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Bell S, Gibbs S, Winskell A, Villarino X, Gill H, Little K. Acceptability of an on-demand pericoital oral contraceptive pill: a systematic scoping review. Reprod Health 2024; 21:93. [PMID: 38943120 PMCID: PMC11212445 DOI: 10.1186/s12978-024-01829-7] [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] [Received: 01/18/2024] [Accepted: 06/12/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Access to an on-demand pericoital oral contraceptive pill - used to prevent pregnancy within a defined window around sexual intercourse - could offer women more reproductive agency. A contraceptive with this indication is not currently available in any market. This review aims to understand international user appeal for an on-demand pericoital oral contraceptive pill. METHODS Systematic scoping review, comprising 30 peer-reviewed papers published between 2014-2023. RESULTS Data from 30 papers reporting on research from 16 countries across five World Health Organisation regions suggests widespread user appeal for on-demand oral contraceptive pills that can be used peri- or post-coitally, especially among women who are younger, more educated or who have less frequent sex. Women of varying age, wealth, employment or relationship status, and with different prior experience of using modern contraceptives, were also interested. Women identified clear rationale for use and preference of these types of product: close alignment with women's sexual lives that comprised unplanned, spontaneous or occasional sex; perceived convenience and effectiveness; discreet use of pills to negotiate contextual circumstances that constrained their reproductive agency. Factors inhibiting use included knowledge barriers and attitudes of service providers, a lack of knowledge and misinformation among end-users, women's dislike of menstrual side effects and myths related to the effects of hormone content on future fertility. CONCLUSIONS Introduction of an on-demand pericoital oral contraceptive pill could expand contraceptive choice for diverse women experiencing unmet need for modern contraception and constrained sexual and reproductive agency. Priorities for future research include: broadening the geographical scope of evidence to include SE Asia and the Pacific, and international rural and peri-urban settings; documenting the perspectives of adolescents and unmarried young people; identifying opportunities for innovation in the supply channels to enhance appropriate, affordable access to on-demand oral contraceptives; and unpacking how to bring new pericoital contraceptives to the market in a variety of international settings.
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Affiliation(s)
- Stephen Bell
- Independent Research Consultant, Sunshine Coast, QLD, Australia
- Burnet Institute, Melbourne, Australia
| | - Susannah Gibbs
- Population Services International, 1120 19 Street NW, Suite 600, Washington, DC, 20036, USA
| | - Abigail Winskell
- Population Services International, 1120 19 Street NW, Suite 600, Washington, DC, 20036, USA
| | | | - Halle Gill
- Population Services International, 1120 19 Street NW, Suite 600, Washington, DC, 20036, USA
| | - Kristen Little
- Population Services International, 1120 19 Street NW, Suite 600, Washington, DC, 20036, USA.
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Beltran-Bless AA, Larocque G, Brackstone M, Arnaout A, Caudrelier JM, Boone D, Fallah P, Ng T, Cross P, Alqahtani N, Hilton J, Vandermeer L, Pond G, Clemons M. The COVID-19 pandemic and its effects on follow-up of patients with early breast cancer: A patient survey. Breast Cancer Res Treat 2024; 204:531-538. [PMID: 38194133 DOI: 10.1007/s10549-023-07232-3] [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: 04/27/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Despite limited evidence supporting its effectiveness, most guidelines recommend long-term, routinely scheduled in-person surveillance of patients with early breast cancer (EBC). The COVID-19 pandemic led to increased use of virtual care. This survey evaluated patient perspectives on follow-up care. METHODS Patients with EBC undergoing surveillance were surveyed about follow-up protocols, perceptions, and interest in clinical trials assessing different follow-up strategies. RESULTS Of 402 approached patients 270 completed the survey (response rate 67%). Median age 62.5 years (range 25-86) and median time since breast cancer diagnosis was 3.8 years (range < 1-33 years). Most (n = 148/244, 60%) were followed by more than one provider. Routine follow-ups with breast examination were mostly conducted by medical/radiation oncologists every 6 months (n = 110/236, 46%) or annually (n = 106/236, 44%). Participants felt routine follow-up was useful to monitor for recurrence, manage side effects of cancer treatment and to provide support/reassurance. Most participants felt regular follow-up care would detect recurrent cancer earlier (n = 214/255, 96%) and increase survival (n = 218/249, 88%). The COVID-19 pandemic reduced the number of in-person visits for 54% of patients (n = 63/117). Patients were concerned this reduction of in-person visits would lead to later detection of both local (n = 29/63, 46%) and distant recurrences (n = 25/63, 40%). While many felt their medical and radiation oncologists were the most suited to provide follow-up care, 55% felt comfortable having their primary care provider (PCP) conduct surveillance. When presented with a scenario where follow-up has no effect on earlier detection or survival, 70% of patients still wanted routine in-person follow-up for reassurance (63%) with the goal of earlier recurrence detection (56%). CONCLUSIONS Despite limited evidence of effectiveness of routine in-person assessment, patients continue to place importance on regularly scheduled in-person follow-up.
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Affiliation(s)
- Ana-Alicia Beltran-Bless
- Division of Medical Oncology, Department of Medicine, The University of Ottawa, Ottawa, ON, Canada
| | - Gail Larocque
- The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Muriel Brackstone
- Department of Surgery, London Health Sciences Centre, London, ON, Canada
| | - Angel Arnaout
- The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
- Department of Surgery, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Jean-Michel Caudrelier
- The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
- Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Denise Boone
- The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Parvaneh Fallah
- Division of Medical Oncology, Department of Medicine, The University of Ottawa, Ottawa, ON, Canada
| | - Terry Ng
- Division of Medical Oncology, Department of Medicine, The University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Peter Cross
- Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Nasser Alqahtani
- Division of Medical Oncology, Department of Medicine, The University of Ottawa, Ottawa, ON, Canada
| | - John Hilton
- Division of Medical Oncology, Department of Medicine, The University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Lisa Vandermeer
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Gregory Pond
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Mark Clemons
- Division of Medical Oncology, Department of Medicine, The University of Ottawa, Ottawa, ON, Canada.
