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Torres GF, Alarcón BA, Reyes-Sanchez JM, Castaño-Gamboa N, Buitrago G. Net costs of breast cancer in Colombia: a cost-of-illness study based on administrative claims databases. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:54. [PMID: 38956674 PMCID: PMC11218325 DOI: 10.1186/s12962-024-00562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Breast Cancer (BC) is associated with substantial costs of healthcare; however, real-world data regarding these costs in Colombia is scarce. The contributory regime provides healthcare services to formal workers and their dependents and covers almost half of the population in Colombia. This study aims to describe the net costs of healthcare in women with BC covered by the contributory regime in Colombia in 2019 from the perspective of the Colombian Health System. METHODS The main data source was the Capitation Sufficiency Database, an administrative database that contains patient-level data on consumption of services included in the National Formulary (PBS, in Spanish Plan de Beneficios en Salud). Data on consumption of services not included in the PBS (non-PBS) were calculated using aggregated data from MIPRES database. All direct costs incurred by prevalent cases of BC, from January 1 to December 31, 2019, were included in the analysis. The net costs of the disease were estimated by multiplying the marginal cost and the expected number of cases with BC by region and age group. Marginal costs were defined as the costs of services delivered to patients with BC after subtracting the expected costs of health services due to age, comorbidity burden or region of residence. To calculate these costs, we used Propensity Score Matching in the main analysis. All costs were expressed in 2019 international dollars. Productivity losses, transportation expenses, and caregiving costs were not included. RESULTS A total of 46,148 patients with BC were identified. Total net costs were $387 million (95% CI $377 to $396 million), 60% associated with non-PBS services. Marginal costs were $8,366 (95% Confidence Interval $8,170 to $8,573), with substantial variations between regions age groups (from $3,919 for older patients in the Amazonia region to $10,070 for younger patients in the Pacific region). The costs for PBS services were higher for ambulatory services and for patients who died during 2020. CONCLUSIONS BC imposes a substantial economic burden for the Colombian Health System with important variations in net costs between regions and age groups. Patients near death and ambulatory services were associated with higher costs of healthcare.
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Affiliation(s)
- Gabriel Fernando Torres
- Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Carrera 45 # 26-85, Bogotá, 111321, Colombia.
| | | | | | | | - Giancarlo Buitrago
- Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Carrera 45 # 26-85, Bogotá, 111321, Colombia
- Hospital Universitario Nacional, Calle 44 # 59-75, Bogotá, 111321, Colombia
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Kim HY, Mullaert J, Tondreau A, Park B, Rouzier R. Development of a model to predict the age at breast cancer diagnosis in a global population. Sci Rep 2024; 14:13845. [PMID: 38879675 PMCID: PMC11180172 DOI: 10.1038/s41598-024-53108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/27/2024] [Indexed: 06/19/2024] Open
Abstract
Knowing the mean age at diagnosis of breast cancer (BC) in a country is important for setting up an efficient BC screening program. The aim of this study was to develop and validate a model to predict the mean age at diagnosis of BC at the country level. To develop the model, we used the CI5plus database from the IARC, which contains incidence data for 122 selected populations for a minimum of 15 consecutive years from 1993 to 2012 and data from the World Bank. The standard model was fitted with a generalized linear model with the age of the population, growth domestic product per capita (GDPPC) and fertility rate as fixed effects and continent as a random effect. The model was validated in registries of the Cancer Incidence in Five Continents that are not included in the CI5plus database (1st validation set: 1950-2012) and in the most recently released volume (2nd validation set: 2013-2017). The intercept of the model was 30.9 (27.8-34.1), and the regression coefficients for population age, GDPPC and fertility rate were 0.55 (95% CI: 0.53-0.58, p < 0.001), 0.46 (95% CI: 0.26-0.67, p < 0.001) and 1.62 (95% CI: 1.42-1.88, p < 0.001), respectively. The marginal R2 and conditional R2 were 0.22 and 0.81, respectively, suggesting that 81% percent of the variance in the mean age at diagnosis of BC was explained by the variance in population age, GDPPC and fertility rate through linear relationships. The model was highly accurate, as the correlations between the predicted age from the model and the observed mean age at diagnosis of BC were 0.64 and 0.89, respectively, and the mean relative error percentage errors were 5.2 and 3.1% for the 1st and 2nd validation sets, respectively. We developed a robust model based on population age and continent to predict the mean age at diagnosis of BC in populations. This tool could be used to implement BC screening in countries without prevention programs.
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Affiliation(s)
- Ha Young Kim
- Department of Health Sciences, College of Medicine, Hanyang University, Seoul, Korea
- Institut Curie, PSL Research University, INSERM, U900, Saint Cloud, France
| | - Jimmy Mullaert
- Institut Curie, PSL Research University, INSERM, U900, Saint Cloud, France
| | - Ambre Tondreau
- Institut Curie, PSL Research University, INSERM, U900, Saint Cloud, France
| | - Boyoung Park
- Department of Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Roman Rouzier
- Institut Curie, PSL Research University, INSERM, U900, Saint Cloud, France.
- Department of Surgery, Centre François Baclesse, Caen, France.
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Brownson KE, Flores-Huidobro Martinez A, Ganbayar J, Sorensen LM, Darelli-Anderson AM, Prathibha S, Hoven N, Nansalmaa E, Mahlow J, Pushkin B, Potter D, Tuttle T, Price RR. Development of an International Virtual Multidisciplinary Tumor Board for Breast Cancer in Mongolia. J Surg Res 2024; 295:776-782. [PMID: 38150869 DOI: 10.1016/j.jss.2023.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 11/19/2023] [Accepted: 11/25/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Breast cancer is the most diagnosed cancer among Mongolian women and mortality rates are high. We describe a virtual multi-institutional and multidisciplinary tumor board (MTB) for breast cancer created to assist the National Cancer Center of Mongolia. MATERIALS AND METHODS A virtual MTB for breast cancer was conducted with participation of two United States and 1 Mongolian cancer centers. A standardized template for presentations was developed. Recommendations were summarized and shared with participants. Collected data included patient demographics, tumor characteristics, stage, imaging and treatments performed, and recommendations. Questions were categorized as treatment, diagnosis, or palliative questions. RESULTS Fifteen patients were evaluated. Median age was 39 y. 86.7% of breast cancers were invasive ductal cancers and 13.3% were metaplastic carcinomas. 53.3% were estrogen and progesterone receptor positive (ER+/PR+), 60% were HER2+, 13.3% were triple negative, and 26.7% were recurrent. 40% of patients were evaluated with mammography. 6% received positron emission tomography scans for metastatic evaluation. 66.7% of surgical patients received neoadjuvant chemotherapy. Herceptin was administered to 55.6% of patients with Her2+ cancers. Modified radical mastectomy was most commonly performed and reconstruction was rare. Sentinel lymph node biopsy was not performed. 66.7% of ER+/PR+ patients received endocrine therapy. 6.7% of patients received radiation. 75% of MTB questions pertained to treatment. Recommendations were related to systemic therapy (40%), surgical management (33.3%), pathology (13.3%), and imaging (13.3%). CONCLUSIONS This study illustrates the development of an international, virtual, multi-institutional breast cancer MTB and provides insight into challenges and potential interventions to improve breast cancer care in Mongolia.
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Affiliation(s)
- Kirstyn E Brownson
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah; Huntsman Cancer Institute, Salt Lake City, Utah; Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
| | | | | | - Leif M Sorensen
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Saranya Prathibha
- Global Surgery and Disparities Program, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Noelle Hoven
- Global Surgery and Disparities Program, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | | | - Jonathon Mahlow
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; ARUP Laboratories, Salt Lake City, Utah
| | | | - David Potter
- Global Surgery and Disparities Program, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Todd Tuttle
- Global Surgery and Disparities Program, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Raymond R Price
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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Shah V, Soh CL, Chhatwal K, Kucharczak J, Airapetyan AA, Avavde D, Torabi S, Mackenzie A, Miller G, Vardanyan R, Arjomandi Rad A, Malawana J. Autologous breast reconstruction in low- and middle-income countries (LMICs): a systematic review of current practices and challenges. Minerva Surg 2024; 79:73-81. [PMID: 38381032 DOI: 10.23736/s2724-5691.23.10111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Efforts to improve global healthcare persist, yet LMICs face challenges accessing surgical care, especially breast reconstruction amidst rising breast cancer cases. This review evaluates the present state and challenges of autologous breast reconstruction in low- and middle-income countries (LMICs). EVIDENCE ACQUISITION Utilizing the PRISMA guidelines and the Cochrane Collaboration's standards, databases such as EMBASE, MEDLINE, Cochrane, PubMed, and Google Scholar were examined for studies on breast reconstruction in LMICs (based on the World Bank's 2022-2023 definitions) up to August 2022. Articles and case reports focusing on autologous reconstruction following breast cancer surgery in these regions were incorporated. EVIDENCE SYNTHESIS From an initial 288 articles, 19 met the criteria after thorough assessment. These articles documented 4899 patient cases from LMICs, with the breakdown being: 11 on LD flaps, nine on TRAM flaps, eight on DIEP flaps, two on TDAP flaps, and one on TMG flap. Flap necrosis emerged as the prevalent complication in four studies. CONCLUSIONS While autologous breast reconstruction presents superior aesthetic benefits without notable long-term economic setbacks, its adoption in LMICs is limited. This is partly due to the domination of implant-based methods among patients and surgeons, selected due to convenience. The scarcity of concrete evidence and standardized metrics in LMICs clouds the understanding of this procedure. Despite its advantages, awareness is low, necessitating more training and awareness campaigns. Uniform reporting, quality data, and financial analysis can provide a comprehensive LMIC understanding, aiding future research.
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Affiliation(s)
- Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Chien L Soh
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Karanjot Chhatwal
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | | | - Arkady A Airapetyan
- Department of Research and Academia, National Institute of Health, Yerevan, Armenia
| | - Dani Avavde
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Saeed Torabi
- Department of Anesthesia, University Hospital Cologne, Cologne, Germany
| | - Alexandra Mackenzie
- Department of Emergency Surgery, Chelsea and Westminster Hospital NHS Trust, London, UK
| | - George Miller
- Research Unit, The Healthcare Leadership Academy, London, UK
- Center for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK -
| | - Arian Arjomandi Rad
- Research Unit, The Healthcare Leadership Academy, London, UK
- Center for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
- Clinical Academic Graduate School, The University of Oxford, Oxford, UK
| | - Johann Malawana
- Research Unit, The Healthcare Leadership Academy, London, UK
- Center for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, UK
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Kennedy SH, Bekele M, Berlin NL, Ranganathan K, Hamill JB, Haileselassie E, Oppong J, Newman LA, Momoh AO. A Prospective Evaluation of the Quality of Life and Mental Health Implications of Mastectomy Alone on Women in sub-Saharan Africa. Ann Surg 2023; 278:e1080-e1086. [PMID: 37144388 DOI: 10.1097/sla.0000000000005891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Assess quality of life and mental health implications of mastectomy for breast cancer on sub-Saharan African women. BACKGROUND Mortality rates amongst women diagnosed with breast cancer in sub-Saharan Africa (SSA) are high, with disparities in survival relative to women in high income countries partly attributed to advanced disease at presentation. Fears of the sequelae of mastectomy are a prominent reason for presentation delays. There is a critical need to better understand the effects of mastectomy on women in SSA to inform preoperative counseling and education for women with breast cancer. METHODS Women with breast cancer in Ghana and Ethiopia undergoing mastectomy were followed prospectively. Breast related quality-of-life and mental health measures were evaluated preoperatively, 3 and 6 months postoperatively, using BREAST-Q, PHQ-9, and GAD-7. Bivariate and logistic regression analyses evaluated changes in these measures for the total cohort and between sites. RESULTS A total of 133 women from Ghana and Ethiopia were recruited. The majority of women presented with unilateral disease (99%) and underwent unilateral mastectomy (98%) with axillary lymph node dissection. Radiation was more common in Ghana ( P <0.001). Across most BREAST-Q subscales, women from both countries reported significantly decreased scores at 3 months postoperative. At 6 months, the combined cohort reported decreased scores for breast satisfaction (mean difference, -3.4). Women in both countries reported similar improvements in anxiety and depression scores postoperatively. CONCLUSIONS Women from Ghana and Ethiopia who underwent mastectomy experienced a decline in breast-related body image while also experiencing decreased levels of depression and anxiety.
