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Joho AA, Mdoe MB, Masoi TJ, Yahaya JJ. Perceived barriers and factors influencing uptake of breast cancer screening among women: a population-based cross-sectional study. Sci Rep 2024; 14:12291. [PMID: 38811672 PMCID: PMC11137058 DOI: 10.1038/s41598-024-62218-5] [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: 08/22/2023] [Accepted: 05/14/2024] [Indexed: 05/31/2024] Open
Abstract
Breast cancer (BC) screening plays a major role in the prevention of BC through early detection and timely treatment. This study aims to determine the level of uptake of BC screening and associated factors. A community-based analytical cross-sectional study was conducted in Dodoma City, Tanzania from July to December 2020. The study included women aged 8 years and above without a known history of breast cancer. Multivariable logistic regression was used to determine the socio-demographic factors associated with BC screening. P value < 0.05 was considered significant. A total of 354 study participants were included in the present study. The mean age of participants was 31.0 ± 11.8 years. The majority of study participants (67.5%, n = 239) were aware of BC screening. However, only (35.3%, n = 125) reported to have ever practised BC screening. Breast self-examination was the most (16.4%, n = 58) frequently used method for BC screening among study participants. Lack of knowledge of all methods of BC screening was the barrier that was perceived by the vast majority (60.2%, n = 213) of the study participants. Having low family income was the only predictor of failure to practice BC screening. In this study, most of the women were aware of BC, however, few of them had undergone breast cancer (BC) screening at the time of the interview. The study also found that the main barrier to BC screening was the lack of knowledge about BC among the study participants. Immediate measures are necessary to increase women's awareness of BC. Such as community sensitization on the importance of screening, can help improve the uptake of BC screening and the early detection of BC.
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Affiliation(s)
- Angelina A Joho
- Department of Clinical Nursing, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania.
| | - Mwajuma B Mdoe
- Department of Clinical Nursing, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
| | - Theresia J Masoi
- Department of Clinical Nursing, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
| | - James J Yahaya
- Department of Pathology, School of Health Sciences, Soroti University, Soroti, Uganda
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Magwesela FM, Msemakweli DO, Fearon D. Barriers and enablers of breast cancer screening among women in East Africa: a systematic review. BMC Public Health 2023; 23:1915. [PMID: 37794414 PMCID: PMC10548570 DOI: 10.1186/s12889-023-16831-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Breast cancer is among the most common cancers globally with a projected increase in incidence and mortality in low- and middle-income countries. The majority of the patients in East Africa present with advanced disease contributing to poor disease outcomes. Breast cancer screening enables earlier detection of the disease and therefore reduces the poor outcomes associated with the disease. This study aims to identify and synthesize the reported barriers and enablers of breast cancer screening among East African women. METHODS Medline, Embase, SCOPUS, and Cochrane library were searched for articles published on the subject from start to March 2022 using PRISMA guidelines. Also, forward citation, manual search of references and searching of relevant journals were done. A thematic synthesis was carried out on the "results/findings" sections of the identified qualitative papers followed by a multi-source synthesis with quantitative findings. RESULTS Of 4560 records identified, 51 were included in the review (5 qualitative and 46 quantitative), representing 33,523 women. Thematic synthesis identified two major themes - "Should I participate in breast cancer screening?" and "Is breast cancer screening worth it?". Knowledge of breast cancer and breast cancer screening among women was identified as the most influencing factor. CONCLUSION This review provides a rich description of factors influencing uptake of breast cancer screening among East African women. Findings from this review suggest that improving knowledge and awareness among both the public and providers may be the most effective strategy to improve breast cancer screening in Eastern Africa.
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Affiliation(s)
| | | | - David Fearon
- College of Medicine and Veterinary Medicine, University of Edinburgh, Old College, South Bridge, Edinburgh, EH8 9YL, UK
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Sakafu LL, Philipo GS, Malichewe CV, Fundikira LS, Lwakatare FA, Van Loon K, Mushi BP, DeBoer RJ, Bialous SA, Lee AY. Delayed diagnostic evaluation of symptomatic breast cancer in sub-Saharan Africa: A qualitative study of Tanzanian women. PLoS One 2022; 17:e0275639. [PMID: 36201503 PMCID: PMC9536581 DOI: 10.1371/journal.pone.0275639] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background Women with breast cancer in sub-Saharan Africa are commonly diagnosed at advanced stages. In Tanzania, more than 80% of women are diagnosed with stage III or IV disease, and mortality rates are high. This study explored factors contributing to delayed diagnostic evaluation among women with breast cancer in Tanzania. Methods A qualitative study was performed at Muhimbili National Hospital in Dar es Salaam, Tanzania. Twelve women with symptomatic pathologically proven breast cancer were recruited. In-depth, semi-structured interviews were conducted in Swahili. Interviews explored the women’s journey from symptom recognition to diagnosis, including the influence of breast cancer knowledge and pre-conceptions, health seeking behaviors, psychosocial factors, preference for alternative treatments, and the contribution of culture and norms. Audio-recorded interviews were transcribed and translated into English. Thematic analysis was facilitated by a cloud-based qualitative analysis software. Results All women reported that their first breast symptom was a self-identified lump or swelling. Major themes for factors contributing to delayed diagnostic presentation of breast cancer included lack of basic knowledge and awareness of breast cancer and misconceptions about the disease. Participants faced barriers with their local primary healthcare providers, including symptom mismanagement and delayed referrals for diagnostic evaluation. Other barriers included financial hardships, fear and stigma of cancer, and use of traditional medicine. The advice and influence of family members and friends played key roles in healthcare-seeking behaviors, serving as both facilitators and barriers. Conclusion Lack of basic knowledge and awareness of breast cancer, stigma, financial barriers, and local healthcare system barriers were common factors contributing to delayed diagnostic presentation of breast cancer. The influence of friends and family also played key roles as both facilitators and barriers. This information will inform the development of educational intervention strategies to address these barriers and improve earlier diagnosis of symptomatic breast cancer in Tanzania.
