Women's knowledge, attitudes and practice about breast cancer screening in the region of Monastir (Tunisia)

Knowledge of risk factors and early detection methods toward breast cancer among healthcare workers in Kinshasa, Democratic Republic of the Congo

BACKGROUND

Breast cancer (BC) is the most prevalent cancer among women, and it typically presents late in developing countries like the Democratic Republic of the Congo (DRC), leading to higher mortality rates. Late detection at advanced stages of breast cancer can be attributed to the absence of appropriate screening programs and low levels of awareness.

AIMS

To evaluate the level of BC knowledge among healthcare workers (HCWs) and identify determinants of good BC knowledge.

METHODS AND RESULTS

An analytical cross-sectional survey was conducted from March 1 to 31, 2022 involving HCWs practicing in Kinshasa, DRC. Data were collected using a questionnaire administered through direct interviews. Bivariate and multivariate regression techniques were applied. The study interviewed 543 HCWs, with a median age of 35 years (interquartile range: 29-43). Of these, 61% had good BC knowledge, while 39% had poor BC knowledge. Multivariate analysis revealed that HCWs aged 50 years and over (adjusted odds ratio [aOR] = 2.3 [1.2-4.5]), female HCWs (aOR = 1.8 [1.1-2.4]), HCWs working in public healthcare facilities (aOR = 1.5 [1.1-2.5]), and HCWs who had received training on BC (aOR = 1.9; 95% CI: 1.5-3.3) were determinants of good BC knowledge.

CONCLUSION

This study found that 61% of the surveyed HCWs had good BC knowledge. However, there is still room for improvement in terms of knowledge dissemination. Therefore, it is important to implement continuing medical education programs that focus on raising awareness and improving BC knowledge among HCWs.

Training health workers in clinical breast examination for early detection of breast cancer in low- and middle-income countries

BACKGROUND

Most women living in low- and middle-income countries (LMICs) present with advanced-stage breast cancer. Limitations of poor serviceable health systems, restricted access to treatment facilities, and lack of breast cancer screening programmes all likely contribute to the late presentation of women with breast cancer living in these countries. Women are diagnosed with advanced disease and frequently do not complete their care due to a number of factors, including financial reasons as health expenditure is largely out of pocket resulting in financial toxicity; health system failures, such as missing services or health worker lack of awareness on common signs and symptoms of cancer; and sociocultural barriers, such as stigma and use of alternative therapies. Clinical breast examination (CBE) is an inexpensive early detection technique for breast cancer in women with palpable breast masses. Training health workers from LMICs to conduct CBE has the potential to improve the quality of the technique and the ability of health workers to detect breast cancers early.

OBJECTIVES

To assess whether training in CBE affects the ability of health workers in LMICs to detect early breast cancer.

SEARCH METHODS

We searched the Cochrane Breast Cancer Specialised Registry, CENTRAL, MEDLINE, Embase, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, and ClinicalTrials.gov up to 17 July 2021.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) (including individual and cluster-RCTs), quasi-experimental studies and controlled before-and-after studies if they fulfilled the eligibility criteria.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened studies for inclusion, and extracted data, assessed risk of bias, and assessed the certainty of the evidence using the GRADE approach. We performed statistical analysis using Review Manager software and presented the main findings of the review in a summary of findings table.

MAIN RESULTS

We included four RCTs that screened a total population of 947,190 women for breast cancer, out of which 593 breast cancers were diagnosed. All included studies were cluster-RCTs; two were conducted in India, one in the Philippines, and one in Rwanda. Health workers trained to perform CBE in the included studies were primary health workers, nurses, midwives, and community health workers. Three of the four included studies reported on the primary outcome (breast cancer stage at the time of presentation). Amongst secondary outcomes, included studies reported CBE coverage, follow-up, accuracy of health worker-performed CBE, and breast cancer mortality. None of the included studies reported knowledge attitude practice (KAP) outcomes and cost-effectiveness. Three studies reported diagnosis of breast cancer at early stage (at stage 0+I+II), suggesting that training health workers in CBE may increase the number of women detected with breast cancer at an early stage compared to the non-training group (45% detected versus 31% detected; risk ratio (RR) 1.44, 95% confidence interval (CI) 1.01 to 2.06; three studies; 593 participants; I2 = 0%; low-certainty evidence). Three studies reported diagnosis at late stage (III+IV) suggesting that training health workers in CBE may slightly reduce the number of women detected with breast cancer at late stage compared to the non-training group (13% detected versus 42%, RR 0.58, 95% CI 0.36 to 0.94; three studies; 593 participants; I2 = 52%; low-certainty evidence). Regarding secondary outcomes, two studies reported breast cancer mortality, implying that the evidence is uncertain for the impact on breast cancer mortality (RR 0.88, 95% CI 0.24 to 3.26; two studies; 355 participants; I2 = 68%; very low-certainty evidence). Due to the study heterogeneity, we could not conduct meta-analysis for accuracy of health worker-performed CBE, CBE coverage, and completion of follow-up, and therefore reported narratively using the 'Synthesis without meta-analysis' (SWiM) guideline. Sensitivity of health worker-performed CBE was reported to be 53.2% and 51.7%; while specificity was reported to be 100% and 94.3% respectively in two included studies (very low-certainty evidence). One trial reported CBE coverage with a mean adherence of 67.07% for the first four screening rounds (low-certainty evidence). One trial reported follow-up suggesting that compliance rates for diagnostic confirmation following a positive CBE were 68.29%, 71.20%, 78.84% and 79.98% during the respective first four rounds of screening in the intervention group compared to 90.88%, 82.96%, 79.56% and 80.39% during the respective four rounds of screening in the control group.