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Affiliation(s)
- Sarah H Kennedy
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Mahteme Bekele
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Nicholas L Berlin
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Kavitha Ranganathan
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jennifer B Hamill
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Etsehiwot Haileselassie
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Joseph Oppong
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Lisa A Newman
- Department of Surgery, Weill Cornell Medicine, New York, NY
| | - Adeyiza O Momoh
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
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Schoenhals S, Mali ME, Sutherland EK, Sorenson J, Dedey F, Nellermoe J, Flores-Huidobro Martinez A, Tounkara MD, Price RR, Brownson KE. Geospatial availability of breast cancer treatment modalities and hypothetical access improvement in Ghana: A nationwide survey. PLoS One 2023; 18:e0291454. [PMID: 37713441 PMCID: PMC10503733 DOI: 10.1371/journal.pone.0291454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
Breast cancer in Ghana is a growing public health problem with increasing incidence and poor outcomes. Lack of access to comprehensive treatment in Ghana may be a contributing factor to its high mortality. The purpose of this study was to evaluate the availability of treatments nationwide and systematically identify high yield areas for targeted expansion. We conducted a cross-sectional, nationwide hospital-based survey from November 2020-October 2021. Surveys were conducted in person with trained research assistants and described hospital availability of all breast cancer treatments and personnel. All individual treatment services were reported, and hospitals were further stratified into levels of multi-modal treatment modeled after the National Comprehensive Cancer Network (NCCN) Framework treatment recommendations for low-resource settings. Level 3 included Tamoxifen and surgery (mastectomy with axillary lymph node sampling); Level 2 included Level 3 plus radiation, aromatase inhibitors, lumpectomy, and sentinel lymph node biopsy; Level 1 included Level 2 plus Her2 therapy and breast reconstruction. Hospitals were identified that could expand to these service levels based on existing services, location and personnel. The distance of the total population from treatment services before and after hypothetical expansion was determined with a geospatial analysis. Of the 328 participating hospitals (95% response rate), 9 hospitals had Level 3 care, 0 had Level 2, and 2 had Level 1. Twelve hospitals could expand to Level 3, 1 could expand to Level 2, and 1 could expand to Level 1. With expansion, the population percentage within 75km of Level 1, 2 and 3 care would increase from 42% to 50%, 0 to 6% and 44% to 67%, respectively. Multi-modal breast cancer treatment is available in Ghana, but it is not accessible to most of the population. Leveraging the knowledge of current resources and population proximity provides an opportunity to identify high-yield areas for targeted expansion.
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Affiliation(s)
- Sarah Schoenhals
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Meghan E. Mali
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Edward K. Sutherland
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Ensign Global College, Kpong, Eastern Region, Ghana
| | - Justin Sorenson
- J.Willard Marriot Library, University of Utah, Salt Lake City, Utah, United States of America
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Greater Accra, Ghana
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Jonathan Nellermoe
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | | | - Mamadou D. Tounkara
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Raymond R. Price
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- General Surgery, Intermountain Medical Center, Murray, Utah, United States of America
| | - Kirstyn E. Brownson
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Surgery, Huntsman Cancer Institute at University of Utah, Salt Lake City, Utah, United States of America
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El Saghir NS, Khalil LE, El Dick J, Atwani RW, Safi N, Charafeddine M, Al-Masri A, El Saghir BN, Chaccour M, Tfayli A, Assi H, Abbas J, Ayoub Z, Sbaity E, Moukadem HA. Improved Survival of Young Patients With Breast Cancer 40 Years and Younger at Diagnosis. JCO Glob Oncol 2023; 9:e2200354. [PMID: 37229627 PMCID: PMC10497296 DOI: 10.1200/go.22.00354] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/11/2023] [Accepted: 02/28/2023] [Indexed: 05/27/2023] Open
Abstract
PURPOSE Around 50% of patients with breast cancer in low- or middle-income countries are younger than 50 years, a poor prognostic variable. We report the outcome of patients with breast cancer 40 years and younger. METHODS We reviewed 386 patients with breast cancer 40 years and younger and retrieved demographic, clinicopathologic, treatment-related, disease progression, and survival data from electronic medical records. RESULTS The median age at diagnosis was 36 years, and infiltrating ductal carcinoma was present in 94.3% of patients, infiltrating lobular carcinoma in 1.3%, and ductal carcinoma in situ in 4.4%. Grade 1 disease was present in 8.5% of patients, grade 2 in 35.5%, and grade 3 in 53.4%; 25.1% had human epidermal growth factor receptor 2 (HER2)-positive, 74.6% had hormone receptor (HR)+, and 16.6% had triple-negative breast cancer. Early breast cancer (EBC) constituted 63.6% (stage I, 22.4%; stage II, 41.2%) of patients, whereas 23.2% had stage III, and 13.2% had metastatic disease at diagnosis. Of patients with EBC, 51% had partial mastectomy and 49.0% had total mastectomy. And 77.1% had chemotherapy with or without anti-HER2 therapy. All HR+ patients received adjuvant hormonal therapy. The disease-free survival at 5 years was 72.5% and 55.9% at 10 years. The overall survival (OS) was 89.4% at 5 years and 76% at 10 years. Patients with stages I/II had an OS of 96.0% at 5 years and 87.1% at 10 years. Patients with stage III had an OS of 88.3% at 5 years and 68.7% at 10 years. The OS of patients with stage IV was 64.5% at 5 years and 48.4% at 10 years. CONCLUSION We report survival rates of 89% at 5 years and 76% at 10 years with modern multidisciplinary management. Best results were seen in EBC: OS rates of 96% and 87% at 5 years and 10 years.
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Affiliation(s)
| | - Lana E. Khalil
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Joud El Dick
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Rula W. Atwani
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadine Safi
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Ahmad Al-Masri
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Maha Chaccour
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Arafat Tfayli
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Hazem Assi
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Jaber Abbas
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina Ayoub
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Eman Sbaity
- American University of Beirut Medical Center, Beirut, Lebanon
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Taj M, Ukani H, Lalani B, Madhani N, Khan ZS, Zaidi F, Sayani S, Muzammil M. Blended Oncology Nursing Training: A Quality Initiative in East Africa. Semin Oncol Nurs 2022; 38:151299. [PMID: 35659153 DOI: 10.1016/j.soncn.2022.151299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/28/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Lack of education and awareness about cancer treatment may result in suboptimal care of patients with cancer. Unlike high-income countries, resource-limited countries lack the standardized training and scope of practice in oncology nursing. This quality improvement project was conducted to assess nurses' knowledge gain, retention of knowledge and clinical skill set, and feasibility of a blended learning approach in the care of adult oncology patients across four hospitals in Kenya and Tanzania. METHOD We used a combination of computer-led eLearning sessions and face-to-face interactions over 12 months for cancer education to oncology nurses. Pre- and posttests with each training session were combined with face-to-face clinical skills training at beginning and completion of the course. A comprehensive postassessment was conducted immediately after the training, and at 6, 9, and 12 months to evaluate knowledge gain and retention. CONCLUSION Of 21 participants across four sites, there was a statistically significant improvement in knowledge scores for 12 participants (P value < .05). The mean pre- and posttest results found significant differences across 10 sessions individually and cumulatively (P value < .01). Results from a one-way repeated measures analysis of variance (ANOVA) test on comprehensive test results suggested that there was no significant difference in knowledge retention across 9 months (F(2, 30) = 1.648412, P > .05). IMPLICATIONS FOR NURSING PRACTICE Blended learning is an effective tool in improving knowledge, skills, and self-efficacy for clinicians practicing in resource-limited countries. Developing a structured oncology training program has implications for bridging knowledge gaps among clinicians in resource-limited countries and promoting international knowledge exchange.
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Nduka IJ, Ejie IL, Okafor CE, Eleje GU, Ekwunife OI. Interventions to increase mammography screening uptake among women living in low-income and middle-income countries: a protocol for a systematic review. BMJ Open 2022; 12:e056901. [PMID: 35354628 PMCID: PMC8968630 DOI: 10.1136/bmjopen-2021-056901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Breast cancer is the most prevalent cancer and the second leading cause of cancer-related deaths among women in low and middle-income countries (LMICs), including sub-Saharan Africa. Mammography screening is the most effective screening method for the early detection of breast cancers in asymptomatic individuals and the only screening test that decreases the risk of breast cancer mortality. Despite the perceived benefits, it has a low utilisation rate in comparison with breast self-examination and clinical breast examination. Several interventions to increase the uptake of mammography have been assessed as well as systematic reviews on mammography uptake. Nonetheless, none of the published systematic reviews focused on women living in LMICs. The review aims to identify interventions that increase mammography screening uptake among women living in LMICs. METHODS AND ANALYSIS Relevant electronic databases will be systematically searched from 1 January 1990 to 30 June 2021 for published and grey literature, including citation and reference list tracking, on studies focusing on interventions to increase mammography screening uptake carried out in LMICs and written in the English language. The search will incorporate the key terms: mammography, interventions, low- and middle-income countries and their associated synonyms. Randomised controlled trials, observational studies and qualitative and mixed methods studies of interventions (carried out with and without comparison groups) reporting interventions to increase mammography screening uptake in LMICs will be identified, data extracted and assessed for methodological quality by two independent reviewers with disagreements to be resolved by consensus or by a third author. We will use narrative synthesis and/or meta-analysis depending on the characteristics of the data. ETHICS AND DISSEMINATION Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021269556.
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Affiliation(s)
- Ifeoma Jovita Nduka
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
- Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Izuchukwu Loveth Ejie
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
- Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Charles Ebuka Okafor
- Centre for Applied Health Economics, Griffith University School of Medicine, Brisbane, Queensland, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
| | - George Uchenna Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Obinna Ikechukwu Ekwunife
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
- Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
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Ikhile D, Omodara D, Seymour-Smith S, Musoke D, Gibson L. “Some They Need Male, Some They Need Female”: A Gendered Approach for Breast Cancer Detection in Uganda. Front Glob Womens Health 2022; 3:746498. [PMID: 35400129 PMCID: PMC8989840 DOI: 10.3389/fgwh.2022.746498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/23/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction There are several challenges associated with breast cancer detection in Uganda and other low-and-middle-income countries. One of the identified challenges is attributed to the health workers' gender, which facilitates gender disparities in access to breast cancer detection services. Although this challenge is well acknowledged in existing literature, there are hardly any studies on how it can be addressed. Therefore, drawing on an intersectionality lens, our study examined how to address gender disparities facilitated by health workers' gender in accessing breast cancer detection services in Uganda. Materials and Methods We collected qualitative data through semi-structured interviews with twenty participants comprising community health workers, primary health care practitioners, non-governmental organizations, district health team, and the Ministry of Health. For the data analysis, thematic analysis was conducted on NVivo using Braun and Clarke's non-linear 6-step process to identify the themes presented in the results section. Results Four themes emerged from the data analysis: understanding a woman's gender constructions; health workers' approachability; focus on professionalism, not sex; and change in organizational culture. These themes revealed participants' perceptions regarding how to address gender disparities relating to the role health workers' gender play in breast cancer detection. Through the intersectionality lens, our findings showed how gender intersects with other social stratifiers such as religious beliefs, familial control, health worker's approachability, and professionalism within the health workforce. Conclusion Our findings show that the solutions to address gender disparities in breast cancer detection are individually and socially constructed. As such, we recommend a gendered approach to understand and redress the underlying power relations perpetuating such constructions. We conclude that taking a gendered approach will ensure that breast cancer detection programs are context-appropriate, cognizant of the prevailing cultural norms, and do not restrict women's access to breast cancer detection services.
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Affiliation(s)
- Deborah Ikhile
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
- *Correspondence: Deborah Ikhile
| | - Damilola Omodara
- Global Public Health, Institute of Population Health Science, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Sarah Seymour-Smith
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
| | - David Musoke
- School of Public Health, Makerere University, Kampala, Uganda
| | - Linda Gibson
- Public Health, Institute of Health and Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
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11
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Akoko LO, Rutashobya AK, Lutainulwa EW, Mwanga AH, Kivuyo SL. The effect of reproductive, hormonal, nutritional and lifestyle on breast cancer risk among black Tanzanian women: A case control study. PLoS One 2022; 17:e0263374. [PMID: 35139096 PMCID: PMC8827470 DOI: 10.1371/journal.pone.0263374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/18/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose This study aimed to determine the effect of reproductive, hormonal, lifestyle and nutritional factors on breast cancer development among Tanzanian black women. Methodology We undertook a case-control study age-matched to ±5years in 2018 at Muhimbili National Hospital. The study recruited 105 BC patients and 190 controls giving it 80% power to detect an odds ratio of ≥2 at the alpha error of <5% for exposure with a prevalence of 30% in the control group with 95% confidence. Controls were recruited from in patients being treated for non-cancer related conditions. Information regarding hormonal, reproductive, nutritional and lifestyle risk for breast cancer and demography was collected by interviews using a predefined data set. Conditional multinomial logistic regression used to determine the adjusted odds ratio for variables that had significant p-value in the binomial logistic regression model with 5% allowed error at 95% confidence interval. Results The study recruited 105 cases and 190 controls. Only old age at menopause had a significant risk, a 2.6 fold increase. Adolescent obesity, family history of breast cancer, cigarette smoking and alcohol intake had increased odds for breast cancer but failed to reach significant levels. The rural residency had 61% reduced odds for developing breast cancer though it failed to reach significant levels. Conclusion Older age at menopause is a significant risk factor for the development of breast cancer among Tanzanian women. This study has shed light on the potential role of modifiable risk factors for breast cancer which need to be studied further for appropriate preventive strategies in similar settings.