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Affiliation(s)
- Lulu Lunogelo Sakafu
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
- * E-mail: (LLS); (AYL)
| | | | | | - Lulu S. Fundikira
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Flora A. Lwakatare
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Beatrice P. Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rebecca J. DeBoer
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Stella A. Bialous
- Department of Social and Behavioral Sciences, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Amie Y. Lee
- Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, California, United States of America
- * E-mail: (LLS); (AYL)
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Makene FS, Ngilangwa R, Santos C, Cross C, Ngoma T, Mujinja PGM, Wuyts M, Mackintosh M. Patients' pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis. BMC Health Serv Res 2022; 22:189. [PMID: 35151290 PMCID: PMC8841053 DOI: 10.1186/s12913-021-07438-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/21/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This article investigates the extent and sources of late diagnosis of cancer in Tanzania, demonstrating how delayed diagnosis was patterned by inequities rooted in patients' socio-economic background and by health system responses. It provides evidence to guide equity-focused policies to accelerate cancer diagnosis. METHODS Tanzanian cancer patients (62) were interviewed in 2019. Using a structured questionnaire, respondents were encouraged to recount their pathways from first symptoms to diagnosis, treatment, and in some cases check-ups as survivors. Patients described their recalled sequence of events and actions, including dates, experiences and expenditures at each event. Socio-demographic data were also collected, alongside patients' perspectives on their experience. Analysis employed descriptive statistics and qualitative thematic analysis. RESULTS Median delay, between first symptoms that were later identified as indicating cancer and a cancer diagnosis, was almost 1 year (358 days). Delays were strongly patterned by socio-economic disadvantage: those with low education, low income and non-professional occupations experienced longer delays before diagnosis. Health system experiences contributed to these socially inequitable delays. Many patients had moved around the health system extensively, mainly through self-referral as symptoms worsened. This "churning" required out-of-pocket payments that imposed a severely regressive burden on these largely low-income patients. Causes of delay identified in patients' narratives included slow recognition of symptoms by facilities, delays in diagnostic testing, delays while raising funds, and recourse to traditional healing often in response to health system barriers. Patients with higher incomes and holding health insurance that facilitated access to the private sector had moved more rapidly to diagnosis at lower out-of-pocket cost. CONCLUSIONS Late diagnosis is a root cause, in Tanzania as in many low- and middle-income countries, of cancer treatment starting at advanced stages, undermining treatment efficacy and survival rates. While Tanzania's policy of free public sector cancer treatment has made it accessible to patients on low incomes and without insurance, reaching a diagnosis is shown to have been for these respondents slower and more expensive the greater their socio-economic disadvantage. Policy implications are drawn for moving towards greater social justice in access to cancer care.
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Affiliation(s)
- Fortunata Songora Makene
- Economic and Social Research Foundation, 51 Uporoto Street, Ursino Estate, P.O Box 31226, Dar es Salaam, Tanzania
| | - Richard Ngilangwa
- Economic and Social Research Foundation, 51 Uporoto Street, Ursino Estate, P.O Box 31226, Dar es Salaam, Tanzania
| | - Cristina Santos
- Faculty of Arts and Social Sciences, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Charlotte Cross
- Faculty of Arts and Social Sciences, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Twalib Ngoma
- Department of Behavioural Sciences, Muhimbili University of Heath and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Phares G. M. Mujinja
- Department of Behavioural Sciences, Muhimbili University of Heath and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Marc Wuyts
- International Institute of Social Studies, Erasmus University Rotterdam, Kortenaerkade 12, The Hague, 2518 AX The Netherlands
| | - Maureen Mackintosh
- Faculty of Arts and Social Sciences, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
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Relevance of miR-223 as Potential Diagnostic and Prognostic Markers in Cancer. BIOLOGY 2022; 11:biology11020249. [PMID: 35205115 PMCID: PMC8869096 DOI: 10.3390/biology11020249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 12/21/2022]
Abstract
In 1993, the discovery of microRNAs in Caenorhabditis elegans (C. elegans) altered the paradigmatic view of RNA biology and post-transcriptional gene regulation. Further study revealed the role of microRNAs in disease development and progression. In particular, this review highlights microRNA-223 (miR-223 or miRNA-223) expression in malignant neoplastic disorders. miR-223 expression controls aspects of hematopoiesis and apoptosis, and cell proliferation, migration, and invasion. miR-223 regulates a number of gene targets, including cytoplasmic activation/proliferation-associated protein-1 (Caprin-1), insulin-like growth factor-1 receptor (IGF-1R), and other cell proliferation- and cell cycle-associated genes. Several studies have proposed miR-223 as a novel biomarker for early cancer diagnosis. Here, we emphasize miR-223′s role in the development and progression of cancer.
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Seifu W, Mekonen L. Breast self-examination practice among women in Africa: a systematic review and Meta-analysis. Arch Public Health 2021; 79:149. [PMID: 34419150 PMCID: PMC8379892 DOI: 10.1186/s13690-021-00671-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 08/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background In resource limited countries breast self-examination has been recommended as the most appropriate method for early detection of breast cancer. Available studies conducted on breast self-examination practice in Africa currently are inconsistent and inclusive evidences. On top of that the available studies are unrepresentative by regions with small sample size. Therefore, this systematic review and meta-analysis were conducted to summarize and pool the results of individual studies to produce content level estimates of breast self-examination practice in Africa. Methods A systematic review and meta-analysis were done among studies conducted in Africa using Preferred Item for Systematic Review and Meta-analysis (PRISRMA) guideline. Studies were identified from PubMed, Google Scholar, HINARI, EMBASE, CINAHL, Cochrane, African Journals Online and reference lists of identified prevalence studies. Unpublished sources were also searched to retrieve relevant articles. Critical appraisal of studies was done through Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). The meta-analysis was conducted using STATA 13 software. Heterogeneity was assessed using I2 statistics while publication was assessed through funnel plot. Forest plot were used to present the pooled prevalence with a 95% confidence interval (CI) using the random effect model. Results In this meta-analysis 56 studies were included with a total of 19, 228 study participants. From the included studies 25(44.64%) were from West Africa, 22(39.29%) East Africa, 5(8.93%) North Africa, 3(5.36%) Central Africa and 1(1.79%) South Africa. The overall pooled prevalence of ever and regular breast self-examination practice in Africa was found to be 44.0% (95% CI: 36.63, 51.50) and 17.9% (95% CI: 13.36, 22.94) respectively. In the subgroup analysis there was significant variations between sub regions with the highest practice in West Africa, 58.87% (95 CI%: 48.06, 69.27) and the lowest in South Africa, 5.33% (95 CI%: 2.73, 10.17). Conclusion This systematic review and meta-analysis revealed that breast self-examination practice among women in Africa was low. Therefore, intensive behavioral change communication and interventions that emphasize different domains should be given by stakeholders. PROSPERO registration number CRD42020119373. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00671-8.