- The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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Ketema B, Kaba M, Negash S, Addissie A, Kantelhardt EJ. Intention to Undergo Clinical Breast Examination and Its Associated Factors among Women Attending Rural Primary Healthcare Facilities in South Central Ethiopia. Breast Care (Basel) 2023; 18:464-472. [PMID: 38125918 PMCID: PMC10730096 DOI: 10.1159/000531944] [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: 02/18/2023] [Accepted: 07/04/2023] [Indexed: 12/23/2023] Open
Abstract
Background Breast cancer is a global public health problem with higher mortality in developing countries. The Ethiopian National Cancer Control Plan recommends clinical breast examination (CBE) for all women aged >18 years. However, there is low breast examination practice in Ethiopia. Therefore, this study aimed to describe level of intention to undergo CBE and associated factors among women visited selected rural healthcare facilities in south central Ethiopia using Theory of Planned Behavior (TPB). Methods This study used facility-based cross-sectional study design. A total of 420 women participated in this study. Interviewer-administered structured questionnaire was adopted from previously published research works and Ajzen's TPB manual. Statistical Package for Social Sciences (SPSS), version 27, was used for analysis. Binary logistic regression model was used to determine factors associated with intention to undergo CBE. Results In this study, nine out of ten women had never had CBE. Mean score for intention to undergo CBE was 12.55 (SD ± 3.22; min 5, max 20). Intention to undergo CBE was negatively associated with being in the second and middle wealth quantiles compared to the highest wealth quantile, and with the spouse not being able to read or write compared to having attended formal education. Positive attitude and higher subjective norm had relevant association with intention to undergo CBE. Conclusion The high score for intention to undergo CBE should encourage primary healthcare facilities to offer CBE. Behavioral change communication interventions could address women's attitude, subjective norm, and spouse's education associated with intention to undergo CBE.
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Affiliation(s)
- Bezawit Ketema
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - Mirgissa Kaba
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sarah Negash
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - Adamu Addissie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
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Rao S, Rao P, Shetty R, Gatty NC, Adappa D, Suresh S, Baliga MS. "Cancer Education on Wheels," a Novel Cost-Effective Method in Creating Awareness in the Community: a Pilot Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1792-1800. [PMID: 37382797 DOI: 10.1007/s13187-023-02334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Abstract
Cancer education raises disease awareness, the value of early identification and importantly the need for prompt screening and treatment when diagnosed. In this study, an effort was made to understand how well a unique cancer education program, "Cancer Education on Wheels," transfers knowledge in general public in society. The community was shown prerecorded cancer awareness videos using a TV monitor, CD player, and speaker system mounted on an eight-seat Toyota Innova. Before and after seeing the video presentation, consenting volunteers filled out questionnaires asking about demographics and understanding of cancer. Frequency and percentage calculations were done on the demographic information and a Wilcoxon signed-rank test was run on the overall subject score. Data was stratified based on demographic information and compared by applying Kruskal-Wallis test and Mann-Whitney test. p values under 0.05 were regarded as significant. A total of 584 people completed the pre-test and post-test questionnaires. The Wilcoxon signed-rank test revealed a difference between the pre-test and post-test (3.29 ± 2.48 vs. 6.78 ± 3.52; P = 0.0001). The pre-test results showed that volunteers between the ages of 18 and 30; men; students; urban residents; single volunteers; graduates; people who had known a person/or family member with cancer; and people who were aware of the suffering cancer causes had a high baseline knowledge of cancer (p = 0.015 to 0.001). The post-test results show that participants who had less baseline scores like housewives and unemployed people performed better (p = 0.006 to 0.0001). The findings unambiguously demonstrated that "Cancer Education on Wheels" was successful in raising participants' awareness of cancer signs and screening. Additionally, the findings showed that volunteers who were aged, married, housewives, and unemployed had higher scores. Most importantly, this approach to cancer education is simple to organize and carry out in a local setting. It is also affordable and simple to execute using readily available technological equipment and manageable logistics. According to the authors' knowledge, this is the first study to use "Cancer Education on Wheels" to spread awareness of cancer throughout the neighborhood especially in budget constrained areas.