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Affiliation(s)
- Larry Onyango Akoko
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- * E-mail:
| | - Amonius K. Rutashobya
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Ally H. Mwanga
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sokoine L. Kivuyo
- National Institute for Medical Research, Muhimbili Branch, Dar es Salaam, Tanzania
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12
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Min J, Allen M, Castro CM, Lee H, Weissleder R, Im H. Computational Optics for Point-of-Care Breast Cancer Profiling. Methods Mol Biol 2022; 2393:153-162. [PMID: 34837178 PMCID: PMC9283060 DOI: 10.1007/978-1-0716-1803-5_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
With the global burden of cancer on the rise, it is critical to developing new modalities that could detect cancer and guide targeted treatments in fast and inexpensive ways. The need for such technologies is vital, especially in underserved regions where severe diagnostic bottlenecks exist. Recently, we developed a low-cost digital diagnostic system for breast cancer using fine-needle aspirates (FNAs). Named, AIDA (artificial intelligence diffraction analysis), the system combines lens-free digital diffraction imaging with deep-learning algorithms to achieve automated, rapid, and high-throughput cellular analyses for breast cancer diagnosis of FNA and subtype classification for better-guided treatments (Min et al. ACS Nano 12:9081-9090, 2018). Although primarily validated for breast cancer and lymphoma (Min et al. ACS Nano 12:9081-9090, 2018; Im et al. Nat Biomed Eng 2:666-674, 2018), the system could be easily adapted to diagnosing other prevalent cancers and thus find widespread use for global health.
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Affiliation(s)
- Jouha Min
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew Allen
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Cesar M Castro
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Hyungsoon Im
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA.
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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13
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Teng NMY, Price CA, McKee AM, Hall LJ, Robinson SD. Exploring the impact of gut microbiota and diet on breast cancer risk and progression. Int J Cancer 2021; 149:494-504. [PMID: 33521932 PMCID: PMC8650995 DOI: 10.1002/ijc.33496] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/23/2020] [Accepted: 01/22/2021] [Indexed: 12/20/2022]
Abstract
There is emerging evidence that resident microbiota communities, that is, the microbiota, play a key role in cancer outcomes and anticancer responses. Although this has been relatively well studied in colorectal cancer and melanoma, other cancers, such as breast cancer (BrCa), have been largely overlooked to date. Importantly, many of the environmental factors associated with BrCa incidence and progression are also known to impact the microbiota, for example, diet and antibiotics. Here, we explore BrCa risk factors from large epidemiology studies and microbiota associations, and more recent studies that have directly profiled BrCa patients' gut microbiotas. We also discuss how in vivo studies have begun to unravel the immune mechanisms whereby the microbiota may influence BrCa responses, and finally we examine how diet and specific nutrients are also linked to BrCa outcomes. We also consider future research avenues and important considerations with respect to study design and implementation, and we highlight some of the important unresolved questions, which currently limit our overall understanding of the mechanisms underpinning microbiota-BrCa responses.
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Affiliation(s)
- Nancy M. Y. Teng
- Gut Microbes & HealthQuadram Institute Bioscience, Norwich Research ParkNorwichUK
| | - Christopher A. Price
- Gut Microbes & HealthQuadram Institute Bioscience, Norwich Research ParkNorwichUK
| | - Alastair M. McKee
- Gut Microbes & HealthQuadram Institute Bioscience, Norwich Research ParkNorwichUK
| | - Lindsay J. Hall
- Gut Microbes & HealthQuadram Institute Bioscience, Norwich Research ParkNorwichUK
- Norwich Medical SchoolUniversity of East Anglia, Norwich Research ParkNorwichUK
- Chair of Intestinal Microbiome, School of Life Sciences, ZIEL‐Institute for Food & HealthTechnical University of MunichFreisingGermany
| | - Stephen D. Robinson
- Gut Microbes & HealthQuadram Institute Bioscience, Norwich Research ParkNorwichUK
- School of Biological SciencesUniversity of East Anglia, Norwich Research ParkNorwichUK
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14
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Clanahan JM, Reddy S, Broach RB, Rositch AF, Anderson BO, Wileyto EP, Englander BS, Brooks AD. Clinical Utility of a Hand-Held Scanner for Breast Cancer Early Detection and Patient Triage. JCO Glob Oncol 2021; 6:27-34. [PMID: 32031433 PMCID: PMC6998011 DOI: 10.1200/jgo.19.00205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Globally, breast cancer represents the most common cause of cancer death among women. Early cancer diagnosis is difficult in low- and middle-income countries, most of which are unable to support population-based mammographic screening. Triage on the basis of clinical breast examination (CBE) alone can be difficult to implement. In contrast, piezo-electric palpation (intelligent Breast Exam [iBE]) may improve triage because it is portable, low cost, has a short learning curve, and provides electronic documentation for additional diagnostic workup. We compared iBE and CBE performance in a screening patient cohort from a Western mammography center. METHODS Women presenting for screening or diagnostic workup were enrolled and underwent iBE then CBE, followed by mammography. Mammography was classified as negative (BI-RADS 1 or 2) or positive (BI-RADS 3, 4, or 5). Measures of accuracy and κ score were calculated. RESULTS Between April 2015 and May 2017, 516 women were enrolled. Of these patients, 486 completed iBE, CBE, and mammography. There were 101 positive iBE results, 66 positive CBE results, and 35 positive mammograms. iBE and CBE demonstrated moderate agreement on categorization (κ = 0.53), but minimal agreement with mammography (κ = 0.08). iBE had a specificity of 80.3% and a negative predictive value of 94%. In this cohort, only five of 486 patients had a malignancy; iBE and CBE identified three of these five. The two cancers missed by both modalities were small—a 3-mm retro-areolar and a 1-cm axillary tail. CONCLUSION iBE performs comparably to CBE as a triage tool. Only minimal cancers detected through mammographic screening were missed on iBE. Ultimately, our data suggest that iBE and CBE can synergize as triage tools to significantly reduce the numbers of patients who need additional diagnostic imaging in resource-limited areas.
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Affiliation(s)
- Julie M Clanahan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sanjana Reddy
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robyn B Broach
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Benjamin O Anderson
- Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Ari D Brooks
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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15
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Kassie AM, Abate BB, Kassaw MW, Shiferaw WS. Breast Self-Examination Practice Among Female University Students in Ethiopia: A Systematic Review and Meta-Analysis. Cancer Control 2021; 28:10732748211019137. [PMID: 34169755 PMCID: PMC8236787 DOI: 10.1177/10732748211019137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Breast self-examination (BSE) is one of the most feasible methods of screening for early stages of breast cancer. However, the practice rate is insufficient in many low and middle-income countries including Ethiopia. Hence, this study aimed to estimate the pooled prevalence of BSE practice among female university students in Ethiopia. Methods: PubMed, Cochrane Library, Scopus, and Google Scholar were searched for studies that assessed BSE practice among female students in Ethiopian universities. The study included articles published from January 1st, 2010 to June 16th, 2020. The Cochran’s Q chi-square and the respective I2 test statistics were used to check heterogeneity among the included studies. To assess publication biases, the funnel plot and Egger’s regression tests were employed. Subgroup analysis was done by using different characteristics of studies. Sensitivity analysis was also run to assess the effect of a single study on the pooled outcome. STATA™ Version 14 software packages were employed for data analysis. Results: Sixteen (n = 16) studies with 5,743 participants were included to estimate the pooled prevalence of BSE practice. The prevalence of regular BSE practice reported in the studies ranges from 0% to 26.4%. The estimated pooled prevalence of regular BSE practice among university students in Ethiopia is 11.23% which is very low. The prevalence of BSE practice was high, 13.6% in studies published before 2015, 12.0% among health science students, and 12.6% in studies with a sample size of 384 participants and above. In addition, the estimated pooled prevalence of irregular self-breast-examination practice was 33.28%. Conclusion: The rate of BSE practice among female university students is low. Thus, awareness strategies need to be designed to increase the practice rate among women in the country as BSE is one of the most feasible strategies in early detection of breast cancer if properly implemented.
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Affiliation(s)
- Ayelign Mengesha Kassie
- Department of Nursing, College of Health Sciences, 487515Woldia University, Woldia, Ethiopia
| | - Biruk Beletew Abate
- Department of Nursing, College of Health Sciences, 487515Woldia University, Woldia, Ethiopia
| | - Mesfin Wudu Kassaw
- Department of Nursing, College of Health Sciences, 487515Woldia University, Woldia, Ethiopia
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REZANEJAD ASL P, ZAYERI F, MOGHISI A. Assessing the Relationship between Chronic Lymphoid Leukemia Mortality Rates and Human Development Index: A 26-Year Trend Analysis Using Location-Scale Mixed Effects Model. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:573-582. [PMID: 34178805 PMCID: PMC8214601 DOI: 10.18502/ijph.v50i3.5603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic lymphoid leukemia (CLL) is one of the most prevalent types of leukemia, which is responsible for a remarkable mortality rate in the world. This study aimed to investigate the global trend of this cancer from 1990 to 2015 and to determine the relationship between trend of CLL mortality rate and Human Development Index (HDI) throughout the world. METHODS The age-standardized mortality rate data of all countries of the world (per 100,000) were extracted from the GBD database. In addition, the HDI values for the studied countries in different years were obtained from the UNDP database. The statistical analysis was performed using the mixed-effects location-scale model in the SAS software, version 9.4. RESULTS The findings of the statistical modeling showed a downward slope for CLL Age Standardized Mortality Rate (ASMR) for total world countries (β̂ = -0.002). We also find a significant association between CLL ASMR and HDI. Countries with higher HDI had higher level of CLL ASMR in years 1990 to 2015 with a negative slope. Furthermore, countries with lower HDI had Lower level of CLL ASMR with rather fixed rates in this period. CONCLUSION These findings showed a decreasing trend of global CLL ASMR in the previous decades, although, the fixed trend of CLL ASMR in countries with low HDI is worrisome. The health policymakers should make more efforts to decrease the mortality due to this cancer in these countries.
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Affiliation(s)
- Parisa REZANEJAD ASL
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid ZAYERI
- Proteomics Research Center and Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza MOGHISI
- Deputy General Director for NCDs, National Focal Person for STEPS Survey & Director for Injury Prevention, Ministry of Health and Medical Education, Tehran, Iran
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Point-of-Care Ultrasound: Applications in Low- and Middle-Income Countries. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:69-75. [PMID: 33424456 PMCID: PMC7785781 DOI: 10.1007/s40140-020-00429-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/31/2023]
Abstract
Purpose of Review This review highlights the applications of point-of-care ultrasound in low- and middle-income countries and shows the diversity of ultrasound in the diagnosis and management of patients. Recent Findings There is a paucity of data on point-of-care ultrasound in anesthesiology in low- and middle-income countries. However, research has shown that point-of-care ultrasound can effectively help manage infectious diseases, as well as abdominal and pulmonary pathologies. Summary Point-of-care ultrasound is a low-cost imaging modality that can be used for the diagnosis and management of diseases that affect low- and middle-income countries. There is limited data on the use of ultrasound in anesthesiology, which provides clinicians and researchers opportunity to study its use during the perioperative period.
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18
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Sbaity E, Bejjany R, Kreidieh M, Temraz S, Shamseddine A. Overview in Breast Cancer Screening in Lebanon. Cancer Control 2021; 28:10732748211039443. [PMID: 34538124 PMCID: PMC8450617 DOI: 10.1177/10732748211039443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Breast cancer (BC) is the most common cancer in women and men combined, and it is the second cause of cancer deaths in women after lung cancer. In Lebanon, the same epidemiological profile applies where BC is the leading cancer among Lebanese females, representing 38.2% of all cancer cases. As per the Center for Disease Control, there was a decline in BC mortality rate from 2003 to 2012 reflecting the adoption of national mammographic screening as the gold standard for BC detection by Western countries. The aim of this review study is to summarize current recommendations for BC screening and the available modalities for detecting BC in different countries, particularly in Lebanon. It also aims at exploring the impact of screening campaigns on BC early stage diagnosis in Lebanon. Despite the considerable debates whether screening mammograms provides more harm than benefits, screening awareness should be stressed since its benefits far outweigh its risks. In fact, the majority of BC mortality cases in Western countries are non-preventable by the use of screening mammograms alone. As such, Lebanon adopted a public focus on education and awareness campaigns encouraging early BC screening. Several studies showed the impact of early detection that is reflected by an increase in early stage disease and a decrease in more aggressive stages. Further studies should shed the light on the effect of awareness campaigns on early breast cancer diagnosis and clinical down staging at a national scope; therefore, having readily available data on pre- and post-adoption of screening campaigns is crucial for analyzing trends in mortality of breast cancer origin and reduction in advanced stages diseases. There is still room for future studies evaluating post-campaigns knowledge, attitudes, and practices of women having participated, emphasizing on the barriers refraining Lebanese women to contribute in BC screening campaigns.
