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Di Girolamo C, Cammarata G, Giordano L, Zengarini N, Ferracin E, Vergini V, Ferrante G, Ricceri F. Contextual and individual inequalities in breast cancer screening participation and outcomes in Turin (North-West Italy). NPJ Breast Cancer 2024; 10:51. [PMID: 38937476 PMCID: PMC11211318 DOI: 10.1038/s41523-024-00660-4] [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: 01/04/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
Breast cancer incidence and screening participation exhibit an unequal distribution in the population. This study aims to investigate the impact of socioeconomic position (SEP) on three breast screening indicators (participation, recall, and cancer detection rates) among women aged 50-69 in the city of Turin between 2010 and 2019. The study also aims to determine whether contextual factors (deprivation index) or individual factors (educational level) have a greater influence. The data used in this study are sourced from the Turin Breast Screening Program (TBSP) and the Turin Longitudinal Study (TLS). To test the hypothesis and account for the hierarchical structure of the data, multilevel models were used. Both contextual and individual SEP were found to be associated with screening participation. Participation increased with higher levels of deprivation (odds ratio for most deprived: 1.13; 95% CI 1.11-1.16) and decreased with higher educational levels (OR for low educated: 1.37; 95% CI 1.34-1.40). Contextual SEP did not show any association with recall or cancer detection rates, but individual SEP had an impact. Women with lower educational levels had a statistically significant 19% lower odds of being recalled and a statistically significant 20% lower odds of being diagnosed with cancer. Additionally, immigrant women were less likely to participate in screening, be recalled, or receive a cancer diagnosis. Educational level consistently influenced the analyzed screening indicators, while contextual deprivation appeared to have less importance. It is likely that women living in less deprived areas and with higher education have greater access to opportunistic screening.
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Affiliation(s)
- Chiara Di Girolamo
- Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH) - Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | | | - Livia Giordano
- SSD Epidemiologia Screening - CRPT, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Nicolás Zengarini
- Epidemiology Department, Local Health Unit TO3, Via Sabaudia, 164, 10095, Grugliasco, Italy
| | - Elisa Ferracin
- Epidemiology Department, Local Health Unit TO3, Via Sabaudia, 164, 10095, Grugliasco, Italy
| | - Viviana Vergini
- SSD Epidemiologia Screening - CRPT, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Gianluigi Ferrante
- SSD Epidemiologia Screening - CRPT, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy.
| | - Fulvio Ricceri
- Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH) - Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
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Smittenaar R, Quaife SL, von Wagner C, Higgins T, Hubbell E, Lee L. Impact of screening participation on modelled mortality benefits of a multi-cancer early detection test by socioeconomic group in England. J Epidemiol Community Health 2024; 78:345-353. [PMID: 38429085 PMCID: PMC11103338 DOI: 10.1136/jech-2023-220834] [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: 05/11/2023] [Accepted: 02/10/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Cancer burden is higher and cancer screening participation is lower among individuals living in more socioeconomically deprived areas of England, contributing to worse health outcomes and shorter life expectancy. Owing to higher multi-cancer early detection (MCED) test sensitivity for poor-prognosis cancers and greater cancer burden in groups experiencing greater deprivation, MCED screening programmes may have greater relative benefits in these groups. We modelled potential differential benefits of MCED screening between deprivation groups in England at different levels of screening participation. METHODS We applied the interception multi-cancer screening model to cancer incidence and survival data made available by the National Cancer Registration and Analysis Service in England to estimate reductions in late-stage diagnoses and cancer mortality from an MCED screening programme by deprivation group across 24 cancer types. We assessed the impact of varying the proportion of people who participated in annual screening in each deprivation group on these estimates. RESULTS The modelled benefits of an MCED screening programme were substantial: reductions in late-stage diagnoses were 160 and 274 per 100 000 persons in the least and most deprived groups, respectively. Reductions in cancer mortality were 60 and 99 per 100 000 persons in the least and most deprived groups, respectively. Benefits were greatest in the most deprived group at every participation level and were attenuated with lower screening participation. CONCLUSIONS For the greatest possible population benefit and to decrease health inequalities, an MCED implementation strategy should focus on enhancing equitable, informed participation, enabling equal participation across all socioeconomic deprivation groups. TRIAL REGISTRATION NUMBER NCT05611632.
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Affiliation(s)
| | | | | | - Thomas Higgins
- National Cancer Registration and Analysis Service, Leeds, UK
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3
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Davies EA, Wang YH. Understanding inequalities in breast cancer screening uptake. BMJ 2023; 382:2084. [PMID: 37734765 DOI: 10.1136/bmj.p2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Elizabeth A Davies
- Cancer Epidemiology and Cancer Services Research, Centre for Cancer, Society and Public Health, Comprehensive Cancer Centre, King's College London, UK
| | - Yueh-Hsin Wang
- Cancer Epidemiology and Cancer Services Research, Centre for Cancer, Society and Public Health, Comprehensive Cancer Centre, King's College London, UK
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Bolarinwa OA, Holt N. Barriers to breast and cervical cancer screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom: evidence from a mixed-methods systematic review. BMC Health Serv Res 2023; 23:390. [PMID: 37087506 PMCID: PMC10122823 DOI: 10.1186/s12913-023-09410-x] [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: 02/02/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Cancer is currently the leading cause of mortality globally, with new cancer cases estimated at 19.3 million and almost 10 million deaths in 2020. Specifically, breast and cervical cancer incidence and mortality prevalence among women of the minority group or marginalised populations in Europe have continued to be a public health concern due to the low uptake of cancer screening. Thus, this study utilised a mixed-method systematic review to identify barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom. METHODS Databases including PubMed, CINAHL, British Nursing Index, Web of Science, EMBASE, and Scopus databases, were systematically searched for studies on barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom published in English between January 2010 to July 2022. This mixed-method systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in reporting the included studies' results. The cluster mapping approach was used to identify and classify the barriers into themes. RESULTS Thirteen eligible studies were included in this current review. Seven of the thirteen studies used quantitative cross-sectional research design, while six used qualitative cross-sectional research design. These studies were conducted across the United Kingdom. Five themes were developed from the cluster mapping, and thirty-four sub-theme barriers to the uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom were identified. The developed themes in relation to the barriers include; socio-demographic characteristics, health service delivery, cultural, religious & language, the gap in knowledge & awareness, and emotional, sexual & family support. CONCLUSION The study concluded that barriers in socio-demographic characteristics, health service delivery, cultural, religious and language, the gap in knowledge & awareness, and emotional, sexual & family support were identified as non-uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom. Reducing or eliminating these barriers would improve the benefits of timely breast and cervical cancer screening in the United Kingdom.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health & Well-Being, Faculty of Health & Social Care, University of Chester, Chester, UK.
- Institute for Advanced Studies in the Humanities, University of Edinburgh, Edinburgh, UK.
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
- Department of Allied and Public Health, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK.
| | - Nicole Holt
- Department of Allied and Public Health, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK
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Ayoub A, Lapointe J, Nabi H, Pashayan N. Risk-Stratified Breast Cancer Screening Incorporating a Polygenic Risk Score: A Survey of UK General Practitioners’ Knowledge and Attitudes. Genes (Basel) 2023; 14:genes14030732. [PMID: 36981003 PMCID: PMC10048009 DOI: 10.3390/genes14030732] [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: 12/13/2022] [Revised: 02/10/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
A polygenic risk score (PRS) quantifies the aggregated effects of common genetic variants in an individual. A ‘personalised breast cancer risk assessment’ combines PRS with other genetic and nongenetic risk factors to offer risk-stratified screening and interventions. Large-scale studies are evaluating the clinical utility and feasibility of implementing risk-stratified screening; however, General Practitioners’ (GPs) views remain largely unknown. This study aimed to explore GPs’: (i) knowledge of risk-stratified screening; (ii) attitudes towards risk-stratified screening; and (iii) preferences for continuing professional development. A cross-sectional online survey of UK GPs was conducted between July–August 2022. The survey was distributed by the Royal College of General Practitioners and via other mailing lists and social media. In total, 109 GPs completed the survey; 49% were not familiar with the concept of PRS. Regarding risk-stratified screening pathways, 75% agreed with earlier and more frequent screening for women at high risk, 43% neither agreed nor disagreed with later and less screening for women at lower-than-average risk, and 55% disagreed with completely removing screening for women at much lower risk. In total, 81% felt positive about the potential impact of risk-stratified screening towards patients and 62% felt positive about the potential impact on their practice. GPs selected training of healthcare professionals as the priority for future risk-stratified screening implementation, preferring online formats for learning. The results suggest limited knowledge of PRS and risk-stratified screening amongst GPs. Training—preferably using online learning formats—was identified as the top priority for future implementation. GPs felt positive about the potential impact of risk-stratified screening; however, there was hesitance and disagreement towards a low-risk screening pathway.