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Affiliation(s)
- Suresh Rao
- Department of Radiation Oncology, Mangalore Institute of Oncology, Pumpwell, Mangalore, 575002, Karnataka, India
| | - Pratima Rao
- Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Pumpwell, Mangalore, 575002, Karnataka, India
| | - Rajesh Shetty
- Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Pumpwell, Mangalore, 575002, Karnataka, India
| | - Nithesh Chandra Gatty
- Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Pumpwell, Mangalore, 575002, Karnataka, India
| | - Durgadas Adappa
- Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Pumpwell, Mangalore, 575002, Karnataka, India
| | - Sucharitha Suresh
- Department of Community Medicine, Father Muller Medical College, Kankanady, Mangalore, India
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Schliemann D, Jamil ASA, Mohan D, Tan MM, Cardwell CR, Ismail R, Taib NA, Su TT, Donnelly M. The development and evaluation of a mHealth, community education and navigation intervention to improve clinical breast examination uptake in Segamat Malaysia: A randomised controlled trial. PLoS One 2023; 18:e0288437. [PMID: 37796803 PMCID: PMC10553222 DOI: 10.1371/journal.pone.0288437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 06/25/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Breast cancer (BC) screening uptake in Malaysia is low and a high number of cases present at a late stage. Community navigation and mobile health (mHealth) may increase screening attendance, particularly by women from rural communities. This randomized controlled study evaluated an intervention that used mHealth and community health workers to educate women about BC screening and navigate them to clinical breast examination (CBE) services in the context of the COVID-19 pandemic. METHODS Women aged 40-74 years, from Segamat, Malaysia, with a mobile phone number, who participated in the South East Asian Community Observatory health survey, (2018) were randomized to an intervention (IG) or comparison group (CG). The IG received a multi-component mHealth intervention, i.e. information about BC was provided through a website, and telephone calls and text messages from community health workers (CHWs) were used to raise BC awareness and navigate women to CBE services. The CG received no intervention other than the usual option to access opportunistic screening. Regression analyses were conducted to investigate between-group differences over time in uptake of screening and variable influences on CBE screening participation. RESULTS We recruited 483 women in total; 122/225 from the IG and 144/258 from the CG completed the baseline and follow-up survey. Uptake of CBE by the IG was 45.8% (103/225) whilst 3.5% (5/144) of women from the CG who completed the follow-up survey reported that they attended a CBE during the study period (adjusted OR 37.21, 95% CI 14.13; 98.00, p<0.001). All IG women with a positive CBE attended a follow-up mammogram (11/11). Attendance by IG women was lower among women with a household income ≥RM 4,850 (adjusted OR 0.48, 95% CI 0.20; 0.95, p = 0.038) compared to participants with a household income CONCLUSION The results suggested that the bespoke multicomponent mHealth intervention may be used to address the significant public health problem of low uptake of BC screening in rural Malaysia.
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Affiliation(s)
- Désirée Schliemann
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Aminatul Saadiah Abdul Jamil
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
- Faculty of Science and Technology, Health Industry Technology, Islamic Science University of Malaysia, Nilai, Malaysia
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Min Min Tan
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Christopher R. Cardwell
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Roshidi Ismail
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, Faculty of Medicine, UM Cancer Research Institute, University of Malaya, Kuala Lumpur, Malaysia
| | - Tin Tin Su
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Michael Donnelly
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen’s University Belfast, Belfast, United Kingdom
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Rao S, Rao P, Shetty R, Kulal Y, Gatty NC, Prabhu N, Suresh S, D'souza RK, Baliga MS. Usefulness of walkathon in improving knowledge on cancer: A cross-sectional study with the participants. J Cancer Res Ther 2023; 19:1760-1765. [PMID: 38376275 DOI: 10.4103/jcrt.jcrt_1675_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/29/2021] [Indexed: 02/21/2024]
Abstract
AIM Globally, walkathon, a type of community event involving walking a determined distance to raise awareness and/or collect donations for a social cause is gaining a lot of public attention. This study was conducted to understand the usefulness of walkathon in creating cancer awareness among the participants. MATERIALS AND METHODS This was a pre- and post-test study and was carried out on World Cancer Day on February 4, 2019 in Mangalore, Karnataka, India. The study subjects were the walkathon participants willing to be volunteers for the study. Differences in the answers were calculated by ascertaining the difference between the pretest and posttest using McNemar, Chi-square, or Fisher's exact test. A P < 0.05 was considered statistically significant. RESULTS Pretest scores indicated most volunteers were aware of the role of tobacco and alcohol in cancer, while most were unaware of the importance of fruits and consumption of vegetables and sedentary lifestyle in the development of cancer. Posttest showed a significant increase in knowledge gain (P = 0.003 to <0.001). CONCLUSIONS For the first time, this study shows Walkathon to be helpful in improving cancer knowledge in the participants. Walkathon is an inexpensive and joyful way to educate people and warrants further study on a range of medical and social themes affecting society to establish its usefulness in public health education.
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Affiliation(s)
- Suresh Rao
- Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Pratima Rao
- Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Rajesh Shetty
- Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Yathish Kulal
- Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Nitish Chandra Gatty
- Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Nagraj Prabhu
- Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Sucharitha Suresh
- Department of Community Medicine, Father Muller Medical College, Mangalore, Karnataka, India
| | - Rhea Katherine D'souza
- Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
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Rao S, Rao P, Shetty R, Prabhu N, Kulala Y, Suresh S, Baliga MS. Usefulness of structured teaching module in improving knowledge about cancer in Accredited Social Health Activist: A pilot study. J Cancer Res Ther 2023; 19:1803-1811. [PMID: 38376282 DOI: 10.4103/jcrt.jcrt_2110_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/09/2022] [Indexed: 02/21/2024]
Abstract
AIM In India, the Accredited Social Health Activists (abbreviated as ASHA) are an important group of community health workers and are involved in initiating and maintaining health care programs in the rural communities they live. This study was conducted with a purpose to evaluate the effectiveness of a structured teaching module in improving knowledge on cancer cause, diagnosis, and treatment in the ASHA workers. MATERIALS AND METHODS This was a cross-sectional pretest posttest study and was conducted from April 2017 to February 2020 with ASHA workers working in the various Primary Health Centers in Udupi and South Kanara districts of Karnataka and Kasargod district of Kerala in India after obtaining the permission from the medical officer in charge of the respective primary health centers. The participants were briefed about the study objective and also that confidentiality will be maintained. A validated investigator developed questionnaire consisting of 20 questions categorized into four domains (general, subject, diagnosis, and treatment aspects) was distributed to the willing volunteers before the start of the program. They were instructed to fill the pretest form before and posttest after the teaching program. Informed content was taken in a separate sheet and volunteers were informed not to write any personal or identification details. Resource persons with experience in cancer cause, diagnosis and treatment delivered the structured talk in the local language Kannada. The data collected from the filled questionnaires were subjected to frequency, percentage, mean, and standard deviation and appropriately subjected to Chi-square test or paired t-test. A P < 0.05 was considered statistically significant. RESULTS The demographic detail suggest that majority of the women were Hindus (79.3%), married (93.7%), between the age of 31-40 (46.7%) and had only matriculation as the highest education (68%). The analysis of the pretest administration collected before the start of teaching program indicates that most participants were aware of self-breast examination (79.74%) and that cancer is a disease as old as human civilization (70.26%), while only 8.82% were unaware of which is the leading type of cancer in rural women. The results analyzed from posttest indicate that the highest percentage change (323.96%) was observed for domain on treatment aspects followed by for general (64.03%), diagnosis (56.70%), and subject (36.42%) aspect and was significant (P < 0.001). The total mean values changed from 6.48 ± 2.01 in pretest to 11.81 ± 2.15 in posttest indicating an increase of 5.33 ± 1.91 and percentage change of 82.25% (P < 0.001). The results also showed that 60.8% had average, while 39.2% had good increment in the knowledge at the end of the program. CONCLUSIONS The observations of the current study indicate the usefulness of the structured teaching module in improving knowledge on cancer cause, diagnosis and treatment in the ASHA workers. It is proposed that with further training ASHA workers can be very useful in the propagation of cancer awareness and screening in the community they serve.
