Promoting Breast Cancer Awareness and Screening Practices for Early Detection in Low-Resource Settings

Evaluation of a pre-post quasi-experimental educational intervention on breast cancer awareness among pharmacy professionals in Karachi, Pakistan

Introduction

Cancer, particularly breast cancer, is a major contributor to mortality and a significant impediment to life expectancy. In 2020, breast cancer accounted for 11.7% of all cancer cases and caused approximately 685,000 deaths worldwide, surpassing lung cancer in prevalence. The study aims to evaluate the impact of an educational intervention on breast cancer awareness among pharmacy students by comparing their understanding before and after the program.

Method

A pre-post quasi-experimental study was designed to assess knowledge and awareness of breast cancer, breast self-examination (BSE) practices, and attitudes toward breast cancer among female university students in Karachi, Pakistan. Participants completed a pre-session questionnaire, attended an awareness workshop and video tutorial, and then completed a post-session questionnaire 2 weeks later.

Results

Of 1,200 participants, 1,015 of them completed both the pre- and post-intervention questionnaires. Key demographic features included 83.9% of the participants being in the 18-24 age group, 26.8% being married, and only 14.2% having a family history of breast cancer. Before the intervention, 60.7% of the participants were not involved in regular breast self-exams due to a lack of awareness. Post-intervention results showed a significant increase in awareness, with 35.9% rising to 94.9%. The use of screening methods increased from 46.7 to 94.8%. Knowledge of breast cancer improved from 51.2 to 96.7%, and the general perception rose from 48.2 to 93.4%. Attitudes toward self-examination also shifted positively, indicating a significant change in perception.

Interpretation and conclusion

The study concludes the baseline knowledge of breast cancer among female students was inadequate but improved significantly from over 40% to over 90% following the educational intervention. The intervention positively influenced the general perception and attitudes toward breast cancer. These findings highlight the need for regular educational sessions to enhance awareness, improve healthcare outcomes, and reduce mortality rates, particularly in developing countries.

Breast cancer screening patterns and associated factors in Iranian women over 40 years

Screening is a key component of breast cancer early detection programs that can considerably reduce relevant mortality rates. The purpose of this study was to determine the breast cancer screening behavioral patterns and associated factors in women over 40 years of age. In this descriptive‑analytical cross‑sectional study, 372 over 40 years of age women visiting health centers in Tabriz, Iran, in 2023 were enrolled using cluster sampling. The data were collected using the sociodemographic characteristics questionnaire, breast cancer perception scale, health literacy for Iranian adults scale, and the Breast Cancer Screening Behavior Checklist. The obtained data were analyzed in SPSS version 16 using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (univariate and multivariate logistic regression analyses). In total, 68.3% of all participants performed breast self‑examination (BSE) (9.9% regularly, once per month), 60.2% underwent clinical breast examination (CBE) (8.9% regularly, twice per year), 51.3% underwent mammography (12.3% regularly, once per year), and 36.2% underwent sonography (3.8% regularly, twice per year). The findings also showed that women with benign breast diseases were more likely to undergo CBE (OR = 8.49; 95% CI 2.55 to 28.21; P < 0.001), mammography (OR = 8.84; 95% CI 2.98 to 10; P < 0.001), and sonography (OR = 18.84; 95% CI 6.40 to 53.33; P < 0.001) than others. Participants with low and moderate breast cancer perception scores were more likely to perform BSE than women with high breast cancer perception scores (OR = 2.20; 95% CI 1.21 to 4.00; P = 0.009) and women who had a history of benign breast disease were more likely to perform screening behaviors than others (OR = 2.47; 95% CI 1.27 to 4.80; P = 0.008). Women between the ages of 50 and 59 were more likely to undergo mammography (OR = 2.33; 95% CI 1.29 to 4.77; P = 0.008) and CBE (OR = 2.40; 95% CI 1.347 to 4.20; P = 0.003) than those ≥ 60 years. Given the low participation of women in regular breast cancer screening, it is suggested that health care providers highlight the need for screening at the specified intervals in their training programs. In addition, health authorities are recommended to use reminder systems to remind women, especially those over 40 years of age, of the best time for breast screening. Moreover, health care providers must seek to improve breast cancer knowledge, attitudes, and perceptions of women who visit health centers, which are the first level of contact with the healthcare system for the general population.

Barriers to Breast Cancer Screening in Saudi Arabia: A Systematic Review and Meta-Analysis

Breast cancer is a significant public health concern globally, and early detection through screening programs can improve treatment outcomes and reduce mortality rates. However, the uptake of breast cancer screening among women in Saudi Arabia is hindered by various barriers. This systematic review and meta-analysis aimed to elucidate the barriers to breast cancer screening among women in Saudi Arabia, providing insights into the multifaceted challenges hindering screening uptake and informing tailored interventions and policy recommendations. A comprehensive literature search was conducted across electronic databases and grey literature sources to identify relevant studies on barriers to breast cancer screening in Saudi Arabia. Studies conducted between 2017 and 2023, employing diverse settings and methodologies, were included in the analysis. Data on the prevalence of barriers, family history of breast cancer, and self-reported breast examination practices were extracted and synthesized. A total of 14 studies met the inclusion criteria, encompassing diverse populations and methodologies. The included studies predominantly employed cross-sectional survey designs and targeted various populations across different regions of Saudi Arabia. The barriers to breast cancer screening were investigated, revealing concerns such as fear of discovering cancer, embarrassment due to breast-related tests, fear of pain related to clinical examination, and lack of awareness. Additionally, a substantial proportion of participants reported a family history of breast cancer, indicating a significant risk factor for the disease. Self-reported breast examination practices varied among participants, with disparities in screening behaviors observed. Our review identified fear of diagnosis, embarrassment, and lack of awareness as key barriers to breast cancer screening in Saudi Arabia. Targeted interventions, including education and improved access, are essential to address these challenges and enhance early detection efforts, reducing the burden of breast cancer.