AUTHORS' CONCLUSIONS

Our review findings suggest some benefit of training health workers from LMICs in CBE on early detection of breast cancer. However, the evidence regarding mortality, accuracy of health worker-performed CBE, and completion of follow up is uncertain and requires further evaluation.

Knowledge regarding breast cancer among Congolese women in Kinshasa, Democratic Republic of the Congo

INTRODUCTION

Breast cancer is the most frequent type of cancer in women and is characterized by late clinical signs in developing countries, including the Democratic Republic of the Congo. One of the main reasons of death from breast cancer is lack of awareness and screening, which has led to late diagnosis (at an advanced stage). This study aims to measure women's knowledge regarding breast cancer in Kinshasa, in the Democratic Republic of the Congo.

MATERIALS AND METHODS

A cross-sectional study of 489 women aged 20-65 years was conducted. Data was collected using a predesigned, tested, self-administered questionnaire. The questionnaire included specific sections to test the participants' knowledge related to breast cancer and its screening, and practices related to breast self-examination (BSE). Bivariate and multivariate analyzes were used.

RESULTS

Our results indicated that 22.09% of the participants had good breast cancer knowledge and 77.91% had poor breast cancer knowledge. Overall, 322 (65.85%) participants recognized that BSE is a valuable method for early screening of BSE. In total, 136 (27.81%) respondents had learned to do the BSE and 216 (44.17%) had reported doing it. Two hundred and ninety-two (59.71%) respondents mentioned that any woman was at risk for breast cancer and 357 (71.78%) mentioned that it was possible to prevent breast cancer. Determinants of an adequate level of knowledge were higher/university educational level (adjusted odds ratio = 2.70; 95% confidence interval: 1.27-5.73; p = .010) and having previously been screened for breast cancer (adjusted odds ratio = 2.31; 95% confidence interval: 1.40-3.83; p = .001).

CONCLUSION

The majority (77.91%) of women have demonstrated poor knowledge of signs/symptoms, risk factors, and screening methods of breast cancer. Additional efforts should be made through women's healthcare workers to raise knowledge of breast cancer screening.

Assessing breast cancer awareness on reproductive age women in West Badewacho Woreda, Hadiyya Zone, South Ethiopia; Community based cross- sectional study

Introduction

Breast cancer is the most commonly diagnosed cancer in women worldwide, in both high- and low-income countries. Individual and community awareness of breast cancer can be extremely beneficial. However, breast cancer awareness is extremely low among Ethiopian women, particularly in rural areas. Thus, the aim of this study was assessing awareness of breast cancer on reproductive-aged women in West Badewacho Woreda, Hadiya Zone, South Ethiopia, 2020.

Method

A community-based-cross sectional study was employed from April 18 to May 16, 2020. To obtain data, a pre-tested structured interviewer-administered questionnaire was employed. A multistage random sampling technique was employed to select reproductive-aged women from Woreda. Data was entered into a computer using Epi data version 3.1, and edited, cleaned and analyzed using SPSS windows version 20. Bivariable and multivariable analyses were used to identify determinants related to awareness of breast cancer.

Result

A total of 578 reproductive-age women participated in this study. Only 364 women of reproductive-age (63%) had heard about breast cancer. 234 (64.3%) of the respondents were aware of breast cancer. After adjusting for other variables, husbands’ educational status [AOR = 0.262; 95% CI (0.076, 0.900)], family history of breast cancer [AOR = 0.281; 95% CI (0.132, 0.594)] and having TV/Radio [AOR = 0.489; 95% CI (0.246, 0.972)] were significant predictors for awareness of breast cancer.