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Affiliation(s)
- Suresh Rao
- Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Pratima Rao
- Department of Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Rajesh Shetty
- Department of Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Nagraj Prabhu
- Department of Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Yathish Kulala
- Department of Cancer Education and Awareness Cell, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Sucharitha Suresh
- Department of Community Medicine, Father Muller Medical College, Mangalore, Karnataka, India
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Cunningham EB, Wheeler A, Hajarizadeh B, French CE, Roche R, Marshall AD, Fontaine G, Conway A, Bajis S, Valencia BM, Presseau J, Ward JW, Degenhardt L, Dore GJ, Hickman M, Vickerman P, Grebely J. Interventions to enhance testing and linkage to treatment for hepatitis C infection for people who inject drugs: A systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103917. [PMID: 36542883 DOI: 10.1016/j.drugpo.2022.103917] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND With the advent of direct acting antiviral (DAA) therapies for the treatment of hepatitis C virus (HCV), the World Health Organization recommended a goal to eliminate HCV as a public health threat globally by 2030. With the majority of new and existing infections in high income countries occurring among people who inject drugs, achieving this goal will require the design and implementation of interventions which address the unique barriers to HCV care faced by this population. METHODS In this systematic review and meta-analysis, we searched bibliographic databases and conference abstracts to July 21, 2020 for studies assessing interventions to improve the following study outcomes: HCV antibody testing, HCV RNA testing, linkage to care, and treatment initiation. We included both randomised and non-randomised studies which included a comparator arm. We excluded studies which enrolled only paediatric populations (<18 years old) and studies where the intervention was conducted in a different healthcare setting than the control or comparator. This analysis was restricted to studies conducted among people who inject drugs. Data were extracted from the identified records and meta-analysis was used to pool the effect of interventions on study outcomes. This study was registered in PROSPERO (CRD42020178035). FINDINGS Of 15,342 unique records, 45 studies described the implementation of an intervention to improve HCV testing, linkage to care and treatment initiation among people who inject drugs. These included 27 randomised trials and 18 non-randomised studies with the risk of bias rated as "critical" for most non-randomised studies. Patient education and patient navigation to address patient-level barriers to HCV care were shown to improve antibody testing uptake and linkage to HCV care respectively although patient education did not improve antibody testing when restricted to randomised studies. Provider care coordination to address provider level barriers to HCV care was effective at improving antibody testing uptake. Three different interventions to address systems-level barriers to HCV care were effective across different stages of HCV care: point-of-care antibody testing (linkage to care); dried blood-spot testing (antibody testing uptake); and integrated care (linkage to care and treatment initiation). INTERPRETATION Multiple interventions are available that can address the barriers to HCV care for people who inject drugs at the patient-, provider-, and systems-level. The design of models of care to improve HCV testing and treatment among people who inject drugs must consider the unique barriers to care that this population faces. Further research, including high-quality randomised controlled trials, are needed to robustly assess the impact these interventions can have in varied populations and settings.
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Affiliation(s)
| | - Alice Wheeler
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Clare E French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK; NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Rachel Roche
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, National Infection Service, Public Health England Colindale, London, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, NIHR, London, UK
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Guillaume Fontaine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Anna Conway
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur GA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK; NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK; NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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Trapani D, Sandoval J, Aliaga PT, Ascione L, Maria Berton Giachetti PP, Curigliano G, Ginsburg O. Screening Programs for Breast Cancer: Toward Individualized, Risk-Adapted Strategies of Early Detection. Cancer Treat Res 2023; 188:63-88. [PMID: 38175342 DOI: 10.1007/978-3-031-33602-7_3] [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: 01/05/2024]
Abstract
Early detection of breast cancer (BC) comprises two approaches: screening of asymptomatic women in a specified target population at risk (usually a target age range for women at average risk), and early diagnosis for women with BC signs and symptoms. Screening for BC is a key health intervention for early detection. While population-based screening programs have been implemented for age-selected women, the pivotal clinical trials have not addressed the global utility nor the improvement of screening performance by utilizing more refined parameters for patient eligibility, such as individualized risk stratification. In addition, with the exception of the subset of women known to carry germline pathogenetic mutations in (high- or moderately-penetrant) cancer predisposition genes, such as BRCA1 and BRCA2, there has been less success in outreach and service provision for the unaffected relatives of women found to carry a high-risk mutation (i.e., "cascade testing") as it is in these individuals for whom such actionable information can result in cancers (and/or cancer deaths) being averted. Moreover, even in the absence of clinical cancer genetics services, as is the case for the immediate and at least near-term in most countries globally, the capacity to stratify the risk of an individual to develop BC has existed for many years, is available for free online at various sites/platforms, and is increasingly being validated for non-Caucasian populations. Ultimately, a precision approach to BC screening is largely missing. In the present chapter, we aim to address the concept of risk-adapted screening of BC, in multiple facets, and understand if there is a value in the implementation of adapted screening strategies in selected women, outside the established screening prescriptions, in the terms of age-range, screening modality and schedules of imaging.