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Affiliation(s)
- Aya Ayoub
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
- Correspondence:
| | - Julie Lapointe
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, QC G1R 3S3, Canada
| | - Hermann Nabi
- Oncology Division, CHU de Québec-Université Laval Research Center, Québec City, QC G1R 3S3, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Nora Pashayan
- Department of Applied Health Research, University College London (UCL), London WC1E 7HB, UK
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Dickson JL, Hall H, Horst C, Tisi S, Verghese P, Mullin AM, Teague J, Farrelly L, Bowyer V, Gyertson K, Bojang F, Levermore C, Anastasiadis T, McCabe J, Navani N, Nair A, Devaraj A, Hackshaw A, Quaife SL, Janes SM. Uptake of invitations to a lung health check offering low-dose CT lung cancer screening among an ethnically and socioeconomically diverse population at risk of lung cancer in the UK (SUMMIT): a prospective, longitudinal cohort study. Lancet Public Health 2023; 8:e130-e140. [PMID: 36709053 PMCID: PMC7615156 DOI: 10.1016/s2468-2667(22)00258-4] [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: 08/09/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Lung cancer screening with low-dose CT reduces lung cancer mortality, but screening requires equitable uptake from candidates at high risk of lung cancer across ethnic and socioeconomic groups that are under-represented in clinical studies. We aimed to assess the uptake of invitations to a lung health check offering low-dose CT lung cancer screening in an ethnically and socioeconomically diverse cohort at high risk of lung cancer. METHODS In this multicentre, prospective, longitudinal cohort study (SUMMIT), individuals aged 55-77 years with a history of smoking in the past 20 years were identified via National Health Service England primary care records at practices in northeast and north-central London, UK, using electronic searches. Eligible individuals were invited by letter to a lung health check offering lung cancer screening at one of four hospital sites, with non-responders re-invited after 4 months. Individuals were excluded if they had dementia or metastatic cancer, were receiving palliative care or were housebound, or declined research participation. The proportion of individuals invited who responded to the lung health check invitation by telephone was used to measure uptake. We used univariable and multivariable logistic regression analyses to estimate associations between uptake of a lung health check invitation and re-invitation of non-responders, adjusted for sex, age, ethnicity, smoking, and deprivation score. This study was registered prospectively with ClinicalTrials.gov, NCT03934866. FINDINGS Between March 20 and Dec 12, 2019, the records of 2 333 488 individuals from 251 primary care practices across northeast and north-central London were screened for eligibility; 1 974 919 (84·6%) individuals were outside the eligible age range, 7578 (2·1%) had pre-existing medical conditions, and 11 962 (3·3%) had opted out of particpation in research and thus were not invited. 95 297 individuals were eligible for invitation, of whom 29 545 (31·0%) responded. Due to the COVID-19 pandemic, re-invitation letters were sent to only a subsample of 4594 non-responders, of whom 642 (14·0%) responded. Overall, uptake was lower among men than among women (odds ratio [OR] 0·91 [95% CI 0·88-0·94]; p<0·0001), and higher among older age groups (1·48 [1·42-1·54] among those aged 65-69 years vs those aged 55-59 years; p<0·0001), groups with less deprivation (1·89 [1·76-2·04] for the most vs the least deprived areas; p<0·0001), individuals of Asian ethnicity (1·14 [1·09-1·20] vs White ethnicity; p<0·0001), and individuals who were former smokers (1·89 [1·83-1·95] vs current smokers; p<0·0001). When ethnicity was subdivided into 16 groups, uptake was lower among individuals of other White ethnicity than among those with White British ethnicity (0·86 [0·83-0·90]), whereas uptake was higher among Chinese, Indian, and other Asian ethnicities than among those with White British ethnicity (1·33 [1·13-1·56] for Chinese ethnicity; 1·29 [1·19-1·40] for Indian ethnicity; and 1·19 [1·08-1·31] for other Asian ethnicity). INTERPRETATION Inviting eligible adults for lung health checks in areas of socioeconomic and ethnic diversity should achieve favourable participation in lung cancer screening overall, but inequalities by smoking, deprivation, and ethnicity persist. Reminder and re-invitation strategies should be used to increase uptake and the equity of response. FUNDING GRAIL.
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Affiliation(s)
- Jennifer L Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Sophie Tisi
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Priyam Verghese
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Anne-Marie Mullin
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Jon Teague
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Laura Farrelly
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Vicky Bowyer
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Kylie Gyertson
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Fanta Bojang
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire Levermore
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - John McCabe
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK.
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Fry A, White B, Nagarwalla D, Shelton J, Jack RH. Relationship between ethnicity and stage at diagnosis in England: a national analysis of six cancer sites. BMJ Open 2023; 13:e062079. [PMID: 36702581 PMCID: PMC9884890 DOI: 10.1136/bmjopen-2022-062079] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Cancer stage at diagnosis is a determinant of treatment options and survival. Previous research has shown differences in barriers to presentation with cancer between ethnic groups. The completeness and quality of cancer stage and ethnicity data has improved markedly over recent years in England, allowing for comparison of stage distributions at diagnosis between ethnic groups. This study aimed to assess relationships between ethnic group and two outcomes: unknown stage cancer and late stage (stages 3 and 4) cancer, after adjustment for confounders. DESIGN AND SETTING A retrospective secondary data analysis using data from NHS Digital's National Cancer Registration and Analysis Service and Hospital Episode Statistics records from 2012 to 2016. PARTICIPANTS This study analysed newly diagnosed breast, colon, non-small cell lung cancer (NSCLC), ovary, prostate and uterine cancers in white British, Caribbean, African, Chinese and Asian patients aged 15-99 in England. RESULTS Caribbean, African and Asian women with breast or ovarian cancer, Caribbean and African women with uterine or colon cancer, Caribbean women with NSCLC and Caribbean men with colon cancer had increased odds of late-stage disease at diagnosis compared with the white British cohort. In contrast, Caribbean and African men with prostate cancer had decreased odds of late-stage cancer. Where stage was known, there were variations in late-stage cancer by ethnic group. CONCLUSIONS Low symptom awareness and barriers to presentation can cause delays, resulting in later stage diagnosis. Targeted intervention campaigns to help raise awareness of cancer signs and symptoms and the benefits of early diagnosis, along with removing barriers to appropriate referrals, could help to improve these inequalities.
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Affiliation(s)
- Anna Fry
- National Cancer Registration and Analysis Service, NHS Digital, London, UK
- Cancer Intelligence, Cancer Research UK, London, UK
| | - Becky White
- Cancer Intelligence, Cancer Research UK, London, UK
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science & Health, Institute of Epidemiology & Health Care, University College London, London, UK
| | | | - Jon Shelton
- Cancer Intelligence, Cancer Research UK, London, UK
| | - Ruth H Jack
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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Marcu A, Marke L, Armes J, Whitaker KL, Ream E. Adapting a breast cancer early presentation intervention for Black women: A focus group study with women of Black African and Black Caribbean descent in the United Kingdom. Eur J Cancer Care (Engl) 2022; 31:e13652. [PMID: 35838142 PMCID: PMC9786577 DOI: 10.1111/ecc.13652] [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: 09/30/2021] [Revised: 05/17/2022] [Accepted: 06/24/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Black women in the United Kingdom are more likely than White women to be diagnosed with advanced breast cancer and have lower survival rates. We consulted women of Black Caribbean and Black African descent in the United Kingdom on how the Promoting Early Presentation (PEP) booklet and intervention could be adapted for Black women to promote early presentation with breast cancer symptoms. METHODS Focus groups with 22 women of Black African and Black Caribbean descent, of whom five had been treated for breast cancer. The participants were recruited from a large UK breast cancer charity and community settings. Data were analysed using Framework Analysis. RESULTS Four themes summarised the participants' views on how the booklet and intervention could be adapted: Justify the focus on Black women, Black people do not talk about cancer, Make interventions inclusive and engaging, and Engage Black communities to deliver interventions. CONCLUSION Breast cancer behaviour change interventions need to be more inclusive, illustrate how breast cancer symptoms manifest on black skin, and emphasise that breast cancer is curable to increase awareness and reduce cancer fear. Researchers should involve Black communities in the design and delivery of interventions to address appropriately cultural barriers to early presentation.
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Affiliation(s)
- Afrodita Marcu
- School of Health SciencesUniversity of SurreyGuildfordUK
| | | | - Jo Armes
- School of Health SciencesUniversity of SurreyGuildfordUK
| | | | - Emma Ream
- School of Health SciencesUniversity of SurreyGuildfordUK
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Bulliard JL, Bovio N, Arveux P, Bergeron Y, Chiolero A, Fournier E, Germann S, Konzelmann I, Maspoli M, Rapiti E, Canu IG. Occupational Factors and Socioeconomic Differences in Breast Cancer Risk and Stage at Diagnosis in Swiss Working Women. Cancers (Basel) 2022; 14:cancers14153713. [PMID: 35954377 PMCID: PMC9367372 DOI: 10.3390/cancers14153713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/12/2022] [Accepted: 07/28/2022] [Indexed: 12/07/2022] Open
Abstract
Socioeconomic differences in breast cancer (BC) incidence are driven by differences in lifestyle, healthcare use and occupational exposure. Women of high socioeconomic status (SES) have a higher risk of BC, which is diagnosed at an earlier stage, than in low SES women. As the respective effects of occupation and SES remain unclear, we examined the relationships between occupation-related variables and BC incidence and stage when considering SES. Female residents of western Switzerland aged 18−65 years in the 1990 or 2000 census, with known occupation, were linked with records of five cancer registries to identify all primary invasive BC diagnosed between 1990 and 2014 in this region. Standardized incidence ratios (SIRs) were computed by occupation using general female population incidence rates, with correction for multiple comparisons. Associations between occupation factors and BC incidence and stage at diagnosis were analysed by negative binomial and multinomial logistic regression models, respectively. The cohort included 381,873 women-years and 8818 malignant BC, with a mean follow-up of 14.7 years. Compared with reference, three occupational groups predominantly associated with a high socioprofessional status had SIRs > 1: legal professionals (SIR = 1.68, 95%CI: 1.27−2.23), social science workers (SIR = 1.29; 95%CI: 1.12−1.49) and some office workers (SIR = 1.14; 95%CI: 1.09−1.20). Conversely, building caretakers and cleaners had a reduced incidence of BC (SIR = 0.69, 95%CI: 0.59−0.81). Gradients in BC risk with skill and socioprofessional levels persisted when accounting for SES. A higher incidence was generally associated with a higher probability of an early-stage BC. Occupation and SES may both contribute to differences in risk and stage at diagnosis of BC.