Conclusion

This study emphasized the importance of raising breast cancer awareness among women in the study area.

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.

Knowledge and barriers to early detection of breast cancer among female primary care patients in Serbia

OBJECTIVES

Breast cancer is the leading cause of cancer mortality among women in Serbia and accounts for 22.8% of total cancer mortality in 2018. This study assessed the knowledge and barriers to early detection of breast cancer in women.

METHODS

In March 2019, at the Primary Healthcare Centre Kikinda, Serbia, a 22-item questionnaire was distributed to a series of patients (N = 403, response rate 91.8%) to assess the odds ratio (OR) and 95% confidence interval (CI) between variables explaining knowledge of breast cancer symptoms and risk factors and barriers to screening, and four types of early detection of breast cancer.

RESULTS

The majority of patients (85.4%) know that a lump in a breast is a common symptom of breast cancer and that a family history of breast cancer is a risk factor (80.1%); 63.8% of respondents aged ≥ 30 years self-examined their breasts in the past month, 39.1% of patients aged ≥ 40 years had clinical, while 34.4% had ultrasound breast examination in the past year, and 51.1% of patients aged ≥ 50 years had mammography once in the past two years. Patients aged ≥ 40 years retired and those with a positive family history were 84% and 63% less likely not to undergo a clinical breast examination in the past year. Participants over 40 years of age who reported a lack of funds were 2.46 times more likely to miss a clinical breast examination than those who did not have that barrier. Among participants aged 50-69 years, the likelihood of not receiving the mammography increases by 2.82 with an increase in wealth status and it was 65% lower for those who lack information about the available treatment.

CONCLUSION

Women under the age of 50 rarely practice breast cancer screening. Study findings can be used to improve breast cancer screening at the primary level.

Ethiopian women's breast cancer self-examination practices and associated factors. A systematic review and meta-analysis

BACKGROUND

Breast neoplasm is the most frequently diagnosed and the leading cause of cancer death in the vast majority of the countries. Breast cancer self-examination is a check-up of a woman does at home to look for changes or problems in the breast tissue. The benefit of early recognition is for early treatment that is more effective, higher long-term survival rates and better quality of life. The aim of this review was to determine the pooled prevalence of breast cancer self-examination practice and identify its associated factors among Ethiopian women.

METHODS

Google Scholar, PubMed, Science Direct, web of science, and Cochrane Library were used for search of articles. This review includes thirty four articles conducted in Ethiopia between 2011 and 2020. The review contains 14,908 women to determine the ever pooled prevalence of breast cancer self-examination practice. Health workers and students made up 28.35% of the total participants. Data were extracted using a standardized data extraction format prepared in Microsoft Excel and analyzed with Stata 14. To assess heterogeneity I² test were used. A random effect meta-analysis model was used to estimate the pooled breast cancer self-examination (BCSE) practice of Ethiopian women. Moreover associated factors were also assessed.

RESULTS

In Ethiopian women, the overall ever and regular pooled breast cancer self-examination practice was 36% (95% CI: 28, 43) and 16% (95% CI: 28, 43) respectively. The ever pooled prevalence for health workers or students was 53% (95% CI: 41, 65), whereas for other participants it was 25% (95% CI: 19, 30). Good knowledge about breast self-examination (AOR: 3.69: 95% CI: 2.70, 5.05), positive attitude towards BCSE (AOR: 2.72: 95% CI: 1.74, 4.24), Getting to know people with breast cancer(AOR: 2.77: 95% CI: 1.51, 5.09), family history of breast cancer (AOR: 2.49: 95% CI: 1.60, 3.88) and personal history of breast cancer (AOR: 2.26: 95% CI: 1.70, 3.01) were associated factors to BCSE practice among Ethiopian women. All of the studies included in this review were conducted in a cross-sectional design was a limitation of this review and meta-analysis.

CONCLUSION

This review and meta-analysis showed the ever and regular pooled prevalence of BCSE among Ethiopian women. More than one third of Ethiopian women ever practiced BCSE. We recommend that awareness creation should be perform in order to tackle the risk of breast cancer.

Breast Cancer Screening Practice and Associated Factors Among Women Aged 20-70 Years in Urban Settings of SNNPR, Ethiopia

Background

Breast cancer is the leading cause of morbidity and mortality among women in many countries around the globe. Early detection of breast cancer plays a great role in cancer prevention and treatment by potentially decreasing mortality. However, evidence is sparse on breast cancer screening practice among women in southern Ethiopia. Therefore, the aim of this study was to assess breast cancer screening practice and associated factors among women 20–70 years of age in an urban setting in SNNPR, Ethiopia.

