Level of awareness of mammography among women attending outpatient clinics in a teaching hospital in Ibadan, South-West Nigeria

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

BACKGROUND

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

OBJECTIVES

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

SEARCH METHODS

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

SELECTION CRITERIA

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

DATA COLLECTION AND ANALYSIS

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

MAIN RESULTS

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

AUTHORS' CONCLUSIONS

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

Level of Awareness of Mammography among Breast Cancer Patients Attending Follow-up at a Tertiary Hospital, Addis Ababa, Ethiopia

BACKGROUND

Breast cancer is the most common cancer type and the most common cancer related cause of death worldwide in women. This study was aimed to assess the awareness of mammography among breast cancer patients attending follow-up at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

METHODS

Hospital based cross sectional study was conducted from July 01 to August 30, 2017 at Tikur Anbessa Specialized Hospital. Interviewer administered questionnaire was used to obtain data from 270 breast cancer patients who came to radiology department for follow up imaging. Collected data were checked for completeness, coded and entered into Epi Info 3.1 software and exported to SPSS Version 21 for analysis.

RESULTS

Two hundred and twenty four (83%) of the study participants had no awareness of mammography while 46 (17%) of them had awareness of mammography. Out of the total 270 women, only 38(14.1%) had mammography test. In multivariate logistic regression analysis; level of education was found to have significant association with awareness of mammography. Women with breast cancer who completed secondary education were 4.5 times (AOR= 4.5; 95% CI: 1.39, 14.77) more likely to have awareness of mammography compared to women with breast cancer who were illiterate.

CONCLUSION

This study revealed low awareness, knowledge and practice of mammography among women with breast cancer. Knowledge of participants about risk factor for breast cancer was also low.

Breast Cancer Awareness and Associated Factors Amongst Women in Peshawar, Pakistan: A Cross-Sectional Study

BACKGROUND

Breast cancer is the most common cancer in women, and the second overall, following lung cancer. Breast cancer can occur at any age, with an increased incidence in women 40 years and above. Worldwide the incidence is around 1 million cases per year, 60% of the cases reported from low- and middle-income countries. The current study was conducted to determine knowledge, attitude, and practices related to breast cancer, the associated risk factors, and screening methods in women presenting to a health care facility from resource-poor settings in Pakistan.

METHODS

A cross-sectional study design was used, and participants were recruited phase-wise from three major outpatient departments (OPDs) (Gynecology and Obstetrics OPD, Medical OPD, and Surgical OPD). Data were collected through the validated "Breast Cancer Awareness Measure" developed by Cancer Research UK, King's College London, and University College London in 2009. Data were analyzed through Statistical Package for Social Sciences software (SPSS) version 23.0. Students's T-Test, ANOVA, and linear regression analysis were conducted.

RESULTS

A total of 430 women were invited for participation in the study from the 3 main OPDs, and 400 took part in the study (response rate = 93.02%). The mean age of the women was 33.62 years ± 12.3 years, and the mean years of formal education were 5.05 ± 6.3 years. Less than a quarter of the participants were aware of the breast cancer warning signs, and 23.3% recognized the pain in the armpit or one of the breasts as a sign of breast cancer. The proportion of women aware of age-related and lifetime risk of getting breast cancer was 15.0%. Furthermore, only 2.5% performed breast self-examination at least once a month. Women identified many barriers like embarrassment, transport, and confidentiality issues in seeking medical help.

CONCLUSION

Overall, women had poor knowledge of breast cancer, related warning signs, breast self-examination, risk factors, and screening methods.

Awareness about breast cancer and mammogram among women attending outpatient clinics, Ain Shams University Hospitals, Egypt

BACKGROUND

Breast diseases in women, whether benign or malignant, are very commonly encountered. The breast is the commonest site for female cancer in Egypt (38.8%). Breast cancer screening can reduce morbidity and mortality and improve the survival rate for this malignancy. Mammogram can be used as a screening technique beside its role as diagnostic, especially in women over 40 years of age.

OBJECTIVES

To assess knowledge, attitude and practice regarding breast cancer and awareness about mammogram as a screening method among a group of females attending Ain Shams University outpatient clinics.

METHODS

A cross-sectional study was performed from August to September 2017. A systematic random sample was taken from attending females (18-70 years) in Ain Shams University outpatient clinics (Internal Medicine, Surgery, Pediatrics Hospital, and Maternity hospital). They were interviewed using a questionnaire inquiring about sociodemographic background, participants' knowledge, attitude, and practice towards breast cancer and its screening.