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Affiliation(s)
- Dario Trapani
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy.
| | - Josè Sandoval
- Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Pamela Trillo Aliaga
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Liliana Ascione
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Pier Paolo Maria Berton Giachetti
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Giuseppe Curigliano
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
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Meredith E, O'Donovan J, Errington L, Mathur M, Hamilton D. The role of community healthcare workers in head and neck cancer: A systematic scoping review of the literature. Glob Public Health 2022; 17:3283-3302. [PMID: 35298354 DOI: 10.1080/17441692.2022.2049847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It is estimated that Head and Neck Cancer (HNC) will cause over 500,000 deaths worldwide by 2030. This is coupled with a shortage of trained healthcare professionals to manage HNC. An alternative cadre of workers - community healthcare workers (CHWs) - could be deployed to address this shortage. A systematic scoping review was conducted. Seven major databases were searched from inception to 30 June 2021. Studies were included from across the globe and excluded if the focus was not on HNC or CHWs. We identified 13 studies for inclusion. Twelve were based in India. CHWs were deployed in education and awareness raising initiatives, community screening, and ensuring compliance with treatment and follow-up. CHWs were compared to specialists for effectiveness in four studies with one reporting sensitivity of 94·3% and specificity 99·3% for HNC screening. This review highlights ways in which CHWs can be deployed to meet the growing demand for HNC services. The existing evidence suggests that CHWs can have potential roles in screening for HNC, therefore facilitating an earlier diagnosis. It is important this screening is implemented where there is appropriate capacity to manage HNC. Further research needs to be carried out to explore barriers and facilitators to these programmes.
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Affiliation(s)
- Ellen Meredith
- Newcastle Upon Tyne Hospital Trust, ENT Department, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Linda Errington
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Manu Mathur
- Public Health Foundation of India, Gurugram, India
| | - David Hamilton
- ENT Department, Freeman Hospital, Newcastle upon Tyne, UK
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Murphy NJ, Groen RS. Interprofessional Care in Obstetrics and Gynecology. Obstet Gynecol Clin North Am 2022; 49:841-868. [DOI: 10.1016/j.ogc.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Uwimana A, Dessalegn S, Vianney Dusengimana JM, Stauber C, Fata A, Hagenimana M, Uwinkindi F, Balinda JP, Shulman LN, Revette A, Rwamuza E, Pace LE. Integrating Breast Cancer Early Detection Into a Resource-Constrained Primary Health Care System: Health Care Workers' Experiences in Rwanda. JCO Glob Oncol 2022; 8:e2200181. [PMID: 36508703 PMCID: PMC10166372 DOI: 10.1200/go.22.00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE There is limited evidence to guide incorporation of breast cancer early detection into resource-constrained health systems where mammography screening is not yet available. To inform such strategies, we sought to understand health care workers' perspectives on a breast cancer early detection initiative integrated into community, primary, and secondary levels of care in Rwanda. METHODS We conducted a qualitative study using semistructured interviews with 33 community health workers, clinicians, and administrators at health facilities participating in the Women's Cancer Early Detection Program (WCEDP), through which women received clinical breast examination if they were receiving cervical cancer screening, or had breast concerns. Through thematic analysis, we identified dynamics and patterns associated with successes and challenges of the program's breast health services. RESULTS Successes and challenges identified by participants corresponded with the community- and primary care-based steps of cancer early diagnosis identified by the WHO. Regarding step 1 (community awareness/access), participants noted increases in awareness and care-seeking. Challenges included difficulty overcoming stigma and engaging older women. Regarding step 2 (clinical evaluation), all participants described increased breast health knowledge, skills, and confidence. Integrating the WCEDP with other services was challenging because of inadequate staffing; offering WCEDP services on a designated day/week had advantages and disadvantages. Although participants appreciated WCEDP referral mechanisms, they desired more communication from referral facilities. Patients' poverty was the most consistently identified impediment to referral completion. CONCLUSION Rwandan health care workers identified real-world successes and challenges of implementing principles of early cancer diagnosis for breast cancer early detection. Future interventions should focus on engagement of older women, community awareness, patient socioeconomic support, and optimizing integration into primary care.
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Ahmad S, Alloubani A, Abu-Sa’da R, Qutaiba Y. Breast Self-Examination: Knowledge, Practice, and Beliefs Among Females in Jordan. SAGE Open Nurs 2022; 8:23779608221124517. [PMID: 36225312 PMCID: PMC9549095 DOI: 10.1177/23779608221124517] [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] [Received: 04/06/2022] [Revised: 08/09/2022] [Accepted: 08/21/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Worldwide, breast cancer is one of the most common types of cancer. It is the leading cause of cancer-related deaths among females in Jordan. Objectives The current study aimed to evaluate breast cancer knowledge levels and practice and assess health beliefs regarding the model supporting self-breast examination (BSE) in a group of females aged between 20 and 60 in Jordan. Methods Descriptive, cross-sectional, correlational design was used; Two hundred females participated in the study, employing convenient sampling. The adjusted version of the Champion's Health Belief Model Scale (CHBMS) was utilized to collect the data. Results Most participants were married (F = 128, 64%), and the mean of the participants' age was (36.18, SD = 10.87). About 73 participants (36.5%) don't practice BSE; however, 53 participants (26.5%) plan to practice BSE in the future monthly. The logistic regression model showed that the impact of confidence as positive predictive value on practicing BSE in the last year (B = 0.141, p < .001) and this year (B = 0.130, p < .001) was statistically significant. Conclusion Implications for practice include identifying culturally specific barriers and improving health education programs to trigger breast self-examination utilization.
