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Castañeda KM, Sidorenkov G, Mourits MJE, van der Vegt B, Siebers AG, Vermeulen KM, Schuuring E, Wisman GBA, de Bock GH. Impact of health-related behavioral factors on participation in a cervical cancer screening program: the lifelines population-based cohort. BMC Public Health 2023; 23:2376. [PMID: 38037016 PMCID: PMC10688458 DOI: 10.1186/s12889-023-17293-0] [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: 03/04/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Regular participation in cervical cancer screening is critical to reducing mortality. Although certain sociodemographic factors are known to be associated with one-time participation in screening, little is known about other factors that could be related to regular participation. Therefore, this study evaluated the association between health-related behavioral factors and regular participation in cervical cancer screening. METHODS The Lifelines population-based cohort was linked to data for cervical cancer screening from the Dutch Nationwide Pathology Databank. We included women eligible for all four screening rounds between 2000 and 2019, classifying them as regular (4 attendances), irregular (1-3 attendances), and never participants. Multinomial logistic regression was performed to evaluate the association between behavioral factors and participation regularity, with adjustment made for sociodemographic factors. RESULTS Of the 48,325 included women, 55.9%, 35.1%, and 9% were regular, irregular, and never screening participants. After adjustment for sociodemographic factors, the likelihood of irregular or never screening participation was increased by smoking, obesity, marginal or inadequate sleep duration, alcohol consumption and low physical activity, while it was decreased by hormonal contraception use. CONCLUSION An association exists between unhealthy behavioral factors and never or irregular participation in cervical cancer screening.
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Affiliation(s)
- Kelly M Castañeda
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, the Netherlands.
| | - Grigory Sidorenkov
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, the Netherlands
| | - Marian J E Mourits
- Department of Gynaecologic Oncology, Cancer Research Center Groningen, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, the Netherlands
| | - Albert G Siebers
- Dutch Nationwide Pathology Databank, PALGA, 3991 SZ, Houten, the Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, the Netherlands
| | - Ed Schuuring
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, the Netherlands
| | - G Bea A Wisman
- Department of Gynaecologic Oncology, Cancer Research Center Groningen, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, the Netherlands
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Htay MNN, Dahlui M, Schliemann D, Cardwell CR, Loh SY, Ibrahim Tamin NSB, Somasundaram S, Donnelly M, Su TT. Changing Health Beliefs about Breast Cancer Screening among Women in Multi-Ethnic Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1618. [PMID: 35162641 PMCID: PMC8835215 DOI: 10.3390/ijerph19031618] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 01/27/2023]
Abstract
This study evaluated the impact of the 'Be Cancer Alert' mass media campaign for breast cancer (BCAC-BC) in terms of changes to women's health beliefs regarding BC susceptibility and the benefits and barriers of breast cancer screening in Malaysia. Pre- and post-campaign surveys evaluated changes in health beliefs among women aged 40 years and above (n = 676). The perceived susceptibility to breast cancer was significantly higher at follow-up (mean ± SD: 7.30 ± 2.77 vs. 7.63 ± 2.58, p = 0.008) whereas the mean score for the perceived benefits of undertaking screening was high at baseline and follow-up (16.34 ± 2.36 vs. 15.95 ± 2.07, p = 0.001). The perceptions or beliefs about barriers to screening did not change significantly (31.70 ± 8.26 vs. 31.77 ± 7.63, p = 0.841). Regression analyses indicated that mean scores for the barriers subscale were significantly lower among Chinese women (-2.61, 95% CI -4.67, -0.55, p = 0.013) compared to Malay, and among single compared to married women (-2.40, 95% CI -4.60, -0.21, p = 0.032) after adjustment for other demographic variables and past screening history. Malaysian women appeared to already have positive perceptions before the BCAC-BC mass media campaign about the benefits of BC screening. However, the campaign appeared to be linked to both an increased awareness of the susceptibility to breast cancer and to positive beliefs that countered emotional barriers to screening, particularly among single women and Chinese-Malay women.
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Affiliation(s)
- Mila Nu Nu Htay
- Centre of Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
- Department of Community Medicine, Manipal University College Malaysia, Manipal Academy of Higher Education (MAHE), Melaka 75150, Malaysia
| | - Maznah Dahlui
- Centre of Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Désirée Schliemann
- Centre for Public Health and UKCRC, Centre of Excellence for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK; (D.S.); (C.R.C.); (M.D.)
| | - Christopher R. Cardwell
- Centre for Public Health and UKCRC, Centre of Excellence for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK; (D.S.); (C.R.C.); (M.D.)
| | - Siew Yim Loh
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | | | | | - Michael Donnelly
- Centre for Public Health and UKCRC, Centre of Excellence for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK; (D.S.); (C.R.C.); (M.D.)