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Affiliation(s)
- Wubareg Seifu
- Department of Epidemiology, College of Medicine and Health Science, School of Public Health, Jigjiga University, Jigjiga, Ethiopia.
| | - Liyew Mekonen
- Department of Reproductive Health, College of Medicine and Health Science, School of Public Health, Jigjiga University, Jigjiga, Ethiopia
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Igiraneza PC, Omondi LA, Nikuze B, Uwayezu MG, Fitch M, Niyonsenga G. Cancer du sein chez les Rwandaises en âge de procréer du district sud de Kayonza : facteurs influençant les pratiques de dépistage. Can Oncol Nurs J 2021; 31:258-265. [PMID: 34395828 DOI: 10.5737/23688076313258265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction Au Rwanda, le cancer du sein est une grande préoccupation pour la santé des femmes puisque la plupart des diagnostics sont faits à un stade avancé de la maladie. On sait pourtant que les pratiques de dépistage du cancer du sein permettent d'accélérer le diagnostic. Objectif Évaluer les facteurs qui influencent les pratiques de dépistage du cancer du sein chez les femmes en âge de procréer habitant le district de Kayonza, au Rwanda. Méthodologie Une étude quantitative a été menée dans quatre centres de santé au sud du district de Kayonza auprès de 246 femmes de 16 à 49 ans. Un questionnaire structuré, prétesté et autoadministré a été utilisé pour évaluer l'influence des connaissances, des centres de santé et des facteurs socioéconomiques et culturels sur les pratiques de dépistage du cancer du sein chez les femmes dans le sud de Kayonza. Résultats Parmi les répondantes, 55,5 % avaient une connaissance moyenne des facteurs de risque du cancer du sein, et 60,2 % sur l'incidence du dépistage du cancer du sein. On a constaté que 28 % étaient familiarisées avec l'auto-examen des seins (AES) et 16,4 % avec l'examen clinique des seins (ECS) et l'échographie mammaire. Au cours des deux années précédentes, les réponses entourant les pratiques de dépistage du sein ont révélé que 72 % des répondantes n'avaient jamais réalisé d'AES et que 81,3 % n'avaient jamais passé d'ECS ou d'échographie mammaire. Pour 30,4 % des répondantes, l'information sur le dépistage du cancer du sein provenait principalement de la radio. Des relations significatives avec les pratiques de dépistage du cancer du sein sont ressorties pour l'âge et l'état matrimonial. Conclusion L'étude témoigne du peu de connaissances sur le cancer du sein, le dépistage et les pratiques relatives au dépistage de cette maladie. Il est donc nécessaire de promouvoir la sensibilisation au cancer du sein et de créer un programme qui puisse améliorer les connaissances et les pratiques en matière de dépistage afin d'améliorer la santé des femmes du sud de Kayonza.
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Affiliation(s)
| | - Lilian A Omondi
- École de sciences infirmières et pratique sagefemme, Université du Rwanda, Collège de médecine et de sciences de la santé, Kigali, Rwanda, Collège des sciences infirmières Rory Meyers de l'Université de New York et École des sciences infirmières de l'Université de Nairobi, Kenya
| | - Bellancille Nikuze
- École de sciences infirmières et pratique sagefemme, Université du Rwanda, Collège de médecine et de sciences de la santé, Kigali, Rwanda, Collège des sciences infirmières Rory Meyers de l'Université de New York et École des sciences infirmières de l'Université de Nairobi, Kenya
| | - Marie Goretti Uwayezu
- École de sciences infirmières et pratique sage-femme, Université du Rwanda, Collège de médecine et de sciences de la santé, Kigali, Rwanda, Collège des sciences infirmières Rory Meyers de l'Université de New York et École des sciences infirmières de l'Université de Nairobi, Kenya
| | - Margaret Fitch
- Collège des sciences infirmières Rory Meyers, Université de New York, New York, États-Unis et Faculté des sciences infirmières Bloomberg, Université de Toronto, Canada
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Igiraneza PC, Omondi LA, Nikuze B, Uwayezu MG, Fitch M, Niyonsenga G. Factors influencing breast cancer screening practices among women of reproductive age in South Kayonza District, Rwanda. Can Oncol Nurs J 2021; 31:251-257. [PMID: 34395827 DOI: 10.5737/23688076313251257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction Breast cancer in Rwanda is a major concern for women's health, as most breast cancer diagnoses are made at an advanced stage. Yet, diagnosis can be done early with breast cancer screening practices. Aim To assess factors influencing breast cancer screening practices among women of reproductive age in South Kayonza District of Rwanda. Methodology A quantitative survey was conducted with 246 women between 16 and 49 years of age from four health centres in South Kayonza District. A structured, pretested, and self-administered questionnaire was used to assess the influence of knowledge, health facilities, and socioeconomic and cultural factors on breast screening practices among women in South Kayonza. Result Among all respondents, 55.5% had moderate knowledge about breast cancer risk factors and 60.2% also had moderate knowledge on the influence of breast cancer screening. While 28% were knowledgeable about Breast Self-Examination (BSE), 16.4% were knowledgeable about Clinical Breast Examination (CBE) and breast ultrasound. Responses about the practice of breast screening in the last two years showed 72% of respondents had never practiced BSE and 81.3% had not used CBE or breast ultrasound scan. The main source of information about breast cancer screening was the radio, used by 30.4% of respondents. Significant relationships were found between age and marital status with breast cancer screening practices. Conclusion This study revealed low levels of knowledge about breast cancer, breast cancer screening, and practice regarding breast cancer screening. There is a need to promote awareness of breast cancer and create a program, which can influence breast cancer screening knowledge and practice to ultimately improve health among women in south Kayonza.