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Affiliation(s)
- Suhad Ahmad
- Breast Clinics/Nursing, King Hussein Cancer Center, Amman, Jordan,Aladeen Alloubani, King Hussein Cancer
Center, Amman, Jordan.
| | | | | | - Yasar Qutaiba
- Early Detection Program, King Hussein Cancer Center, Amman, Jordan
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14
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Schliemann D, Tan MM, Hoe WMK, Mohan D, Taib NA, Donnelly M, Su TT. mHealth Interventions to Improve Cancer Screening and Early Detection: Scoping Review of Reviews. J Med Internet Res 2022; 24:e36316. [PMID: 35969450 PMCID: PMC9425170 DOI: 10.2196/36316] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer screening provision in resource-constrained settings tends to be opportunistic, and uptake tends to be low, leading to delayed presentation and treatment and poor survival. OBJECTIVE The aim of this study was to identify, review, map, and summarize findings from different types of literature reviews on the use of mobile health (mHealth) technologies to improve the uptake of cancer screening. METHODS The review methodology was guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Ovid MEDLINE, PyscINFO, and Embase were searched from inception to May 2021. The eligible criteria included reviews that focused on studies of interventions that used mobile phone devices to promote and deliver cancer screening and described the effectiveness or implementation of mHealth intervention outcomes. Key data fields such as study aims, types of cancer, mHealth formats, and outcomes were extracted, and the data were analyzed to address the objective of the review. RESULTS Our initial search identified 1981 titles, of which 12 (0.61%) reviews met the inclusion criteria (systematic reviews: n=6, 50%; scoping reviews: n=4, 33%; rapid reviews: n=1, 8%; narrative reviews: n=1, 8%). Most (57/67, 85%) of the interventions targeted breast and cervical cancer awareness and screening uptake. The most commonly used mHealth technologies for increasing cancer screening uptake were SMS text messages and telephone calls. Overall, mHealth interventions increased knowledge about screening and had high acceptance among participants. The likelihood of achieving improved uptake-related outcomes increased when interventions used >1 mode of communication (telephone reminders, physical invitation letters, and educational pamphlets) together with mHealth. CONCLUSIONS mHealth interventions increase cancer screening uptake, although multiple modes used in combination seem to be more effective.
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Affiliation(s)
- Désirée Schliemann
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Min Min Tan
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Subang Jaya, Malaysia
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Wilfred Mok Kok Hoe
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Subang Jaya, Malaysia
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur, Malaysia
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Tin Tin Su
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Subang Jaya, Malaysia
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
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15
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Khapre M, Ravi B, Sharda P, Mehta A, Kumari R. Evaluation of an Interventional Health Education Project: Screening of Breast Cancer and Health Education (SHE). Asian Pac J Cancer Prev 2022; 23:2361-2366. [PMID: 35901342 PMCID: PMC9727362 DOI: 10.31557/apjcp.2022.23.7.2361] [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: 12/21/2021] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
There is an increasing incidence of breast cancer in India, especially among younger women. The study's main objective was to create awareness related to breast cancer and breast self-examination by community health workers and assess the effectiveness of improving knowledge and practice. Secondary objective was to conduct clinical breast examination (CBE) of women and prompt referral. METHODS An outcome evaluation of the Educational Interventional project was conducted in a hilly district of Uttarakhand. Twenty Accredited Social Health Activists (ASHA) were identified and trained in breast cancer awareness, the procedure of breast self-examination, and screening methods. These ASHA's further created awareness among study participants (women above 30 years). A structured questionnaire on knowledge and practice was administered before and after educational intervention by ASHA workers. Clinical Breast Examination (CBE) camps were held for women at high risk for breast cancer who were referred to the Division of Breast Surgery, AIIMS Rishikesh, for further management. RESULT One thousand sixty-one females participated in health education sessions by ASHAs. There was an improvement in knowledge and practice regarding Breast Self-examination after health education intervention. A low prevalence of risk factors for breast cancer was found among attendees of the CBE camp. 3.2% of participants had abnormalities on breast examination needing further workup. CONCLUSION In the pre-test assessment, we found a low awareness and practice regarding breast cancer which increased significantly among women after behavioral change intervention. The prevalence of risk factors for breast cancer was very low. Trained community health workers were found to be effective in raising awareness, selective screening, and prompt referral.
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Affiliation(s)
| | - Bina Ravi
- Integrated Breast Care Centre (IBCC) All India Institute of Medical Sciences, Rishikesh, India.
| | - Prateek Sharda
- Integrated Breast Care Centre (IBCC) All India Institute of Medical Sciences, Rishikesh, India.
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16
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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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Mehrotra R, Yadav K. Breast cancer in India: Present scenario and the challenges ahead. World J Clin Oncol 2022; 13:209-218. [PMID: 35433294 PMCID: PMC8966510 DOI: 10.5306/wjco.v13.i3.209] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/17/2021] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
Breast cancer is the commonest malignancy among women globally. From being fourth in the list of most common cancers in India during the 1990s, it has now become the first. In this review, we examine the available literature to understand the factors that contributed to the high burden of breast cancer in the country. We also provide the landscape of changes in the field of early diagnosis and the treatment modalities as well as the limitations of the Indian healthcare delivery systems (e.g., delayed diagnosis, human resources and funding for treatment). This review also sheds light on the newer interventions and the future of breast cancer management keeping in mind the coronavirus disease 2019 imposed limitations.