| | - Tin Tin Su
- Centre of Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
- South East Asia Community Observatory (SEACO) and Global Public Health, Jeffery Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia
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Buranello MC, Walsh IAPD, Pereira GDA, Castro SSD. Histórico familiar para câncer de mama em mulheres: estudo populacional em Uberaba (MG) utilizando o Family History Screen-7. SAÚDE EM DEBATE 2021. [DOI: 10.1590/0103-1104202113009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetiva-se determinar a prevalência de mulheres com risco de desenvolvimento de câncer de mama pelo histórico familiar em Uberaba (MG), e essa prevalência nas diferentes condições socioeconômicas e epidemiológicas. Pesquisa quantitativa, analítica, observacional e transversal de base populacional. Amostra com 1.520 mulheres a partir de 20 anos. Dados coletados por entrevistas domiciliares sobre informações socioeconômicas e epidemiológicas. A avaliação do risco hereditário de câncer de mama foi realizada pelo Family History Screen-7 (FHS-7). Como resultado, 28,6% da amostra apresentaram risco hereditário para câncer de mama. Houve associação significativa do risco de câncer quanto a: faixa etária, sendo nas mulheres com idade de 70 anos ou mais a maior proporção com risco (33,5%); etnia, sendo a maior proporção entre mulheres de etnia branca (31,2%); renda familiar, com maior ocorrência para renda per capita > 2,5 salários-mínimos (31,6%); prática de exames preventivos (30,6%); e alterações benignas na mama (46,7%). Conclui-se que, a partir do histórico familiar pelo FHS-7, o risco de as mulheres desenvolverem câncer mostrou-se significativamente associado com maior faixa etária, etnia branca e maior renda per capita, com a prática de exames preventivos em dia e alterações benignas na mama. Tais resultados possibilitam melhores direcionamentos de políticas públicas.
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Barrios C, Freitas-Junior R, Martins S, Bines J, Del Pilar Estevez-Diz M, Caleffi M. Challenge of Incorporating New Drugs for Breast Cancer in Brazil: A Proposed Framework for Improving Access to Innovative Therapies. JCO Glob Oncol 2021; 7:474-485. [PMID: 33822641 PMCID: PMC8081546 DOI: 10.1200/go.20.00566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/27/2021] [Accepted: 02/16/2021] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The objective of this review is to address the barriers limiting access to treatment of advanced metastatic breast cancer (mBC) in Brazil, specifically for patients in the public health care system, arguably those with the least access to innovation. MATERIALS AND METHODS A selected panel of Brazilian experts in BC were provided with a series of relevant questions to address in a multiday conference. During the conference, responses were discussed and edited by the entire group through numerous drafts and rounds of discussion until a consensus was achieved. RESULTS The authors propose specific and realistic recommendations for implementing access to new drugs in cancer care in Brazil. Moreover, in creating these recommendations and framework, the authors strive to address the most important barriers and impediments for technology incorporation. A feasible and specific multidisciplinary process is proposed, which is based on the collective participation of all involved stakeholders. CONCLUSION Given the current benefits and likely future developments, there is a great need to expand treatments for mBC not only in Brazil but also in most other countries in the world where access issues remain an unresolved demand. Adapting the current framework is essential for accomplishing this goal. The recommendations in this review can serve as a framework for adoption of new technologies in countries with limited resources.
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Affiliation(s)
- Carlos Barrios
- Grupo Oncoclínicas, Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Ruffo Freitas-Junior
- CORA, Advanced Center for Diagnosis of Breast Diseases, Federal University of Goias, Goiânia, Brazil
- Araujo Jorge Hospital of Associação de Combate ao Câncer em Goiás, Goiânia, Brazil
| | - Sandro Martins
- Medical Oncology Unit, University Hospital of Brasília/EBSERH, Brasília, Brazil
| | - Jose Bines
- Clínica São Vicente, Rio de Janeiro, Brazil
| | - Maria Del Pilar Estevez-Diz
- Instituto do Câncer do Estado de São Paulo/Faculdade de Medicina da Universidade de São Paulo, Onco Star Rede D'Or, São Paulo, Brazil
| | - Maira Caleffi
- Hospital Moinhos de Vento, Femama, Porto Alegre, Brazil
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Heinig M, Schwarz S, Haug U. Self-selection for mammography screening according to use of hormone replacement therapy: A systematic literature review. Cancer Epidemiol 2021; 71:101812. [PMID: 33608235 DOI: 10.1016/j.canep.2020.101812] [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: 03/05/2020] [Revised: 09/01/2020] [Accepted: 09/05/2020] [Indexed: 11/27/2022]
Abstract
Mammography screening participation may be influenced by the awareness of an increase in breast cancer risk due to hormone replacement therapy (HRT), which received particular attention upon publication of the Women's Health Initiative (WHI) trial results in 2002. Our aim was to synthesize evidence on a potential self-selection for mammography screening according to HRT use. We systematically searched the literature (MEDLINE, EMBASE, CINAHL) for studies reporting on the association between HRT use and mammography screening participation. Data were extracted independently by two reviewers. Overall, 2018 studies were identified. Of these, 32 studies from nine countries, predominantly from North America (50%) and Europe (28%), were included. In studies from all countries and 94% of all studies, higher mammography screening uptake among HRT users compared to non-users was reported. In all 21 studies reporting an odds ratio, the association was positive, and in about 70% of these studies, this association was ≥2. This also held true for studies exclusively using data collected before publication of the WHI findings in 2002 (63% of all studies). The association was not restricted to certain types of screening (organized vs. opportunistic) or certain types of HRT (combined vs. estrogen-only). We found a consistent and relevant association between mammography screening uptake and HRT use. This is of considerable relevance for the design and interpretation of studies investigating risk factors or evaluating preventive measures for breast cancer.