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Affiliation(s)
- Jean-Luc Bulliard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
- Neuchâtel and Jura Cancer Registry, 2000 Neuchâtel, Switzerland;
- Correspondence:
| | - Nicolas Bovio
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
| | - Patrick Arveux
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
| | - Yvan Bergeron
- Fribourg Cancer Registry, 1701 Fribourg, Switzerland;
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, 1700 Fribourg, Switzerland;
- Valais Cancer Registry, Valais Health Observatory, 1950 Sion, Switzerland;
| | - Evelyne Fournier
- Geneva Cancer Registry, University of Geneva, 1211 Geneva, Switzerland; (E.F.); (E.R.)
| | - Simon Germann
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
| | | | - Manuela Maspoli
- Neuchâtel and Jura Cancer Registry, 2000 Neuchâtel, Switzerland;
| | - Elisabetta Rapiti
- Geneva Cancer Registry, University of Geneva, 1211 Geneva, Switzerland; (E.F.); (E.R.)
| | - Irina Guseva Canu
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
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Acharya A, Ashrafian H, Cunningham D, Ruwende J, Darzi A, Judah G. Evaluating the impact of a novel behavioural science informed animation upon breast cancer screening uptake: protocol for a randomised controlled trial. BMC Public Health 2022; 22:1388. [PMID: 35854267 PMCID: PMC9295097 DOI: 10.1186/s12889-022-13781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Breast cancer screening is estimated to save 1300 lives annually in the United Kingdom. Despite this, uptake of invitations has fallen over the past decade. Behavioural science-informed interventions addressing the determinants of attendance behaviour have shown variable effectiveness. This may be due to the narrow repertoire of techniques trialled, and the difficulties of implementation at a population-scale. The aim of this study is to evaluate the impact on breast screening uptake of a novel behavioural video intervention which can contain more complex combinations of behavioural change techniques. METHODS A 3-armed randomised controlled trial will be undertaken in London comparing the impact of (1) the usual care SMS reminder, to (2) a behavioural plain text SMS reminder and (3) a novel video sent as a link within the behavioural plain text SMS reminder. A total of 8391 participants (2797 per group) will be allocated to one of the three trial arms using a computer randomisation process, based upon individuals' healthcare identification numbers. The novel video has been co-designed with a diverse range of women to overcome the barriers faced by underserved communities and the wider population. The behavioural SMS content has also been co-designed through the same process as the video. Messages will be sent through the current reminder system used by the London screening programmes, with reminders 7 days and 2 days prior to a timed appointment. The primary outcome is attendance at breast cancer screening within 3 months of the initial invitation. Secondary outcomes will include evaluating the impact of each message amongst socio-demographic groups and according to the appointment type e.g. first invitation or recall. DISCUSSION In addition to general declining trends in attendance, there is also concern of increasing healthcare inequalities with breast cancer screening in London. The current novel intervention, designed with underserved groups and the general population, incorporates several behavioural techniques to overcome the barriers to attendance. Understanding its potential impact in a real-world setting therefore may provide significant information on how to address reducing attendance and healthcare disparities. TRIAL REGISTRATION This study was registered on ClinicalTrials.gov ( NCT05395871 ) on the 27th May 2022.
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Affiliation(s)
- Amish Acharya
- Department of Surgery and Cancer, St Mary's Hospital, 10th Floor Queen Elizabeth Queen Mother Building, W2 1NY, London, UK.
| | - Hutan Ashrafian
- Department of Surgery and Cancer, St Mary's Hospital, 10th Floor Queen Elizabeth Queen Mother Building, W2 1NY, London, UK
| | - Deborah Cunningham
- Department of Radiology, Imperial College Healthcare NHS Trust, W2 1NY, London, UK
| | | | - Ara Darzi
- Department of Surgery and Cancer, St Mary's Hospital, 10th Floor Queen Elizabeth Queen Mother Building, W2 1NY, London, UK
| | - Gaby Judah
- Department of Surgery and Cancer, St Mary's Hospital, 10th Floor Queen Elizabeth Queen Mother Building, W2 1NY, London, UK
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11
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Delon C, Brown KF, Payne NWS, Kotrotsios Y, Vernon S, Shelton J. Differences in cancer incidence by broad ethnic group in England, 2013-2017. Br J Cancer 2022; 126:1765-1773. [PMID: 35233092 PMCID: PMC9174248 DOI: 10.1038/s41416-022-01718-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/05/2022] [Accepted: 01/25/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cancer incidence variation between population groups can inform public health and cancer services. Previous studies have shown cancer incidence rates vary by ethnic group in England. Since their publication, the completeness of ethnicity recording in cancer data has improved, and relevant inequalities (e.g. risk factor prevalence and healthcare access) may have changed. METHODS Age-standardised incidence rates were calculated for Asian, Black, Mixed/Multiple and White ethnic groups in England in 2013-2017, using almost 3 million diagnoses across 31 cancer sites. Rate ratios were calculated with the White ethnic group as reference. Sensitivity analyses used imputed ethnicity for cases with missing data and perturbed population estimates. RESULTS Incidence rates for most cancer sites and ethnic group and sex combinations were lower in non-White minority ethnic groups compared with the corresponding White group, with particularly low rate ratios (below 0.5) for melanoma skin cancer and some smoking-related cancers (lung, bladder and oesophageal cancers). Exceptions included prostate cancer (2.1 times higher in males of Black ethnicity), myeloma (2.7-3.0 times higher in people of Black ethnicity), several gastrointestinal cancers (1.1-1.9 times higher in people of Black ethnicity, 1.4-2.2 times higher in people of Asian ethnicity), Hodgkin lymphoma (1.1 times higher in males of Asian ethnicity, 1.3 times higher in males of Black ethnicity) and thyroid cancers (1.4 times higher in people of Asian ethnicity, 1.2 times higher in people of Black ethnicity). Sensitivity analyses did not materially alter these results (rate ratios changed by a maximum of 12 percentage points, the direction and significance of results were unchanged in all but two cancer site/sex/ethnic group combinations). CONCLUSIONS People of non-White minority ethnicity in England generally have lower cancer risk than the White population, though there are a number of notable exceptions. These results should galvanise efforts to better understand the reasons for this variation, and the possible impact on cancer services, patient experiences and outcomes.
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Affiliation(s)
- Christine Delon
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK.
| | - Katrina F Brown
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Nick W S Payne
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Yannis Kotrotsios
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Sally Vernon
- National Disease Registration Service, NHS Digital, 7 and 8 Wellington Place, Leeds, LS1 4AP, UK
| | - Jon Shelton
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
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12
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Abraham S, Foreman N, Sidat Z, Sandhu P, Marrone D, Headley C, Akroyd C, Nicholson S, Brown K, Thomas A, Howells LM, Walter HS. Inequalities in cancer screening, prevention and service engagement between UK ethnic minority groups. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S14-S24. [PMID: 35648663 DOI: 10.12968/bjon.2022.31.10.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
More people in the UK are living with cancer than ever before. With an increasingly ethnically diverse population, greater emphasis must be placed on understanding factors influencing cancer outcomes. This review seeks to explore UK-specific variations in engagement with cancer services in minority ethnic groups and describe successful interventions. The authors wish to highlight that, despite improvement to engagement and education strategies, inequalities still persist and work to improve cancer outcomes across our communities still needs to be prioritised. There are many reasons why cancer healthcare inequities exist for minority communities, reported on a spectrum ranging from cultural beliefs and awareness, through to racism. Strategies that successfully enhanced engagement included language support; culturally-sensitive reminders; community-based health workers and targeted outreach. Focusing on the diverse city of Leicester the authors describe how healthcare providers, researchers and community champions have worked collectively, delivering targeted community-based strategies to improve awareness and access to cancer services.
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Affiliation(s)
- Shalin Abraham
- F2 Academic Foundation Doctor, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Nalini Foreman
- Quality Assistant, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Zahirah Sidat
- Senior Research Practitioner, Hope Clinical Trials Facility, University Hospitals of Leicester NHS Trust, Leicester
| | - Pavandeep Sandhu
- Research Technician, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Domenic Marrone
- Research Technician, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Catherine Headley
- Senior Cancer Services Manager, Leicester City Clinical Commissioning Group, Leicester
| | - Carol Akroyd
- Collaboration for Leadership in Applied Health Research and Care Equality and Diversity Theme Manager, Centre for Ethnic Health Research, University of Leicester, Leicester
| | - Sarah Nicholson
- Hope Clinical Trials Facility Manager/Cancer, Haematology, Urology, Gastroenterology, General Surgery Research Lead, Hope Clinical Trials Facility, University Hospitals of Leicester NHS Trust, Leicester
| | - Karen Brown
- Professor in Translational Cancer Research, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Anne Thomas
- Professor of Cancer Therapeutics, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Lynne M Howells
- Experimental Cancer Medicine Centre Translational Research Manager, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Harriet S Walter
- Associate Professor of Medical Oncology, Leicester Cancer Research Centre, University of Leicester, Leicester
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13
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Ding L, Wang J, Greuter MJW, Goossens M, Van Hal G, de Bock GH. Determinants of Non-Participation in Population-Based Breast Cancer Screening: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:817222. [PMID: 35311110 PMCID: PMC8924365 DOI: 10.3389/fonc.2022.817222] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer (BC) screening can be performed in a screening program (BCSP) or in opportunistic screening. The existing reviews on the determinants of non-participation depend on self-reported data which may be biased. Furthermore, no distinction was made between the probably different determinants of both screening strategies. Objective To find the determinants of non-participation in BCSP by means of a meta-analysis. Methods PubMed, Embase, and Web of Science were searched for observational studies which quantified factors associated with non-participation in BCSP in a general population. Studies on opportunistic screening and studies using self-reported data were excluded. A random-effect model was used to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Potential sources of heterogeneity were explored by stratification of the results. Results Twenty-nine studies with in a total of 20,361,756 women were included. Low income (OR: 1.20, 95% CI: 1.10–1.30), low education (OR: 1.18, 95% CI: 1.05–1.32), living far from an assigned screening unit (OR: 1.15, 95% CI: 1.07–1.24), being immigrant (OR: 2.64, 95% CI: 2.48–2.82), and having a male family doctor (OR: 1.43, 95% CI: 1.20–1.61) was associated with higher non-participation in screening. Reminders sent to non-attenders and estimations of ORs (adjusted or not) partly explained substantial heterogeneity. Conclusion In this meta-analysis excluding studies on the non-participation in opportunistic screening, or with self-reported data on non-participation, the well-known determinants for non-participation are still significant, but less strong. This analysis only supports the relevance of meta-analysis of studies with registered non-participation in a BCSP. Systematic Review Registration PROSPERO, CRD42020154016.