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Affiliation(s)
- Ravi Mehrotra
- Department of Health Research, Ministry of Health and Family Welfare, India Cancer Research Consortium, New Delhi 110001, India
- CHIP Foundation, Noida 201301, India
| | - Kavita Yadav
- Centre of Social Medicine & Community Health, Jawahar Lal Nehru University, New Delhi 110067, India
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18
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Rademaker C, Bhandary S, Harder H. Knowledge, awareness, attitudes and screening practices towards breast and cervical cancer among women in Nepal: a scoping review. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abstract
Aim
Breast and cervical cancers have emerged as major global health challenges and disproportionately affect women in low- and middle-income countries, including Nepal. This scoping review aimed to map the knowledge, attitudes and screening practices for these cancers among Nepali women to improve cancer outcomes and reduce inequality.
Methods
Five electronic databases (CINAHL, Embase, Global Health, PsycINFO and PubMed), grey literature, and reference and citation lists were searched for articles published in English up to June 2021. Articles were screened against inclusion/exclusion criteria, and data from eligible studies were extracted. Results were summarised narratively.
Results
The search yielded 615 articles, 38 of which were included in this scoping review (27 cervical cancer, 10 breast cancer, 1 both cancers). Levels of knowledge regarding breast and cervical varied widely. The main knowledge gaps were misconceptions about symptoms and risk factors, and poor understanding of screening behaviours. Screening practices were mostly inadequate due to socio-cultural, geographical or financial barriers. Positive attitudes towards cervical screening were associated with higher education and increased knowledge of screening modalities. Higher levels of knowledge, (health) literacy and participation in awareness campaigns facilitated breast cancer screening.
Conclusion
Knowledge and screening practices for breast and cervical cancer among Nepali women were poor and highlight the need for awareness and education programmes. Future research should explore community health worker-led awareness and screening interventions for cervical cancer, and programmes to increase the practice of breast self-examination and clinical breast examinations to support early diagnosis of breast cancer.
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Bretas G, Renna NL, Bines J. Practical considerations for expediting breast cancer treatment in Brazil. LANCET REGIONAL HEALTH. AMERICAS 2021; 2:100028. [PMID: 36779036 PMCID: PMC9904000 DOI: 10.1016/j.lana.2021.100028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022]
Abstract
Patients in Brazil continue to present with late-stage breast cancer. Notwithstanding these figures, policies and programs to overcome this long-lasting scenario have had limited results. We enlist the main barriers for advancing breast cancer diagnosis in Brazil, based on the available evidence, and we propose feasible strategies that may serve as a platform to address this major public health challenge.
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Affiliation(s)
- Gustavo Bretas
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- Grupo Oncoclínicas, Rio de Janeiro, Brazil
| | | | - José Bines
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
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20
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Dare AJ, Knapp GC, Romanoff A, Olasehinde O, Famurewa OC, Komolafe AO, Olatoke S, Katung A, Alatise OI, Kingham TP. High-burden Cancers in Middle-income Countries: A Review of Prevention and Early Detection Strategies Targeting At-risk Populations. Cancer Prev Res (Phila) 2021; 14:1061-1074. [PMID: 34507972 DOI: 10.1158/1940-6207.capr-20-0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/06/2021] [Accepted: 08/23/2021] [Indexed: 12/09/2022]
Abstract
Cancer incidence is rising in low- and especially middle-income countries (MIC), driven primarily by four high-burden cancers (breast, cervix, lung, colorectal). By 2030, more than two-thirds of all cancer deaths will occur in MICs. Prevention and early detection are required alongside efforts to improve access to cancer treatment. Successful strategies for decreasing cancer mortality in high-income countries are not always effective, feasible or affordable in other countries. In this review, we evaluate strategies for prevention and early detection of breast, cervix, lung, and colorectal cancers, focusing on modifiable risk factors and high-risk subpopulations. Tobacco taxation, human papilloma virus vaccination, cervical cancer screen-and-treat strategies, and efforts to reduce patient and health system-related delays in the early detection of breast and colorectal cancer represent the highest yield strategies for advancing cancer control in many MICs. An initial focus on high-risk populations is appropriate, with increasing population coverage as resources allow. These strategies can deliver significant cancer mortality gains, and serve as a foundation from which countries can develop comprehensive cancer control programs. Investment in national cancer surveillance infrastructure is needed; the absence of national cancer data to identify at-risk groups remains a barrier to the development of context-specific cancer control strategies.
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Affiliation(s)
- Anna J Dare
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory C Knapp
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anya Romanoff
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Akinwumi O Komolafe
- Department of Morbid Anatomy and Forensic Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin, Ilorin, Nigeria
| | - Aba Katung
- Department of Surgery, Federal Medical College - Owo, Owo, Nigeria
| | | | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. .,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
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21
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Nuche-Berenguer B, Sakellariou D. Socioeconomic Determinants of Participation in Cancer Screening in Argentina: A Cross-Sectional Study. Front Public Health 2021; 9:699108. [PMID: 34504827 PMCID: PMC8423085 DOI: 10.3389/fpubh.2021.699108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
Low socioeconomic status is associated with late cancer diagnosis and mortality in Argentina. It is important that cancer screening services are accessible to the whole population so that cancer can be detected early. Our aim in this study was to investigate socioeconomic determinants for the disparities in the use of breast, cervical, and colorectal cancer screening services in Argentina, and to measure the country progress in reducing differences in cancer screening participation across socioeconomic levels. We performed a secondary analysis of cross-sectional data from the 2018 National Survey of Risk Factors of Argentina. The sample included data from 49,170 households. We also compared the results with data from the 2013 wave of the same survey in order to assess progress on cancer screening participation across income and education categories. Income, education, health insurance, disability, and marital status were associated with cancer screening underuse in Argentina. Comparison between 2013 and 2018 demonstrated that there has been some progress toward increasing cancer screening uptake, but this increase is not equitably distributed across the population. To further reduce disparities in cancer participation across socioeconomic levels, cancer screening programs in Argentina should reinforce strategies to become more accessible. It is important to proactively reach those populations that are underusers of cancer screening and ensure that barriers that stop people from accessing cancer screening are explored and adequately addressed.