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Affiliation(s)
| | - Lilian A Omondi
- School of Nursing and Midwifery, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda, New York University, Rory Meyers College of Nursing, and School of Nursing Sciences, University of Nairobi, Kenya
| | - Bellancille Nikuze
- School of Nursing and Midwifery, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda, New York University, Rory Meyers College of Nursing, and School of Nursing Sciences, University of Nairobi, Kenya
| | - Marie Goretti Uwayezu
- School of Nursing and Midwifery, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda, New York University, Rory Meyers College of Nursing, and School of Nursing Sciences, University of Nairobi, Kenya
| | - Margaret Fitch
- Rory Meyer's College of Nursing, New York University, New York, USA, and the Bloomberg Faculty of Nursing, University of Toronto, Canada
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Nyagabona SK, Luhar R, Ndumbalo J, Mvungi N, Ngoma M, Meena S, Siu S, Said M, Mwaiselage J, Tarimo E, Buckle G, Selekwa M, Mushi B, Mmbaga EJ, Van Loon K, DeBoer RJ. Views from Multidisciplinary Oncology Clinicians on Strengthening Cancer Care Delivery Systems in Tanzania. Oncologist 2021; 26:e1197-e1204. [PMID: 34041817 PMCID: PMC8265360 DOI: 10.1002/onco.13834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background In response to the increasing burden of cancer in Tanzania, the Ministry of Health, Community Development, Gender, Elderly and Children launched National Cancer Treatment Guidelines (TNCTG) in February 2020. The guidelines aimed to improve and standardize oncology care in the country. At Ocean Road Cancer Institute (ORCI), we developed a theory‐informed implementation strategy to promote guideline‐concordant care. As part of the situation analysis for implementation strategy development, we conducted focus group discussions to evaluate clinical systems and contextual factors that influence guideline‐based practice prior to the launch of the TNCTG. Materials and Methods In June 2019, three focus group discussions were conducted with a total of 21 oncology clinicians at ORCI, stratified by profession. A discussion guide was used to stimulate dialogue about facilitators and barriers to delivery of guideline‐concordant care. Discussions were audio recorded, transcribed, translated, and analyzed using thematic framework analysis. Results Participants identified factors both within the inner context of ORCI clinical systems and outside of ORCI. Themes within the clinical systems included capacity and infrastructure, information technology, communication, efficiency, and quality of services provided. Contextual factors external to ORCI included interinstitutional coordination, oncology capacity in peripheral hospitals, public awareness and beliefs, and financial barriers. Participants provided pragmatic suggestions for strengthening cancer care delivery in Tanzania. Conclusion Our results highlight several barriers and facilitators within and outside of the clinical systems at ORCI that may affect uptake of the TNCTG. Our findings were used to inform a broader guideline implementation strategy, in an effort to improve uptake of the TNCTGs at ORCI. Implications for Practice This study provides an assessment of cancer care delivery systems in a low resource setting from the unique perspectives of local multidisciplinary oncology clinicians. Situational analysis of contextual factors that are likely to influence guideline implementation outcomes is the first step of developing an implementation strategy for cancer treatment guidelines. Many of the barriers identified in this study represent actionable targets that will inform the next phases of our implementation strategy for guideline‐concordant cancer care in Tanzania and comparable settings. Guidelines to improve and standardize oncology care in Tanzania were developed in 2020. This study utilized focus group discussions to assess the barriers and facilitators to guideline implementation at Ocean Road Cancer Institute.
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Affiliation(s)
| | - Rohan Luhar
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | | | | | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Stephen Meena
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Sadiq Siu
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Mwamvita Said
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | - Edith Tarimo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Geoffrey Buckle
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Beatrice Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia John Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,University of Oslo, Norway
| | - Katherine Van Loon
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Rebecca J DeBoer
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
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Chao CA, Huang L, Visvanathan K, Mwakatobe K, Masalu N, Rositch AF. Understanding women's perspectives on breast cancer is essential for cancer control: knowledge, risk awareness, and care-seeking in Mwanza, Tanzania. BMC Public Health 2020; 20:930. [PMID: 32539723 PMCID: PMC7296642 DOI: 10.1186/s12889-020-09010-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Breast Cancer is the most common cancer in women worldwide. Since 2008, Mwanza, Tanzania, has worked to provide comprehensive cancer services through its Zonal consultant hospital. New national guidelines focused on clinical breast exam requires that women be aware of and seek care for breast concerns. Therefore, this study aims to understand breast cancer awareness in Mwanza and describe women-level barriers, care-seeking behavior, and perspectives on breast cancer. METHODS A community-based survey was administered to conveniently sampled women aged 30 and older to assess women's perspectives on breast cancer and care-seeking behavior. RESULTS Among 1129 women with a median age of 37 (IQR: 31-44) years, 73% have heard of cancer and 10% have received breast health education. Women self-evaluated their knowledge of breast cancer (from 1-none to 10-extremely knowledgeable) with a median response of 3 (IQR: 1-4). Only 14% felt they knew any signs or symptoms of breast cancer. Encouragingly, 56% of women were fairly-to-very confident they would notice changes in their breasts, with 24% of women practicing self-breast examination and 21% reporting they had received a past breast exam. Overall, 74% said they would be somewhat-to-very likely to seek care if they noticed breast changes, with 96% noting severity of symptoms as a motivator. However, fear of losing a breast (40%) and fear of a poor diagnosis (38%) were most frequent barriers to care seeking. In assessing knowledge of risk factors, about 50% of women did not know any risk factors for breast cancer whereas 42% of women believed long term contraceptive use a risk factor. However, 37% and 35% of women did not think that family history or being older were risk factors, respectively. CONCLUSIONS The success of efforts to improve early diagnosis in a setting without population-based screening depends on women being aware of breast cancer signs and symptoms, risks, and ultimately seeking care for breast concerns. Fortunately, most women said they would seek care if they noticed a change in their breasts, but the low levels of cancer knowledge, symptoms, and common risk factors highlight the need for targeted community education and awareness campaigns.
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Affiliation(s)
- Christina A Chao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Liuye Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kisa Mwakatobe
- Tanzania Breast Cancer Foundation, Dar es Salaam, Tanzania
| | - Nestory Masalu
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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11
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Alsowiyan AA, Almotyri HM, Alolayan NS, Alissa LI, Almotyri BH, AlSaigh SH. Breast cancer knowledge and awareness among females in Al-Qassim Region, Saudi Arabia in 2018. J Family Med Prim Care 2020; 9:1712-1718. [PMID: 32509677 PMCID: PMC7266218 DOI: 10.4103/jfmpc.jfmpc_1065_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/26/2020] [Accepted: 03/05/2020] [Indexed: 11/05/2022] Open
Abstract
Aim: This study aimed to measure breast cancer (BC) awareness among women in Al-Qassim and to compare the results to previous studies in Saudi Arabia and international studies. Method: This is a cross-sectional study conducted in Al-Qassim region, Saudi Arabia. All women above 18 years of age were included and those who could not complete the questionnaire for any reason were excluded. The data were collected by using a valid pretested structured questionnaire taken from previous studies. Descriptive statistics were presented using frequency and proportion for all categorical variables and mean ± standard deviation for continuous variable. The relationship between dependent variable versus independent variables had been conducted using Chi-square test. P value of ≤0.05 was considered as statistically significant. Results: Nearly all participants were highly aware of BC (95.4%) and half of them correctly identified that not only females are affected by BC. With regards to personal breast assessment, more than a half of them have done breast self-examination; however, only one out of four females had done clinical breast examination and mammography test. The most common risk factor of BC was family history and the commonest signs and symptoms were the size and shape changes of the breast. The prevalence of poor knowledge was 202 (38.9%) while good knowledge was 317 (61.1%). Age group in years and use of oral contraceptives were the independent significant factors of poor knowledge. Conclusion: The overall knowledge of women about BC in this study was inadequate. While half of the women performed breast self-examination on the contrary, the actual clinical breast examination found to be low. The most common risk factor being identified was family history of BC and smoking. Size and shape changes of breast as well as breast lump were the most common signs and symptoms. Age group in years and the use of contraceptives pills were being identified as the significant factors of knowledge toward BC.