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Affiliation(s)
- Lilu Ding
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - J Wang
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - M J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, Netherlands
| | - M Goossens
- Center for Cancer Detection, Flanders, Belgium
| | - Guido Van Hal
- Center for Cancer Detection, Flanders, Belgium.,Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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14
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Wu H, Wong K, Lu SE, Broggio J, Zhang L. Changing Trends in the Proportional Incidence and Five-year Net Survival of Screened and Non-screened Breast Cancers among Women During 1995-2011 in England. JOURNAL OF CLINICAL AND TRANSLATIONAL PATHOLOGY 2022; 2:23-30. [PMID: 35403174 PMCID: PMC8994161 DOI: 10.14218/jctp.2022.00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Uptake of breast cancer screening has been decreasing in England since 2007. However, the associated factors are unclear. On the other hand, survival among breast cancer patients have recently increased. We conducted a quasi-experimental analysis to test whether the trend-change in proportional incidence of non-screened cancers coincided with that in five-year net-survival. METHODS We extracted population-based proportional incidence and age-standardized five-year net-survival data from Public Health England that included English women with invasive breast cancer diagnosed during 1995-2011 (linked to death certificates, followed through 2016). Piece-wise log-linear models with change-point/joinpoint were used to estimate temporal trends. RESULTS Among 254,063 women in England with invasive breast cancer diagnosed during 1995-2011, there was downward-to-upward trend-change in proportional incidence of non-screened breast cancers (annual percent change [APC]=5.6 after 2007 versus APC=-3.5 before 2007, p<0.001) in diagnosis-year 2007, when a steeper upward-trend in age-standardized five-year net survival started (APC=5.7 after 2007/2008 versus APC=0.3 before 2007/2008, p<0.001). Net-survival difference of screened versus non-screened cancers also significantly narrowed (18% in 2007/2008 versus 5% in 2011). Similar associations were found in all strata of race, cancer stage, grade, and histology, except in Black patients or patients with stage I, stage III, or grade I cancer. CONCLUSIONS There was a downward-to-upward trend-change in proportional incidence of non-screened breast cancers in 2007 that coincided with a steeper upward-trend in age-standardized five-year net survival among English women in 2007. Survival benefits of breast cancer screening decreased during 2007-2011. The data support reduction of breast cancer screening in some patients, but future validation studies are warranted.
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Affiliation(s)
- Haiyan Wu
- Health Data Research UK London, UCL Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - Kwok Wong
- National Cancer Registration and Analysis Service, Public Health England, Birmingham B3 2PW, UK
| | - Shou-En Lu
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Biostatistics, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - John Broggio
- National Cancer Registration and Analysis Service, Public Health England, Birmingham B3 2PW, UK
| | - Lanjing Zhang
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Pathology, Princeton Medical Center, Plainsboro, NJ, USA
- Department of Biological Sciences, Rutgers University, Newark, NJ, USA
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
- Correspondence to: Lanjing Zhang, Department of Pathology, Princeton Medical Center, 1 Plainsboro Rd, Plainsboro, NJ 08536, USA. Tel: +1-609-853-6833, Fax: +1-609-853-6841,
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15
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Kwok C, Lee CF. Assessment of the validity and reliability of the Vietnamese version of the Breast Cancer Screening Beliefs Questionnaire. Asia Pac J Oncol Nurs 2021; 9:69-74. [PMID: 35528800 PMCID: PMC9072186 DOI: 10.1016/j.apjon.2021.11.003] [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: 09/10/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of this study was to evaluate the cultural adaptability and psychometric properties of the Vietnamese version of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ). Methods A total of 253 women aged 18 years and older with no history of breast cancer was included in the analysis. Results Confirmatory factor analysis showed an adequate fit for the hypothesized three-factor structure of the original version of the BCSBQ. The results indicated that the frequency of women’s breast cancer screening practices and their educational levels were significantly associated with “Attitudes towards general check-ups”. Demonstrating the Cronbach’s α of the three subscales ranged between 0.79 and 0.85 while the corrected item-total correlations for the hypothesized subscales ranged from 0.38 to 0.74, constituted a result which indicated that the Vietnamese version of the BCSBQ had satisfactory validity and internal consistency. Conclusions The Vietnamese version of the BCSBQ is a culturally appropriate, valid, and reliable instrument for examining the beliefs, knowledge, and attitudes about breast cancer and breast cancer screening practices among Vietnamese women living in Australia.
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16
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Gathani T, Chaudhry A, Chagla L, Chopra S, Copson E, Purushotham A, Vidya R, Cutress R. Ethnicity and breast cancer in the UK: Where are we now? Eur J Surg Oncol 2021; 47:2978-2981. [PMID: 34452771 DOI: 10.1016/j.ejso.2021.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022] Open
Abstract
Outcomes from breast cancer for women in the UK have improved significantly over recent decades. These gains are largely attributable to a combination of earlier diagnosis and access to treatments delivered to patients by the National Health Service irrespective of cost. Ethnic minority groups make up almost fifteen percent of the UK population and there is concern however that these groups may have poorer outcomes from the disease. In this short report we seek to summarise what the current evidence tells us about the patterns of breast cancer incidence and outcomes in ethnic minority women in the UK in order to raise awareness about this topic and provide consideration for what future research is needed to address the gaps that may exist.
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Affiliation(s)
- Toral Gathani
- Senior Clinical Research Fellow, Nuffield Department of Population Health, University of Oxford, United Kingdom; Department of Surgery, Oxford University Hospitals NHS Foundation Trust, United Kingdom.
| | - Anushka Chaudhry
- Department of Breast Surgery, Great Western Hospital NHS Foundation Trust, Swindon, United Kingdom.
| | - Leena Chagla
- Department of Breast Surgery, St Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside, United Kingdom.
| | - Sharat Chopra
- Cardiff and Vale University Hospital NHS Trust, United Kingdom.
| | - Ellen Copson
- Cancer Sciences Division at the University of Southampton, United Kingdom.
| | | | - Raghavan Vidya
- Department of Oncoplastic Breast Surgery, Royal Wolverhampton Hospital NHS Trust, United Kingdom.
| | - Ramsey Cutress
- Cancer Sciences Division at the University of Southampton, United Kingdom.
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17
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Froelicher JH, Forjaz G, Rosenberg PS, Chernyavskiy P. Geographic disparities of breast cancer incidence in Portugal at the district level: A spatial age-period-cohort analysis, 1998-2011. Cancer Epidemiol 2021; 74:102009. [PMID: 34399245 DOI: 10.1016/j.canep.2021.102009] [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: 02/24/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast cancer is the most common malignancy in women world-wide and the most common cause of cancer deaths, which can often be managed with early diagnosis and subsequent treatment. Here, we focus on geographic disparities in incidence within Portugal for three age groups of women (30-49; 50-69; 70-84 years). METHODS Age-period-cohort (APC) models are widely used in cancer surveillance, and these models have recently been extended to allow spatially-varying effects. We apply novel spatial APC models to estimate relative risk and age-adjusted temporal trends at the district level for the 20 districts in Portugal. Our model allows us to report on country-wide trends, but also to investigate geographic disparities between districts and trends within districts. RESULTS Age-adjusted breast cancer incidence was increasing over 1998-2011 for all three age groups and in every district in Portugal. However, we detect spatially-structured between-district heterogeneity in relative risk and age-adjusted trends (Net Drifts) for each of the three age groups, which is most pronounced in the highly-screened (50-69yo) and late-onset (70-84yo) groups of women. CONCLUSIONS We present evidence of disparities in breast cancer incidence at a more granular geographic level than previously reported. Some disparities may be due to latent risk factors, which cannot be accounted for by age, birth year, and geographic location alone. IMPACT Our study motivates resuming data collection for breast cancer incidence at the district level in Portugal, as well as the study of exogenous risk factors.
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Affiliation(s)
- Joseph H Froelicher
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.
| | - Gonçalo Forjaz
- Data Analytics Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
| | - Philip S Rosenberg
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | - Pavel Chernyavskiy
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
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18
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Gathani T, Reeves G, Broggio J, Barnes I. Ethnicity and the tumour characteristics of invasive breast cancer in over 116,500 women in England. Br J Cancer 2021; 125:611-617. [PMID: 34040176 PMCID: PMC8368149 DOI: 10.1038/s41416-021-01409-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ethnic minority women are commonly reported to have more aggressive breast cancer than White women, but there is little contemporary national evidence available. METHODS We analysed data from the National Cancer Registration and Analysis Service on women diagnosed with invasive breast cancer during 2013-2018. Multivariable logistic regression yielded adjusted odds ratios (and 95% confidence intervals) of less favourable tumour characteristics (high stage, high grade, ER negative, Her2 positive) by ethnicity (black African, black Caribbean, Indian, Pakistani and white) in younger (30-46 years) and older (53-70 years) women. RESULTS In 24,022 women aged 30-46 at diagnosis, all ethnic minority groups apart from Indian women had a significantly greater odds of certain less favourable tumour characteristics compared to white women in fully adjusted models. In 92,555 women aged 53-70, all ethnic minorities had a significantly greater adjusted odds of several of the less favourable tumour characteristics. These differences were most marked in black African and black Caribbean women. CONCLUSIONS Ethnic minority women are at greater risk of breast cancers with less favourable characteristics, even after allowing for age and other potential confounders. These differences are greater in older than younger women, and in the Black rather than South Asian ethnic groups.
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Affiliation(s)
- Toral Gathani
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
- Department of Breast Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Gillian Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John Broggio
- National Cancer Registration and Analysis Service, Public Health England, Birmingham, UK
| | - Isobel Barnes
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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19
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Chakrabarthi S. Stereotactic breast biopsy: A review & applicability in the Indian context. Indian J Med Res 2021; 154:237-247. [PMID: 35142645 PMCID: PMC9131754 DOI: 10.4103/ijmr.ijmr_1815_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Indexed: 11/13/2022] Open
Abstract
Stereotactic biopsy is used for sampling of suspicious non-palpable lesions identified on mammography or digital breast tomosynthesis which are not visible on ultrasound. Stereotactic biopsy is preferable to surgical excision biopsy and helps avoid surgery for benign lesions. Providing tissue diagnosis in patients with early breast cancer may help in formulating a management strategy. Stereotactic biopsy can be carried out using either a dedicated prone table with the patient lying prone or an upright mammographic add-on system with the patient in a sitting or lateral decubitus position. This review focuses on the advantages and disadvantages of both these systems, the indications, contraindications and the complications inherent with this technique. The important pitfalls and their management as well as ways to ensure quality assurance have also been elaborated upon. Data regarding uptake of stereotactic biopsy in other parts of the world have been discussed using evidence from existing registries and databases and attempts made to quantify the need of the technique in the Indian set-up. In the absence of a national breast screening programme and limited resources in India, a hub and spoke model has been proposed as a viable model for healthcare providers for providing stereotactic biopsy.
