sampling and constituted of home makers and working women. The FGDs were led by trained facilitators and the discussions recorded. Ideas and concepts that emerged were listed as codes. Related and similar codes were grouped to form six themes.

Results:

Women in the study belonged to low- and middle-income households with a mean age of 42.8 ± 7.8 years and almost all had attended school. Although the respondents exhibited fairly good knowledge about the disease, cultural inhibitions, forgetfulness, economic constraints and apprehension towards tertiary health care facility were some of the barriers reported in the uptake of screening services. Participants hailed the role of female health care providers as motivational figures and stressed the need for easily comprehensible information dissemination strategies besides expecting an equal participation of men in issues involving women’s health.

Conclusion:

Involving cancer survivors as educators and empowering men on women’s health in addition to the felt need of a patient advocate to improve accessibility were some of the highlights of the discussions. Addressing these could go a long way in improving the cancer care continuum in the region.

Exploring the barriers preventing Indigenous Australians from accessing cancer genetic counseling

In Australia, individuals of Aboriginal and Torres Strait Islander descent (Indigenous Australians) have poorer health outcomes than the general population, including higher incidence of cancer and reduced life expectancy up to 14 years compared to non-Indigenous Australians. Although differences in engagement with healthcare and beliefs about disease/cancer exist between Indigenous communities, a number of common barriers have been identified hindering attendance at mainstream health services. To inform exploration of barriers that may impact access to a cancer genetic counseling service, consultations with Aboriginal stakeholders were undertaken. Ethical principles for studies that engage Indigenous communities were followed throughout the research endeavor. Using a stakeholder-endorsed focus group approach, the views of an Aboriginal Elders group (n = 9) were sought with additional semi-structured interviews with social science and genetics researchers working with Indigenous communities in Australia (n = 7). Thematic analysis of the results identified three themes: explanatory models of illness, barriers to keeping well and attending services, and recommendations for improvements to access/attendance. Barriers common to accessing both mainstream health services and clinical genetic services were identified, including attributions of illness and cancer. Specific genetic counseling barriers included the cultural inclusivity and accessibility of services, and a lack of awareness of genetic counseling both in the community and by clinicians unfamiliar with genetics. Recommendations included developing flexible service delivery models and culturally appropriate resources for Indigenous patients. These findings may inform future studies to improve Indigenous health outcomes and promote a more accessible, culturally appropriate approach to provision of cancer genetics services for Australia's First Peoples.

The impact of a volunteer-led community cancer awareness programme on knowledge of cancer risk factors and symptoms, screening, and barriers to seeking help

OBJECTIVE

To analyse the impact of a community cancer awareness programme on knowledge of cancer risk factors and symptoms, screening, and barriers to seeking help.

METHODS

Personalised information through peer-led champions was delivered to 5500 people in a range of settings and Cancer Awareness Measures questionnaires were completed by 119 participants at pre-arranged sessions (convenience sampling) before and after the intervention. Data were analysed using McNemar tests, Mann-Whitney U test and a Wilcoxon Signed Rank test.

RESULTS

Data showed increase in knowledge after the intervention for cancer screening programmes (p < 0.05), recognition of warning signs for cancer (p < 0.05), and recognition of risk factors for cancer in seven of the eleven options (p < 0.001). Results suggest a decrease in perception of barriers to seeking help (p < 0.05). The intervention had a stronger impact on recognition of cancer symptoms for people who have been affected by cancer (p = 0.02).

CONCLUSION

The Cancer Awareness Measures questionnaire proved an effective tool for evaluation and awareness improved after the intervention amongst those who completed it.

PRACTICE IMPLICATIONS

Enhancing the perceived personal relevance of information to those with experience of cancer may improve information processing and retention. The study highlights cancer awareness gaps among the public for future intervention development.

Engagement barriers and service inequities in the NHS Breast Screening Programme: Views from British-Pakistani women

Objectives

Previous research has largely attempted to explore breast screening experiences of South Asian women by combining opinions from Pakistani, Bangladeshi, and Indian women. This research often fails to reach the most underserved sub-groups of this population, with socioeconomic status not routinely reported, and English fluency being a participation requirement. With uptake low amongst British-Pakistani women, this study explores the experiences these women encounter when accessing the NHS Breast Screening Programme.

Methods

19 one-to-one semi-structured interviews were carried out with British-Pakistani women from East Lancashire, UK. 14 interviews were conducted via an interpreter.

Results

Data were analysed using thematic analysis. Three themes were identified: ‘Absence of autonomy in screening and healthcare access’ describes how currently the screening service does not facilitate confidentiality or independence. Access requires third-party intervention, with language barriers preventing self-expression. ‘Appraisal of information sources’ makes distinctions between community and NHS communication. Whereas community communication was invaluable, NHS materials were deemed inaccessible due to translation incongruences and incomprehensible terminology. ‘Personal suppositions of breast screening’ explores the subjective issues associated with disengagement, including, the cultural misalignment of the service, and perceiving screening as a symptomatic service.

Conclusions

British-Pakistani women face some unique challenges when accessing breast screening. To promote uptake, the service needs to address the translation of screening materials and optimize upon community networks to disseminate knowledge, including knowledge of the screening environment within the context of culture to promote informed choice about attendance.

Ethnic differences in barriers to symptomatic presentation in primary care: A survey of women in England

OBJECTIVE

The majority of cancers are diagnosed following a decision to access medical help for symptoms. People from ethnic minority backgrounds have longer patient intervals following identification of cancer symptoms. This study quantified ethnic differences in barriers to symptomatic presentation including culturally specific barriers. Correlates of barriers (eg, migration status, health literacy, and fatalism) were also explored.