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Affiliation(s)
- Miriam Heinig
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany.
| | - Sarina Schwarz
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany.
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany; Faculty of Human and Health Sciences, University of Bremen, Grazer Str. 2, 28359 Bremen, Germany.
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Patrão AL, de Almeida MDCC, Matos SMA, Menezes G, Gabrielli L, Goes EF, Aquino EML. Healthy lifestyle behaviors and the periodicity of mammography screening in Brazilian women. WOMEN'S HEALTH 2021; 17:17455065211063294. [PMID: 34841999 PMCID: PMC8640279 DOI: 10.1177/17455065211063294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Certain behaviors have been associated with health promotion, including mammography screening, in women worldwide. Objective: The objective of this study was to determine whether there is an association between the periodicity of mammography screening and healthy lifestyle behaviors in Brazilian women employed at a public university in Bahia, Brazil. Methods: A total of 635 women of 50–69 years of age at the time of the interview, from the Brazilian Longitudinal Study of Adult Health cohort who were resident in Bahia, participated in the study. Data were collected using a multidimensional questionnaire that included questions on participants’ sociodemographic characteristics and health-related behaviors (smoking, alcohol consumption, leisure-time physical activity and diet) and another questionnaire that dealt with risk factors and breast cancer screening. Measures of association were calculated using simple and multivariate logistic regression. Results: The practice of physical activity, not smoking, moderate alcohol consumption and a healthy diet were the health behaviors most adopted by the women who had last had a mammogram ⩽2 years previously (which is in line with the interval recommended by the Brazilian Ministry of Health). A statistically significant association was found between a lapse of ⩾3 years since last undergoing mammography screening and excessive alcohol consumption, while a borderline association was found between the same screening interval and leisure-time physical inactivity. Conclusion: There was an association between lifestyle risk behaviors and a longer time interval between mammography screenings. The present results contribute to the debate on the use of mammography, lifestyle behaviors and health promotion among women.
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Affiliation(s)
- Ana Luísa Patrão
- Center for Psychology, Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Ana Luísa Patrão, Center for Psychology, Faculty of Psychology and Education Science, University of Porto, Rua Alfredo Allen, 4099-002 Porto, Portugal.
| | | | | | - Greice Menezes
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Ligia Gabrielli
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Secretary of Health of the State of Bahia, Salvador, Brazil
| | - Emanuelle F Goes
- Center for Integrated Data and Information on Healthcare, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Estela ML Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
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Moreira CB, Dahinten VS, Howard AF, Fernandes AFC, Schirmer J. Factors related to mammography adherence among women in Brazil: A scoping review. Nurs Open 2020; 8:2035-2049. [PMID: 34388860 PMCID: PMC8363398 DOI: 10.1002/nop2.706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/30/2020] [Accepted: 11/04/2020] [Indexed: 01/24/2023] Open
Abstract
AIM To explore and synthesize the literature on factors related to mammography screening adherence among women in Brazil. DESIGN A scoping review. METHODS We searched 11 databases for studies published between 2006-January 2020. All identified articles were screened, and data were extracted from eligible studies. We used the UK Government Social Research Service weight of evidence appraisal tool to appraise the quality of the included study. RESULTS From a total of 1,384 identified articles, 22 were retained. All included studies used quantitative, non-experimental methods and all but two studies used cross-sectional data. Quality of evidence varied across studies. We identified 41 factors that were investigated across the set of studies. Demographic and socio-economic factors were the most commonly investigated, with older age, urban residence, living in the southeast of Brazil, higher level of education, higher income and private health insurance most consistently associated with mammography adherence.