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Affiliation(s)
- Asma A Alsowiyan
- General Surgery, 5th Year Medical Student, Al-Qassim University, Buraydah, Saudi Arabia
| | - Hadeel M Almotyri
- General Surgery, 5th Year Medical Student, Al-Qassim University, Buraydah, Saudi Arabia
| | - Najd S Alolayan
- General Surgery, 5th Year Medical Student, Al-Qassim University, Buraydah, Saudi Arabia
| | - Lamees I Alissa
- General Surgery, 5th Year Medical Student, Al-Qassim University, Buraydah, Saudi Arabia
| | - Bashayer H Almotyri
- General Surgery, 5th Year Medical Student, Al-Qassim University, Buraydah, Saudi Arabia
| | - Sultan H AlSaigh
- General Surgery Consultant, Chairman of OR/Anesthesia Department and Chief of Wound Care Unit, King Fahad Specialist Hospital (KFSH), Buraydah, Saudi Arabia
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12
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Johnson OE. Awareness and Practice of Breast Self Examination among Women in Different African Countries: A 10-Year Review of Literature. Niger Med J 2019; 60:219-225. [PMID: 31844349 PMCID: PMC6900901 DOI: 10.4103/nmj.nmj_84_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 12/24/2022] Open
Abstract
Breast self examination (BSE) is an important screening technique in detecting breast abnormalities. This procedure enables women become familiar with their breasts, thus making it easier for them to detect any changes that may occur. Routine performance of BSE is recommended for females above 20 years. This review of literature was conducted to assess the awareness and practice of BSE among women in different countries in Africa. A total of 28 out of 80 articles were reviewed from 15 African countries based on relevance. Review identification was performed through the search of Google Scholar and PubMed/MEDLINE/PubMed Central databases. Search terms used were “BSE,” “awareness,” “practice,” and “Africa.” Reference lists of identified studies were also used to find more studies. Majority of the reviewed studies showed adequate awareness, mainly from the media, but poor practice of BSE among women in various countries in Africa. A major barrier identified was inadequate knowledge of BSE technique. Although awareness of BSE was relatively high in many of the reviewed studies, the practice was low. Educational intervention program should be carried out among women in various African countries, not only to raise awareness but also to educate on the skills required to carry out BSE effectively.
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Affiliation(s)
- Ofonime Effiong Johnson
- Department of Community Health, University of Uyo Teaching Hospital/University of Uyo, Uyo, Nigeria
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13
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Yang K, Msami K, Calixte R, Mwaiselage J, Dorn J, Soliman AS. Educational Opportunities for Down-Staging Breast Cancer in Low-Income Countries: an Example from Tanzania. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:1225-1230. [PMID: 31435911 DOI: 10.1007/s13187-019-01587-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
While more than 90% of breast cancer patients in western countries survive for at least 5 years, the survival rate in Tanzania is less than 45% because of late stage at presentation. The aim of this study was to identify patient and health system factors related to early or late stages of a breast cancer diagnosis. The study was conducted at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania, and included interviews with 196 breast cancer patients diagnosed with early (stage I/II, n = 44) or late (stage III/IV, n = 152) stage who were referred to ORCI from January 2016 to August 2018. The questionnaire elicited information regarding disease history, sociodemographics, barriers to navigating the health system, and patient attitudes towards breast cancer. More early-stage patients (54.5%) stated history of previous breast examinations before their initial diagnosis compared to late-stage patients (19.7%) (p = < 0.001). Financial restraints were cited more often as barriers to diagnosis among late-stage presentation patients (55.7%) compared to early-stage patients (35.5%) (p = 0.047). Patients who were diagnosed at late-stage (47.5%) were also more likely to state time restraints as significant barriers to their diagnosis than early-stage patients (25.8%) (p = 0.041). Although the late diagnosis of breast cancer will take immense efforts of policy workers to resolve, this study offers significant opportunities for making immediate health system changes through patient and physician education that can aid in reducing diagnosis delay in Tanzania other low-income developing countries, and low-income communities within the USA.
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Affiliation(s)
- Kristen Yang
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA
| | - Khadija Msami
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Rose Calixte
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA
| | | | - Joan Dorn
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA
| | - Amr S Soliman
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA.
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14
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Alawa J, Alhalabi F, Khoshnood K. Breast Cancer Management Among Refugees and Forcibly Displaced Populations: a Call to Action. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-00314-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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15
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Ng'ida FD, Kotoroi GL, Mwangi R, Mabelele MM, Kitau J, Mahande MJ. Knowledge and practices on breast cancer detection and associated challenges among women aged 35 years and above in Tanzania: a case in Morogoro Rural District. BREAST CANCER-TARGETS AND THERAPY 2019; 11:191-197. [PMID: 31239761 PMCID: PMC6554511 DOI: 10.2147/bctt.s199889] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 03/11/2019] [Indexed: 11/23/2022]
Abstract
Background: Breast cancer is the leading cause of cancer-related deaths among women globally including Tanzania. However, timely access to diagnosis remains a challenge due to lack of specialized facilities. Most patients presents with advanced stages of the disease making management impossible. This leads to an increase in breast cancer-related mortality. Little is known about knowledge and practices on breast cancer screening in Tanzania. This study described knowledge and practices on breast-cancer detection and associated challenges among women aged 35 years and above in Morogoro rural District in Tanzania. Methods: This descriptive cross-sectional study was conducted in Lubungo, Newland and Fulwe villages at Mikese ward in Morogoro rural District from June and July 2017. A standardized questionnaire was used to obtain information from 130 study participants regarding breast cancer knowledge and practices. Data were analyzed using (SPSS) software version 23 and descriptive statistics were summarized in frequencies and percentages. Results: One hundred and thirty women were studied, all participants have heard of breast cancer; 71.5% knew the effects of breast cancer; 37.7% knew about the signs and symptoms. The most frequently reported cause and risk factor of breast cancer were putting money under brassiere (30.8%) and fat diet (17.7%) respectively. The participants (73.8%) have never heard of breast self-examination (BSE) as an early detection method of breast cancer hence do not practice it. Lack of knowledge on early signs and symptoms of breast cancer was reported as the main challenge for breast cancer screening (73.8%). The frequently reported source of information about this disease was television/radio programs (83.1%). Conclusion: Most of the women have heard of breast cancer but they lack adequate knowledge on its risk factors, causes, symptoms and effects. The majority of the women do not practice BSE due to lack of knowledge. Efforts to improve women’s knowledge on breast cancer is warranted.