RESULTS

The mean age ± SD of attending females (18-70 years) was 37 ± 11 years. Most study participants had correct information about mammography. They showed poor knowledge level about risk factors. Mass media such as TV and internet were identified as the main source of information on breast cancer by 43% and 23.9%, respectively. In general, participants had positive attitude towards breast cancer screening by mammography. Around 90% agreed that mammogram was the best way to find a very small lump in the breast, and 91.4% agreed that women who have regular screening by mammogram have better disease outcome than those who do not screen. Regarding mammography practice rate, a small percent of participants (8.1%) was advised by their doctors to conduct a screening mammography. The level of knowledge was significantly and positively correlated with their attitude towards breast cancer screening.

CONCLUSION

The poor knowledge and practices of women illustrate the need for health education program directed to Egyptian females to improve their knowledge about breast cancer-especially its risk factors-and its screening. Using TV and Internet as media for spreading information about this disease is crucial.

Are Nigerian Women Pro-Active about Noncommunicable Disease Prevention? A Quantitative Survey

Background:

Noncommunicable diseases (NCDs) continue to cause significant morbidity and mortality worldwide with incidence increasing rapidly in developing countries. Poor utilization of preventive healthcare services contributes to this high burden.

Objective:

To assess the knowledge and utilization of preventive healthcare services among women in Lagos, Nigeria.

Methods:

This was a cross-sectional descriptive study carried out at Mainland Local Government Area (LGA) between May and July 2014. Respondents were selected using the multistage sampling method. A pretested, interviewer-administered questionnaire was used to obtain information. Data were analyzed using Epi info software version 7. Summary and inferential statistics were done and the level of significance was set at <5% (p < 0.05).

Findings:

Awareness of specified NCDs among the 322 respondents was 82.61% and of preventive healthcare services for the NCDs was 65.22%. Virtually all (99.05%) of the respondents had poor knowledge of these preventive services. Utilization rates were equally poor. Most common screening/tests done were Blood Pressure measurement (78.18%), Self breast examination (69.96%) and blood sugar test (58.33%). Much lower utilization rates were recorded for lipid profile (37.57%), Pap smear (26.11%), Visual Inspection with Acetic Acid (VIA) (19.72%), Human Papilloma Virus (HPV) immunization (16.55%) and mammography (14.72%).

Conclusions:

Respondents were aware of specified NCDs and preventive healthcare services. They considered routine medical check-up important, however they had poor knowledge of the preventive health services for NCDs and hardly utilized them. Women should be given detailed information on the preventive healthcare services to improve their knowledge and utilization so as to reduce the NCD burden.

Knowledge and Source of Information About Early Detection Techniques of Breast Cancer Among Women in Iran: A Systematic Review

Background

An increase of access to knowledge about early detection techniques of breast cancer can reduce this mortality rate. This study aimed to determine the knowledge and source of information about early detection techniques of breast cancer among Iranian women.

Methods

Both International (PubMed, Web of Science, and Google Scholar) and national (scientific information database [SID] and Magiran) databases were reviewed launching to September, 2017 to obtain related articles. Steps involving the screening, analysis of quality of the studies and extraction of papers were performed by two researchers.

Results

Of the 749 studies searched initially, 25 studies performed on 11,756 people were selected for the final stage. General knowledge for breast cancer screening among women ranged from 4.5% to 45%. The number of people with sufficient knowledge about breast self-examination in various studies was between 5% and 79.8%. The most important source of information was the Healthcare team.

Conclusions

Considering the poor knowledge and different source of information, it is suggested that educational programs be conducted around the country especially in at-risk populations.

Breast Cancer Genetics Knowledge and Testing Intentions among Nigerian Professional Women

Genetic testing services for breast cancer are well established in developed countries compared to African populations that bear a disproportionate burden of breast cancer (BC). The objective of this study is to examine the knowledge of professional Nigerian women about BC genetics and their intentions to utilize genetic testing services when it is made available in Nigeria. In this study, 165 lecturers and 189 bankers were recruited and studied using a validated self-administered questionnaire. The respondents' mean age was 34.9 years (SD = 10.9), 6.5% had family history of BC, and 84.7% had limited knowledge of breast cancer genetics. The proportion of women with genetic testing intentions for breast cancer was 87.3%. Health care access (OR = 2.35, 95% CI, 1.07-5.13), religion (OR = 3.51, 95% CI, 1.03-11.92), and perceived personal risk if a close relative had breast cancer (OR = 2.31, 95% CI, 1.05-5.08) independently predicted testing intentions. The genetic testing intentions for BC were high despite limited knowledge about breast cancer genetics. Promotion of BC genetics education as well as efforts to make BC genetic testing services available in Nigeria at reduced cost remains essential.