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Affiliation(s)
- Camila Brasil Moreira
- School of Nursing, Federal University of São Paulo, São Paulo, Brazil.,School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - V Susan Dahinten
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - A Fuchsia Howard
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | - Janine Schirmer
- School of Nursing, Federal University of São Paulo, São Paulo, Brazil
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Kulkarni SV, Mishra GA, Dusane RR. Determinants of Compliance to Breast Cancer Screening and Referral in Low Socio-Economic Regions of Urban India. Int J Prev Med 2019; 10:84. [PMID: 31198519 PMCID: PMC6547800 DOI: 10.4103/ijpvm.ijpvm_335_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/06/2018] [Indexed: 12/21/2022] Open
Abstract
Background: Breast cancer (BC) is the most common cancer among women globally and also in India. Early detection by screening is likely to reduce mortality and improve survival. To study the determinants of compliance to BC screening and referral by women in a community based BC screening programme in urban India. Methods: A community-based one-time cancer screening programme, implemented in the urban slums of Mumbai, India. The programme involves screening for breast cancer by Clinical Breast Examination (CBE) performed by trained primary health workers (PHWs), referral of screen-positive women to the nodal hospital for further investigations, confirmation of diagnosis and treatment. Univariate and multivariate logistic regression analysis in SPSS version 16 was used. Results: The compliance to screening, referral and treatment were 90.58%, 74.22% and 100% respectively. The results of multivariate logistic regression analysis demonstrate literate women, having family history of cancer, with tobacco habit, being treated for breast abnormalities, being ever pregnant and having history of contraceptive use were positive predictors while, women belonging to Muslim religion or speaking mother-tongue other than Marathi or Hindi were negative predictors of participation to screening. Educational status was the only significant predictor of compliance to referral. Screen-positive women with education of secondary school level or more were more likely to comply with referral. Conclusions: The programme ensured good compliance with screening, referral and treatment indicating feasibility and acceptability of CBE based BC screening programme by the community.
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Affiliation(s)
- Sheetal V Kulkarni
- Department of Preventive Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gauravi A Mishra
- Department of Preventive Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rohit R Dusane
- Department of Preventive Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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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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Ohl ICB, Ohl RIB, Chavaglia SRR, Goldman RE. Public actions for control of breast cancer in Brazil: integrative review. Rev Bras Enferm 2016; 69:793-803. [PMID: 27508487 DOI: 10.1590/0034-7167.2016690424i] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 01/03/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to analyze the scientific production on "breast cancer" in the period from 2002 to 2013 and determine the public policies for screening and early diagnosis of breast cancer. METHOD this is an integrative literature review conducted in the databases MEDLINE, LILACS, SciELO and Google Scholar. INCLUSION CRITERIA year and period of publication; availability of the full article; publication in Brazil; and the cross-check of the keywords Breast Cancer, Primary Health Care, Screening Programs, and Early Detection of Cancer. RESULTS after analysis, four thematic categories were obtained: breast self-examination, clinical examination of breast, mammography, and factors that hinder the adherence to the screening. CONCLUSION health professionals have deficits of knowledge on the area, indicating the need for other studies on the subject addressed and greater investment in continuing education of professionals.
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Affiliation(s)
| | - Rosali Isabel Barduchi Ohl
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem Clínica e Cirúrgica. São Paulo-SP, Brasil
| | - Suzel Regina Ribeiro Chavaglia
- Universidade Federal do Triângulo Mineiro, Departamento de Enfermagem na Assistência Hospitalar. Belo Horizonte-MG, Brasil
| | - Rosely Erlach Goldman
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem na Saúde da Mulher. São Paulo-SP, Brasil
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11
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Palmero EI, Alemar B, Schüler-Faccini L, Hainaut P, Moreira-Filho CA, Ewald IP, dos Santos PK, Ribeiro PLI, de Oliveira CB, Kelm FLC, Tavtigian S, Cossio SL, Giugliani R, Caleffi M, Ashton-Prolla P. Screening for germline BRCA1, BRCA2, TP53 and CHEK2 mutations in families at-risk for hereditary breast cancer identified in a population-based study from Southern Brazil. Genet Mol Biol 2016; 39:210-22. [PMID: 27223485 PMCID: PMC4910552 DOI: 10.1590/1678-4685-gmb-2014-0363] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 11/24/2015] [Indexed: 01/22/2023] Open
Abstract
In Brazil, breast cancer is a public health care problem due to its high incidence and mortality rates. In this study, we investigated the prevalence of hereditary breast cancer syndromes (HBCS) in a population-based cohort in Brazils southernmost capital, Porto Alegre. All participants answered a questionnaire about family history (FH) of breast, ovarian and colorectal cancer and those with a positive FH were invited for genetic cancer risk assessment (GCRA). If pedigree analysis was suggestive of HBCS, genetic testing of the BRCA1, BRCA2, TP53, and CHEK2 genes was offered. Of 902 women submitted to GCRA, 214 had pedigrees suggestive of HBCS. Fifty of them underwent genetic testing: 18 and 40 for BRCA1/BRCA2 and TP53 mutation screening, respectively, and 7 for CHEK2 1100delC testing. A deleterious BRCA2 mutation was identified in one of the HBOC probands and the CHEK2 1100delC mutation occurred in one of the HBCC families. No deleterious germline alterations were identified in BRCA1 or TP53. Although strict inclusion criteria and a comprehensive testing approach were used, the suspected genetic risk in these families remains unexplained. Further studies in a larger cohort are necessary to better understand the genetic component of hereditary breast cancer in Southern Brazil.