Methods

A community-based cross-sectional study was conducted from March to April 2020. Multistage sampling technique was applied to select the study participants. Data were collected by using a pretested interviewer-administered structured questionnaire. Bivariable and multivariable logistic regression was done to confirm association between dependent variable and covariates.

Results

From the total study participants, 83 (13.6%; 95%CI: 10.8, 16.4%), have regularly engaged in at least one breast cancer screening method. Women with a favorable attitude towards breast cancer and its screening (AOR=3.0; 95%CI: 1.63–5.56), educational status of college and above (AOR=3.8; 95%CI: 1.25– 11.48), family history of breast cancer (AOR=3.7; 95%CI: 1.73–7.96), awareness about breast cancer screening methods (AOR=3.0; 95%CI: 1.46–6.22), knowing someone screened for breast cancer (AOR=2.2; 95%CI: 1.10–4.38), and recommendation by health professionals for BCS (AOR=5.0; 95%CI: 2.35–10.68) were variables significantly associated with BCS practice.

Conclusion

Breast cancer screening practice is low. Women with college and above education level, favorable attitude towards breast cancer and its screening, awareness about breast cancer screening methods, family history of breast cancer, having a recommendation from health professionals and knowing someone who screened for breast cancer were associated with BCS practice. Therefore, this finding implies the need to intervene upon those factors.

Women's knowledge, attitude, and practice of breast self- examination in sub-Saharan Africa: a scoping review

Background

Breast cancer (BC) is a non-communicable disease with increased morbidity and mortality. Early detection of BC contributes to prompt linkage to care and reduction of complications associated with BC. Breast self-examination (BSE) is useful for detecting breast abnormalities particularly in settings with poor access to healthcare for clinical breast examination and mammography. Therefore, we mapped evidence on women’s knowledge, attitude, and practice of BSE in sub-Sahara Africa (SSA).

Methods

We conducted a systematic scoping review using Arskey and O’Malleys’ framework as a guide. We searched PubMed, Google Scholar, CINAHL, and Science Direct databases for relevant studies on women’s knowledge, attitude and practice on BSE. Studies included in the review were from SSA countries as defined by the World Health Organization published from 2008 to May 2019. Two reviewers independently screened the articles at the abstract and full-text screening guided by inclusion and exclusion criteria. All relevant data were extracted, and a thematic analysis conducted. The themes were collated, and a narrative summary of the findings reported.

Results

Of the 264 potentially eligible articles identified from 595,144, only 21 met the inclusion criteria and were included for data extraction. These included studies were conducted in 7 countries of which 11 were conducted in Nigeria; two each in Ethiopia, Ghana, Cameroon, and Uganda; and one each in Kenya and Sudan. Of the 21 included studies, 18 studies reported evidence on BSE knowledge and practice; two on only knowledge; one on only practice only; and six presented evidence on women’s attitude towards BSE. The study findings suggest varying knowledge levels on BSE among women in SSA countries. The study findings also suggest that BSE practice is still a challenge in SSA.

Conclusion

There is a paucity of published literature on women’s knowledge, practice, and attitude of BSE in SSA. Hence, this study recommends further studies on knowledge, practice, and attitude of BSE, to identify contextual challenges and provide evidence-based solutions to improve women’s knowledge, practice, and attitude of BSE in SSA.

Female medical students' awareness, attitudes, and knowledge about early detection of breast cancer in Syrian Private University, Syria

INTRODUCTION

Breast cancer is the most frequent cancer among women, impacting 2.1 million women each year, and also causes the greatest number of cancer-related deaths among women. The study aims to determine the community awareness levels in our country and extrapolate knowledge and awareness about the methods of early detection.

METHODS

It was performed as cross-sectional study in Syrian Private University in Damascus, Syria from January to March 2019. The population included female students of all years in medical faculties: medicine, pharmacy and dentistry collages. Data collection have been done by breast cancer awareness measure (BCAM) questionnaire.

RESULTS

The total participants were 407 divided into three faculties. The average knowledge rate was (57.5%). (70 %) of participants were not familiar with mammography. It is a good result that (86.7 %) acquainted about self-examination and (94.8%) believe that it is very important. But it is obvious that the practical side is poor, there were (32.7%) of students who apply BSE.

CONCLUSION

This study showed a lack of awareness among medical students. Perhaps the most important reason is the lack of awareness programs that must include all strata of society, especially students of medical colleges and doctors for their important role in spreading awareness to avoid this danger that surrounds our ladies.