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Affiliation(s)
- Faraja D Ng'ida
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Rose Mwangi
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Mabula M Mabelele
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jovin Kitau
- Department of Parasitology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Michael J Mahande
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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16
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Alwash Z, Henke O, Serventi F, Kantelhardt EJ. Staff Perspectives Toward Challenges in a Newly Established Cancer Center in Tanzania: A Qualitative Study. J Glob Oncol 2019; 5:1-8. [PMID: 30943098 PMCID: PMC6528737 DOI: 10.1200/jgo.18.00246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Cancer is a growing public health concern in low-income countries (LICs). From 14 million new patient cases identified worldwide each year, 8 million are diagnosed in LICs. The fatality rate is 75% in LICs compared with 46% in high-income countries. Causes are low literacy levels, lack of awareness and knowledge about cancer, and limited education of health care professionals that leads to late detection and diagnosis. In Tanzania, cancer incidence will double to 60,000 in 2030. The referral hospital of Northern Tanzania established a new cancer unit in December 2016 to meet these needs. However, there is limited knowledge about perceptions of health care professionals toward cancer care in LICs. This study aims to understand attitudes and perspectives of those professionals and the treatment-related challenges in a newly established center to assist future efforts in this field. METHODS A qualitative method approach using in-depth interviews was chosen to achieve inductive conceptualization. Analysis of data was performed according to qualitative content analysis. RESULTS Eleven interviews were conducted. Five main categories were found: training and education of staff, availability of financial support, challenges in management, interests in future developments, and job satisfaction. Subcategories elaborated in more detail within the main categories. CONCLUSION Limitations in staffing, training, and education were major concerns. The importance of sustainable funding and the needed cooperation of the government with international aid were identified as key points. The involvement of different stakeholders requires guidance by health care management. Health care professionals expressed their satisfaction with the possibilities of treating cancer and the rewarding feedback from patients. Misconceptions and poor knowledge by patients were mentioned as reasons for delayed health-seeking behavior. Screening and awareness programs were seen as useful interventions.
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Affiliation(s)
- Zainab Alwash
- Institute for Tropical Medicine and International Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Henke
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Furaha Serventi
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Eva Johanna Kantelhardt
- Institut für Med. Epidemiologie, Biometrie u. Informatik Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Clinical University of Halle (Saale), Halle (Saale), Germany
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17
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Schilling MPR, Silva IFD, Opitz SP, Borges MFDSO, Koifman RJ, Koifman S. Beliefs about Breast Cancer among Women in the Western Amazon: A Population-Based Study. Asian Pac J Cancer Prev 2019; 20:469-478. [PMID: 30803209 PMCID: PMC6897015 DOI: 10.31557/apjcp.2019.20.2.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 01/28/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: Evaluate the beliefs about the risk factors for breast cancer in a population of women from the western Amazon and determine the factors associated with the higher belief scores presented by this population. Methods: A population-based cross-sectional study included 478 women aged >40 years residing in Rio Branco, Acre, Brazil. An American Cancer Society questionnaire was applied to assess the knowledge, attitudes, and beliefs about breast cancer. Results: The main beliefs about the risk factors for breast cancer were breast trauma (95%), use of underwire bra (58.5%), and a high number of sexual partners (55.5%). Women from younger age groups presented higher belief scores (Bcoefficient: –0.04, 95% CI: –0.07; –0.01) than those of women from older age groups. A strong association was noted between high knowledge scores of risk factors and signs/symptoms of the disease and high belief scores in the study group (Bcoefficient:0.33;95%CI:0.28;0.38). Conclusion: The results indicate the existence of important beliefs related to the risk factors for breast cancer. Women from younger age groups, women who have seen a gynecologist in the past 2 years, and women who had more knowledge about the risk factors and signs and symptoms of breast cancer had higher belief scores.
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Affiliation(s)
- Marla Presa Raulino Schilling
- National School of Public Health, Oswaldo Cruz Foundation, Postgraduate Program in Public Health and Environment, Brazil.
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18
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Rick TJ, Deming CM, Helland JR, Hartwig KA. Cancer Training for Frontline Healthcare Providers in Tanzania. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:111-115. [PMID: 28815475 DOI: 10.1007/s13187-017-1274-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cervical and breast cancer are responsible for the highest cancer-related mortality in Tanzania, although both are preventable or curable if diagnosed at an early stage. Limited knowledge of cervical cancer by clinic and dispensary level healthcare providers in Tanzania is a barrier for prevention and control strategies. The purpose of the study was to provide basic oncology training to frontline healthcare workers with a focus on cervical and breast cancer in order to increase knowledge. A 1-day cancer training symposium was conducted in Arusha, Tanzania, with 43 clinicians. Pre- and post-intervention surveys assessed cancer knowledge and confidence of clinicians in risk assessment. Sixty-nine percent of the participants reported never receiving any cervical cancer training in the past. A significant difference was found between the pre- and post-test in a majority of knowledge questions and in reported confidence recognizing signs and symptoms of breast and cervical cancer (p < 0.05). The 1-day community oncology training symposium was effective in delivering and increasing basic knowledge about cervical and breast cancers to these healthcare providers. The low level of baseline cancer knowledge among frontline medical providers in Tanzania illustrates the need for increased training around the country.
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Affiliation(s)
- Tara J Rick
- Masters of Physician Assistant Studies Program, Saint Catherine University, #4227, 2004 Randolph Ave., St. Paul, MN, 55105, USA.