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Affiliation(s)
- Edenir Inêz Palmero
- Programa de Pós Graduação em Genética e Biologia Molecular,
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Laboratório de Medicina Genômica, Hospital de Clinicas de Porto
Alegre, Porto Alegre, RS, Brazil
- Cluster of Molecular Carcinogenesis, International Agency for
Research on Cancer, Lyon, France
- Centro de Pesquisa em Oncologia Molecular, Hospital de Câncer de
Barretos, Barretos, SP, Brazil
- Faculdade de Ciências da Saúde Dr. Paulo Prata, São Paulo, SP,
Brazil
| | - Bárbara Alemar
- Programa de Pós Graduação em Genética e Biologia Molecular,
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Laboratório de Medicina Genômica, Hospital de Clinicas de Porto
Alegre, Porto Alegre, RS, Brazil
| | - Lavínia Schüler-Faccini
- Programa de Pós Graduação em Genética e Biologia Molecular,
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Serviço de Genética Médica, Hospital de Clinicas de Porto Alegre,
Porto Alegre, RS, Brazil
- Departmento de Genética, Universidade Federal do Rio Grande do Sul,
Porto Alegre, RS, Brazil
| | - Pierre Hainaut
- Cluster of Molecular Carcinogenesis, International Agency for
Research on Cancer, Lyon, France
| | - Carlos Alberto Moreira-Filho
- Centro de Pesquisa Experimental, Instituto de Educação e Pesquisa
Albert Einstein, São Paulo, SP, Brazil
- Departmento de Imunologia, Instituto de Ciências Biomédicas,
Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ingrid Petroni Ewald
- Laboratório de Medicina Genômica, Hospital de Clinicas de Porto
Alegre, Porto Alegre, RS, Brazil
| | - Patricia Koehler dos Santos
- Programa de Pós Graduação em Genética e Biologia Molecular,
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Laboratório de Medicina Genômica, Hospital de Clinicas de Porto
Alegre, Porto Alegre, RS, Brazil
| | | | | | - Florence Le Calvez Kelm
- Cluster of Molecular Carcinogenesis, International Agency for
Research on Cancer, Lyon, France
| | - Sean Tavtigian
- Cluster of Molecular Carcinogenesis, International Agency for
Research on Cancer, Lyon, France
| | - Silvia Liliana Cossio
- Laboratório de Medicina Genômica, Hospital de Clinicas de Porto
Alegre, Porto Alegre, RS, Brazil
- Programa de Pós Graduação em Gastroenterologia, Universidade Federal
do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roberto Giugliani
- Programa de Pós Graduação em Genética e Biologia Molecular,
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Serviço de Genética Médica, Hospital de Clinicas de Porto Alegre,
Porto Alegre, RS, Brazil
- Departmento de Genética, Universidade Federal do Rio Grande do Sul,
Porto Alegre, RS, Brazil
| | - Maira Caleffi
- Nucleo Mama Porto Alegre e Associação Hospitalar Moinhos de Vento,
Porto Alegre, RS, Brazil
| | - Patricia Ashton-Prolla
- Programa de Pós Graduação em Genética e Biologia Molecular,
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Laboratório de Medicina Genômica, Hospital de Clinicas de Porto
Alegre, Porto Alegre, RS, Brazil
- Serviço de Genética Médica, Hospital de Clinicas de Porto Alegre,
Porto Alegre, RS, Brazil
- Departmento de Genética, Universidade Federal do Rio Grande do Sul,
Porto Alegre, RS, Brazil
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12
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Dey S. Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal. World J Clin Oncol 2014; 5:509-519. [PMID: 25114864 PMCID: PMC4127620 DOI: 10.5306/wjco.v5.i3.509] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/27/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
To review the present status of breast cancer (BC) screening/early detection in low- and middle-income countries (LMICs) and identify the way forward, an open focused search for articles was undertaken in PubMed, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on ResearchGate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer (BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. Notably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of mHealth for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.