Factors associated with breast cancer screening awareness and practices of women in Addis Ababa, Ethiopia

Background

Breast cancer is a global health problem being the most common cancer of women in both developed and under-developed countries. Public and individual awareness can play a vital role in the prevention, early diagnosis and treatment of breast cancer. However evidence is sparse on awareness and practice of breast cancer screening methods used among women of reproductive age in Ethiopia. The present study was designed to determine factors associated with breast cancer screening awareness and practices of women in Addis Ababa.

Methods

A facility based cross-sectional study was conducted among women who came for maternal and child health care services to selected public health centers. The participants were interviewed using a structured questionnaire. Following data collection, data entry and analysis was done using Epi-Info version 7and SPSS Version 21 respectively. Cross tabulation of each independent variable with the dependent variable with their 95% confidence interval was done and those variables associated at binary logistic regression with a significance level of 0.2 were entered into multiple logistic regression.

Results

About half (53%) of women have heard about breast cancer and 35.5% of women are aware of at least one breast cancer screening method. Among those who are informed about breast cancer screening, 97% indicated that screening improves the chance of survival. Among the common screening methods; self-breast examination, clinical-breast examination and mammographic examination were practiced by 24.3%, 7.6% and 3.8% of respondents, respectively. Women who had high level of income were about 3 times more likely to be aware about breast cancer screening methods, [AOR = 2.5; 95%CI (1.04–-5.91)], while women who attended secondary and tertiary school were 2 and 4 times more likely to practice breast cancer screening methods [AOR = 2.46; 95% CI (1.12–-5.38)] and [AOR = 4.00; 95% CI(1.48–-10.86)] respectively.

Conclusion

This study has showed that self-reported breast cancer screening coverage is low. About two-thirds of women had no information about breast cancer screening methods.

Breast cancer in the global south and the limitations of a biomedical framing: a critical review of the literature

Public health researchers are devoting increasing attention to the growing burden of breast cancer in low-and middle-income countries (LMICs), previously thought to be minimally impacted by this disease. A critical examination of this body of literature is needed to explore the assumptions, advantages and limitations of current approaches. In our critical literature review, we find that researchers and public health practitioners predominantly privilege a biomedical perspective focused on patients' adherence (or non-adherence) to 'preventive' practices, screening behaviours and treatment regimens. Cost-effective 'quick fixes' are prioritized, and prevention is framed in terms of individual 'risk behaviours'. Thus, individuals and communities are held responsible for the success of the biomedical system; traditional belief systems and 'harmful' social practices are problematized. Inherently personal, social and cultural experiences of pain and suffering are neglected or reduced to the issue of chemical palliation. This narrow approach obscures the complex aetiology of the disease and perpetuates silence around power relations. This article calls for a social justice-oriented interrogation of the role of power and inequity in the global breast cancer epidemic, which recognizes the agency and experiences of women (and men) who experience breast cancer in the global south.

Breast Cancer: The Perspective of Northern Nigerian Women

Background:

The rising incidence of breast cancer is complicated by late presentation, which marks breast cancer diagnosis in Nigeria with about 70% of cases presenting at advanced stages of the disease. The aim of this study is to determine the general level of awareness of breast cancer, breast cancer risk factors, signs/symptoms as well as preventive measures nothern Nigerian women. It also aimed at determining their attitudes toward breast cancer cure, prevention and cause. Finally, it aims to determine their practices toward breast cancer and its associated factors.

Methods:

A cross-sectional community survey was used to study 230 women aged 15–60 years in Chikun Local Government Area. The subjects were selected based on nonprobability sampling. Data collected using self-administered questionnaire were analyzed using Statistical Package for Social Science students (version 16). Test of associations employed Chi-square statistical tool with the level of significance taken at 0.05.

Results:

About 75.2% knew about breast cancer with health facility (29.13%) being the greatest source of information. An average of 29.35% had knowledge of the risk factors tested. Mean knowledge of the signs and symptoms was 50.1% Average knowledge of breast cancer screening methods was 34.26% with breast self-examination (BSE) (46.1%) being the most recognized. In relation to perception, about 21.7% strongly agreed with the fact that breast cancer is treatable following early detection while 18.3% strongly agreed that screening is effective in detecting breast cancer. Concerning practice, an average of 10.2% practiced any of the screening methods, with BSE (17.4%) being the most practiced. Strongest reasons for nonpractice was ignorance (17.4%). An association was established between knowledge and practice of all the screening methods (P = 0.001 respectively).

Conclusions:

There is insufficient knowledge, as well as poor practices in relation to important factors associated with breast cancer prevalence.