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Affiliation(s)
- Eman Sbaity
- Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rachelle Bejjany
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malek Kreidieh
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Temraz
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Biswas S, Syiemlieh J, Nongrum R, Sharma S, Siddiqi M. Impact of Educational Level and Family income on Breast Cancer Awareness among College-Going Girls in Shillong (Meghalaya), India. Asian Pac J Cancer Prev 2020; 21:3639-3646. [PMID: 33369463 PMCID: PMC8046293 DOI: 10.31557/apjcp.2020.21.12.3639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Breast cancer (BC) is the most common cancer among women in India and shows an increasing trend. The mammography screening seems unfeasible as a public health service in India. Thus, breast self-examination (BSE), followed by clinical breast examination (CBE), is the affordable method to downstage BC. A cross-sectional study was conducted with senior school and college-going girls in Shillong (Meghalaya) to study the impact of girls’ academic level and family income on breast cancer knowledge and the prevalence of BC’s known risk factors in girls. Methods: A self-administered questionnaire was employed to collect relevant information. The data were analysed using statistical software SPSS version 22. The categorical data presented as frequency (%) and the comparison made using Chi-square or Fisher exact test. Results: (i) 78.2% girls knew about breast cancer, 19.2% of these were aware of BSE, and 22.9% of BSE knowing ever performed it (ii) Awareness of breast cancer and BSE, and its practice is significantly associated with their academic level and family income (iii) The consumption of alcohol beverages and physical activity of girls was positively associated with educational level and family income (iv) Body mass index (BMI) was weakly associated with family income with an insignificant relationship with academic level (v) oily food consumption related inversely with the level of education irrespective of family income (vi) there was a positive correlation between parents education and family income. Conclusions: The results show a severe lack of breast cancer knowledge in senior school and college-going girls under the survey. To spread community awareness, we suggest a public health policy-driven educational intervention through culturally relevant mass/social media on the risk factors of breast cancer and practice of BSE. It is also recommended that dedicated facilities be created for breast cancer early diagnosis in the public health system.
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Affiliation(s)
- Sutapa Biswas
- Cancer Foundation of India, Kolkata, West Bengal, India
| | | | | | - Shashi Sharma
- National Institute of Cancer Prevention & Research, NOIDA, U.P, India
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Abdul-Khalek RA, Abu-Sitta G, El Achi N, Kayyal W, Elamine A, Noubani A, Menassa M, Ahmed F, Sullivan R, Mukherji D. Mapping breast cancer journal publications in conflict settings in the MENA region: a scoping review. Ecancermedicalscience 2020; 14:1129. [PMID: 33209120 PMCID: PMC7652545 DOI: 10.3332/ecancer.2020.1129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 01/22/2023] Open
Abstract
Background Breast cancer is a major cause of cancer-related morbidity and mortality among women in the the Middle East and North Africa (MENA) region. Conflict and political instability in the region may affect medical research output, including that on breast cancer. This scoping review aims to systematically identify and map breast cancer publications across different stages of the cancer care pathway and across conflict-affected countries within the MENA region. The findings of this work will highlight the impact of conflict on cancer research that could be mitigated with the proper contextualised capacity strengthening intervention. Methods We followed the PRISMA-Scr methodology. We searched for peer-reviewed publications on topics related to breast cancer in 11 databases: Medline, PubMed, EMBASE, Web of Science, PROQUEST, CINAHL, Global Index Medicus, Arab World Searches Complete, Popline, Scopus and Google Scholar using both controlled vocabulary and keywords. Publication abstracts and full-text versions were screened for duplicates and included in our study based on pre-specified eligibility criteria: focused on breast cancer, related to the specific country of analysis and human or health system studies. We used a structured data extraction form to extract information related to the article, its methodology and the cancer care pathway being studied. Results A total of 19,215 citations were retrieved from our search. After removing duplicates, a total of 8,622 articles remained. Title and abstract screening retained 1,613 articles. Publications with first author affiliations to Turkey were consistently the highest across all categories of the cancer care pathway. Trends show an increase in articles from Lebanon, Jordan and Palestine after 2015. Early exploratory and epidemiological studies represented the majority of breast cancer research, followed by policy and implementation research and lastly experimental research. Most research conducted followed an observational study design. Important gaps were identified in the research output related to advanced breast cancer and palliative care (Libya, Syria and Yemen), mental health (Libya), and knowledge and education of breast cancer (Libya and Syria). Conclusion This scoping review has identified key areas in breast cancer research that lack significant research activity in conflict MENA settings. These areas, including but are not limited to palliative care, mental health, and education, can be prioritised and developed through regional collaboration and contextualised capacity strengthening initiatives.
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Affiliation(s)
- Rima A Abdul-Khalek
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ghassan Abu-Sitta
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nassim El Achi
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Walaa Kayyal
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ahmad Elamine
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Aya Noubani
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Marilyne Menassa
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Fahad Ahmed
- Institute of Oncology, Hacettepe University, Ankara, Turkey
| | - Richard Sullivan
- King's Health Partners Comprehensive Cancer Centre and Institute of Cancer Policy, King's College London, London, UK
| | - Deborah Mukherji
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
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Hunter N, Dempsey N, Tbaishat F, Jahanzeb M, Al-Sukhun S, Gralow JR. Resource-Stratified Guideline-Based Cancer Care Should Be a Priority: Historical Context and Examples of Success. Am Soc Clin Oncol Educ Book 2020; 40:1-10. [PMID: 32223670 DOI: 10.1200/edbk_279693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Low- and middle-income countries (LMICs) are shouldering most of the burden of the rapidly increasing cancer incidence and mortality worldwide, and this situation is projected to worsen in coming decades. Studies estimate that more than one million deaths could be prevented annually if all patients received high-quality care, but most LMICs lack the resources and infrastructure to adopt U.S. or European clinical oncology practice guidelines. Several organizations have developed resource-stratified guidelines (RSGs) to provide graduated and/or region-specific strategies for cancer diagnosis and treatment. The birth of these efforts traces to 2002, when the World Health Organization (WHO) called for tailoring cancer treatments to the level of available resources by country; the Breast Health Global Initiative (BHGI) formalized the first stratified guidelines for breast cancer shortly thereafter. Since then, multiple organizations including ASCO and the National Comprehensive Cancer Network (NCCN) have created guidelines customized for various cancer subtypes and regions. These RSGs offer roadmaps for policy makers, clinicians, and health care administrators in LMICs to design projects in implementation science that can gradually and strategically raise the quality of cancer care in their nation or region. Although the same resource limitations that complicate cancer care in these areas also pose barriers to data gathering and research, some countries have met the challenge and are improving cancer care using RSGs as a metric for success.
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Affiliation(s)
- Natasha Hunter
- Division of Oncology, University of Washington, Seattle, WA
| | | | - Fayez Tbaishat
- Department of Oncology, Al Bashir Hospital, Amman, Jordan
| | | | | | - Julie R Gralow
- Division of Oncology, University of Washington, Seattle, WA
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Chao CA, Huang L, Visvanathan K, Mwakatobe K, Masalu N, Rositch AF. Understanding women's perspectives on breast cancer is essential for cancer control: knowledge, risk awareness, and care-seeking in Mwanza, Tanzania. BMC Public Health 2020; 20:930. [PMID: 32539723 PMCID: PMC7296642 DOI: 10.1186/s12889-020-09010-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Breast Cancer is the most common cancer in women worldwide. Since 2008, Mwanza, Tanzania, has worked to provide comprehensive cancer services through its Zonal consultant hospital. New national guidelines focused on clinical breast exam requires that women be aware of and seek care for breast concerns. Therefore, this study aims to understand breast cancer awareness in Mwanza and describe women-level barriers, care-seeking behavior, and perspectives on breast cancer. METHODS A community-based survey was administered to conveniently sampled women aged 30 and older to assess women's perspectives on breast cancer and care-seeking behavior. RESULTS Among 1129 women with a median age of 37 (IQR: 31-44) years, 73% have heard of cancer and 10% have received breast health education. Women self-evaluated their knowledge of breast cancer (from 1-none to 10-extremely knowledgeable) with a median response of 3 (IQR: 1-4). Only 14% felt they knew any signs or symptoms of breast cancer. Encouragingly, 56% of women were fairly-to-very confident they would notice changes in their breasts, with 24% of women practicing self-breast examination and 21% reporting they had received a past breast exam. Overall, 74% said they would be somewhat-to-very likely to seek care if they noticed breast changes, with 96% noting severity of symptoms as a motivator. However, fear of losing a breast (40%) and fear of a poor diagnosis (38%) were most frequent barriers to care seeking. In assessing knowledge of risk factors, about 50% of women did not know any risk factors for breast cancer whereas 42% of women believed long term contraceptive use a risk factor. However, 37% and 35% of women did not think that family history or being older were risk factors, respectively. CONCLUSIONS The success of efforts to improve early diagnosis in a setting without population-based screening depends on women being aware of breast cancer signs and symptoms, risks, and ultimately seeking care for breast concerns. Fortunately, most women said they would seek care if they noticed a change in their breasts, but the low levels of cancer knowledge, symptoms, and common risk factors highlight the need for targeted community education and awareness campaigns.
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Affiliation(s)
- Christina A Chao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Liuye Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kisa Mwakatobe
- Tanzania Breast Cancer Foundation, Dar es Salaam, Tanzania
| | - Nestory Masalu
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Predicting Factors of Mammography Adherence among Iranian Women Based on Transtheoretical Model. JOURNAL OF RESEARCH DEVELOPMENT IN NURSING AND MIDWIFERY 2020. [DOI: 10.52547/jgbfnm.17.2.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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24
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Bansal S, Deshpande V, Zhao X, Lauer JA, Meheus F, Ilbawi A, Gopalappa C. Analysis of Mammography Screening Schedules under Varying Resource Constraints for Planning Breast Cancer Control Programs in Low- and Middle-Income Countries: A Mathematical Study. Med Decis Making 2020; 40:364-378. [PMID: 32160823 DOI: 10.1177/0272989x20910724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Low-and-middle-income countries (LMICs) have higher mortality-to-incidence ratio for breast cancer compared to high-income countries (HICs) because of late-stage diagnosis. Mammography screening is recommended for early diagnosis, however, the infrastructure capacity in LMICs are far below that needed for adopting current screening guidelines. Current guidelines are extrapolations from HICs, as limited data had restricted model development specific to LMICs, and thus, economic analysis of screening schedules specific to infrastructure capacities are unavailable. Methods. We applied a new Markov process method for developing cancer progression models and a Markov decision process model to identify optimal screening schedules under a varying number of lifetime screenings per person, a proxy for infrastructure capacity. We modeled Peru, a middle-income country, as a case study and the United States, an HIC, for validation. Results. Implementing 2, 5, 10, and 15 lifetime screens would require about 55, 135, 280, and 405 mammography machines, respectively, and would save 31, 62, 95, and 112 life-years per 1000 women, respectively. Current guidelines recommend 15 lifetime screens, but Peru has only 55 mammography machines nationally. With this capacity, the best strategy is 2 lifetime screenings at age 50 and 56 years. As infrastructure is scaled up to accommodate 5 and 10 lifetime screens, screening between the ages of 44-61 and 41-64 years, respectively, would have the best impact. Our results for the United States are consistent with other models and current guidelines. Limitations. The scope of our model is limited to analysis of national-level guidelines. We did not model heterogeneity across the country. Conclusions. Country-specific optimal screening schedules under varying infrastructure capacities can systematically guide development of cancer control programs and planning of health investments.
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Affiliation(s)
| | | | - Xinmeng Zhao
- University of Massachusetts-Amherst, Amherst, MA, USA
| | | | - Filip Meheus
- International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
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25
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Setyowibowo H, Hunfeld JAM, Iskandarsyah A, Yudiana W, Passchier J, Sadarjoen SS, Badudu DF, Suardi DR, Hof EV, Sijbrandij M. A self-help intervention for reducing time to diagnosis in Indonesian women with breast cancer symptoms. Psychooncology 2019; 29:696-702. [PMID: 31852021 PMCID: PMC7217183 DOI: 10.1002/pon.5316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/06/2019] [Accepted: 10/28/2019] [Indexed: 12/26/2022]
Abstract
Objective We investigated the effectiveness of a self‐help intervention named PERANTARA, which aims to improve adherence to diagnostic procedures among women with breast cancer (BC) symptoms to reduce the time to a definitive diagnosis. Methods With a cluster randomized crossover design across four hospitals, PERANTARA and treatment as usual (TAU) or TAU only was provided at successive periods in a randomly determined order. The main outcome was the time between the first medical consultation and the definitive diagnosis. Secondary outcomes were BC knowledge, measured by the Breast Cancer Knowledge Test (BCKT); symptoms of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS); quality of life, measured by the World Health Organization Quality of Life‐BREF (WHOQOL‐BREF); and health status, measured by the EQ‐5D‐5L. A linear mixed model analysis was conducted to analyse the outcomes. Results We recruited 132 women with BC symptoms from four hospitals; 67 participants were in the intervention group, and 65 participants were in the control group. PERANTARA reduced the time to definitive diagnosis by 13.3 days (M [SD]: 25.90 [23.20] in the intervention group vs 39.29 [35.10] in the control group; mean difference = −13.26, 95% CI = −24.51 to −2.00, P = .02). No significant difference was found between the groups in BC knowledge, symptoms of anxiety, depression, quality of life, or health status. Conclusions PERANTARA reduced the time to definitive diagnosis among Indonesian women with BC symptoms. Psychoeducation may be an important addition to regular BC care to prevent undue delays in diagnostic procedures.