METHODS

A cross-sectional survey of 720 White British, Caribbean, African, Indian, Pakistani, and Bangladeshi women aged 30 to 60 (n = 120/group) was carried out in England. Barrier items were taken from the widely used cancer awareness measure; additional culturally specific barriers to symptomatic presentation were included following qualitative work (11 barriers in total). Migration status, health literacy, and fatalism were included as correlates to help-seeking barriers.

RESULTS

Ethnic minority women reported a higher number of barriers (P < .001, 2.6-3.8 more than White British women). Emotional barriers were particularly prominent. Women from ethnic minority groups were more likely to report "praying about a symptom" (P < .001, except Bangladeshi women) and "using traditional remedies" (P < .001, except Caribbean women). Among ethnic minority women, adult migration to the United Kingdom, low health literacy, and high fatalistic beliefs increased likelihood of reporting barriers to symptomatic presentation. For example, women who migrated as adults were more likely to be embarrassed (OR = 1.83; CI, 1.06-3.15), worry what the GP might find (OR = 1.91; CI, 1.12-3.26), and be low on body vigilance (OR = 4.44; CI, 2.72-7.23).

CONCLUSIONS

Campaigns addressing barriers to symptomatic presentation among ethnic minority women should be designed to reach low health literacy populations and include messages challenging fatalistic views. These would be valuable for reducing ethnic inequalities in cancer outcomes.

The Effect of Counseling on Breast Cancer Awareness in Rural Iranian Women: a Randomized Controlled Clinical Trial

In a community such as Iran where late presentation is predominant and the majority of breast cancer patients are diagnosed at advanced stages of the disease, there is an urgent need for improving the level of awareness about breast cancer and early detection measures. Given that rural residents are at higher risk for late diagnosis of breast cancer because they have less education, income, and access to advanced screening technologies, this study was conducted to determine the effect of counseling on breast cancer awareness of rural Iranian women. This randomized clinical trial was conducted on 60 rural women from the Abish Ahmad area in northwestern Iran in 2017. The randomized cluster method was used for sampling. From 20 rural health houses and centers, about one third were selected randomly. From the six selected clusters, three were randomly allocated as the control group and three as the intervention group. Using convenience sampling, 30 women between the ages of 40 and 69 were selected from the control group and 30 from the intervention group. The intervention group attended six group counseling sessions. Data was gathered using a demographic and obstetrical information questionnaire and breast cancer awareness measures. The chi-square, independent t test and ANCOVA by controlling for the baseline scores were used to analyze the data. After counseling, the mean knowledge about breast cancer score was significantly higher in the intervention group than in the control group (adjusted mean difference, 17.02; confidence interval (CI) 95%, 15.44 to 18.59; p < 0.001). The mean barriers to breast cancer screening score showed a significant decrease in the intervention group compared to the control group (AMD, - 1.74; 95% CI - 3.12 to - 0.36, p < 0.001). After intervention, the frequency of breast self-exam showed a significant difference between groups (p < 0.001); but for confidence about noticing breast changes, no significant difference was observed between groups (p = 0.08). Group counseling had a significant effect on enhancing breast cancer awareness of rural Iranian women, except for confidence about noticing breast changes.

Knowledge towards Cervical and Breast Cancers among Industrial Workers: Results from a Multisite Study in Northern Vietnam

Breast and cervical cancer cases are rising among service and industrial women workers in Vietnam. We conducted a cross-sectional study among 287 workers in three factories in Hanoi and Bac Ninh from July to September 2018 to describe the knowledge of these cancers among industrial workers in Northern Vietnam using a structured questionnaire. Factors associated with knowledge of breast and cervical cancer were identified using generalized linear models (GLM). In our study, approximately one-third of participants believed breast cancer was caused by the lack of breastfeeding, exposure to pollution, and chemicals. Less than 50% knew about sexually transmitted infections that can cause cervical cancer or were aware of a vaccine for cervical cancer. Having one sexual partner within the last year was positively associated with having a higher score of knowledge for both diseases. Receiving a medical checkup within the last 12 months and seeking health information via the internet were related to greater breast cancer knowledge. Targeted education campaigns are needed to ensure proper knowledge and improve awareness of breast cancer and cervical cancer among industrial workers.

Breast Cancer Awareness and Barriers to Early Presentation in the Gaza-Strip: A Cross-Sectional Study

PURPOSE

Timely detection of breast cancer (BC) is important to reduce its related deaths. Hence, high awareness of its symptoms and risk factors is required. This study aimed to assess the awareness level of BC among females in Gaza.

MATERIALS AND METHODS

A cross-sectional study was performed during September and October 2017 in Gaza, Palestine. Stratified sampling was used to recruit patients from four hospitals and seven high schools. The validated Breast Cancer Awareness Measure (BCAM) was used to assess confidence and behavior in relation to breast changes, awareness of BC symptoms and risk factors, barriers to seek medical help, and knowledge of BC screening. Women (age ≥ 18 years) visiting or admitted to any of the four hospitals, and female adolescents (age 15 to 17 years) in any of the seven schools, were recruited for face-to-face interviews to complete the BCAM.