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Affiliation(s)
- Suma Chakrabarthi
- Peerless Hospital & B. K. Roy Research Centre, Kolkata, West Bengal, India
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20
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French DP, Astley S, Brentnall AR, Cuzick J, Dobrashian R, Duffy SW, Gorman LS, Harkness EF, Harrison F, Harvie M, Howell A, Jerrison A, Machin M, Maxwell AJ, McWilliams L, Payne K, Qureshi N, Ruane H, Sampson S, Stavrinos P, Thorpe E, Ulph F, van Staa T, Woof V, Evans DG. What are the benefits and harms of risk stratified screening as part of the NHS breast screening Programme? Study protocol for a multi-site non-randomised comparison of BC-predict versus usual screening (NCT04359420). BMC Cancer 2020; 20:570. [PMID: 32552763 PMCID: PMC7302349 DOI: 10.1186/s12885-020-07054-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/09/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In principle, risk-stratification as a routine part of the NHS Breast Screening Programme (NHSBSP) should produce a better balance of benefits and harms. The main benefit is the offer of NICE-approved more frequent screening and/ or chemoprevention for women who are at increased risk, but are unaware of this. We have developed BC-Predict, to be offered to women when invited to NHSBSP which collects information on risk factors (self-reported information on family history and hormone-related factors via questionnaire; mammographic density; and in a sub-sample, Single Nucleotide Polymorphisms). BC-Predict produces risk feedback letters, inviting women at high risk (≥8% 10-year) or moderate risk (≥5 to < 8% 10-year) to have discussion of prevention and early detection options at Family History, Risk and Prevention Clinics. Despite the promise of systems such as BC-Predict, there are still too many uncertainties for a fully-powered definitive trial to be appropriate or ethical. The present research aims to identify these key uncertainties regarding the feasibility of integrating BC-Predict into the NHSBSP. Key objectives of the present research are to quantify important potential benefits and harms, and identify key drivers of the relative cost-effectiveness of embedding BC-Predict into NHSBSP. METHODS A non-randomised fully counterbalanced study design will be used, to include approximately equal numbers of women offered NHSBSP (n = 18,700) and BC-Predict (n = 18,700) from selected screening sites (n = 7). In the initial 8-month time period, women eligible for NHSBSP will be offered BC-Predict in four screening sites. Three screening sites will offer women usual NHSBSP. In the following 8-months the study sites offering usual NHSBSP switch to BC-Predict and vice versa. Key potential benefits including uptake of risk consultations, chemoprevention and additional screening will be obtained for both groups. Key potential harms such as increased anxiety will be obtained via self-report questionnaires, with embedded qualitative process analysis. A decision-analytic model-based cost-effectiveness analysis will identify the key uncertainties underpinning the relative cost-effectiveness of embedding BC-Predict into NHSBSP. DISCUSSION We will assess the feasibility of integrating BC-Predict into the NHSBSP, and identify the main uncertainties for a definitive evaluation of the clinical and cost-effectiveness of BC-Predict. TRIAL REGISTRATION Retrospectively registered with clinicaltrials.gov (NCT04359420).
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Affiliation(s)
- David P French
- Manchester Centre of Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Coupland Street, Manchester, M13 9PL, England.
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England.
| | - Susan Astley
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester, Manchester, England
| | - Adam R Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, England
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, England
| | - Richard Dobrashian
- East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Haslingden Road, Lancashire, BB2 3HH, England
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, England
| | - Louise S Gorman
- The Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, England
| | - Elaine F Harkness
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester, Manchester, England
- The Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
| | | | - Michelle Harvie
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England
- The Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, 555 Wilmslow Rd, Manchester, M20 4GJ, England
| | - Anthony Howell
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England
- The Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, 555 Wilmslow Rd, Manchester, M20 4GJ, England
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX, England
| | - Andrew Jerrison
- Research IT, IT Services, University of Manchester, Manchester, M13 9PL, England
| | - Matthew Machin
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester, Manchester, England
| | - Anthony J Maxwell
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester, Manchester, England
- The Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
| | - Lorna McWilliams
- Manchester Centre of Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Coupland Street, Manchester, M13 9PL, England
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England
| | - Katherine Payne
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, M13 9PL, England
| | - Nadeem Qureshi
- School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, England
| | - Helen Ruane
- The Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
| | - Sarah Sampson
- The Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
| | - Paula Stavrinos
- The Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
| | - Emma Thorpe
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England
| | - Fiona Ulph
- Manchester Centre of Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Coupland Street, Manchester, M13 9PL, England
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England
| | - Tjeerd van Staa
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester, Manchester, England
| | - Victoria Woof
- Manchester Centre of Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Coupland Street, Manchester, M13 9PL, England
| | - D Gareth Evans
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England
- The Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, 555 Wilmslow Rd, Manchester, M20 4GJ, England
- Genomic Medicine, Division of Evolution and Genomic Sciences, The University of Manchester, St Mary's Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, England
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21
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Woof VG, Ruane H, French DP, Ulph F, Qureshi N, Khan N, Evans DG, Donnelly LS. The introduction of risk stratified screening into the NHS breast screening Programme: views from British-Pakistani women. BMC Cancer 2020; 20:452. [PMID: 32434564 PMCID: PMC7240981 DOI: 10.1186/s12885-020-06959-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND UK national guidelines suggest women at high-risk of breast cancer should be offered more frequent screening or preventative medications. Currently, only 1 in 6 high-risk women are identified. One route to identify more high-risk women is via multifactorial risk assessment as part of the UK's NHS Breast Screening Programme (NHSBSP). As lower socioeconomic and minority ethnic populations continue to experience barriers to screening, it is important that any new service does not exacerbate issues further. To inform service development, this study explored views of women from underserved backgrounds regarding the introduction of risk stratification into the NHSBSP. METHODS Nineteen semi-structured interviews were conducted with British-Pakistani women from low socioeconomic backgrounds from East Lancashire, UK. Fourteen interviews were conducted via an interpreter. RESULTS Thematic analysis produced three themes. Attitudes toward risk awareness concerns the positive views women have toward the idea of receiving personalised breast cancer risk information. Anticipated barriers to accessibility emphasises the difficulties associated with women's limited English skills for accessing information, and their I.T proficiency for completing an online risk assessment questionnaire. Acceptability of risk communication strategy highlights the diversity of opinion regarding the suitability of receiving risk results via letter, with the option for support from a healthcare professional deemed essential. CONCLUSIONS The idea of risk stratification was favourable amongst this underserved community. To avoid exacerbating inequities, this new service should provide information in multiple languages and modalities and offer women the opportunity to speak to a healthcare professional about risk. This service should also enable completion of personal risk information via paper questionnaires, as well as online.
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Affiliation(s)
- Victoria G Woof
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Room 1.13, Coupland 1, Coupland Street, Off Oxford Road, Manchester, M13 9PL, UK.
| | - Helen Ruane
- Nightingale & Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust (MFT), Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - David P French
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Room 1.13, Coupland 1, Coupland Street, Off Oxford Road, Manchester, M13 9PL, UK
| | - Fiona Ulph
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Room 1.13, Coupland 1, Coupland Street, Off Oxford Road, Manchester, M13 9PL, UK
| | - Nadeem Qureshi
- NIHR School of Primary Care, School of Medicine, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - Nasaim Khan
- Department of Genomic Medicine, Division of Evolution and Genomic Science, MAHSC, University of Manchester, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - D Gareth Evans
- Nightingale & Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust (MFT), Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.,Department of Genomic Medicine, Division of Evolution and Genomic Science, MAHSC, University of Manchester, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Louise S Donnelly
- Nightingale & Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust (MFT), Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
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22
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Woof VG, Ruane H, Ulph F, French DP, Qureshi N, Khan N, Evans DG, Donnelly LS. Engagement barriers and service inequities in the NHS Breast Screening Programme: Views from British-Pakistani women. J Med Screen 2019; 27:130-137. [PMID: 31791172 PMCID: PMC7645618 DOI: 10.1177/0969141319887405] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives Previous research has largely attempted to explore breast screening experiences of South Asian women by combining opinions from Pakistani, Bangladeshi, and Indian women. This research often fails to reach the most underserved sub-groups of this population, with socioeconomic status not routinely reported, and English fluency being a participation requirement. With uptake low amongst British-Pakistani women, this study explores the experiences these women encounter when accessing the NHS Breast Screening Programme. Methods 19 one-to-one semi-structured interviews were carried out with British-Pakistani women from East Lancashire, UK. 14 interviews were conducted via an interpreter. Results Data were analysed using thematic analysis. Three themes were identified: ‘Absence of autonomy in screening and healthcare access’ describes how currently the screening service does not facilitate confidentiality or independence. Access requires third-party intervention, with language barriers preventing self-expression. ‘Appraisal of information sources’ makes distinctions between community and NHS communication. Whereas community communication was invaluable, NHS materials were deemed inaccessible due to translation incongruences and incomprehensible terminology. ‘Personal suppositions of breast screening’ explores the subjective issues associated with disengagement, including, the cultural misalignment of the service, and perceiving screening as a symptomatic service. Conclusions British-Pakistani women face some unique challenges when accessing breast screening. To promote uptake, the service needs to address the translation of screening materials and optimize upon community networks to disseminate knowledge, including knowledge of the screening environment within the context of culture to promote informed choice about attendance.