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Affiliation(s)
- Hari Setyowibowo
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Educational Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Joke A M Hunfeld
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Aulia Iskandarsyah
- Department of Clinical Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Whisnu Yudiana
- Department of Experimental Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Jan Passchier
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sawitri S Sadarjoen
- Department of Clinical Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | | | - Drajat R Suardi
- Department of Surgical Oncology, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Edith Van't Hof
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Memon F, Saxena D, Puwar T, Raithatha S. Can urban Accredited Social Health Activist (ASHA) be change agent for breast cancer awareness in urban area: Experience from Ahmedabad India. J Family Med Prim Care 2019; 8:3881-3886. [PMID: 31879630 PMCID: PMC6924211 DOI: 10.4103/jfmpc.jfmpc_544_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/22/2019] [Accepted: 09/26/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Globally, breast cancer is one of the major public health problem. In Indian women, breast cancer is now the most common cancer, having recently overtaken cervical cancer in this respect. Breast Cancer though on the rise among Indian women, they still do not perceive themselves at risk. Poor awareness about the disease, its risk factors and the absence of population-based screening contribute to delayed diagnosis. The aim of this study is to assess knowledge and practice of breast cancer in general and breast self-examination (BSE) amongst urban accredited social health activist in Ahmedabad, Gujarat. Methods The study was conducted in three phases: pre-intervention phase, intervention phase, and post-intervention phase during 2018. A total of 104 ASHA participants were included and awareness about breast cancer and practices of breast self-examination was assessed through interviewing two different groups at two points of time: Control and Intervention group at the base line and end line. Interventional breast health education was administrated through lectures, charts and silicon breast model for the basic knowledge of the breast cancer. The data had been analyzed by using software Epi info. Results There was a significant improvement in knowledge regarding breast cancer and breast self-examination among the intervention group from pre- to post-test. An overall increase in the awareness of breast cancer 33%, Method of doing BSE of 54% and 42% of BSE practice was observed in the study group after intervention. Conclusion A significant changes were observed in the knowledge. However, the behavior change requires reinforced training in regular interval.
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Affiliation(s)
- Farjana Memon
- Department of Epidemiology, Indian Institute of Public Health Gandhinagar (IIPHG), Gujarat, India
| | - Deepak Saxena
- Department of Epidemiology, Indian Institute of Public Health Gandhinagar (IIPHG), Gujarat, India
| | - Tapasvi Puwar
- Department of Epidemiology, Indian Institute of Public Health Gandhinagar (IIPHG), Gujarat, India
| | - Shyamsundar Raithatha
- Department of Extension Programmes, Pramukh Swami Medical College, Karamsad, Gujarat, India
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Razis E, Balogun J, Lushi M, Abdel Karim K, Kalapanida D, Kadzatsa W. Report from the Front: a Glimpse at Breast Cancer Research in Low- and Middle-Income Countries. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-00329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ssentongo P, Lewcun JA, Candela X, Ssentongo AE, Kwon EG, Ba DM, Oh JS, Amponsah-Manu F, McDonald AC, Chinchilli VM, Soybel DI, Dodge DG. Regional, racial, gender, and tumor biology disparities in breast cancer survival rates in Africa: A systematic review and meta-analysis. PLoS One 2019; 14:e0225039. [PMID: 31751359 PMCID: PMC6872165 DOI: 10.1371/journal.pone.0225039] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 10/28/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The survival rates from breast cancer in Africa are poor and yet the incidence rates are on the rise. In this study, we hypothesized that, in Africa, a continent with great disparities in socio-economic status, race, tumor biology, and cultural characteristics, the survival rates from breast cancer vary greatly based on region, tumor biology (hormone receptor), gender, and race. We aimed to conduct the first comprehensive systematic review and meta-analysis on region, gender, tumor-biology and race-specific 5-year breast cancer survival rates in Africa and compared them to 20-year survival trends in the United States. METHODS We searched MEDLINE, EMBASE, and Cochrane Library to identify studies on breast cancer survival in African published before October 17, 2018. Pooled 5-year survival rates of breast cancer were estimated by random-effects models. We explored sources of heterogeneity through subgroup meta-analyses and meta-regression. Results were reported as absolute difference (AD) in percentages. We compared the survival rates of breast cancer in Africa and the United States. FINDINGS There were 54 studies included, consisting of 18,970 breast cancer cases. There was substantial heterogeneity in the survival rates (mean 52.9%, range 7-91%, I2 = 99.1%; p for heterogeneity <0.0001). Meta-regression analyses suggested that age and gender-adjusted 5-year survival rates were lower in sub-Saharan Africa compared to north Africa (AD: -25.4%; 95% CI: -34.9 - -15.82%), and in predominantly black populations compared to predominantly non-black populations (AD: -25.9%; 95% CI: 35.40 - -16.43%). Survival rates were 10 percentage points higher in the female population compared to male, but the difference was not significant. Progesterone and estrogen receptor-positive breast cancer subtypes were positively associated with survival (r = 0.39, p = 0.08 and r = 0.24, p = 0.29 respectively), but triple-negative breast cancer was negatively associated with survival. Survival rates are increasing over time more in non-black Africans (55% in 2000 versus 65% in 2018) compared to black Africans (33% in 2000 versus 40% in 2018); but, the survival rates for Africans are still significantly lower when compared to black (76% in 2015) and white (90% in 2015) populations in the United States. CONCLUSION Regional, sub-regional, gender, and racial disparities exist, influencing the survival rates of breast cancer in Africa. Therefore, region and race-specific public health interventions coupled with prospective genetic studies are urgently needed to improve breast cancer survival in this region.
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Affiliation(s)
- Paddy Ssentongo
- Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, Pennsylvania, United States of America
- Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
- Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
- * E-mail:
| | - Joseph A. Lewcun
- Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Xavier Candela
- Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Anna E. Ssentongo
- Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
- Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Eustina G. Kwon
- Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Djibril M. Ba
- Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - John S. Oh
- Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Forster Amponsah-Manu
- Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
- Department of Surgery, Eastern Regional Hospital, Koforidua, Ghana
| | - Alicia C. McDonald
- Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - David I. Soybel
- Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Daleela G. Dodge
- Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
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Cancer and Body Composition: An Association of Global Relevance. WOMEN’S HEALTH BULLETIN 2019. [DOI: 10.5812/whb.65315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ekdahl Hjelm T, Matovu A, Mugisha N, Löfgren J. Breast cancer care in Uganda: A multicenter study on the frequency of breast cancer surgery in relation to the incidence of breast cancer. PLoS One 2019; 14:e0219601. [PMID: 31295322 PMCID: PMC6622523 DOI: 10.1371/journal.pone.0219601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/27/2019] [Indexed: 12/29/2022] Open
Abstract
Background Breast cancer is the most common cancer in women worldwide. Considerable funding and efforts are invested in breast cancer research and healthcare, but only a fraction of this reaches women and healthcare systems in low income countries. Surgical treatment is an essential part of breast cancer care, but access to surgery is in general very limited in low income countries such as Uganda. In this study, the previously unknown nationwide rate of breast cancer surgery was investigated. Methods and findings This was a multicenter, retrospective study, investigating breast cancer surgery in the public healthcare system in Uganda. Data were collected from operating theater registries at primary, secondary and tertiary level healthcare centres throught the country, including 14 general hospitals, the 14 regional referral hospitals and the national referral hospital. Patients who underwent major surgery for breast cancer at these hospitals during 2013 and 2014 were included. The number of breast cancer procedures performed, geographical variation, level of healthcare staff performing surgery and patient characteristics were investigated. After correction for missing data, a total of 137 breast cancer procedures were performed each year within the public healthcare system, corresponding to 5.7% of the breast cancer incidence in the country at that time. Most procedures (n = 161, 59.0%) were performed at the national referral hospital by qualified surgeons. Many of the patients were young; 30.1% being less than 40 years old. The proportion of male breast cancers in the study was large (6.2%). Conclusions The rate of breast cancer surgery in Uganda is minimal and in several parts of the country breast cancer surgery is not performed at all. More resources must be directed towards breast cancer in low income countries such as Uganda. The fact that the patients were young calls for further research, prevention and treatment specifically targeting young women in the study setting.
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Affiliation(s)
- Tove Ekdahl Hjelm
- Department of Oncology, Stockholm South General Hospital, Stockholm, Sweden
- * E-mail:
| | | | - Noleb Mugisha
- Department of Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Jenny Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Validation of a low-cost, carbon dioxide-based cryoablation system for percutaneous tumor ablation. PLoS One 2019; 14:e0207107. [PMID: 31269078 PMCID: PMC6608927 DOI: 10.1371/journal.pone.0207107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 06/02/2019] [Indexed: 11/23/2022] Open
Abstract
Breast cancer rates are rising in low- and middle-income countries (LMICs), yet there is a lack of accessible and cost-effective treatment. As a result, the cancer burden and death rates are highest in LMICs. In an effort to meet this need, our work presents the design and feasibility of a low-cost cryoablation system using widely-available carbon dioxide as the only consumable. This system uses an 8-gauge outer-diameter needle and Joule-Thomson expansion to percutaneously necrose tissue with cryoablation. Bench top experiments characterized temperature dynamics in ultrasound gel demonstrated that isotherms greater than 2 cm were formed. Further, this system was applied to mammary tumors in an in vivo rat model and necrosis was verified by histopathology. Finally, freezing capacity under a large heat load was assessed with an in vivo porcine study, where volumes of necrosis greater than 1.5 cm in diameter confirmed by histopathology were induced in a highly perfused liver after two 7-minute freeze cycles. These results demonstrate the feasibility of a carbon-dioxide based cryoablation system for improving solid tumor treatment options in resource-constrained environments.
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Ghose S, Radhakrishnan V, Bhattacharya S. Ethics of cancer care: beyond biology and medicine. Ecancermedicalscience 2019; 13:911. [PMID: 31123494 PMCID: PMC6467456 DOI: 10.3332/ecancer.2019.911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Indexed: 11/23/2022] Open
Abstract
Treatable cancers are on the rise due to improved early diagnosis and more innovative treatments, and preventative strategies against cancer are becoming a global concern. With the rapidly increasing complexity of cancer treatment, a clear definition of what constitutes ethical cancer care has become a matter of great debate. This situation is more complex in a developing country where healthcare resources are limited. Doctors, nurses and public health professionals engaged in the prevention, screening, diagnosis, treatment and research of cancers are often posed with ethical dilemmas while making complex choices. With a special focus on low- and middle-income countries, this paper is intended to highlight these real-world ethical concerns facing those involved in the management of cancer patients. While taking a neutral view, this paper has adopted a theme-wise approach to discuss barriers in cancer care.
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Affiliation(s)
- Soumita Ghose
- Administration and Policy, Tata Medical Centre, Kolkata 700156, India
| | - Vivek Radhakrishnan
- Department of Clinical Haematology and Hematopoietic Cell Therapy, Tata Medical Centre, Kolkata 700156, India
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Crouch BT, Gallagher J, Wang R, Duer J, Hall A, Soo MS, Hughes P, Haystead T, Ramanujam N. Exploiting heat shock protein expression to develop a non-invasive diagnostic tool for breast cancer. Sci Rep 2019; 9:3461. [PMID: 30837677 PMCID: PMC6400939 DOI: 10.1038/s41598-019-40252-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/12/2019] [Indexed: 01/23/2023] Open
Abstract
Leveraging the unique surface expression of heat shock protein 90 (Hsp90) in breast cancer provides an exciting opportunity to develop rapid diagnostic tests at the point-of-care setting. Hsp90 has previously been shown to have elevated expression levels across all breast cancer receptor subtypes. We have developed a non-destructive strategy using HS-27, a fluorescently-tethered Hsp90 inhibitor, to assay surface Hsp90 expression on intact tissue specimens and validated our approach in clinical samples from breast cancer patients across estrogen receptor positive, Her2-overexpressing, and triple negative receptor subtypes. Utilizing a pre-clinical biopsy model, we optimized three imaging parameters that may affect the specificity of HS-27 based diagnostics – time between tissue excision and staining, agent incubation time, and agent dose, and translated our strategy to clinical breast cancer samples. Findings indicated that HS-27 florescence was highest in tumor tissue, followed by benign tissue, and finally followed by mammoplasty negative control samples. Interestingly, fluorescence in tumor samples was highest in Her2+ and triple negative subtypes, and inversely correlated with the presence of tumor infiltrating lymphocytes indicating that HS-27 fluorescence increases in aggressive breast cancer phenotypes. Development of a Gaussian support vector machine classifier based on HS-27 fluorescence features resulted in a sensitivity and specificity of 82% and 100% respectively when classifying tumor and benign conditions, setting the stage for rapid and automated tissue diagnosis at the point-of-care.