RESULTS

Of 3,055 women approached, 2,774 participants completed the BCAM questionnaire (response rate, 90.8%); 1,588 (57.2%) were adults, and 1,186 (42.8%) were adolescents. Of these, 1,781 (64.2%) rarely (or never) checked their breasts, and 909 (32.8%) were not confident to notice changes. In total, 1,675 (60.4%) were aware of the availability of BC screening programs. The overall mean ± standard deviation score for awareness of BC symptoms was 5.9 ± 2.9 of 11, and that of risk factors 7.5 ± 3.1 of 16. Feeling scared was the most reported barrier to seeking advice reported among women (n = 802; 50.2%), whereas feeling embarrassed was the most reported in adolescents (n = 745; 62.8%).

CONCLUSION

Awareness of BC symptoms, risk factors, and screening programs is suboptimal in Gaza. Educational interventions are necessary to increase public awareness of BC and to train local female breast surgeons to address barriers to early detection.

Cascaded CNN for View Independent Breast Segmentation in Thermal Images

Breast Cancer is the leading cause of cancer deaths in women today. Use of thermal imaging for early stage breast cancer screening is gaining more adoption in recent times and automated analysis of these thermal images with computer aided diagnosis is the key to maintain objectivity in assessment and improve quality of diagnosis. One of the main challenges in automated breast thermography is accurate segmentation of breast region robust to technician errors in image capture - such as view, distance from imaging device, position, etc. Existing algorithms for segmentation are mostly based on heuristic rules and are highly dependent upon the image capture correctness. We propose a cascaded CNN architecture to perform accurate segmentation robust to subject views and capture errors. The proposed approach can detect breasts region independent of the image capture and view angle, enabling automated image and video analysis. We also detailed and compared our algorithm with a multi-view heuristics-based segmentation method. Our proposed technique resulted a dice index of 0.92 when compared with expert segmentation on a test set comprising of 900 images collected from 150 subjects at five different view angles.

Cultural beliefs about breast cancer in Vietnamese women

Background

This study examined factors influencing cultural beliefs associated with later-stage detection of breast cancer and determined what factors influence those cultural beliefs in Vietnamese women residing in a rural Vietnamese community.

Methods

A cross-sectional survey was conducted with 289 women aged 20–64 years from 12 villages using a self-administered structured questionnaire. Cultural beliefs were measured with a 13-item cultural beliefs scale consisting of four domains—characteristics of breast lumps, self-help techniques, faith-based beliefs, and futility of treatment. Data were collected in February 2017 and analyzed using chi-square tests, nonparametric tests, Fisher’s exact tests, and multiple linear regression analyses with SPSS/WIN 24.0 statistical software.

Results

Although the total score was relatively low (3.4 out of 13), cultural beliefs that could contribute to later-stage breast cancer were identified. Younger women (β = .15, p = .016) and women with a lower income (β = .21, p < .001) held more erroneous cultural beliefs as compared to their counterparts. Most women believed they would not get breast cancer if they took care of themselves. More than one-third held cultural beliefs about breast lumps, thinking they would need to be painful and/or actively growing to be breast cancer.

Conclusions

The results support the urgent need for education concerning breast cancer health promotion, including breast cancer assessment as well as guidance on evidence-based and up-to-date detection measures to change rural Vietnamese women’s cultural beliefs.

Electronic supplementary material

The online version of this article (10.1186/s12905-019-0777-3) contains supplementary material, which is available to authorized users.

Hong Kong female’s breast cancer awareness measure: Cross-sectional survey

BACKGROUND

In women worldwide, breast cancer is the most common cancer. Breast cancer accounted for 26.6% of all new cancers in females diagnosed in 2015 in Hong Kong.

AIM

To examine women’s awareness, perception, knowledge, and screening practice of breast cancer in Hong Kong.

METHODS

We carried out a population-based survey using random telephone interviews to women aged 18 or above using the United Kingdom Cancer Research Breast Cancer Awareness Measure (United Kingdom CAM). The data was analysed using proportions, chi-square test (χ²-test) and adjusted odds ratios (ORs).

RESULTS

A total of 1000 participants completed the CAM questionnaire from 1,731 responses (response rate = 57.8%) from September to October 2017. One in five and one in four respondents recalled ≥ 3 early warning signs and ≥ 2 risk factors of breast cancer respectively. The majority (62.6%) reported they were not confident that they would notice a change in their breasts. Among the respondents, 16.8% would have regular mammography at least every two years. In general, 4 in 10 women had tried practices on preventing breast cancer. Respondents with better result in recalling breast cancer signs and symptoms were more likely to seek immediate medical help when noticed a change in their breasts (χ²-test P = 0.038), and more likely had tried prevention practice (χ²-test P < 0.001). Respondents received higher education (secondary school or above) had higher breast cancer awareness (OR = 2.83, CI: 1.61-4.97), more frequent screening (OR = 2.64, CI: 1.63-4.26) and more had tried prevention practices (OR = 2.80, CI: 1.96-4.02) when compared to those with lower education. Those in age groups 31-45 and 46-60 had higher percentages in performing breast self-exam and mammography when compared to the 18-30 and 61 or above age groups.

CONCLUSION

Population-wide public health initiatives should emphasize on prevention and early detection of breast cancer in women, with targeted strategy for those with low education level and advance in age.

A systematic review of barriers and enablers to South Asian women's attendance for asymptomatic screening of breast and cervical cancers in emigrant countries

OBJECTIVES

The aim of this review was to identify the cultural, social, structural and behavioural factors that influence asymptomatic breast and cervical cancer screening attendance in South Asian populations, in order to improve uptake and propose priorities for further research.