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Affiliation(s)
- Victoria G Woof
- Division of Psychology & Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Helen Ruane
- Nightingale & Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust (MFT), Manchester, UK
| | - Fiona Ulph
- Division of Psychology & Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - David P French
- Division of Psychology & Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Nadeem Qureshi
- NIHR School of Primary Care, School of Medicine, University Park, Nottingham, UK
| | - Nasaim Khan
- Department of Genomic Medicine, Division of Evolution and Genomic Science, MAHSC, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - D Gareth Evans
- Nightingale & Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust (MFT), Manchester, UK.,Department of Genomic Medicine, Division of Evolution and Genomic Science, MAHSC, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Louise S Donnelly
- Nightingale & Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust (MFT), Manchester, UK
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23
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Hudson SM, Wilkinson LS, Denholm R, De Stavola BL, Dos-Santos-Silva I. Ethnic and age differences in right-left breast asymmetry in a large population-based screening population. Br J Radiol 2019; 93:20190328. [PMID: 31661305 DOI: 10.1259/bjr.20190328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Exposure to sex hormones is important in the pathogenesis of breast cancer and inability to tolerate such exposure may be reflected in increased asymmetrical growth of the breasts. This study aims to characterize, for the first time, asymmetry in breast volume (BV) and radiodense volume (DV) in a large ethnically diverse population. METHODS Automated measurements from digital raw mammographic images of 54,591 cancer-free participants (aged 47-73) in a UK breast screening programme were used to calculate absolute (cm3) and relative asymmetry in BV and DV. Logistic regression models were fitted to assess asymmetry associations with age and ethnicity. RESULTS BV and DV absolute asymmetry were positively correlated with the corresponding volumetric dimension (BV or DV). BV absolute asymmetry increased, whilst DV absolute asymmetry decreased, with increasing age (P-for-linear-trend <0.001 for both). Relative to Whites, Blacks had statistically significantly higher, and Chinese lower, BV and DV absolute asymmetries. However, after adjustment for the corresponding underlying volumetric dimension the age and ethnic differences were greatly attenuated. Median relative (fluctuating) BV and DV asymmetry were 2.34 and 3.28% respectively. CONCLUSION After adjusting for the relevant volumetric dimension (BV or DV), age and ethnic differences in absolute breast asymmetry were largely resolved. ADVANCES IN KNOWLEDGE Previous small studies have reported breast asymmetry-breast cancer associations. Automated measurements of asymmetry allow the conduct of large-scale studies to further investigate these associations.
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Affiliation(s)
- Sue M Hudson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Louise S Wilkinson
- Oxford Breast Imaging Centre, University of Oxford Hospitals NHS Foundation Trust, Oxford, UK
| | - Rachel Denholm
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bianca L De Stavola
- Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, UK
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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24
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Giri VN, Selvan P, Mohanty S, Lum R, Serrao S, Leader AE. Exploring Asian Indian views about cancer and participation in cancer research: an evaluation of a culturally tailored educational intervention. J Community Genet 2019; 11:193-203. [PMID: 31522341 DOI: 10.1007/s12687-019-00436-5] [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: 12/14/2018] [Accepted: 08/29/2019] [Indexed: 01/22/2023] Open
Abstract
Asian Indians (AIs) are a growing population in the United States (US) with increased cancer incidence and mortality. However, screening rates among this population are low, and the population has been underrepresented in clinical research. This pilot study aims to address gaps in the literature in order to understand if a culturally tailored educational intervention will improve knowledge, risk perceptions, and awareness of cancer risk assessments among AIs. We delivered an educational intervention comprised of culturally tailored case studies describing risk factors for developing cancer in both males and females. We assessed knowledge gaps about cancer risk and genetic testing, cancer risk perceptions, and willingness to participate in medical research studies, pre- and post-intervention. Among 23 participants, knowledge of genetic testing use and screening recommendations significantly improved post-intervention, with increased willingness to discuss cancer with family members, participate in medical research, and undergo genetic testing for cancer risk assessment. However, findings at the 1-month follow-up time did not show significant changes, except for one knowledge item. Culturally tailored educational interventions, delivered in a community setting, can influence knowledge and risk perceptions about cancer risk and genetics among AIs. Our findings lay the groundwork to continue educational efforts in the area of cancer risk and genetic testing in the AI population, a growing population that has been understudied in the US.
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Affiliation(s)
- Veda N Giri
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
| | - Preethi Selvan
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Salini Mohanty
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3141 Chestnut St, Philadelphia, PA, 19104, USA.,Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Ray Lum
- Department of Management and Health Policy, Dornsife School of Public Health, Drexel University, 3141 Chestnut St, Philadelphia, PA, 19104, USA
| | - Samantha Serrao
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3141 Chestnut St, Philadelphia, PA, 19104, USA
| | - Amy E Leader
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 19107, USA
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25
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So WKW, Law BMH, Choi KC, Chan DNS, Chan CWH. A Mixed-Method Study Examining Cancer Screening Uptake among South Asian Ethnic Minorities in Hong Kong. Asia Pac J Oncol Nurs 2019; 7:12-17. [PMID: 31879679 PMCID: PMC6927150 DOI: 10.4103/apjon.apjon_36_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/12/2019] [Indexed: 11/30/2022] Open
Abstract
Objective: Utilization of cancer screening is an effective means of cancer prevention. However, South Asian ethnic minorities in Western countries are reported to face barriers in cancer screening utilization, resulting in a low screening uptake by these individuals. The purpose of this mixed-method study is to assess the uptake rate of cancer screening among South Asian ethnic minorities in the Chinese Society of Hong Kong and to examine the factors affecting their participation in cancer screening. Methods: This study utilized a sequential mixed-method design, involving two phases. Following the implementation of a self-report survey among South Asian participants via an author-developed questionnaire with 1547 participants in Phase 1, a focus group interview was conducted with 34 participants in Phase 2 to assess the barriers to screening utilization. Convenience sampling was adopted to recruit participants at South Asian community centers in Phase 1, whereas purposive sampling was used for recruiting participants in Phase 2. Results: The findings revealed a low (<40%) uptake rate of cancer screening among the participants. Health illiteracy, language barrier, limited access to health information and screening services, and cultural issues were the major barriers to their cancer screening utilization. Conclusions: Our findings provided valuable information for both policymakers and health professionals to better understand the needs of ethnic minorities in Hong Kong. As cancer death rates can be lowered by early detection and primary preventive measures, health professionals should focus on the development of culture-specific interventions. Similarly, training the community health workers can strengthen the primary care system in enhancing knowledge on cancer, its prevention, and access to cancer screening services among local ethnic minorities.
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Affiliation(s)
- Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Bernard M H Law
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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26
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Smith D, Thomson K, Bambra C, Todd A. The breast cancer paradox: A systematic review of the association between area-level deprivation and breast cancer screening uptake in Europe. Cancer Epidemiol 2019; 60:77-85. [PMID: 30927689 PMCID: PMC6547165 DOI: 10.1016/j.canep.2019.03.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022]
Abstract
Breast cancer rates are lower amongst women from more socio-economically deprived areas. However, their mortality rates are higher. One explanation of this breast cancer paradox is that women from more deprived areas are less likely to attend breast cancer screening programmes. This systematic review is the first to examine this issue in Europe. A systematic review of Embase, Medline and PsychINFO (from 2008 to 2019) was undertaken (PROSPERO registration number: CRD42018083703). Observational studies were included if they were based in Europe, measured breast cancer screening uptake, compared at least two areas, included an area-level measure of socio-economic deprivation and were published in the English language. The Joanna Briggs Institute critical appraisal checklist was used to assess study quality and risk of bias. Thirteen studies from seven different European countries met our inclusion criteria and were included in the review. In ten of the thirteen studies, there was a significant negative association between screening uptake and area-level socio-economic deprivation - with women living in more socio-economically deprived neighbourhoods less likely to attend breast cancer screening. Although universal screening programmes were provided in most studies, there were still strong negative associations between screening uptake and area-level socio-economic deprivation. Future breast cancer screening strategies should acknowledge these challenges, and consider developing targeted interventions in more deprived areas to increase screening participation.
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Affiliation(s)
- Dinah Smith
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle 14 upon Tyne, NE1 7RU, UK
| | - Katie Thomson
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Clare Bambra
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Adam Todd
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle 14 upon Tyne, NE1 7RU, UK; Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
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27
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Solikhah S, Promthet S, Hurst C. Awareness Level about Breast Cancer Risk Factors, Barriers, Attitude and Breast Cancer Screening among Indonesian
Women. Asian Pac J Cancer Prev 2019; 20:877-884. [PMID: 30912407 PMCID: PMC6825774 DOI: 10.31557/apjcp.2019.20.3.877] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Globally, breast cancer is the second most common cancer in women and is a leading cause of mortality
in Indonesia. Raising awareness of breast cancer is particularly important to help at risk women seek medical treatment
for this disease. This study aimed to comprehensively investigate the Indonesian women’s level of knowledge about
breast cancer risk factors, barriers, attitude and breast cancer screening. Methods: This population-based cross-sectional
study administered the breast cancer awareness Indonesian scale (BCAS-I) to 856 Indonesian women. Samples were
selected in rural and urban combinations from three provinces by stratified random sampling. The ordinal logistic
model was used to investigate the clustering effect of the participant’s characteristics in this study. Results: Of the
women, 62% lived in rural areas and 38% lived in urban areas. Living in an urban area was significantly associated
with a lower knowledge of the risk factors. However, living in an urban area was significantly associated with better
attitudes and healthier behaviours related to breast cancer awareness. Women with higher education levels had 70%
worse attitudes toward breast cancer awareness. Women living South of Sumatera, women living in Yogyakarta, and
unmarried women were 5.03, 3.84, and 1.56 times as likely to have higher perceived barriers, respectively. Conclusion:
Urban women had a poorer level of knowledge of breast cancer risk factors compared to women living in more rural
areas. The result of this study may reflect inadequate breast cancer awareness campaigns or a lack of breast cancer
awareness campaigns. These findings suggest that additional education programs aiming to increase awareness and
educate the public are needed.