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Affiliation(s)
- Brian T Crouch
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
| | | | - Roujia Wang
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Joy Duer
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Allison Hall
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Mary Scott Soo
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Philip Hughes
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Timothy Haystead
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.,Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
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Demchig D, Mello-Thoms C, Lee W, Khurelsukh K, Ramish A, Brennan P. Observer Variability in Breast Cancer Diagnosis between Countries with and without Breast Screening. Acad Radiol 2019; 26:62-68. [PMID: 29580792 DOI: 10.1016/j.acra.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/20/2018] [Accepted: 03/01/2018] [Indexed: 11/25/2022]
Abstract
RATIONAL AND OBJECTIVES Image reporting is a vital component of patient management depending on individual radiologists' performance. Our objective was to explore mammographic diagnostic efficacy in a country where breast cancer screening does not exist. MATERIALS AND METHODS Two mammographic test sets were used: a typical screening (TS) and high-difficulty (HD) test set. Nonscreening (NS) radiologists (n = 11) read both test sets, while 52 and 49 screening radiologists read the TS and HD test sets, respectively. The screening radiologists were classified into two groups: a less experienced (LE) group with ≤5 years' experience and a more experienced (ME) group with ≥5 years' experience. A Kruskal-Wallis and Tukey-Kramer post hoc test were used to compare reading performance among reader groups, and the Wilcoxon matched pairs tests was used to compare TS and ND test sets for the NS radiologists. RESULTS Across the three reader groups, there were significant differences in case sensitivity (χ2 [2] = 9.4, P = .008), specificity (χ2 [2] = 10.3, P = .006), location sensitivity (χ2 [2] = 19.8, P < .001), receiver operating characteristics, area under the curve (χ2 [2] = 19.7, P < .001) and jack-knife free-response receiver operating characteristics (JAFROCs) (χ2 [2] = 18.1, P < .001). NS performance for all measured scores was significantly lower than those for the ME readers (P < .006), while only location sensitivity was lower (χ2 [2] = 17.5, P = .026) for the NS compared to the LE group. No other significant differences were observed. CONCLUSION Large variations in mammographic performance exist between radiologists from screening and nonscreening countries.
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Molanouri Shamsi M, Chekachak S, Soudi S, Gharakhanlou R, Quinn LS, Ranjbar K, Rezaei S, Shirazi FJ, Allahmoradi B, Yazdi MH, Mahdavi M, Voltarelli FA. Effects of exercise training and supplementation with selenium nanoparticle on T-helper 1 and 2 and cytokine levels in tumor tissue of mice bearing the 4 T1 mammary carcinoma. Nutrition 2019; 57:141-147. [DOI: 10.1016/j.nut.2018.05.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/16/2018] [Accepted: 05/07/2018] [Indexed: 11/26/2022]
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Wu TY, Lee J. Promoting Breast Cancer Awareness and Screening Practices for Early Detection in Low-Resource Settings. Eur J Breast Health 2018; 15:18-25. [PMID: 30816360 DOI: 10.5152/ejbh.2018.4305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/14/2018] [Indexed: 12/12/2022]
Abstract
Objective Breast cancer is the most common type of cancer among women in the Philippines. Philippines has one of the highest breast cancer mortality rate and the lowest mortality-to-incidence ratio in Asia. This study has three objectives: 1) explore Filipino women's knowledge, attitudes toward, and practices of breast cancer and cancer screening, 2) examine if an educational program increases women's intention to seek future breast cancer screening, and 3) examine associations between demographic variables and breast cancer screening practices. Materials and Methods A total of 944 women from two urban areas (Calasciao and Tacloban City) and one rural area (Sogood) of the Philippines participated in this cross-sectional study. Study participants attended an educational program and completed study questionnaires regarding demographics, knowledge about, and practices of breast self-exams, clinical breast exams and mammography as well as reported barriers toward future screening. Results The results showed a disparity between knowledge of routine breast cancer screening and actuals screening behaviors. Following breast health education and screening programs, participants reported greater intention to adhere to recommended breast cancer screening guidelines. The multivariate analyses showed that education level is a significant predictor for CBE and mammography uptake in current study. Conclusion This study has implications for breast cancer control among women in low-resources settings. Designing and implementing effective educational programs that increase women's awareness about breast cancer and promote screening uptake are important steps to reduce the burden affected by breast cancer among women in the Philippines and other South Asian low- to middle-income countries.
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Affiliation(s)
- Tsu-Yin Wu
- Department of Nursing, Eastern Michigan University School of Nursing, MI, USA
| | - Joohyun Lee
- Department of Mental Health Behavioral Sciences, James A. Haley VA Medical Center, Tempa, FL
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Min J, Im H, Allen M, McFarland PJ, Degani I, Yu H, Normandin E, Pathania D, Patel J, Castro CM, Weissleder R, Lee H. Computational Optics Enables Breast Cancer Profiling in Point-of-Care Settings. ACS NANO 2018; 12:9081-9090. [PMID: 30113824 PMCID: PMC6519708 DOI: 10.1021/acsnano.8b03029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The global burden of cancer, severe diagnostic bottlenecks in underserved regions, and underfunded health care systems are fueling the need for inexpensive, rapid, and treatment-informative diagnostics. On the basis of advances in computational optics and deep learning, we have developed a low-cost digital system, termed AIDA (artificial intelligence diffraction analysis), for breast cancer diagnosis of fine needle aspirates. Here, we show high accuracy (>90%) in (i) recognizing cells directly from diffraction patterns and (ii) classifying breast cancer types using deep-learning-based analysis of sample aspirates. The image algorithm is fast, enabling cellular analyses at high throughput (∼3 s per 1000 cells), and the unsupervised processing allows use by lower skill health care workers. AIDA can perform quantitative molecular profiling on individual cells, revealing intratumor molecular heterogeneity, and has the potential to improve cancer diagnosis and treatment. The system could be further developed for other cancers and thus find widespread use in global health.
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Affiliation(s)
- Jouha Min
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
| | - Hyungsoon Im
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114
| | - Matthew Allen
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
| | | | - Ismail Degani
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Hojeong Yu
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
| | - Erica Normandin
- Department of Systems Biology, Harvard Medical School, Boston, MA 02115
| | - Divya Pathania
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
| | - Jaymin Patel
- BreastCare Center, Division of Hematology Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Cesar M. Castro
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
- Massachusetts General Hospital Cancer Center, Boston, MA 02114
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114
- Department of Systems Biology, Harvard Medical School, Boston, MA 02115
| | - Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114
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Pačarić S, Kristek J, Mirat J, Kondža G, Turk T, Farčić N, Orkić Ž, Nemčić A. The quality of life of Croatian women after mastectomy: a cross-sectional single-center study. BMC Public Health 2018; 18:999. [PMID: 30097040 PMCID: PMC6086072 DOI: 10.1186/s12889-018-5929-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 08/02/2018] [Indexed: 12/31/2022] Open
Abstract
Background Measuring the quality of life (QoL) of women with breast cancer is an important aspect of measuring treatment success. In Croatia, no QoL studies have been carried out with a focus on patients after mastectomy. The aim of this study was to examine QoL 1 month and 1 year after mastectomy. Methods This cross-sectional single-center study of quality of life was conducted in 101 patients, 50 of whom had undergone a mastectomy 1 month prior, and 51 of whom had undergone a mastectomy 1 year prior. The study was conducted from July 2015 to June 2016. The questionnaires used in the study were developed by the European Organisation for Research and Treatment of Cancer (EORTC). The questionnaire EORTC QLQ-C30 assesses the QoL of cancer patients, and the questionnaire EORTC QLQ-BR23 is a disease-specific breast cancer module. A chi square test, Fisher’s exact test, Kolmogorov-Smirnov test, Student’s t-test and Mann-Whitney U test were performed in the statistical analysis using the statistical program SPSS (Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc.). Results Patients who had undergone a mastectomy a year earlier placed a higher value on their health state than did those who had undergone a mastectomy a month earlier. The most affected values of functional status on the EORTC QLQ-C30 scale were emotional functioning (37.5 [95% CI 33.3–61.6]) and sexual functioning (16.67 [95% CI 0–33.3]) 1 month and 1 year after mastectomy, respectively. The most affected symptoms on the EORTC QLQ-C30 scale were hair loss 66.67 [95% CI 33.3–100]) and fatigue 33.33 [95% CI 24–44]) 1 month and 1 year after mastectomy, respectively. Conclusion In our study, both functional and symptom scales were more affected in women 1 month after mastectomy. QoL was considerably improved in women 1 year after the surgery compared to 1 month after mastectomy. The results of this study could contribute to the public awareness of the QoL of breast cancer patients.
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Affiliation(s)
- Stana Pačarić
- Department of Surgery, Faculty of Medicine, University of Osijek, Osijek, Croatia. .,Department of Surgery, University Hospital Osijek, Huttlerova 4, 31000, Osijek, Croatia.
| | - Jozo Kristek
- Department of Surgery, Faculty of Medicine, University of Osijek, Osijek, Croatia.,Department of Surgery, University Hospital Osijek, Huttlerova 4, 31000, Osijek, Croatia
| | - Jure Mirat
- Faculty of Medicine, University of Osijek, Cara Hadrijana 10/E, HR, 31000, Osijek, Croatia
| | - Goran Kondža
- Department of Surgery, Faculty of Medicine, University of Osijek, Osijek, Croatia.,Department of Surgery, University Hospital Osijek, Huttlerova 4, 31000, Osijek, Croatia
| | - Tajana Turk
- Department of Biophysics and Radiology, Faculty of Medicine, University of Osijek, Osijek, Croatia.,Department of Diagnostic and Interventional Radiology, University Hospital Osijek, Huttlerova 4, 31000, Osijek, Croatia
| | - Nikolina Farčić
- Department of Surgery, University Hospital Osijek, Huttlerova 4, 31000, Osijek, Croatia.,Department of Nursing, Medical Ethics and Palliative Medicine, Faculty of Medicine, University of Osijek, Osijek, Croatia
| | - Želimir Orkić
- Department of Surgery, Faculty of Medicine, University of Osijek, Osijek, Croatia.,Department of Surgery, University Hospital Osijek, Huttlerova 4, 31000, Osijek, Croatia
| | - Ana Nemčić
- Department of Surgery, Faculty of Medicine, University of Osijek, Osijek, Croatia.,Department of Surgery, University Hospital Osijek, Huttlerova 4, 31000, Osijek, Croatia
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Ginsburg O, Rositch AF, Conteh L, Mutebi M, Paskett ED, Subramanian S. Breast Cancer Disparities Among Women in Low- and Middle-Income Countries. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0286-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Demchig D, Mello-Thoms C, Lee WB, Khurelsukh K, Ramish A, Brennan PC. Mammographic detection of breast cancer in a non-screening country. Br J Radiol 2018; 91:20180071. [PMID: 29987982 DOI: 10.1259/bjr.20180071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE: To compare the diagnostic accuracy between radiologists' from a country with and without breast cancer screening. METHODS: All participating radiologists gave informed consent. A test-set involving 60 mammographic cases (20 cancer and 40 non-cancer) were read by 11 radiologists from a non-screening (NS) country during a workshop in July 2016. 52 radiologists from a screening country read the same test-set at the Royal Australian and New Zealand College of Radiologists' meetings in July 2015. The screening radiologists were classified into two groups: those with less than or equal to 5 years of experience; those with more than 5 years of experience, and each group was compared to the group of NS radiologists. A Kruskal-Wallis test followed by post-hoc multiple comparisons test were used to compare measures of diagnostic accuracy among the reader groups. RESULTS: The diagnostic accuracy of the NS radiologists was significantly lower in terms of sensitivity [mean = 54.0; 95% confidence interval (CI) (40.0-67.0)], location sensitivity [mean = 26.0; 95% CI (16.0-37.0)], receive roperating characteristic area under curve [mean = 73.0; 95% CI (66.5-81.0)] and Jackknifefree-response receiver operating characteristics figure-of-merit [mean = 45.0; 95% CI (40.0-50.0)] when compared with the less and more experienced screening radiologists, whilst no difference in specificity [mean = 75.0; 95% CI (70.0- 81.0)] was found. No significant differences in all measured diagnostic accuracy were found between the two groups of screening radiologists. CONCLUSION: The mammographic performance of a group of radiologists from a country without screening program was suboptimal compared with radiologists from Australia. ADVANCES IN KNOWLEDGE: Identifying mammographic performance in developing countries is required to optimize breast cancer diagnosis.