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22
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Hand T, Rosseau NA, Stiles CE, Sheih T, Ghandakly E, Oluwasanu M, Olopade OI. The global role, impact, and limitations of Community Health Workers (CHWs) in breast cancer screening: a scoping review and recommendations to promote health equity for all. Glob Health Action 2021; 14:1883336. [PMID: 33899695 PMCID: PMC8079044 DOI: 10.1080/16549716.2021.1883336] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introduction: Innovative interventions are needed to address the growing burden of breast cancer globally, especially among vulnerable patient populations. Given the success of Community Health Workers (CHWs) in addressing communicable diseases and non-communicable diseases, this scoping review will investigate the roles and impacts of CHWs in breast cancer screening programs. This paper also seeks to determine the effectiveness and feasibility of these programs, with particular attention paid to differences between CHW-led interventions in low- and middle-income countries (LMICs) and high-income countries (HICs).Methods: A scoping review was performed using six databases with dates ranging from 1978 to 2019. Comprehensive definitions and search terms were established for ‘Community Health Workers’ and ‘breast cancer screening’, and studies were extracted using the World Bank definition of LMIC. Screening and data extraction were protocolized using multiple independent reviewers. Chi-square test of independence was used for statistical analysis of the incidence of themes in HICs and LMICs.Results: Of the 1,551 papers screened, 33 were included based on inclusion and exclusion criteria. Study locations included the United States (n=27), Bangladesh (n=1), Peru (n=1), Malawi (n=2), Rwanda (n=1), and South Africa (n=1). Three primary roles for CHWs in breast cancer screening were identified: education (n=30), direct assistance or performance of breast cancer screening (n=7), and navigational services (n=6). In these roles, CHWs improved rates of breast cancer screening (n=23) and overall community member knowledge (n=21). Two studies performed cost-analyses of CHW-led interventions.Conclusion: This review extends our understanding of CHW effectiveness to breast cancer screening. It illustrates how CHW involvement in screening programs can have a significant impact in LMICs and HICs, and highlights the three CHW roles of education, direct performance of screening, and navigational services that emerge as useful pillars around which governments and NGOs can design effective programs in this area.
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Affiliation(s)
- Taylor Hand
- School of Medicine and Health Sciences, The George Washington University, Washington, USA
| | - Natalie A Rosseau
- School of Medicine and Health Sciences, The George Washington University, Washington, USA
| | | | - Tianna Sheih
- School of Medicine and Health Sciences, The George Washington University, Washington, USA
| | - Elizabeth Ghandakly
- School of Medicine and Health Sciences, The George Washington University, Washington, USA
| | - Mojisola Oluwasanu
- Department of Health Promotion & Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Olufunmilayo I Olopade
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.,Center for Clinical Cancer Genetics & Global Health, The University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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23
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Yeshitila YG, Kassa GM, Gebeyehu S, Memiah P, Desta M. Breast self-examination practice and its determinants among women in Ethiopia: A systematic review and meta-analysis. PLoS One 2021; 16:e0245252. [PMID: 33444380 PMCID: PMC7808636 DOI: 10.1371/journal.pone.0245252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/26/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The survival rate from breast cancer is lowest in African countries and the distribution of breast self-examination practice of and its determinants are not well investigated in Ethiopia. Therefore, this systematic review and meta-analysis was designed to determine the pooled prevalence of breast self-examination and its associated factors among women in Ethiopia. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for this systematic review and meta-analysis. The databases used were; PUBMED, Cochrane Library, Google Scholar, CINAHL, African Journals Online, Dimensions and Summon per country online databases. Search terms used were; breast self-examination, breast cancer screening, early detection of breast cancer and Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. The meta-analysis was conducted using STATA 15 software. The pooled meta-analysis was computed to present the pooled prevalence and relative risks (RRs) of the determinate factors with 95% confidence intervals (CIs). RESULTS We identified 2,637 studies, of which, 40 articles (with 17,820 participants) were eligible for inclusion in the final meta-analysis. The pooled estimate of breast self-examination in Ethiopia was 36.72% (95% CI: 29.90, 43.53). The regional distribution breast self-examination ranged from 21.2% (95% CI: 4.49, 37.91) in Tigray to 61.5% (95% CI: 53.98, 69.02) in Gambela region. The lowest prevalence of breast self-examination was observed among the general population (20.43% (95% CI: 14.13, 26.72)). Women who had non-formal educational status (OR = 0.4 (95% CI: 0.21, 0.77)), family history of breast cancer (OR = 2.04 (95% CI: 1.23, 3.39)), good knowledge of breast self-examination (OR = 4.8 (95% CI: 3.03, 7.6)) and favorable attitude toward breast self-examination (OR = 2.75, (95% CI: 1.66, 4.55)) were significantly associated with practice of breast self-examination. CONCLUSIONS Only a third of women in Ethiopia practiced breast examination despite WHO guidelines advocating for this practice among all women of reproductive age. Intervention programs should address the factors that are associated with breast self-examination. Population specific programs are needed to promote breast self-examination.
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Affiliation(s)
| | | | - Selamawit Gebeyehu
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Peter Memiah
- Division of Epidemiology and Prevention: Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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