DESIGN

A systematic review of the literature for inductive, comparative, prospective and intervention studies. We searched the following databases: MEDLINE/In-Process, Web of Science, EMBASE, SCOPUS, CENTRAL, CDSR, CINAHL, PsycINFO and PsycARTICLES from database inception to 23 January 2018. The review included studies on the cultural, social, structural and behavioural factors that influence asymptomatic breast and cervical cancer screening attendance and cervical smear testing (Papanicolaou test) in South Asian populations and those published in the English language. The framework analysis method was used and themes were drawn out following the thematic analysis method.

SETTINGS

Asymptomatic breast or cervical screening.

PARTICIPANTS

South Asian women, including Bangladeshi, Indian, Pakistani, Sri Lankan, Bhutanese, Maldivian and Nepali populations.

RESULTS

51 included studies were published between 1991 and 2018. Sample sizes ranged from 25 to 38 733 and participants had a mean age of 18 to 83 years. Our review showed that South Asian women generally had lower screening rates than host country women. South Asian women had poorer knowledge of cancer and cancer prevention and experienced more barriers to screening. Cultural practices and assumptions influenced understandings of cancer and prevention, emphasising the importance of host country cultures and healthcare systems.

CONCLUSIONS

High-quality research on screening attendance is required using prospective designs, where objectively validated attendance is predicted from cultural understandings, beliefs, norms and practices, thus informing policy on targeting relevant public health messages to the South Asian communities about screening for cancer.

PROSPERO REGISTRATION NUMBER

CSD 42015025284.

Low Awareness of Breast Cancer and Considerable Barriers to Early Presentation Among Saudi Women at a Primary Care Setting

In Saudi Arabia, breast cancer is diagnosed at advanced stage compared to Western countries. Nevertheless, the perceived barriers to delayed presentation have been poorly examined. Additionally, available breast cancer awareness data are lacking validated measurement tool. The aim of this study is to evaluate the level of breast cancer awareness and perceived barriers to seeking medical care among Saudi women, using internationally validated tool. A cross-sectional study was conducted among adult Saudi women attending a primary care center in Riyadh during February 2014. Data were collected using self-administered questionnaire based on the Breast Cancer Awareness Measure (CAM-breast). Out of 290 women included, 30 % recognized five or more (out of nine) non-lump symptoms of breast cancer, 31 % correctly identified the risky age of breast cancer (set as 50 or 70 years), 28 % reported frequent (at least once a month) breast checking. Considering the three items of the CAM-breast, only 5 % were completely aware while 41 % were completely unaware of breast cancer. The majority (94 %) reported one or more barriers. The most frequently reported barrier was the difficulty of getting a doctor appointment (39 %) followed by worries about the possibility of being diagnosed with breast cancer (31 %) and being too busy to seek medical help (26 %). We are reporting a major gap in breast cancer awareness and several logistic and emotional barriers to seeking medical care among adult Saudi women. The current findings emphasized the critical need for an effective national breast cancer education program to increase public awareness and early diagnosis.

Factors associated with insufficient awareness of breast cancer among women in Northern and Eastern China: a case-control study

OBJECTIVES

To investigate the awareness and knowledge level of breast cancer among Chinese participants.

DESIGN

Case-control study.

SETTINGS

This study was based on the database of the minister-affiliated hospital key project of the Ministry of Health of the People's Republic of China that included 21 Chinese hospitals between April 2012 and April 2013.

PARTICIPANTS

Matched study was designed among 2978 participants with Han ethnicity aged between 25 and 70.

PRIMARY AND SECONDARY OUTCOME MEASURES

Student's t-test, Pearson's χ² test, reliability analysis, exploratory factor analysis, and univariate and multivariate logistic regression analyses were performed to know the level of breast cancer knowledge and find the breast cancer awareness-associated factors.

RESULTS

80.0% (2383/2978) of the participants had poor awareness level of breast cancer. In-depth knowledge of breast cancer such as early symptoms and risk factors was poorly found among them. Television broadcast and relatives or friends with breast cancers were the main sources of information about breast cancer. Of all participants, 72.8% (2167/2978) had heard about breast cancer as a frequent cancer affecting women, and 63.3% (1884/2978) knew that family history of breast cancer was a risk factor for breast cancer. Over half of them were aware that a breast lump could be a symptom of breast cancer. Multivariate analysis identified the following variables that predicted awareness of breast cancer: young age (OR=0.843, 95% CI 0.740 to 0.961), occupation (agricultural worker) (OR=12.831, 95% CI 6.998 to 23.523), high household social status (OR=0.644, 95% CI 0.531 to 0.780), breast hyperplasia history (OR=1.684, 95% CI 1.273 to 2.228), high behavioural prevention score (OR=4.407, 95% CI 3.433 to 5.657).

CONCLUSION

Most women were aware of breast cancer as a disease, but their in-depth knowledge of it was poor. More publicity and education programmes to increase breast cancer awareness are necessary and urgent, especially for the ageing women and agricultural workers.

Barriers to early presentation of breast cancer among women in Soweto, South Africa

PURPOSE

Reported breast cancer incidence is rising in South Africa, where some women are diagnosed late and have poor outcomes. We studied patient and provider factors associated with clinical stage at diagnosis among women diagnosed at the Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg in 2015-2016.