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Affiliation(s)
- Delgermaa Demchig
- 1 Medical Image Optimization and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney , Sydney, NSW , Australia
| | - Claudia Mello-Thoms
- 1 Medical Image Optimization and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney , Sydney, NSW , Australia
| | - Warwick B Lee
- 1 Medical Image Optimization and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney , Sydney, NSW , Australia
| | - Khulan Khurelsukh
- 2 Department of Diagnostic Radiology, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Asai Ramish
- 3 Department of Diagnostic Radiology, National Cancer Center , Ulaanbaatar , Mongolia
| | - Patrick C Brennan
- 1 Medical Image Optimization and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney , Sydney, NSW , Australia
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El Saghir NS, El Tomb PA, Carlson RW. Breast Cancer Diagnosis and Treatment in Low- and Mid-Resource Settings: the Role of Resource-Stratified Clinical Practice Guidelines. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0287-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42
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Dusengimana JMV, Hategekimana V, Borg R, Hedt-Gauthier B, Gupta N, Troyan S, Shulman LN, Nzayisenga I, Fadelu T, Mpunga T, Pace LE. Pregnancy-associated breast cancer in rural Rwanda: the experience of the Butaro Cancer Center of Excellence. BMC Cancer 2018; 18:634. [PMID: 29866062 PMCID: PMC5987575 DOI: 10.1186/s12885-018-4535-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 05/21/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Breast cancer is the most common malignancy encountered during pregnancy. However, the burden of pregnancy-associated breast cancer (PABC) and subsequent care is understudied in sub-Saharan Africa (SSA). Here, we describe the characteristics, diagnostic delays and treatment of women with PABC seeking care at a rural cancer referral facility in Rwanda. METHODS Data from female patients aged 18-50 years with pathologically confirmed breast cancer who presented for treatment between July 1, 2012 and February 28, 2014 were retrospectively reviewed. PABC was defined as breast cancer diagnosed in a woman who was pregnant or breastfeeding. Numbers and frequencies are reported for demographic and diagnostic delay variables and Wilcoxon rank sum and Fisher's exact tests are used to compare characteristics of women with PABC to women with non-PABC at the alpha = 0.05 significance level. Treatment and outcomes are described for women with PABC only. RESULTS Of the 117 women with breast cancer, 12 (10.3%) had PABC based on medical record review. The only significant demographic differences were that women with PABC were younger (p = 0.006) and more likely to be married (p = 0.035) compared to women with non-PABC. There were no significant differences in diagnostic delays or stage at diagnosis between women with PABC and women with non-PABC women. Eleven of the women with PABC received treatment, three had documented treatment delays or modifications due to their pregnancy or breastfeeding, and four stopped breastfeeding to initiate treatment. At the end of the study period, six patients were alive, three were deceased and three patients were lost to follow-up. CONCLUSIONS PABC was relatively common in our cohort but may have been underreported. Although patients with PABC did not experience greater diagnostic delays, most had treatment modifications, emphasizing the potential value of PABC-specific treatment protocols in SSA. Larger prospective studies of PABC are needed to better understand particular challenges faced by these patients and inform policies and practices to optimize care for women with PABC in Rwanda and similar settings.
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Affiliation(s)
| | | | - Ryan Borg
- Partners In Health/Inshuti Mu Buzima, P.O.Box 3432, Kigali, Rwanda
| | - Bethany Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, P.O.Box 3432, Kigali, Rwanda
- Harvard Medical School, Boston, MA USA
| | - Neil Gupta
- Partners In Health/Inshuti Mu Buzima, P.O.Box 3432, Kigali, Rwanda
- Harvard Medical School, Boston, MA USA
- Brigham and Women’s Hospital, Boston, MA USA
| | - Susan Troyan
- Harvard Medical School, Boston, MA USA
- Brigham and Women’s Hospital, Boston, MA USA
| | | | | | | | | | - Lydia E. Pace
- Harvard Medical School, Boston, MA USA
- Brigham and Women’s Hospital, Boston, MA USA
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Demonstration of an algorithm to overcome health system-related barriers to timely diagnosis of breast diseases in rural Zambia. PLoS One 2018; 13:e0196985. [PMID: 29746541 PMCID: PMC5945023 DOI: 10.1371/journal.pone.0196985] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/24/2018] [Indexed: 01/07/2023] Open
Abstract
Background Long delays to diagnosis is a major cause of late presentation of breast diseases in sub-Saharan Africa. Aims We designed and implemented a single-visit breast care algorithm that overcomes health system-related barriers to timely diagnosis of breast diseases. Methods A multidisciplinary team of Zambian healthcare experts trained a team of mid- and high-level Zambian healthcare practitioners how to evaluate women for breast diseases, and train trainers to do likewise. Working collaboratively, the two teams then designed a clinical platform that provides multiple breast care services within a single visit. The service platform was implemented using a breast outreach camp format, during which breast self-awareness, psychosocial counseling, clinical breast examination, breast ultrasound, ultrasound-guided biopsy, imprint cytology of biopsy specimens and surgical treatment or referral, were offered within a single visit. Results Eleven hundred and twenty-nine (1129) women attended the camps for breast care. Mean age was 35.9 years. The majority were multiparous (79.4%), breast-fed (76.0%), and reported hormone use (50.4%). Abnormalities were detected on clinical breast examination in 122 (10.8%) women, 114 of whom required ultrasound. Of the 114 who underwent ultrasound, 48 had identifiable lesions and were evaluated with ultrasound-guided core needle biopsy (39) or fine-needle aspiration (9). The concordance between imprint cytology and histopathology was 100%, when breast specimens were classified as either benign or malignant. However, when specimens were classified by histopathologic subtype, the concordance between imprint cytology and histology was 85.7% for benign and 100% for malignant lesions. Six (6) women were diagnosed with invasive cancer. Eighteen (18) women with symptomatic breast lesions had next-day surgery. Significance Similar to its impact on cervical cancer prevention services, a single visit breast care algorithm has the potential to overcome health system-related barriers to timely diagnosis of breast diseases, including cancer, in rural African settings.
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Ndetei D, Musyimi C, Tele A, Musau A, Gitonga I, Mutiso V. Psychological Well-Being and Social Functioning Across the Cancer Stages: Implications for Palliative Care. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2018; 14:194-208. [PMID: 31307350 DOI: 10.1080/15524256.2018.1472718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 06/10/2023]
Abstract
Studies conducted regarding cancer care have mainly focused on the management of physical conditions, with few studies assessing psychological well-being throughout illness course. This cross-sectional study (n = 389) examined the psychological well-being and social functioning of patients with cancer across cancer stages, among adult patients attending a cancer clinic at a public referral hospital in Kenya. Social and occupational functioning entails the ability to interact optimally with one's environments including work, social activities, and relationships and fulfill the roles within such environments, as well as engage in meaningful activities of daily life. Psychological well-being, on the other hand, is a dynamic concept that includes subjective, social, and psychological dimensions and health-related behaviors. We used various measures to assess different facets of respondent's life and psychological well-being. Results showed that cancer status was negatively associated with social and occupational functioning and psychological well-being. Results also revealed that increasing severity of an individual's cancer disease placed them at a higher risk of disability and psychological impairment. To reduce this risk, routine psychological care across the disease continuum is recommended.
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Affiliation(s)
- David Ndetei
- a Africa Mental Health Foundation , Nairobi , Kenya
- b Department of Psychiatry , University of Nairobi , Nairobi , Kenya
| | | | - Albert Tele
- a Africa Mental Health Foundation , Nairobi , Kenya
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Fu S, Cheng J, Wei C, Yang L, Xiao X, Zhang D, Stewart MD, Fu J. Development of diagnostic SCAR markers for genomic DNA amplifications in breast carcinoma by DNA cloning of high-GC RAMP-PCR fragments. Oncotarget 2018; 8:43866-43877. [PMID: 28410206 PMCID: PMC5546446 DOI: 10.18632/oncotarget.16704] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/19/2017] [Indexed: 12/28/2022] Open
Abstract
Cancer is genetically heterogeneous regarding to molecular genetic characteristics and pathogenic pathways. A wide spectrum of biomarkers, including DNA markers, is used in determining genomic instability, molecular subtype determination and disease prognosis, and estimating sensitivity to different drugs in clinical practice. In a previous study, we developed highly effective DNA markers using improved random amplified polymorphic DNA (RAPD) with high-GC primers, which is a valuable approach for the genetic authentication of medicinal plants. In this study, we applied this effective DNA marker technique to generate genetic fingerprints that detect genomic alterations in human breast cancer tissues and then developed sequence-characterized amplified region (SCAR) markers. Three SCAR markers (BC10-1, BC13-4 and BC31-2) had high levels of genomic DNA amplification in breast cancer. The PHKG2 and RNF40 genes are either overlapping or close to the sequences of SCAR marker BC13-4, while SCAR marker BC10-1 is in the intron and overlap the DPEP1 gene, suggesting that alterations in the expression of these genes could contribute to cancer progression. Screening of breast cancer cell lines showed that the mRNA expression levels for the PHKG2 and DPEP1 were lower in non-tumorigenic mammary epithelial cell MCF10A, but elevated in other cell lines. The DPEP1 mRNA level in invasive ductal carcinoma specimens was significantly higher than that of the adjacent normal tissues in women. Taken together, high-GC RAMP-PCR provides greater efficacy in measuring genomic DNA amplifications, deletion or copy number variations. Furthermore, SCAR markers BC10-1 and BC13-4 might be useful diagnostic markers for breast cancer carcinomas.
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Affiliation(s)
- Shangyi Fu
- Honors College, University of Houston, Houston, TX 77204, USA
| | - Jingliang Cheng
- Key Laboratory of Epigentics and Oncology, the Research Center for Preclinical Medicine, Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Chunli Wei
- Key Laboratory of Epigentics and Oncology, the Research Center for Preclinical Medicine, Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Luquan Yang
- Key Laboratory of Epigentics and Oncology, the Research Center for Preclinical Medicine, Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Xiuli Xiao
- Department of Pathology, Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Dianzheng Zhang
- Department of Bio-Medical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131, USA
| | - M David Stewart
- Honors College, University of Houston, Houston, TX 77204, USA.,Department of Biology & Biochemistry, University of Houston, Houston, TX 77204, USA.,Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX 77030, USA
| | - Junjiang Fu
- Key Laboratory of Epigentics and Oncology, the Research Center for Preclinical Medicine, Southwest Medical University, Luzhou, Sichuan 646000, China.,Judicial Authentication Center, Southwest Medical University, Luzhou, Sichuan 646000, China
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Cubasch H, Dickens C, Joffe M, Duarte R, Murugan N, Tsai Chih M, Moodley K, Sharma V, Ayeni O, Jacobson JS, Neugut AI, McCormack V, Ruff P. Breast cancer survival in Soweto, Johannesburg, South Africa: A receptor-defined cohort of women diagnosed from 2009 to 11. Cancer Epidemiol 2018; 52:120-127. [PMID: 29306221 PMCID: PMC6127863 DOI: 10.1016/j.canep.2017.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND South Africa's public healthcare system is better equipped to manage breast cancer than most other SSA countries, but survival rates are unknown. METHODS A historical cohort of 602 women newly diagnosed with invasive breast carcinoma during 2009-2011 at Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, was followed using health systems data to December 2014. 'Overall survival' time was defined from diagnosis to death or terminal illness. Cox regression was used to estimate hazard ratios (HR) associated with woman and tumour characteristics. RESULTS During a median 2.1 years follow-up (IQR 0.5-3.8), 149 women died or were classified terminally ill; 287 were lost-to-follow-up. 3-year survival was 84% for early stage (I/II) and 56% for late stage (III/IV) tumours (late v early: HR 2.8 (95% confidence interval (CI): 1.9-4.1), however the 42% cumulative losses to follow-up over this period were greater for late stage, half of which occurred within 6 months of diagnosis. After mutual adjustment for stage, grade, age, receptor subtype and HIV status, lower survival was also associated with triple negative (HR 3.1 (95% CI: 1.9-5.0)) and HER2-enriched (2.5 (95% CI: 1.4-4.5)) compared to ER/PR+ HER2- tumours, but not with age or HIV-infection (1.4 (95% CI: 0.8, 2.3)). CONCLUSION In this South African cohort, breast cancer survival is suboptimal, but was better for early stage and hormone receptor-positive tumours. Efforts to reduce clinic losses in the immediate post-diagnosis period, in addition to early presentation and accelerated diagnosis and treatment, are needed to prevent breast cancer deaths, and survival improvements need to be monitored using prospective studies with active follow-up.