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13
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Tsu VD, Jeronimo J, Anderson BO. Why the time is right to tackle breast and cervical cancer in low-resource settings. Bull World Health Organ 2014; 91:683-90. [PMID: 24101784 DOI: 10.2471/blt.12.116020] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 05/29/2013] [Accepted: 05/30/2013] [Indexed: 01/04/2023] Open
Abstract
The health concerns of women in their mid-adult years - when the prime age of reproduction has passed - have been traditionally given little or no attention by health systems and donors, despite the heavy burden that diseases such as breast and cervical cancer impose on women and their families. The risk of sexually transmitted infections that accompanies sexual relations and the risk of death and morbidity associated with pregnancy have long been recognized and have stimulated major control efforts that are finally yielding positive results. Much less attention has been focused, however, on how experiences in early life can affect women's health in adulthood. Breast and cervical cancers kill more women than any other types of cancer in all parts of the developing world. In most of Asia and Latin America and some African countries, deaths from these two forms of cancer now outnumber pregnancy-related deaths. There are five compelling reasons for focusing on these cancers now to try to reverse these epidemiologic trends: (i) the burden of breast and cervical cancer is large and is growing; (ii) effective screening and treatment are available; (iii) research is generating new knowledge; (iv) there are opportunities for synergy with other health programmes; and (v) noncommunicable diseases are the focus of much current interest.
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Affiliation(s)
- Vivien Davis Tsu
- PATH, PO Box 900922, Seattle, WA 98109, United States of America (USA)
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14
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Lourenço TS, Mauad EC, Vieira RADC. [Barriers in the breast cancer screening and the role of nursing: an integrative review]. Rev Bras Enferm 2014; 66:585-91. [PMID: 24008714 DOI: 10.1590/s0034-71672013000400018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 05/31/2013] [Indexed: 11/22/2022] Open
Abstract
Mammographic breast cancer screening is a fact in developed countries. Nursing acts in different ways in this process, having an important role in the barriers related to non-adherence to screening, but its effectiveness is little proven, with limited number of clinical trials about this topic. An integrative review of the literature in PubMed and LILACS (Latin American Literature) was conducted, aiming to evaluate controlled clinical trials about nurse's role in breast cancer screening. It was used the key words breast cancer screening, clinical trials and nurse. From 110 publications in PubMed, 18 were clinical trials and showed the nurse's role in breast cancer screening. None publication was observed in LILACS database. This review shows the effectiveness of nursing in breast cancer screening, presenting new nurse's role in the multidisciplinary team that qualify actions related to women's health.
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15
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Lagerlund M, Sontrop JM, Zackrisson S. Psychosocial factors and attendance at a population-based mammography screening program in a cohort of Swedish women. BMC WOMENS HEALTH 2014; 14:33. [PMID: 24565263 PMCID: PMC3942217 DOI: 10.1186/1472-6874-14-33] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 11/21/2013] [Indexed: 11/10/2022]
Abstract
Background A better understanding of the factors that influence mammography screening attendance is needed to improve the effectiveness of these screening programs. The objective of the study was to examine whether psychosocial factors predicted attendance at a population-based invitational mammography screening program. Methods Data on cohabitation, social network/support, sense of control, and stress were obtained from the Malmö Diet and Cancer Cohort Study and linked to the Malmö mammography register in Sweden. We analyzed 11,409 women (age 44 to 72) who were free of breast cancer at study entry (1992 to 1996). Mammography attendance was followed from cohort entry to December 31, 2009. Generalized Estimating Equations were used to account for repeated measures within subjects. Adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported. Results Among 69,746 screening opportunities there were 5,552 (8%) cases of non-attendance. Higher odds of non-attendance were found among women who lived alone (OR = 1.47 (1.33-1.63)) or with children only (OR = 1.52 (1.29-1.81)), had one childbirth (OR = 1.12 (1.01-1.24)) or three or more childbirths (OR = 1.34 (1.21-1.48)), had low social participation (OR= 1.21 (1.10-1.31)), low sense of control (OR = 1.12 (1.02-1.23)), and experienced greater stress (OR = 1.24 (1.13-1.36)). Conclusions Public health campaigns designed to optimize mammography screening attendance may benefit from giving more consideration of how to engage with women who are less socially involved.
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Affiliation(s)
- Magdalena Lagerlund
- Department of Clinical Sciences in Malmö, Diagnostic Radiology, Lund University, Skåne University Hospital Malmö, Inga Marie Nilssons gata 49, SE 20502 Malmö, Sweden.