METHODS

From face-to-face interviewer-administered questionnaires we compared self-reported socioeconomics, demographics, comorbidities, risk factors, personal and health system barriers, and from patient clinical records, clinical staging, receptor subtype, and tumor grade among 499 consecutive women newly diagnosed with advanced stage (III/IV) breast cancer versus those diagnosed early (stage 0/I/II). Logistic regression models were used to identify factors associated with advanced stage at diagnosis.

RESULTS

Among the women, 243 (49%) were diagnosed at early and 256 (51%) at advanced stages. In the multiple logistic regression adjusted model, completion of high school or beyond (odds ratio (OR) 0.59, and greater breast cancer knowledge and awareness (OR 0.86) were associated with lower stage of breast cancer at presentation. Advanced stage was associated with Luminal B (OR 2.25) and triple-negative subtypes (OR 3.17) compared to luminal A, with delays >3 months from first breast symptoms to accessing the health system (OR 2.79) and with having more than 1 visit within the referral health system (OR 3.19) for 2 visits; OR 2.73 for ≥3 visits).

CONCLUSIONS

Limited patient education, breast cancer knowledge and awareness, and health system inefficiencies were associated with advanced stage at diagnosis. Sustained community and healthcare worker education may down-stage disease and improve cancer outcomes.

Reasons why people do not attend NHS Health Checks: a systematic review and qualitative synthesis

Background

The NHS Health Check programme is a prevention initiative offering cardiovascular risk assessment and management advice to adults aged 40–74 years across England. Its effectiveness depends on uptake. When it was introduced in 2009, it was anticipated that all those eligible would be invited over a 5-year cycle and 75% of those invited would attend. So far in the current cycle from 2013 to 2018, 33.8% of those eligible have attended, which is equal to 48.5% of those invited to attend. Understanding the reasons why some people do not attend is important to maximise the impact of the programmes.

Aim

To review why people do not attend NHS Health Checks.

Design and setting

A systematic review and thematic synthesis of qualitative studies.

Method

An electronic literature search was carried out of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index to Nursing and Allied Health Literature, Global Health, PsycINFO, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov, and the ISRCTN registry from 1 January 1996 to 9 November 2016, and the reference lists of all included papers were also screened manually. Inclusion criteria were primary research studies that reported the views of people who were eligible for but had not attended an NHS Health Check.

Results

Nine studies met the inclusion criteria. Reasons for not attending included lack of awareness or knowledge, misunderstanding the purpose of the NHS Health Check, aversion to preventive medicine, time constraints, difficulties with access to general practices, and doubts regarding pharmacies as appropriate settings.

Conclusion

The findings particularly highlight the need for improved communication and publicity around the purpose of the NHS Health Check programme and the personal health benefits of risk factor detection.

Barriers and facilitators to cervical cancer screening among Pakistani and Somali immigrant women in Oslo: a qualitative study

Norway has a low incidence and mortality rate of cervical cancer, which is mainly due to the high participation rate of women in cervical cancer screening. However, the attendance of cervical cancer screening was reported to be low among immigrant women. For this reason, we conducted a qualitative study to obtain better insight into perceived barriers and challenges to cervical cancer screening among Somali and Pakistani women in the Oslo region. A convenient sample of 35 (18 Pakistani, 17 Somali) women were recruited for the study in collaboration with Somali and Pakistani community partners. Focus group discussions were used to explore barriers and facilitators to cervical cancer screening, whereas the Ecological Model was used as the framework for the study. The study found three levels of barriers to cervical cancer screening. The individual level included a lack of understanding of the benefits of the screening. The sociocultural level included the stigma attached to the disease and the belief that women who are unmarried are sexually inactive. The system-related level included a lack of trust toward the health care system. Based on the study results, and using a common denominator approach for the immigrant groups included, the study recommends three communication strategies with the potential to improve women’s participation in cervical cancer screening: 1) in-person communication and information material at health centers; 2) verbal communication with women through seminars and workshops to educate them about their risk of cancer and the importance of screening and 3) the initiation of better recall through SMS and letters written in native languages. Finally, an intervention study that compares the aforementioned strategies and proves their effectiveness in increasing immigrant women’s participation in cervical cancer screening is recommended.

Breast Cancer Awareness among Women in Western Amazon: a Population Based Cross-Sectional Study

Background:

A general lack of women`s awareness of breast cancer has been one of the barriers to screening and early presentation. Thus, the aim of this study was to evaluate levels of knowledge about risk factors, and early warning signs of breast cancer, and to determine factors associated with better levels of comprehension.

Methods:

A population-based cross-sectional study was carried out among 478 women over 40 years old, living in Rio Branco city, western Amazon. All were interviewed using the “Breast cancer knowledge, attitudes and practice scale”, developed by American Cancer Society.

Results:

Among the respondents, only 28.6% of women were aware that advanced age highly increases the risk. Around 30% of participants recognized nipple retraction as a sign of breast cancer. Breast cancer knowledge varied according to age in such a way that the mean scores were high from 40-69 years and decreased dramatically among those aged ≥70 (β=-0.06, p=0.031). Access to health services such as the Pap-test (β=2.45, p=0.027) and attending a gynecologist in the past two years (β=1.88, p=0.005) were statistically associated with the score of breast cancer knowledge.

Conclusion:

The findings indicate that women living in urban areas, having gynecological assessment, considering herself at high risk of developing breast cancer and thinking that breast cancer is a fatal disease are statistically associated with good knowledge of breast cancer risk factors, signs and symptoms, even adjusting for age and education.