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Affiliation(s)
- Solikhah Solikhah
- Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia.
| | - Supannee Promthet
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.,ASEAN Cancer Epidemiology and Prevention Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Cameron Hurst
- Biostatistics Center of Excellence, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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28
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Marmarà D, Marmarà V, Hubbard G. Predicting reattendance to the second round of the Maltese national breast screening programme: an analytical descriptive study. BMC Public Health 2019; 19:189. [PMID: 30760275 PMCID: PMC6374893 DOI: 10.1186/s12889-019-6507-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 02/01/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A range of barriers influence women's uptake to a first breast screening invitation. Few studies however, have examined factors associated with second screening uptake. This study follows Maltese women to explore predictors and behaviours to re-attendance, and to determine if uptake of first invitation to the Maltese Breast Screening Programme (MBSP) is a significant predictor of second screening uptake. METHODS A prospective study was conducted to determine factors associated with re-attendance for 100 women invited to the second MBSP round. Records of women's second attendance to the MBSP were extracted in January 2016 from the MBSP database. Data were analyzed using chi-square tests, Independent Samples t-test, Mann Whitney test, Shapiro Wilk test and logistic regression. RESULTS There were no significant associations for sociodemographic or health status variables with second screening uptake (p > 0.05), except breast condition (Fisher's exact test, p = 0.046). Non-attendees at second screening were most unsure of screening frequency recommendations (χ2 = 9.580, p = 0.048). Attendees were more likely to perceive their susceptibility to breast cancer (p = 0.041), believed breast cancer to be life changing (p = 0.011) and considered cues to action to aid attendance (p = 0.028). Non-attendees were in stronger agreement on mammography pain (p = 0.008) and were less likely to consider cues to action (15.4% non-attendees vs 1.4% attendees) (p = 0.017 respectively). 'Perceived barriers', 'breast cancer identity', 'causes' and 'consequences' were found to be significant predictors of second screening uptake, with 'perceived barriers' being the strongest. The inclusion of illness perception items improved the regression model's accuracy in predicting non-attendance to the second screening round (84.6% vs 30.8%). First screening uptake was found to be a significant predictor of subsequent uptake (OR = 0.102; 95% CI = 0.037, 0.283; p = 0.000). CONCLUSIONS Interventions to increase uptake should target first invitees since attending for the first time is a strong predictor of uptake to the second cycle. Further research is required given the small sample. Particular attention should be paid to women who did not respond to their first invite or are unsure or reluctant participants initially.
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Affiliation(s)
- Danika Marmarà
- Faculty of Health Sciences, University of Stirling, School of Health Sciences, Room E9, Pathfoot, Stirling, FK9 4LA Scotland
- Cancer Care Pathways Directorate, Sir Anthony Mamo Oncology Centre, Level -1, Dun Karm Street, Msida, MSD 2090 Malta
| | | | - Gill Hubbard
- Highland Campus, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH UK
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29
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Stevens C, Vrinten C, Smith SG, Waller J, Beeken RJ. Determinants of willingness to receive healthy lifestyle advice in the context of cancer screening. Br J Cancer 2018; 119:251-257. [PMID: 29991698 PMCID: PMC6048170 DOI: 10.1038/s41416-018-0160-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Providing lifestyle advice at cancer screening may help reduce the cancer burden attributable to health-related behaviour. We examined determinants of willingness to receive advice about several behavioural cancer risk factors. METHODS A population-based sample of English adults eligible for cancer screening (n = 1221) completed items on willingness to receive lifestyle advice. Sociodemographic, psychological (risk perceptions, cancer risk factor awareness) and behavioural factors were used to predict interest in advice about diet, weight, physical activity, smoking and alcohol consumption. RESULTS Two thirds (62-67%) reported interest in advice about diet, weight, and physical activity; 17% were willing to receive advice about smoking, and 32% about alcohol consumption. Willingness to receive advice was higher in those not adhering to guidelines for weight, physical activity, smoking and alcohol consumption (all p < 0.01). Non-White ethnicity was associated with interest in advice about diet, physical activity and smoking (all p < 0.01). Willingness to receive advice about diet, weight, physical activity and alcohol consumption increased with greater recognition of cancer risk factors (all p < 0.01). CONCLUSIONS Willingness to receive lifestyle advice at cancer screening was high, suggesting this context may provide an opportunity to support behaviour change. Increasing awareness of cancer risk factors may facilitate interest in lifestyle advice.
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Affiliation(s)
- Claire Stevens
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Charlotte Vrinten
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Samuel G Smith
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK.
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK.
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30
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Influences on Polish migrants' breast screening uptake in Lothian, Scotland. Public Health 2018; 158:86-92. [DOI: 10.1016/j.puhe.2017.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 11/08/2017] [Accepted: 11/24/2017] [Indexed: 11/18/2022]
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31
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Evans DG, Brentnall AR, Harvie M, Astley S, Harkness EF, Stavrinos P, Donnelly LS, Sampson S, Idries F, Watterson D, Cuzick J, Wilson M, Jain A, Harrison F, Maxwell AJ, Howell A. Breast cancer risk in a screening cohort of Asian and white British/Irish women from Manchester UK. BMC Public Health 2018; 18:178. [PMID: 29370783 PMCID: PMC5784727 DOI: 10.1186/s12889-018-5090-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 01/17/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The differences between breast cancer risk factors in white British/Irish and Asian women attending screening in the UK are not well documented. METHODS Between 2009-15 ethnicity and traditional breast cancer risk factors were self-identified by a screening cohort from Greater Manchester, with follow up to 2016. Risk factors and incidence rates were compared using age-standardised statistics (European standard population). RESULTS Eight hundred and seventy-nine Asian women and 51,779 unaffected white British/Irish women aged 46-73 years were recruited. Asian women were at lower predicted breast cancer risk from hormonal and reproductive risk factors than white British/Irish women (mean 10 year risk 2.6% vs 3.1%, difference 0.4%, 95%CI 0.3-0.5%). White British/Irish women were more likely to have had a younger age at menarche, be overweight or obese, taller, used hormone replacement therapy and not to have had children.. However, despite being less overweight Asian women had gained more weight from age 20 years and were less likely to undertake moderate physical activity. Asian women also had a slightly higher mammographic density. Asian age-standardised incidence was 3.2 (95%CI 1.6-5.2, 18 cancers) per thousand women/year vs 4.5 (95%CI 4.2-4.8, 1076 cancers) for white British/Irish women. CONCLUSIONS Asian women attending screening in Greater Manchester are likely to have a lower risk of breast cancer than white British/Irish women, but they undertake less physical activity and have more adult weight gain.
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Affiliation(s)
- D. Gareth Evans
- Department of Genomic Medicine, Division of Evolution and Genomic Science, MAHSC, University of Manchester, Central Manchester NHS Foundation Trust, Oxford Road, Manchester, UK
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
- Department of Genomic Medicine, MAHSC, St Mary’s Hospital, Central Manchester NHS Foundation Trust, Manchester, M13 9WL UK
| | - Adam R. Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Michelle Harvie
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
| | - Susan Astley
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
| | - Elaine F. Harkness
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
| | - Paula Stavrinos
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
| | - Louise S. Donnelly
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
| | - Sarah Sampson
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
| | - Faiza Idries
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
| | - Donna Watterson
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Mary Wilson
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
| | - Anil Jain
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
- School of Medical Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Fiona Harrison
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
| | - Anthony J. Maxwell
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
| | - Anthony Howell
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
- Nightingale & Prevention Breast Cancer Centre, University Hospital of South Manchester, Manchester, UK
- The Christie, Manchester, UK
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Lam M, Kwok C, Lee MJ. Prevalence and sociodemographic correlates of routine breast cancer screening practices among migrant-Australian women. Aust N Z J Public Health 2017; 42:98-103. [DOI: 10.1111/1753-6405.12752] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/01/2017] [Accepted: 10/01/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Michelle Lam
- Discipline of Physiotherapy, Faculty of Health Sciences; The University of Sydney; New South Wales
| | - Cannas Kwok
- School of Nursing and Midwifery; Western Sydney University; New South Wales
| | - Mi-Joung Lee
- Discipline of Physiotherapy, Faculty of Health Sciences; The University of Sydney; New South Wales
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Brown T, Dyck I, Greenhough B, Raven-Ellison M, Dembinsky M, Ornstein M, Duffy SW. Fear, family and the placing of emotion: Black women's responses to a breast cancer awareness intervention. Soc Sci Med 2017; 195:90-96. [DOI: 10.1016/j.socscimed.2017.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/22/2017] [Accepted: 10/31/2017] [Indexed: 12/16/2022]
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Leader AE, Mohanty S, Selvan P, Lum R, Giri VN. Exploring Asian Indian and Pakistani views about cancer and participation in cancer genetics research: toward the development of a community genetics intervention. J Community Genet 2017; 9:27-35. [PMID: 28660599 DOI: 10.1007/s12687-017-0312-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/08/2017] [Indexed: 01/25/2023] Open
Abstract
Cancer is a leading cause of mortality among the three million Asian Indian/Pakistanis (AIPs) in the USA. AIPs have traditionally been underrepresented in cancer-related research, although reasons remain largely unexplored. We sought to understand AIP's awareness and perceptions of cancer to improve their participation in risk assessment and cancer genetics research. Four focus groups, stratified by gender and birthplace (US-born vs. foreign-born), were held at an AIP cultural center. Discussions focused on knowledge and awareness of cancer risk; how AIP culture influences cancer perceptions; access to health care services for cancer screening, diagnosis, or treatment; and willingness to or experiences with participating in cancer genetics research. Sessions were audio-recorded, transcribed verbatim, and content analyzed using NVivo®11 for dominant themes. Thirty-two AIP adults participated in a focus group. Information on family cancer history is challenging to obtain due to the desire for privacy, cancer stigma, and loss of medical records. Interest in genetic testing for cancer risk was mixed: some were in favor of knowing their personal risk, yet many noted that future generations in their family would benefit more by knowing their risk. Participants felt that the AIP community has largely been overlooked in recruitment efforts for research studies. Recommendations for improving recruitment efforts included partnering with community events and festivities, posting culturally and linguistically relevant recruitment materials, and focusing on population-wide health improvement. Understanding the culture and perceptions of AIPs, separate from Asian Americans at large, will allow for more tailored approaches for including this population in cancer genetics research.