Breast Cancer Knowledge, Behaviors, and Preferences in Malawi: Implications for Early Detection Interventions From a Discrete Choice Experiment

PURPOSE

Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge.

METHODS

We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software.

RESULTS

Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE); few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both) was the most important attribute of an intervention, followed by the encounter setting and travel time.

CONCLUSION

Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women's preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position.

Breast cancer patients in Nigeria: Data exploration approach

Breast cancer is the type of cancer that develops from breast tissue; it is mostly common in women and it is one of the most studied diseases, largely because of its high mortality (second to lung cancer). However, it occurs in males also. This article presents a statistical study of the distribution of age, gender, length of stay, mode of diagnosis, status (dead or alive) after treatment and the location of breast cancer among 300 patients admitted in the University of Ilorin teaching hospital, Ilorin, Nigeria. The study covers a period of five (5) years; from 2011 to 2016 and logistic regression was used to perform the basic analysis in this study. It was discovered that the age of patients and the location of the breast cancer (right or left) contributes significantly to the survival of the patients. However, early detection and treatment of the disease is highly encouraged. This study also recommends that awareness should be taken to the grassroots and males should not be excluded from this discussion.

Breast Cancer Beliefs as Potential Targets for Breast Cancer Awareness Efforts to Decrease Late-Stage Presentation in Uganda

Purpose

To assess breast cancer beliefs in Uganda and determine whether these beliefs are associated with factors potentially related to nonparticipation in early detection.

Methods

A survey with open- and close-ended items was conducted in a community sample of Ugandan women to assess their beliefs about breast cancer. Linear regression was used to ascertain associations between breast cancer beliefs and demographic factors potentially associated with early detection, including socioeconomic factors, health care access, prior breast cancer knowledge, and personal detection practices.

Results

Of the 401 Ugandan women surveyed, most had less than a primary school education and received medical care at community health centers. Most women either believed in or were unsure about cultural explanatory models for developing breast cancer (> 82%), and the majority listed these beliefs as the most important causes of breast cancer (69%). By comparison, ≤ 45% of women believed in scientific explanatory risks for developing breast cancer. Although most believed that regular screening and early detection would find breast cancer when it is easy to treat (88% and 80%, respectively), they simultaneously held fatalistic attitudes toward their own detection efforts, including belief or uncertainty that a cure is impossible once they could self-detect a lump (54%). Individual beliefs were largely independent of demographic factors.

Conclusion

Misconceptions about breast cancer risks and benefits of early detection are widespread in Uganda and must be addressed in future breast cancer awareness efforts. Until screening programs exist, most breast cancer will be self-detected. Unless addressed by future awareness efforts, the high frequency of fatalistic attitudes held by women toward their own detection efforts will continue to be deleterious to breast cancer early detection in sub-Saharan countries like Uganda.

Level of Awareness and Knowledge of Breast Cancer in Nigeria. A Systematic Review

Background

Despite reports of improved awareness of breast cancer entity and seemingly upbeat levels of other awareness subthemes in Nigeria, patients continue to present late when treatment is least rewarding. This paradoxical trend of both rising awareness and late presentation coupled with reports suggesting other competing drivers of late presentation question the “theory of poor awareness” as the foremost driver of late presentations. By aggregating available data, we aimed to assess what still constitutes poor breast cancer awareness in Nigeria in order to suggest how to allocate resources to reverse the paradox

Method

Studies conducted on Nigerian populace from 2000 to date were reviewed systematically. Search was made in PROSPERO, PubMed/MEDLINE, AJOL, Cochrane library, GOOGLE, ResearchGate and ACADEMIA. Primary outcome was level of awareness about breast cancer entity.

Result

Fifty-one eligible (48 descriptive surveys, 3 interventional ones) studies were reviewed. They included 19,598 respondents (98.5% females; 43% rural dwellers). 17,086(87.2%) were laypersons in various walks of life; 2,512(12.8%) were healthcare professionals. There were high levels of awareness of breast cancer entity, BSE, knowledge of fatality and benefit of early detection (weighted percentages 80.6%, 60.1%, 73.2% and 73.9% respectively). Weighted percentages of knowledge of symptoms/signs was 45.1%. Weighted percentages of sense of susceptibility and performance of BSE were low-26.8% and 22.9% respectively. Generally, rate of performance of screening did not vary with changes in the level of awareness/knowledge of concepts.