| | - Cassondra M Deming
- Masters of Physician Assistant Studies Program, Saint Catherine University, #4227, 2004 Randolph Ave., St. Paul, MN, 55105, USA
| | - Janey R Helland
- Masters of Physician Assistant Studies Program, Saint Catherine University, #4227, 2004 Randolph Ave., St. Paul, MN, 55105, USA
| | - Kari A Hartwig
- Masters of Physician Assistant Studies Program, Saint Catherine University, #4227, 2004 Randolph Ave., St. Paul, MN, 55105, USA
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19
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Black E, Richmond R. Improving early detection of breast cancer in sub-Saharan Africa: why mammography may not be the way forward. Global Health 2019; 15:3. [PMID: 30621753 PMCID: PMC6325810 DOI: 10.1186/s12992-018-0446-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/07/2018] [Indexed: 12/13/2022] Open
Abstract
Background and methods The prevention and control of breast cancer in sub-Saharan Africa (SSA) is an increasingly critical public health issue. Breast cancer is the most frequent female cancer in SSA and mortality rates from this disease are the highest globally. Breast cancer has traditionally been considered a disease of high-income countries, and programs for early detection have been developed and implemented in these settings. However, screening programs for breast cancer in SSA have been less effective than in high-income countries. This article reviews the literature on breast cancer in SSA, focusing on early detection practices. It then examines the case for and against mammography and other early detection approaches for breast cancer in SSA. Results Women with breast cancer in SSA are younger compared with high-income countries. Most women present with advanced disease and because treatment options are limited, have poor prognoses. Delay between symptom onset and healthcare seeking is common. Engagement with early detection practices such as mammography and breast examination is low and contributes to late stage at diagnosis. Discussion While early detection of breast cancer through screening has contributed to important reductions in mortality in many high-income countries, most countries in SSA have not been able to implement and sustain screening programs due to financial, logistical and sociocultural constraints. Mammography is widely used in high-income countries but has several limitations in SSA and is likely to have a higher harm-to-benefit ratio. Breast self-examination and clinical breast examination are alternative early detection methods which are more widely used by women in SSA compared with mammography, and are less resource intensive. An alternative approach to breast cancer screening programs for SSA is clinical downstaging, where the focus is on detecting breast cancer earlier in symptomatic women. Evidence demonstrates effectiveness of clinical downstaging among women presenting with late stage disease. Conclusions Approaches for early detection of breast cancer in SSA need to be context-specific. While screening programs with mammography have been effective in high-income countries, evidence suggests that other strategies might be equally important in reducing mortality from breast cancer, particularly in low-resource settings. There is a strong argument for further research into the feasability and acceptability of clinical downstaging for the control of breast cancer in SSA. Electronic supplementary material The online version of this article (10.1186/s12992-018-0446-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eleanor Black
- School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, 2052, Australia.
| | - Robyn Richmond
- School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, 2052, Australia
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20
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Smith SG, Beard E, McGowan JA, Fox E, Cook C, Pal R, Waller J, Shahab L. Development of a tool to assess beliefs about mythical causes of cancer: the Cancer Awareness Measure Mythical Causes Scale. BMJ Open 2018; 8:e022825. [PMID: 30552257 PMCID: PMC6303629 DOI: 10.1136/bmjopen-2018-022825] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/09/2018] [Accepted: 10/17/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES We aimed to develop a reliable and valid measure to assess public beliefs in mythical causes of cancer: the Cancer Awareness Measure-MYthical Causes Scale (CAM-MYCS). DESIGN AND SETTING Cancer myth items were generated from a literature review, social media and interviews (n=16). The CAM-MYCS was prepared by reducing items using (a) an online sample (n=527) with exploratory factor analysis and (b) cancer experts with Delhpi methodology (n=13). To assess test-retest reliability and sensitivity to change, students (n=91) completed the CAM-MYCS at baseline and 1 week after exposure to information on lifestyle-related cancer causes or control information. Construct validity was tested by comparing CAM-MYCS scores between cancer experts (n=25) and students (n=91). Factor structure and internal reliability were investigated in a national sample (n=1993). RESULTS Out of 42 items generated, 12 were retained based on factor loadings, prevalence of endorsement and expert consensus. CAM-MYCS scores improved (fewer myths endorsed) among students exposed to information on cancer causes compared with the control group (p<0.001) and showed high test-retest reliability (r=0.90, p<0.001). Cancer experts reported higher CAM-MYCS scores (fewer myths endorsed) than students (p<0.001). The factor structure of the CAM-MYCS was confirmed in the national sample and internal reliability was high (α=0.86). Inclusion of the CAM-MYCS alongside items assessing knowledge of actual cancer causes did not affect responses. CONCLUSIONS The CAM-MYCS tool is a reliable and valid tool assessing beliefs in mythical causes of cancer, and it can be used alongside items assessing known causes of cancer.
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Affiliation(s)
- Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Emma Beard
- Research Department of Behavioural Science and Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jennifer A McGowan
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Emma Fox
- Division of General Internal Medicine, Northwestern University, Chicago, IL, USA
| | | | - Radhika Pal
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Lion Shahab
- Research Department of Behavioural Science and Health, University College London, London, UK
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21
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Freitas ÂGQ, Weller M. Women's knowledge about risk factors of breast cancer in a Brazilian community. Women Health 2018; 59:558-568. [PMID: 30285565 DOI: 10.1080/03630242.2018.1516266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Knowledge about risk factors for breast cancer was identified as an important variable that affects women's avoidance behavior and their screening performance. The present study assessed women's knowledge about risk factors and associated socio-economic variables. Data from 417 women aged 20-86 years were obtained in Caicó, Rio Grande do Norte, Brazil. In agreement with the recognition of 26 potential risk factors and prevention behaviors, two groups with good (N = 203) and poor (N = 214) knowledge were formed, respectively. Having a close relative with cancer remained the unique significant variable in the adjusted model. Women without any close relative with cancer, were 1.54 (95% confidence interval [CI] 1.036-2.288) times as likely to have poor knowledge, compared to women who had a close relative with cancer (p = 0.033). Other socio-economic variables, including income, employment status and educational level had no significant association with knowledge (p = 0.450, p = 0.914, p = 0.639, respectively). Of 417 women, 302 (72.42%), 339 (81.29%), and 309 (74.10%), respectively, did not identify "physical inactivity," "overweight after menopause," and "no breastfeeding of children" as risk factors. Knowledge could help to avoid risk factors and motivate prevention behavior. Information about risk factors should be disseminated in health campaigns.