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Affiliation(s)
- Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa; Batho Pele Breast Unit, Chris Hani Baragwanath Academic Hospital, 26 Chris Hani Road, Diepkloof, Johannesburg, 1864, South Africa; Wits Health Consortium, University of Witwatersrand, 8 Blackwood Ave, Parktown, Johannesburg, 2193, South Africa
| | - Caroline Dickens
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Maureen Joffe
- Batho Pele Breast Unit, Chris Hani Baragwanath Academic Hospital, 26 Chris Hani Road, Diepkloof, Johannesburg, 1864, South Africa; Wits Health Consortium, University of Witwatersrand, 8 Blackwood Ave, Parktown, Johannesburg, 2193, South Africa; Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Raquel Duarte
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Nivashni Murugan
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa; Batho Pele Breast Unit, Chris Hani Baragwanath Academic Hospital, 26 Chris Hani Road, Diepkloof, Johannesburg, 1864, South Africa
| | - Ming Tsai Chih
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa; Batho Pele Breast Unit, Chris Hani Baragwanath Academic Hospital, 26 Chris Hani Road, Diepkloof, Johannesburg, 1864, South Africa
| | - Kiashanee Moodley
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Vinay Sharma
- Wits Health Consortium, University of Witwatersrand, 8 Blackwood Ave, Parktown, Johannesburg, 2193, South Africa; Department of Radiation Oncology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Oluwatosin Ayeni
- Batho Pele Breast Unit, Chris Hani Baragwanath Academic Hospital, 26 Chris Hani Road, Diepkloof, Johannesburg, 1864, South Africa; Wits Health Consortium, University of Witwatersrand, 8 Blackwood Ave, Parktown, Johannesburg, 2193, South Africa
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, 630 W 168th St., New York, NY 10032, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, United States
| | - Alfred I Neugut
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, 630 W 168th St., New York, NY 10032, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, United States; Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY 10032, United States
| | - Valerie McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Paul Ruff
- Wits Health Consortium, University of Witwatersrand, 8 Blackwood Ave, Parktown, Johannesburg, 2193, South Africa; Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa; Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
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Khullar P, Garg C, Sinha SN, Kaur I, Datta NR. An in silico comparative dosimetric study of postmastectomy locoregional irradiation using intensity-modulated vs 3-dimensional conventional radiotherapy. Med Dosim 2018; 43:370-376. [PMID: 29352629 DOI: 10.1016/j.meddos.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/27/2017] [Accepted: 12/07/2017] [Indexed: 11/15/2022]
Abstract
An in silico dosimetric evaluation of intensity-modulated radiation therapy (IMRT) vs 3-dimensional conventional radiation therapy (3D-CRT) treatment plans in postmastectomy radiation therapy (PMRT) to the chest wall and regional lymphatics was conducted. Twenty-five consecutive patients with breast cancer referred for locoregional PMRT, stages T2-4 with N1-3, were planned to receive 50 Gy in 25 fractions with IMRT. Additionally, a 3D-CRT plan was generated using identical contours for the clinical target volumes (CTV), planning target volumes (PTV), and organs at risk (OAR). Treatment plans were assessed using dose-volume histogram (DVH) parameters of D98, D95, D50, D2, and homogeneity index for individual CTVs and PTVs. OARs evaluated were ipsilateral and contralateral lungs, heart, spinal cord, and opposite breast. Most DVH parameters pertaining to CTVs and PTVs significantly favored IMRT. V20 for ipsilateral and contralateral lungs, D33 of heart and maximum dose to spinal cord favored IMRT (all p < 0.001). The mean dose to the opposite breast was significantly lesser with 3D-CRT (5.8 ± 1.8 Gy vs 2.0 ± 1.0 Gy, p < 0.001). Thus, except for the mean dose to the opposite breast, the compliance to DVH constraints applied to PTV and OARs were significantly better with IMRT. At a median follow-up of 76 months (7-91), none had locoregional failure or pulmonary or cardiac morbidity. For PMRT, requiring comprehensive irradiation to both chest wall and regional lymphatics, IMRT offers superior dosimetric advantages over 3D-CRT. This was also corroborated by long-term outcomes in these patients treated with IMRT.
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Affiliation(s)
- Pooja Khullar
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Charu Garg
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sujit Nath Sinha
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Inderjit Kaur
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Niloy Ranjan Datta
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
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Pinder LF, Henry-Tillman R, Linyama D, Kusweje V, Nzayisenga JB, Shibemba A, Sahasrabuddhe V, Lishimpi K, Mwanahamuntu M, Hicks M, Parham GP. Leverage of an Existing Cervical Cancer Prevention Service Platform to Initiate Breast Cancer Control Services in Zambia: Experiences and Early Outcomes. J Glob Oncol 2017; 4:1-8. [PMID: 30241176 PMCID: PMC6180756 DOI: 10.1200/jgo.17.00026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In 2005, the Cervical Cancer Prevention Program in Zambia (CCPPZ) was implemented and has since provided cervical cancer screen-and-treat services to more than 500,000 women. By leveraging the successes and experiences of the CCPPZ, we intended to build capacity for the early detection and surgical treatment of breast cancer. METHODS Our initiative sought to build capacity for breast cancer care through the (1) formation of a breast cancer advocacy alliance to raise awareness, (2) creation of resource-appropriate breast cancer care training curricula for mid- and high-level providers, and (3) implementation of early detection and treatment capacity within two major health care facilities. RESULTS Six months after the completion of the initiative, the following outcomes were documented: Breast health education and clinical breast examination (CBE) services were successfully integrated into the service platforms of four CCPPZ clinics. Two new breast diagnostic centers were opened, which provided access to breast ultrasound, ultrasound-guided core needle biopsy, and needle aspiration. Breast health education and CBE were provided to 1,955 clients, 167 of whom were evaluated at the two diagnostic centers; 55 of those evaluated underwent core-needle biopsy, of which 17 were diagnosed with invasive cancer. Newly trained surgeons performed six sentinel lymph node mappings, eight sentinel lymph node dissections, and 10 breast conservation surgeries (lumpectomies). CONCLUSION This initiative successfully established clinical services in Zambia that are critical for the early detection and surgical management of breast cancer.
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Affiliation(s)
- Leeya F Pinder
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Ronda Henry-Tillman
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - David Linyama
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Victor Kusweje
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Jean-Baptiste Nzayisenga
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Aaron Shibemba
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Vikrant Sahasrabuddhe
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Kennedy Lishimpi
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Mulindi Mwanahamuntu
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Michael Hicks
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Groesbeck P Parham
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
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Miguel F, Lopes LV, Ferreira E, Ribas E, Pelaez AF, Leal C, Amaro T, Lopes P, Santos CM, Lopes C, Santos LL. Breast cancer in Angola, molecular subtypes: a first glance. Ecancermedicalscience 2017; 11:763. [PMID: 28900476 PMCID: PMC5574661 DOI: 10.3332/ecancer.2017.763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 12/27/2022] Open
Abstract
Purpose The aim of this study was to investigate the breast cancer (BC) molecular subtypes according to its surrogate immunohistochemistry (IHC) markers. We conducted a preliminary study, to correlate the clinical pathological profiles and molecular subtypes of breast cancer in Luanda, Angola. Methods From January 2011 to 30 December 2014, 140 consecutive cases of microscopically confirmed invasive breast carcinoma were classified regarding histology and IHC (ER, PR, HER2, and Ki-67). Surrogate molecular subtypes were classified according to ESMO recommendations. Results All patients were female; the median age was 47 years (24–84 years). Invasive carcinoma NST was the most common type (91.4%) and grade 2 was prevalent (70.7%). Most tumours were locally advanced (stage III – 65% and stage IV – 3.6%). In 140 studied cases, 74 (52.8%) malignancies were hormone receptor positive; 25.7% were luminal A like, 19.3% luminal B and HER2 negative like, 7.9% luminal B and HER2-positive like, 15.7% HER2 positive, and 31.4% were triple negative. Conclusion Women’s BC in Luanda-Angola is diagnosed at a young age and at an advanced stage. The two predominant molecular subtypes are HR positive and triple negative. The percentage of HER2-positive BC cases was high. Determining the molecular subtype using surrogate IHC markers has important treatment and prognostic implications for Angolan women with BC. There is an urgent need to study a prospective BC series in order to confirm the present results.
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Affiliation(s)
- Fernando Miguel
- Angolan Institute of Cancer Control, Rua Amílcar Cabral, Luanda, Angola.,These authors contributed equally to this work
| | - Lygia Vieira Lopes
- Sagrada Esperança Clinic, Av Murtala Mohammed, Luanda, Angola.,These authors contributed equally to this work
| | - Eduardo Ferreira
- Eduardo Ferreira Pathology Laboratory, Rua de Camões, 218-5º andar, Porto 4000-000, Portugal.,These authors contributed equally to this work
| | - Emília Ribas
- Sagrada Esperança Clinic, Av Murtala Mohammed, Luanda, Angola
| | | | - Conceição Leal
- Pathology Service, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal
| | - Teresina Amaro
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal
| | - Paula Lopes
- Eduardo Ferreira Pathology Laboratory, Rua de Camões, 218-5º andar, Porto 4000-000, Portugal
| | - Cristina Mendes Santos
- Sagrada Esperança Clinic, Av Murtala Mohammed, Luanda, Angola.,ONCOCIR - Education and Care in Oncology - Lusophone Africa, Rua de Quires 168-10J, Moreira da Maia 4470- 643, Portugal
| | - Carlos Lopes
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal
| | - Lúcio Lara Santos
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal.,ONCOCIR - Education and Care in Oncology - Lusophone Africa, Rua de Quires 168-10J, Moreira da Maia 4470- 643, Portugal.,Surgical Oncology Department, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal.,These authors contributed equally to this work
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50
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Soto-Perez-de-Celis E, Smith DD, Rojo-Castillo MP, Hurria A, Pavas-Vivas AM, Gitler-Weingarten R, Mohar A, Chavarri-Guerra Y. Implementation of a School-Based Educational Program to Increase Breast Cancer Awareness and Promote Intergenerational Transmission of Knowledge in a Rural Mexican Community. Oncologist 2017; 22:1249-1256. [PMID: 28652281 DOI: 10.1634/theoncologist.2017-0063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/26/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Rural women have limited access to breast cancer education, which partially contributes to late diagnosis and treatment. In this pilot study, we tested the feasibility of implementing a school-based breast cancer educational program for adolescents in a rural Mexican community. We hypothesized that the adolescents' knowledge on breast cancer would increase as a result of the program, and that there would be intergenerational transmission of that knowledge to their older female relatives. MATERIALS AND METHODS Female adolescents from a rural middle school received the educational program. The program would be considered feasible and acceptable if more than 75% reported being satisfied with its contents. Changes in knowledge in the students and their relatives were evaluated using baseline and 4 months follow-up questionnaires. RESULTS One hundred twenty-six students were enrolled. The program was considered acceptable by 96% of the participants. The students' knowledge regarding breast cancer increased significantly from baseline to 4 months follow-up (63% to 82%). One hundred ninety-four female relatives completed the initial knowledge questionnaires. The relatives' knowledge regarding breast cancer showed a significant increase from baseline to 4 months follow-up (55% to 61%). CONCLUSION Implementing breast cancer educational programs for adolescents in rural communities is feasible and acceptable. The program increased the adolescents' knowledge on breast cancer, and promoted the intergenerational transmission of that knowledge to their female relatives. Intergenerational transmission of knowledge represents a potential method for providing population-based health awareness education globally. IMPLICATIONS FOR PRACTICE In limited-resource settings, education is a valuable tool for achieving early detection and downstaging of breast cancer. Unfortunately, rural women lack access to educational opportunities and information about breast cancer, which is a factor contributing to late diagnosis and treatment. In this study, we demonstrated that implementing a school-based breast cancer educational program for female adolescents in a rural Mexican community was feasible, acceptable, and increased their knowledge about breast cancer. Furthermore, the program encouraged the transmission of information to the students' older relatives. Intergenerational transmission of knowledge represents a novel and potentially effective tool in cancer education and promotion.
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Affiliation(s)
- Enrique Soto-Perez-de-Celis
- Cancer Care in the Elderly Clinic, Department of Geriatrics, Mexico City, Mexico
- City of Hope, Duarte, California, USA
| | - David D Smith
- City of Hope, Duarte, California, USA
- Queensland Institute of Medical Research, Brisbane, Australia
| | - Maria Patricia Rojo-Castillo
- Cancer Care in the Elderly Clinic, Department of Geriatrics, Mexico City, Mexico
- Alma Foundation, Mexico City, Mexico
| | | | | | | | - Alejandro Mohar
- Unit of Biomedical Cancer Research, National Cancer Institute and Biomedical Institute, Mexico City, Mexico
| | - Yanin Chavarri-Guerra
- Hemato-Oncology Department, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
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