Conclusion

In general, low awareness of breast cancer may not be the direct and foremost driver of persistent late presentation in Nigeria.

Mammographic Breast Density: Comparison Across Women with Conclusive and Inconclusive Mammography Reports

AIMS

To compare breast density (BD) across women with conclusive and inconclusive reports to establish whether BD impacts decisions to recall patients in Nigeria.

METHODS

A total of 653 mammograms with associated radiologists' reports were retrieved from mammography archives across Nigeria. Ultrasound and biopsy results of cases reported as inconclusive and referred for additional examination were examined. Data were divided into two groups based on radiologists' reports (conclusive, 1 and inconclusive, 2). Each group was subgrouped into A-B and C-D, representing cases with low- and high-mammographic BD, respectively. A Mann-Whitney U test was used to compare breast densities (A-B vs. C-D) in subjects with conclusive and inconclusive mammographic reports.

RESULT

About 75.4% (n = 492) of mammograms had a conclusive report and comprised negative (n = 216), benign (n = 208), and equivocal to highly suggestive of malignancy (n = 68). A total of 161 cases had inconclusive reports, of which, 103 demonstrated high mammographic BD (C-D). Low BD (A-B) was significantly higher in subjects with conclusive mammography reports (mean = 0.88 ± 0.36) compared with high BD (z-score = 4.5; P = .0001). High BD (C-D) was significantly higher in subjects with inconclusive reports (mean = 0.64 ± 0.48) compared with low BD (z-score = 5.2; P = .005).

CONCLUSION

Findings demonstrate that high mammographic BD impact on radiologists' inconclusive decisions in Nigeria, suggesting a need to explore avenues to improve reader efficiency.

Bilateral breast cancer among three Yoruba women in a Nigerian teaching hospital

Breast cancer is the most common cancer among females in Nigeria. Bilateral breast cancer can occur synchronously or metachronously. We report three different cases of bilateral breast cancer in three female patients managed by the Ibadan Multidisciplinary Breast Tumour Board, domiciled at the University College Hospital (UCH), over a 3-year period. Two of these patients had synchronous bilateral breast cancer and developed cancer in the second breast during the course of management. These case reports may therefore stimulate further research on the clinicopathological features and the progression of bilateral breast cancer among females, especially in our environment. Our patients were premenopausal and the immunochemistry of the tumours showed a triple-negative immunophenotype. The other features of presentation, investigation, diagnosis and follow-up care are the highlights of this presentation.

Awareness and prevalence of mammography screening and its predictors--a cross sectional study in a primary care clinic in Malaysia

BACKGROUND

Worldwide, over half a million women died of breast cancer in 2011 alone. Mammography screening is associated with a reduction of 20 to 35% in breast cancer mortality. The aim of this study was to determine the awareness and practice of mammography screening and predictors of its uptake in Malaysian women attending a primary care clinic.

MATERIALS AND METHODS

A cross-sectional study was carried out among women aged 40 to 74 years attending a primary care clinic in Selangor, Malaysia. An assisted structured questionnaire included questions on socio-demography, source of information and level of knowledge. An adapted version of the revised Champion Health Belief Model Scale plus other associated factors for mammography screening up-take were also included as part of the questionnaire. Predictors for mammography screening uptake were only determined in those who were aware about mammography screening. Significant predictors were determined by logistic regression.

RESULTS

447 women were recruited for this study; 99.1% of them (n: 411) were aware about breast cancer. Only 50.1% (n: 206) had knowledge about mammography screening. Prevalence of clinical breast-examination (CBE) was 23.3% (n: 104) and mammography screening up-take was 13.2% (n: 59). The predictors for the latter were those who have had clinical breast-examination (aOR=17.58, 95%CI: 7.68-39.82) and those aged between 50 to 59 years (aOR=3.94, 95%CI: 1.61-9.66) as well as those aged 60 years and above (aOR=6.91, 95%CI: 2.28-20.94). Good knowledge and positive beliefs about mammography screening were not associated with mammography screening uptake.

CONCLUSIONS

Half of our Malaysian women were aware about mammography screening. However, the uptake of mammography was low. Previous CBE and older age were significant predictors of mammography screening uptake. Increasing CBE services may increase compliance with guidelines.