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Affiliation(s)
| | - Mathias Weller
- a Programa de Pós-Graduação em Saúde Pública. Universidade Estadual da Paraíba (UEPB) , Campina Grande , Brasil
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22
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Ginsburg O, Rositch AF, Conteh L, Mutebi M, Paskett ED, Subramanian S. Breast Cancer Disparities Among Women in Low- and Middle-Income Countries. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0286-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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23
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Martei YM, Vanderpuye V, Jones BA. Fear of Mastectomy Associated with Delayed Breast Cancer Presentation Among Ghanaian Women. Oncologist 2018; 23:1446-1452. [PMID: 29959283 DOI: 10.1634/theoncologist.2017-0409] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/17/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Breast cancer is the leading cause of cancer mortality among women globally. Most women in Ghana present with advanced stage disease. The aim of this study is to characterize sociocultural factors associated with delayed presentation. MATERIALS AND METHODS Qualitative study (grounded theory, constant comparative method) using individual in-depth interviews with breast cancer patients seen at the Korle Bu Teaching Hospital in Accra, Ghana. Interviews were conducted in English and three local languages. We achieved theoretical saturation with 31 participants. RESULTS The mean length of delay reported by patients was approximately 1 year. Five recurrent themes were related to delayed presentation: (a) Women with a confirmed breast cancer diagnosis delay treatment because of the fear of mastectomy due to self and societal stigma; (b) role of the church as a social support system given the societal stigma associated with breast cancer; (c) study participants expressed some awareness of breast cancer, but with varying depths of breast cancer knowledge encompassing both myths and misconceptions about breast cancer; (d) most patients present late because they do not associate a "painless" breast lump with possible breast malignancy; and (e) delayed presentation linked to significant financial burden associated with breast cancer treatment. CONCLUSION Despite current efforts to increase breast cancer awareness, the fear of mastectomy remains one of the main reasons for delayed presentation. Successful breast cancer education programs will need to be framed within the broader sociocultural dimensions of femininity that address some of the stigma associated with mastectomy reported in the Ghanaian context. IMPLICATIONS FOR PRACTICE Most women in Ghana present with advanced-stage disease. The aim of this study was to characterize sociocultural factors associated with delayed presentation. Although several quantitative studies have been conducted on delays in presentation in sub-Saharan Africa (SSA), this study is one of the few to identify fear of mastectomy as a reason for delayed presentation. Anecdotal data from current clinical experiences in SSA suggest that this is still an issue that has not been adequately reported and addressed in most SSA countries. The research results presented here will hopefully guide health providers and national organizations in designing breast cancer education programs in Ghana and other parts of SSA.
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Affiliation(s)
- Yehoda M Martei
- Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Verna Vanderpuye
- National Center for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Beth A Jones
- Yale School of Public Health, Yale Comprehensive Cancer Center, New Haven, Connecticut, USA
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Moghaddam Tabrizi F, Vahdati S, Khanahmadi S, Barjasteh S. Determinants of Breast Cancer Screening by Mammography in Women Referred to Health Centers of Urmia, Iran. Asian Pac J Cancer Prev 2018; 19:997-1003. [PMID: 29693968 PMCID: PMC6031808 DOI: 10.22034/apjcp.2018.19.4.997] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: In women, breast cancer accounts for 30 percent of all cancers and it is the second leading cause of mortality. Mammography is considered an effective procedure to detect early breast cancer recommended by World Health Organization. This study was aimed to evaluate breast cancer screening determinants in women referred to health centers of Urmia for mammography in 2017. Materials and Methods: In this descriptive-analytic cross-sectional study, 348 women referred to health centers of Urmia were selected using multistage sampling. Data were collected using a standard questionnaire for mammography screening determinants, with a checklist including demographic characteristics, family, social and economic factors and midwifery background. Analysis was with SPSS software version 20for descriptive and inferential statistic tests, P<0.05 being considered significant. Results: The proportion performing mammography was 12%. Significant relationships were noted with income, menopause status, a history of breast cancer in close relatives, beliefs, inaccessibility, knowledge, cues to action, emotions, self-care, and life priorities (P<0.05). There were no significant links with age at marriage, first age of delivery, number of children, duration of breastfeeding, status of residency, education, marital status, occupation, history of breastfeeding, and previous breast problems (P>0.05). Conclusions: The findings of this study showed that the status of breast cancer screening in participating women was not satisfactory. Therefore, promotion of screening methods by health policy makers in Iran is necessary and given that reliance solely on education is not sufficient, it is essential to pay attention to barriers and eliminate them.
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Kohler RE, Gopal S, Lee CN, Weiner BJ, Reeve BB, Wheeler SB. Breast Cancer Knowledge, Behaviors, and Preferences in Malawi: Implications for Early Detection Interventions From a Discrete Choice Experiment. J Glob Oncol 2017; 3:480-489. [PMID: 29094086 PMCID: PMC5646878 DOI: 10.1200/jgo.2016.005371] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
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.
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Affiliation(s)
- Racquel E. Kohler
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Satish Gopal
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Clara N. Lee
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Bryan J. Weiner
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Bryce B. Reeve
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Stephanie B. Wheeler
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
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Rick TJ, Merinyo JJ. Call for Breast Cancer Risk Factor Education in Countries With Limited Health Care Resources. J Glob Oncol 2017; 3:427-428. [PMID: 28831452 PMCID: PMC5560463 DOI: 10.1200/jgo.2016.007781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Tara J Rick
- , St Catherine University, St Paul, MN; , Arusha Lutheran Medical Centre, Arusha, Tanzania
| | - Judith J Merinyo
- , St Catherine University, St Paul, MN; , Arusha Lutheran Medical Centre, Arusha, Tanzania
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Akuoko CP, Armah E, Sarpong T, Quansah DY, Amankwaa I, Boateng D. Barriers to early presentation and diagnosis of breast cancer among African women living in sub-Saharan Africa. PLoS One 2017; 12:e0171024. [PMID: 28192444 PMCID: PMC5305236 DOI: 10.1371/journal.pone.0171024] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/13/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Breast cancer (BC) has been described as the leading cause of cancer deaths among women especially in the developing world including sub Saharan Africa (SSA). Delayed presentation and late diagnosis at health facilities are parts of the contributing factors of high BC mortality in Africa. This review aimed to appraise the contributing factors to delayed breast cancer presentation and diagnosis among SSA women. METHODS Five databases encompassing medical and social sciences were systematically searched using predefined search terms linked with breast cancer presentation and diagnosis and sub Saharan Africa. Reference lists of relevant papers were also hand searched. Quality of quantitative and qualitative articles were assessed using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Critical Appraisal Skills Programme (CASP) quality appraisal checklist. Thematic analysis was used to synthesize the qualitative studies to integrate findings. RESULTS Fourteen (14) quantitative studies, two (2) qualitative studies and one (1) mixed method study merited inclusion for analysis. This review identified low knowledge of breast cancer among SSA women. This review also found lack of awareness of early detection treatment, poor perception of BC, socio-cultural factors such as belief, traditions and fear as factors impacting African women's health seeking behavior in relation to breast cancer. CONCLUSION Improving African women's knowledge and understanding will improve behaviors related to breast cancer and facilitate early presentation and detection and enhance proper management and treatment of breast cancer.
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Affiliation(s)
| | | | | | - Dan Yedu Quansah
- Graduate School of Public health, Seoul National University, Seoul, South Korea
| | | | - Daniel Boateng
- Julius Global Health, University Medical Center, Utrecht University, the Netherlands
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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