Barriers to early presentation and diagnosis of breast cancer among African women living in sub-Saharan Africa

BACKGROUND

Breast cancer (BC) has been described as the leading cause of cancer deaths among women especially in the developing world including sub Saharan Africa (SSA). Delayed presentation and late diagnosis at health facilities are parts of the contributing factors of high BC mortality in Africa. This review aimed to appraise the contributing factors to delayed breast cancer presentation and diagnosis among SSA women.

METHODS

Five databases encompassing medical and social sciences were systematically searched using predefined search terms linked with breast cancer presentation and diagnosis and sub Saharan Africa. Reference lists of relevant papers were also hand searched. Quality of quantitative and qualitative articles were assessed using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Critical Appraisal Skills Programme (CASP) quality appraisal checklist. Thematic analysis was used to synthesize the qualitative studies to integrate findings.

RESULTS

Fourteen (14) quantitative studies, two (2) qualitative studies and one (1) mixed method study merited inclusion for analysis. This review identified low knowledge of breast cancer among SSA women. This review also found lack of awareness of early detection treatment, poor perception of BC, socio-cultural factors such as belief, traditions and fear as factors impacting African women's health seeking behavior in relation to breast cancer.

CONCLUSION

Improving African women's knowledge and understanding will improve behaviors related to breast cancer and facilitate early presentation and detection and enhance proper management and treatment of breast cancer.

Affluence and Private Health Insurance Influence Treatment and Survival in Non-Hodgkin's Lymphoma

BACKGROUND

The aim of this study was to investigate inequalities in survival for non-Hodgkin's lymphoma (NHL), distinguishing between direct and indirect effects of patient, social and process-of-care factors.

METHODS

All cases of NHL diagnosed in Ireland in 2004-2008 were included. Variables describing patient, cancer, stage and process of care were included in a discrete-time model of survival using Structural Equation Modelling software.

RESULTS

Emergency admissions were more common in patients with co-morbid conditions or with more aggressive cancers, and less frequent for patients from more affluent areas. Aggressive morphology, female sex, emergency admission, increasing age, comorbidity, treatment in a high caseload hospital and late stage were associated with increased hazard of mortality. Private patients had a reduced hazard of mortality, mediated by systemic therapy, admission to high caseload hospitals and fewer emergency admissions.

DISCUSSION

The higher rate of emergency presentation, and consequent poorer survival, of uninsured patients, suggests they face barriers to early presentation. Social, educational and cultural factors may also discourage disadvantaged patients from consulting with early symptoms of NHL. Non-insured patients, who present later and have more emergency admissions would benefit from better access to diagnostic services. Older patients remain disadvantaged by sub-optimal treatment, treatment in non-specialist centres and emergency admission.

Is cancer survival associated with cancer symptom awareness and barriers to seeking medical help in England? An ecological study

BACKGROUND

Campaigns aimed at raising cancer awareness and encouraging early presentation have been implemented in England. However, little is known about whether people with low cancer awareness and increased barriers to seeking medical help have worse cancer survival, and whether there is a geographical variation in cancer awareness and barriers in England.

METHODS

From population-based surveys (n=35 308), using the Cancer Research UK Cancer Awareness Measure, we calculated the age- and sex-standardised symptom awareness and barriers scores for 52 primary care trusts (PCTs). These measures were evaluated in relation to the sex-, age-, and type of cancer-standardised cancer survival index of the corresponding PCT, from the National Cancer Registry, using linear regression. Breast, lung, and bowel cancer survival were analysed separately.

RESULTS

Cancer symptom awareness and barriers scores varied greatly between geographical regions in England, with the worst scores observed in socioeconomically deprived parts of East London. Low cancer awareness score was associated with poor cancer survival at PCT level (estimated slope=1.56, 95% CI: 0.56; 2.57). The barriers score was not associated with overall cancer survival, but it was associated with breast cancer survival (estimated slope=-0.66, 95% CI: -1.20; -0.11). Specific barriers, such as embarrassment and difficulties in arranging transport to the doctor's surgery, were associated with worse breast cancer survival.

CONCLUSIONS

Cancer symptom awareness and cancer survival are associated. Campaigns should focus on improving awareness about cancer symptoms, especially in socioeconomically deprived areas. Efforts should be made to alleviate barriers to seeking medical help in women with symptoms of breast cancer.

Adolescents' Health Awareness and Understanding of Cancer and Tumor Prevention: When and Why an Adolescent Decides to Consult a Physician

BACKGROUND

A feature often seen in adolescent patients with cancer is a lengthy symptom interval, especially in comparison with children. It has been suggested that inadequate awareness of cancer risk among adolescents may play an important role in this study.

METHODS

The Società Italiana Adolescenti con Malattie Onco-ematologiche and the Fondazione Umberto Veronesi conducted a survey to investigate health awareness among healthy adolescents and their understanding of cancer and its signs and symptoms by commissioning a specialized agency (AstraRicerche). A questionnaire was administered to 500 Italian adolescents from the age group of 15 to 19 years using the computer-aided web interviewing method.

RESULTS

Approximately 80% of the adolescents interviewed claimed to be well informed about their own health, 85% said they were aware that some lifestyle habits could influence their health, and 80% reported that they know that cancer can develop in adolescence too. It was also noted that, while some adolescents were worried about a given symptom, 22% of them reportedly preferred a wait-and-see approach (either to avoid alarming their parents, or they hoped that the symptom would be temporary).

CONCLUSIONS

This study showed that a majority of adolescents are concerned about their own health, but sometimes prefer not to report their symptoms to anyone. Hence, it is important to develop information campaigns tailored to raise awareness among this age group and help them interpret their symptoms.