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Affiliation(s)
- Amy E Leader
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Salini Mohanty
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Preethi Selvan
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ray Lum
- Department of Management and Health Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Veda N Giri
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
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Møller H, Henson K, Lüchtenborg M, Broggio J, Charman J, Coupland VH, Davies E, Jack RH, Sullivan R, Vedsted P, Horgan K, Pearce N, Purushotham A. Short-term breast cancer survival in relation to ethnicity, stage, grade and receptor status: national cohort study in England. Br J Cancer 2016; 115:1408-1415. [PMID: 27780193 PMCID: PMC5129821 DOI: 10.1038/bjc.2016.335] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/07/2016] [Accepted: 09/25/2016] [Indexed: 12/31/2022] Open
Abstract
Background: In the re-organisation of cancer registration in England in 2012, a high priority was given to the recording of cancer stage and other prognostic clinical data items. Methods: We extracted 86 852 breast cancer records for women resident in England and diagnosed during 2012–2013. Information on age, ethnicity, socio-economic status, comorbidity, tumour stage, grade, morphology and oestrogen, progesterone and HER2 receptor status was included. The two-year cumulative risk of death from any cause was estimated with the Kaplan-Meier method, and univariate and multivariate Cox proportional hazards regressions were used to estimate hazard ratios (HR) and their 95% confidence intervals (95% CI). The follow-up ended on 31 December 2014. Results: The completeness of registration for prognostic variables was generally high (around 80% or higher), but it was low for progesterone receptor status (41%). Women with negative receptor status for each of the oestrogen, progesterone and HER2 receptors (triple-negative cancers) had an adjusted HR for death of 2.00 (95%CI 1.84–2.17). Black women had an age-adjusted HR of 1.77 (1.48–2.13) compared with White women. Conclusions: The excess mortality of Black women with breast cancer has contributions from socio-economic factors, stage distribution and tumour biology. The study illustrates the richness of detail in the national cancer registration data. This allows for analysis of cancer outcomes at a high level of resolution, and may form the basis for risk stratification.
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Affiliation(s)
- Henrik Møller
- Cancer Epidemiology, Population and Global Health, King's College London, Bermondsey Wing, 3rd Floor, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.,National Cancer Registration and Analysis Service, Public Health England, Skipton House, 80 London Road, London SE1 6LH, UK.,Research Centre for Cancer Diagnosis in Primary Care, Department of Public Health, Aarhus University, Nordre Ringgade 1, Aarhus C 8000, Denmark
| | - Katherine Henson
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Margreet Lüchtenborg
- Cancer Epidemiology, Population and Global Health, King's College London, Bermondsey Wing, 3rd Floor, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.,National Cancer Registration and Analysis Service, Public Health England, Skipton House, 80 London Road, London SE1 6LH, UK
| | - John Broggio
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Jackie Charman
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Victoria H Coupland
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Elizabeth Davies
- Cancer Epidemiology, Population and Global Health, King's College London, Bermondsey Wing, 3rd Floor, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Ruth H Jack
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Richard Sullivan
- Cancer Epidemiology, Population and Global Health, King's College London, Bermondsey Wing, 3rd Floor, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care, Department of Public Health, Aarhus University, Nordre Ringgade 1, Aarhus C 8000, Denmark
| | - Kieran Horgan
- School of Medicine, University of Leeds, Leeds, West Yorkshire, LS9 7TF, UK.,Department of Breast Surgery, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Neil Pearce
- Departments of Medical Statistics and Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Arnie Purushotham
- Cancer Epidemiology, Population and Global Health, King's College London, Bermondsey Wing, 3rd Floor, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
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Eichholzer M, Richard A, Rohrmann S, Schmid SM, Leo C, Huang DJ, Güth U. Breast cancer screening attendance in two Swiss regions dominated by opportunistic or organized screening. BMC Health Serv Res 2016; 16:519. [PMID: 27663642 PMCID: PMC5035496 DOI: 10.1186/s12913-016-1760-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/15/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In Switzerland, the French-speaking region has an organized breast cancer (BC) screening program; in the German-speaking region, only opportunistic screening until recently had been offered. We evaluated factors associated with attendance to breast cancer screening in these two regions. METHODS We analyzed the data of 50-69 year-old women (n = 2769) from the Swiss Health Survey 2012. Factors of interest included education level, place of residence, nationality, marital status, smoking history, alcohol consumption, physical activity, diet, self-perceived health, history of chronic diseases and mental distress, visits to medical doctors and cervical and colorectal cancer screening. Outcome measures were dichotomized into ≤2 years since most recent mammography versus >2 years or never. RESULTS In the German- and French-speaking regions, mammography attendance within the last two years was 34.9 % and 77.8 %, respectively. In the French region, moderate alcohol consumption (adjusted OR 2.01, 95 % CI 1.28-3.15) increased screening attendance. Compared to those with no visit to a physician during the recent year, women in both regions with such visits attended statistically significantly more often BC screening (1-5 times vs. no visit: German (adjusted OR 3.96, 95 % CI 2.58-6.09); French: OR 7.25, 95 % CI 4.04-13.01). Non-attendance to cervical screening had a negative effect in both the German (adjusted OR 0.44, 95 % CI 0.25-0.79) and the French region (adjusted OR 0.57, 95 % CI 0.35-0.91). The same was true for colorectal cancer screening (German (adjusted OR 0.66, 95 % CI 0.52-0.84); French: OR 0.52, 95 % CI 0.33-0.83). No other factor was associated with BC screening and none of the tests of interaction comparing the two regions revealed statistically significant results. CONCLUSION The effect of socio-demographic characteristics, lifestyle, health factors and screening behavior other than mammography on non-attendance to BC screening did not differ between the two regions with mainly opportunistic and organized screening, respectively, and did not explain the large differences in attendance between regions. Other potential explanations such as public promotion of attendance for BC screening, physicians' recommendations regarding mammography participation or women's beliefs should be further investigated.
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Affiliation(s)
- Monika Eichholzer
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland.
| | - Aline Richard
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Seraina M Schmid
- Department of Gynecology & Obstetrics, Spital Grabs, Spitalstrasse 44, CH-9472, Grabs, Switzerland.,Breast Center St. Gallen, Rorschacher Strasse 150, CH-9006, St.Gallen, Switzerland
| | - Cornelia Leo
- Department of Gynecology and Obstetrics, Kantonsspital Baden AG, Interdisciplinary Breast Centre, CH-5404, Baden, Switzerland
| | - Dorothy J Huang
- Department of Gynecology and Obstetrics, University Hospital Basel (UHB), Spitalstrasse 21, CH-4031, Basel, Switzerland
| | - Uwe Güth
- Breast Center Zurich, Seefeldstrasse 214, CH-8008, Zurich, Switzerland
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Kwok C. Conducting Cancer Research among Culturally and Linguistically Diverse Groups in Australia: A Reflection on Challenges and Strategies. AIMS Public Health 2016; 3:460-469. [PMID: 29546176 PMCID: PMC5689810 DOI: 10.3934/publichealth.2016.3.460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 07/06/2016] [Indexed: 11/26/2022] Open
Abstract
Background While effort has been made to include minority groups in cancer studies in Western countries, overseas experience indicates that recruiting immigrant members to participate in cancer research is challenging. The aim of the paper is to set out the challenges and strategies needed to ensure the success of cancer research among culturally and linguistically diverse (CALD) groups in Australia. Discussion Author suggested that partnership with ethnic community organization, research team, research setting and data collection methods, access to national data in cancer register, the informed consent process, and resources management are important elements to ensure the success of cancer research among CALD groups. Summary The paper provides health care professionals with insight into methodological and practical issues needed to plan and conduct cancer research among CALD populations not only in Australia but also other Western countries, where numbers of minority groups are increasing significantly.
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Affiliation(s)
- Cannas Kwok
- School of Nursing and Midwifery, Western Sydney University, Locked bag 1797, Penrith, 2751, New South Wales, Australia
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38
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Kwok C, Pillay R, Lee CF. Psychometric Properties of the Breast Cancer Screening Beliefs Questionnaire Among Women of Indian Ethnicity Living in Australia. Cancer Nurs 2016. [DOI: 10.1097/ncc.0000000000000294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kwok C, Endrawes G, Lee CF. Breast Cancer Screening Beliefs Questionnaire: Psychometric properties assessment of the Arabic version. Eur J Oncol Nurs 2016; 20:42-8. [DOI: 10.1016/j.ejon.2015.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/07/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
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Haddad FG, Kourie HR, Adib SM. Trends in mammography utilization for breast cancer screening in a Middle-Eastern country: Lebanon 2005-2013. Cancer Epidemiol 2015; 39:819-24. [PMID: 26651440 DOI: 10.1016/j.canep.2015.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/08/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In Lebanon, annual national breast awareness campaigns were started in 2002 during the international breast month of October to promote the utilization of mammography for women aged ≥ 40. The impact of the campaigns has been assessed periodically since 2003. Results of 2003-2005 campaigns have been published previously. OBJECTIVES To measure the prevalence of two behavioral outcomes of interest: ever-use of mammography, and repeat mammography in the previous 12 months among ever-users. The prevalence was described by region and age group. The aim was to document the effectiveness of the program towards reaching a nationally defined goal of 80% screening coverage. METHODS The survey's sampling frame was developed incrementally, and since 2005 it has included women aged ≥ 40 from all areas of Lebanon. The sample size has also increased incrementally from 1200 in 2005 to 2400 in 2013. Results have been tabulated biannually and presented as historical trends with regional and demographic variations covering a 9-year period. RESULTS In all six consecutive surveys presented here, the mean age of participating women was about 50 years. Year-by-year increases in utilization indicators were detected, with consistent differences in favor of the more urban areas in and around the capital city Beirut and its suburbs (Greater Beirut or GB). By 2013, ever-utilization had reached 43% (41-45) and recent mammography 20% (18-22) nationwide. Utilization was significantly more important in the age group 50-59 compared with the age group 40-49 or ≥ 60. While recent rates have increased nationwide, they have reached a plateau of about 25% in GB and are tending to the same level in other areas. DISCUSSION AND CONCLUSIONS While initial progress was slow, it has been accelerating in the last 4-5 years, indicating that the message is being accepted by a larger audience of targeted women at each iteration. However, concern remains that women between 40 and 50 and those >60 are not responding as well as desired to the screening message, for reasons currently under investigation.
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Affiliation(s)
- Fady G Haddad
- Faculty of Medicine of the Saint-Joseph University (USJ), Beirut, Lebanon.
| | | | - Salim M Adib
- Faculty of Medicine of the Saint-Joseph University (USJ), Beirut, Lebanon
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