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16
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Do reproductive and hormonal risk factors for breast cancer associate with attendance at mammography screening? Cancer Causes Control 2013; 24:1687-94. [DOI: 10.1007/s10552-013-0243-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 05/27/2013] [Indexed: 11/27/2022]
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17
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Breast cancer screening: review of benefits and harms, and recommendations for developing and low-income countries. Med Oncol 2013; 30:471. [PMID: 23420062 DOI: 10.1007/s12032-013-0471-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 01/15/2013] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most common cancer in women worldwide. The disease remains a public health concern as recent evidence indicates that the breast cancer burden has increased mainly in developing and low-income countries (DLICs). Despite the demonstrated benefits, the debate about the real benefits and harms of breast cancer screening is ongoing. Many experts believe that the benefits of screening, in terms of reduced breast cancer mortality, outweigh the harms, whereas others think the opposite. In this review, we assess the clinical utility of available screening modalities, present evidence, overdiagnosis, cost-effectiveness, and other pertinent issues. We also examine relevant data from DLICs to underscore the barriers and challenges that impede implementation of screening strategies in those populations. We also provide recommendations concerning rational preventive strategies for breast cancer control for women in DLICs.
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18
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Isoppo de Souza C, Rosa DD, Ettrich B, Cibeira GH, Giacomazzi J, Tusset P, Ashton-Prolla P, Medeiros LR, Caleffi M, Neto EC, Moriguchi EH, Graudenz MS. Association of adipokines and adhesion molecules with indicators of obesity in women undergoing mammography screening. Nutr Metab (Lond) 2012; 9:97. [PMID: 23113882 PMCID: PMC3541161 DOI: 10.1186/1743-7075-9-97] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 10/08/2012] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED BACKGROUND The soluble cell adhesion molecules and adipokines are elevated in patients with obesity, hypertension, type 2 diabetes mellitus, breast cancer and atherosclerosis. OBJECTIVE To investigate the relationship between anthropometric profile, dietary intake, lipid profile and fasting glycemia with serum levels of adipokines (adiponectin and PAI-1) and adhesion molecules (ICAM-1 and VCAM-1) in women without breast cancer undergoing routine mammographic screening. DESIGN Transversal study. SUBJECTS One hundred and forty-five women over 40-years old participated in this study. RESULTS In 39.3% of cases the BMI was above 30 kg/m2; 46.9% had hypertension, 14.5% had type 2 Diabetes Mellitus, 31.7% had dyslipidemia and 88.3% presented a waist-to-hip ratio ≥ 0.8. A linear correlation was found between serum levels of PAI-1 and triglycerides, between serum levels of PAI-1 and WHR and between serum levels of VCAM-1 and BMI. CONCLUSION We found a high prevalence of obesity and metabolic syndrome. PAI-1 and VCAM-1 levels were correlated with clinical indicators of obesity and overweight.
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Affiliation(s)
- Caroline Isoppo de Souza
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
| | - Daniela Dornelles Rosa
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brasil
- Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brasil
| | - Betina Ettrich
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
| | - Gabriela Hermann Cibeira
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
- Programa de Pós Graduação em Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
| | - Juliana Giacomazzi
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
- Laboratório de Medicina Genômica do Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brasil
| | - Paloma Tusset
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
| | - Patrícia Ashton-Prolla
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
- Laboratório de Medicina Genômica do Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brasil
- Instituto Nacional de Genética Médica Populacional (INAGEMP), Porto Alegre, Brasil
- Departamento de Genética, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brasil
| | - Lidia Rosi Medeiros
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
| | - Maira Caleffi
- Grupo Brasileiro de Estudos do Câncer de Mama (GBECAM), São Paulo, Brasil
- Programa de Pós Graduação em Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
- Núcleo Mama Porto Alegre (NMPOA), Rio Grande do Sul, Brasil
| | | | - Emilio Hideyuki Moriguchi
- Programa de Pós Graduação em Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
| | - Marcia Silveira Graudenz
- Programa de Pós Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rio Grande do Sul, Brasil
- Departamento de Patologia, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brasil
- Hospital de Clinicas de Porto Alegre (HCPA), , Rio Grande do Sul, Brazil
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19
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Wee LE, Koh GCH, Chin RT, Yeo WX, Seow B, Chua D. Socioeconomic factors affecting colorectal, breast and cervical cancer screening in an Asian urban low-income setting at baseline and post-intervention. Prev Med 2012; 55:61-7. [PMID: 22561028 DOI: 10.1016/j.ypmed.2012.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 04/06/2012] [Accepted: 04/18/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Inequalities in cancer screening are little studied in Asian societies. We determined whether area and individual measures of socio-economic status (SES) affected cancer screening participation in Singapore and prospectively evaluated an access-enhancing community-based intervention. METHODS The study population involved all residents aged >40 years in two housing estates comprising of owner-occupied (high-SES area) and rental (low-SES area) flats. From 2009 to 2011, non-adherents to regular screening for colorectal/breast/cervical cancer were offered free convenient screening over six months. Pre- and post-intervention screening rates were compared with McNemar's test. Multi-level logistic regression identified factors of regular screening at baseline; Cox regression analysis identified predictors of screening post-intervention. RESULTS Participation was 78.2% (1081/1383). In the low-SES area, 7.7% (33/427), 20.4% (44/216), and 14.3% (46/321) had regular colorectal, cervical and breast cancer screening respectively. Post-intervention, screening rates in the low-SES area rose significantly to 19.0% (81/427), 25.4% (55/216), and 34.3% (74/216) respectively (p<0.001). Area SES was more consistently associated with screening than individual SES at baseline. Post-intervention, for colorectal cancer screening, those with higher education were more likely to attend (p=0.004); for female cancer screening, the higher-income were less likely to attend (p=0.032). CONCLUSIONS Access-enhancing community-based interventions improve participation among disadvantaged strata of Asian societies.