Ethnic differences in cancer symptom awareness and barriers to seeking medical help in England

BACKGROUND

Ethnic differences in cancer symptom awareness and barriers to seeking medical help in the English population are not fully understood. We aimed to quantify these differences, to help develop more effective health campaigns, tailored to the needs of different ethnic groups.

METHODS

Using a large national data set (n=38 492) of cross-sectional surveys that used the Cancer Research UK Cancer Awareness Measure, we examined how cancer symptom awareness and barriers varied by ethnicity, controlling for socio-economic position, age and gender. Data were analysed using multivariable logistic regression.

RESULTS

Awareness of cancer symptoms was lower in minority ethnic groups than White participants, with the lowest awareness observed among Bangladeshis and Black Africans. Ethnic minorities were more likely than White British to report barriers to help-seeking. South Asians reported the highest emotional barriers, such as lack of confidence to talk to the doctor, and practical barriers, such as worry about many other things. The Irish were more likely than the White British to report practical barriers, such as being too busy to visit a doctor. White British participants were more likely than any other ethnic group to report that they would feel worried about wasting the doctor's time. Overall, Black Africans had the lowest barriers. All differences were statistically significant (P<0.01 level), after controlling for confounders.

CONCLUSIONS

Our findings suggest the need for culturally sensitive and targeted health campaigns, focused on improving recognition of cancer symptoms among ethnic minorities. Campaigns should tackle the specific barriers prevalent in each ethnic group.

Minority ethnicity patient satisfaction and experience: results of the National Cancer Patient Experience Survey in England

OBJECTIVES

This study sought to explore the differential patient satisfaction reported by patients with cancer who are from ethnic minority backgrounds, examining patient-reported experience of interacting with medical and nursing staff.

SETTING

As a secondary analysis, we collated data collected over two consecutive annual rounds of the National Cancer Patient Experience Survey (NCPES) from September 2012 to November 2013.

PARTICIPANTS

There were 138 878 responses from 155 hospital trusts across the National Health Service in England, representing a response rate of 63.9% based on the total identified cohort of patients receiving cancer care over those 2 years.

OUTCOMES

We used the results of the annual survey, which sought to assess overall patient satisfaction along with patient experience of interacting with clinical nurse specialists, hospital doctors and ward nurses.

RESULTS

Ethnic minority patients reported lower satisfaction and less positive experiences of care overall. While some of this difference appeared related to demographic and socioeconomic variation, ethnic minority patients remained less positive than those in the White British group, after statistical adjustment. Ethnic minority patients also reported lower confidence in, and less understanding of, healthcare professionals, including clinical nurse specialists, doctors and ward nurses.

CONCLUSIONS

Given the diversity of the British population, as well as the clustering of ethnic minority patients in certain urban areas, a better understanding of the expectations and additional needs of ethnic minority patients is required to improve their experience of and satisfaction with cancer care.

Breast Cancer Awareness at the Community Level among Women in Delhi, India

BACKGROUND

To assess women's awareness from diverse sections of society in Delhi regarding various aspects of breast cancer (BC)--perceptions, signs and symptoms, risk factors, prevention, screening and treatment.

MATERIALS AND METHODS

Community-level survey was undertaken in association with the Indian Cancer Society (ICS), Delhi during May 2013-March 2014. Women attending BC awareness workshops by ICS were given self-administered questionnaires before the workshop in the local language to assess BC literacy. Information provided by 2017 women was converted into awareness scores (aware=1) for analysis using SPSS. Awareness scores were dichotomized with median score=19 as cut off, create more aware and less aware categories. Bivariate and multivariate analysis provided P-values, odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Broadly, 53.4% women were aware about various aspects of BC. Notably, 49.1% women believed that BC was incurable and 73.9% women believed pain to be an initial BC symptom. Only 34.9% women performed breast self-examination (BSE) and 6.9% women had undergone clinical breast-examination/mammography. 40.5% women had higher awareness (awareness score>median score of 19), which was associated with education [graduates (OR=2.31; 95%CI=1.78, 3.16), post-graduates (OR=7.06; 95%CI=4.14, 12.05) compared to ≤high school] and socio-economic status (SES) [low-middle (OR=4.20; 95%CI=2.72, 6.49), middle (OR=6.00; 95%CI=3.82, 9.42) and upper (OR=6.97; 95%CI=4.10, 11.84) compared to low SES].

CONCLUSIONS

BC awareness of women in Delhi was suboptimal and was associated with low SES and education. Awareness must be drastically increased via community outreach and use of media as a first step in the fight against BC.

Leveraging Social Media to Promote Public Health Knowledge: Example of Cancer Awareness via Twitter

Background

As social media becomes increasingly popular online venues for engaging in communication about public health issues, it is important to understand how users promote knowledge and awareness about specific topics.

Objective

The aim of this study is to examine the frequency of discussion and differences by race and ethnicity of cancer-related topics among unique users via Twitter.

Methods

Tweets were collected from April 1, 2014 through January 21, 2015 using the Twitter public streaming Application Programming Interface (API) to collect 1% of public tweets. Twitter users were classified into racial and ethnic groups using a new text mining approach applied to English-only tweets. Each ethnic group was then analyzed for frequency in cancer-related terms within user timelines, investigated for changes over time and across groups, and measured for statistical significance.

Results

Observable usage patterns of the terms "cancer", "breast cancer", "prostate cancer", and "lung cancer" between Caucasian and African American groups were evident across the study period. We observed some variation in the frequency of term usage during months known to be labeled as cancer awareness months, particularly September, October, and November. Interestingly, we found that of the terms studied, "colorectal cancer" received the least Twitter attention.

Conclusions

The findings of the study provide evidence that social media can serve as a very powerful and important tool in implementing and disseminating critical prevention, screening, and treatment messages to the community in real-time. The study also introduced and tested a new methodology of identifying race and ethnicity among users of the social media. Study findings highlight the potential benefits of social media as a tool in reducing racial and ethnic disparities.

Cancer screening behaviours among South Asian immigrants in the UK, US and Canada: a scoping study

South Asian (SA) immigrants settled in the United Kingdom (UK) and North America [United States (US) and Canada] have low screening rates for breast, cervical and colorectal cancers. Incidence rates of these cancers increase among SA immigrants after migration, becoming similar to rates in non-Asian native populations. However, there are disparities in cancer screening, with low cancer screening uptake in this population. We conducted a scoping study using Arksey & O'Malley's framework to examine cancer screening literature on SA immigrants residing in the UK, US and Canada. Eight electronic databases, key journals and reference lists were searched for English language studies and reports. Of 1465 identified references, 70 studies from 1994 to November 2014 were included: 63% on breast or cervical cancer screening or both; 10% examined colorectal cancer screening only; 16% explored health promotion/service provision; 8% studied breast, cervical and colorectal cancer screening; and 3% examined breast and colorectal cancer screening. A thematic analysis uncovered four dominant themes: (i) beliefs and attitudes towards cancer and screening included centrality of family, holistic healthcare, fatalism, screening as unnecessary and emotion-laden perceptions; (ii) lack of knowledge of cancer and screening related to not having heard about cancer and its causes, or lack of awareness of screening, its rationale and/or how to access services; (iii) barriers to access including individual and structural barriers; and (iv) gender differences in screening uptake and their associated factors. Findings offer insights that can be used to develop culturally sensitive interventions to minimise barriers and increase cancer screening uptake in these communities, while recognising the diversity within the SA culture. Further research is required to address the gap in colorectal cancer screening literature to more fully understand SA immigrants' perspectives, as well as research to better understand gender-specific factors that influence screening uptake.

Validation of the Breast Cancer Screening Beliefs Questionnaire among African Australian women

Background

The Breast Cancer Screening Beliefs Questionnaire (BCSBQ) has been designed as a culturally appropriate instrument for assessing women’s beliefs, knowledge and attitudes to breast cancer and breast cancer screening practices. While it has proved to be a reliable instrument when applied to women of Chinese, Arabic and Korean origin living in Australia, its psychometric properties among women from African backgrounds have not been tested. The aim of this study is to examine the psychometric properties of the BCSBQ among African Australian women.

Methods

The BCSBQ was administered to 284 African Australian women who were recruited from a number of African community organizations and churches. Factor analysis was conducted to study the factor structure. Construct validity was examined using Cuzick’s non-parametric test while Cronbach alpha was used to assess internal consistency reliability.

Results

Exploratory factor analysis results demonstrated that the African-Australian BCSBQ can be conceptualized as a 4-factor model. The third factor, viz. “barriers to mammography”, was split into two separate factors namely, “psychological” and “practical” barriers. The results indicated that the African-Australian BCSBQ had both satisfactory validity and internal consistency. The Cronbach’s alpha of the three subscales ranged between 0.84-0.92. The frequency of breast cancer screening practices (breast awareness, clinical breast-examination and mammography) were significantly associated with attitudes towards general health check-ups and perceived barriers to mammographic screening.

Conclusions

Our study provided evidence to support the psychometric properties of the BCSBQ.in African Australian women. The study moreover demonstrated that the use of the instrument can help health professionals to understand the beliefs, knowledge and attitudes to breast cancer among African Australian women and also the factors that impact on their breast cancer screening practices.

Influences of cancer symptom knowledge, beliefs and barriers on cancer symptom presentation in relation to socioeconomic deprivation: a systematic review

BACKGROUND

People from lower socioeconomic groups have worse survival outcomes for cancer, which in part reflects later-stage disease at diagnosis. The mechanisms underlying delayed cancer symptom presentation in lower socioeconomic groups are not well understood.

METHODS

Systematic review of studies of actual or anticipated symptom presentation across all tumour sites. Included studies measured socioeconomic group, symptom presentation and one or more of the following variables: cancer symptom knowledge, beliefs about cancer, barriers/facilitators to symptom presentation.

RESULTS

A total of 60 studies was included. Symptom knowledge overall was lowest and actual presentation time was longest in lower socioeconomic groups. Knowledge for specific symptoms such as lumps and bleeding was good and encouraged timely symptom presentation, in contrast to non-specific symptoms which were not well recognised. The combination of fearful and fatalistic beliefs was typically associated with later presentation, especially in lower socioeconomic groups. Emotional barriers such as 'worry what the doctor might find' were more frequently reported in lower socioeconomic groups, and there was evidence to suggest that disclosing symptoms to family/friends could help or hinder early presentation.

CONCLUSIONS

Poor symptom knowledge, fearful and fatalistic beliefs about cancer, and emotional barriers combine to prolong symptom presentation among lower socioeconomic groups. Targeted interventions should utilise social networks to improve knowledge of non-specific symptoms, challenge negative beliefs and encourage help-seeking, in order to reduce avoidable delays and minimise socioeconomic group inequalities.