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Affiliation(s)
- Liang En Wee
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
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Lin JH, Zhang SM, Manson JE. Predicting adherence to tamoxifen for breast cancer adjuvant therapy and prevention. Cancer Prev Res (Phila) 2012; 4:1360-5. [PMID: 21893499 DOI: 10.1158/1940-6207.capr-11-0380] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment with the selective estrogen receptor modulator (SERM) tamoxifen for 5 years has produced dramatic breast cancer-related benefits in (a) the adjuvant setting, with 30% to 50% reductions in recurrence, contralateral disease, and mortality and (b) the prevention setting of healthy high-risk women, where tamoxifen reduces the risk of invasive and noninvasive breast cancer by 50%. Despite these striking data, adherence to tamoxifen is low, and low adherence is associated with poor survival. Although toxicity is a major predictor of poor adherence after starting therapy, pretreatment (baseline) predictors of poor tamoxifen adherence have been minimally studied. The adherence-survival link underscores the critical need to identify early predictors of poor adherence, and recent work is beginning to address this need. A major baseline predictor of poor adherence to prevention is current smoking, which is interestingly absent from studies of adherence to adjuvant therapy. Other important prevention adherence factors include breast cancer risk, extremes of age, non-white ethnicity, low socioeconomic status, and alcohol use. The strongest adjuvant therapy predictors are age (especially very young), ethnicity, and socioeconomic status. Future studies involving prospective systematic evaluation of these and other potential predictors in endocrine chemoprevention (e.g., other SERMs and aromatase inhibitors) are critical, as is the development of effective/targeted interventions to improve adherence and thus treatment outcomes in at-risk women.
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Affiliation(s)
- Jennifer H Lin
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
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21
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Land SR, Cronin WM, Wickerham DL, Costantino JP, Christian NJ, Klein WMP, Ganz PA. Cigarette smoking, obesity, physical activity, and alcohol use as predictors of chemoprevention adherence in the National Surgical Adjuvant Breast and Bowel Project P-1 Breast Cancer Prevention Trial. Cancer Prev Res (Phila) 2011; 4:1393-400. [PMID: 21862698 DOI: 10.1158/1940-6207.capr-11-0172] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The double-blind, prospective, National Surgical Adjuvant Breast and Bowel Project (NSABP) Breast Cancer Prevention Trial (BCPT) showed a 50% reduction in the risk of breast cancer for tamoxifen versus placebo, yet many women at risk of breast cancer do not adhere to the 5-year course. This first report of the rich BCPT drug adherence data examines predictors of adherence. Between June, 1992 and September, 1997 13,338 women at high risk of breast cancer were randomly assigned to 20 mg/d tamoxifen versus placebo; we analyzed the 11,064 enrolled more than 3 years before trial unblinding. Primary endpoint was full drug adherence (100% of assigned pills per staff report, excluding protocol-required discontinuation) at 1 and 36 months; secondary was adequate adherence (76%-100%). Protocol-specified multivariable logistic regression tested lifestyle factors, controlling for demographic and medical predictors. About 13% were current smokers; 60% were overweight/obese; 46% had moderate/heavy physical activity; 21%, 66%, 13% drank 0, 0-1, 1+ drinks per day, respectively; 91% were adequately adherent at 1 month; and 79% were at 3 years. Alcohol use was associated with reduced full adherence at 1 month (P = 0.016; OR = 0.79 1+ vs. 0), as was college education (P <0.001; OR = 0.78 vs. high school); age (P < 0.001; OR = 1.4 age 60+) and per capita household annual income (P < 0.001; OR = 1.2 per $30,000) with increased adherence. Current smoking (P = 0.003; OR = 0.75), age (P = 0.024, OR = 1.1), college education (P = 0.037; OR = 1.4), tamoxifen assignment (P = 0.031; OR = 0.84), and breast cancer risk (P <.001; OR = 1.5 high vs. low) predicted adequate adherence at 36 months. There were no significant associations with obesity or physical activity. Alcohol use and smoking might indicate a need for greater adherence support.
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Affiliation(s)
- Stephanie R Land
- National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers, University of Pittsburgh, PA, USA.
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