A Descriptive Cross-Sectional Study on Clinical Epidemiology of Different Types of Cancer in a Tertiary Care Centre: Insights From Eastern India

Background and aim Cancer poses a significant burden in India, with a considerable number of people living with the disease and a substantial increase in new cases every year. Hence, considering the unique challenges faced by developing nations regarding the disease burden, this study has been designed. The aim of this work was to carry out a descriptive retrospective cross-sectional study on various types of cancer conducted in a tertiary care centre in India. Methods One thousand cancer patients who attended the outpatient department (OPD) from tertiary care cancer hospitals from July 2019 to December 2023 in Eastern India were enrolled. Patients included were of either gender, with their demographic details and the disease duration, who visited the OPD of hospitals meeting the eligibility criteria. Exclusion criteria were terminally ill cancer patients and patients who did not visit the outpatient department of the studied site. Descriptive analysis and chi-square test were carried out using the SPSS statistical software, version 20.0 (IBM Corp., Armonk, NY) for data analysis. Ethics committee approval was taken. Results Gastrointestinal tract cancer (31.3%, n=313) and breast cancer (19.8%, n=198) were found to be the most common types of cancer among all. Out of the total patients studied, 41.1% were males and 58.9% were females. Among regions, North Chotanagpur had the highest (40.5%) prevalence, followed by South Chotanagpur (26.0%). The majority of individuals belonged to 41 to 60 years (49.0%, n=490), followed by 21-40 years (28.9%, n=289). Gastrointestinal cancer was more prevalent among males (35.5%, n=146), while breast cancer was predominant among females (31.4%, n=185). Conclusion Cancer is more prevalent among rural females (58.9%), providing valuable insights into the prevalence of various cancers and highlighting differences between regions, age groups, and genders.

Analysis of Breast Cancer Screening Results and Influencing Factors of Breast Cancer in Guangdong Province from 2017 to 2021

BACKGROUNDS

Breast cancer screening plays an important role in the early detection, diagnosis and treatment of breast cancer. The aim of this study was to evaluate the screening results and explore the influencing factors of breast cancer detection rate in Guangdong.

METHODS

This cross-sectional study was conducted among 2,024,960 women aged 35-64 in Guangdong Province during 2017-2021. The data about breast cancer screening information were collected from the Guangdong maternal and child health information system. Descriptive statistical analysis was used to explain demographic characteristics and results of breast cancer screening. The generalized linear regression model was applied to analyze the related influencing factors of breast cancer detection rate.

RESULTS

The estimated detection rate of breast cancer in Guangdong Province is 70.32/105, with an early diagnosis rate of 82.06%. After adjusting covariates, those women with older age (45-55 [OR (95% CI) 2.174 (1.872, 2.526)], 55-65 [OR (95% CI) 2.162 (1.760, 2.657)]), education for high school ([OR (95% CI) 1.491 (1.254, 1.773)]) and older age at first birth ([OR (95% CI) 1.632 (1.445, 1.844)]) were more likely to have higher detection rate of breast cancer. No history of surgery or biopsy ([OR (95% CI) 0.527 (0.387, 0.718)]), no history of breast cancer check ([OR (95% CI) 0.873 (0.774, 0.985)]) and no family history of breast cancer ([OR (95% CI) 0.255 (0.151, 0.432)]) women were more likely to screen negative for breast cancer (P < 0.05).

CONCLUSION

The detection rate of breast cancer in screening showed an increasing trend year by year in Guangdong Province. Older age, education for high school and older age at first birth were risk factors for breast cancer detection rate, while no surgery or biopsy history, no family history of breast cancer and no history of breast cancer check were protective factors.

Illuminating the breast cancer survival rates among Southeast Asian women: A systematic review and meta-analysis spanning four decades

In Southeast Asia, breast cancer is the most prevalent cancer among women and ranks as the second leading cause of cancer-related deaths. This systematic review and meta-analysis, encompassing 27 observational cohort studies with a minimum one-year follow-up period, aimed to examine temporal trends in breast cancer survival rates. Among the subset of five out of eleven Southeast Asian nations with available data, our analysis revealed pooled survival rates of 88.8 % at 1 year, 73.8 % at 3 years, 70.8 % at 5 years, and 49.3 % at 10 years for breast cancer patients. The mean age at diagnosis was 50.77±10.07 years, with 52.81 % of patients presenting with positive lymph nodes. Notably, stages I and II remained predominant even five years post-diagnosis. Although an overall amelioration in survival rates transpired over the preceding four decades, a noticeable exception pertained to the 3-year rate, demonstrating limited improvement. These findings underscore the pressing need for enhanced research efforts, particularly in countries within the region that lack survival data, to enable accurate estimations. Furthermore, our review also emphasizes the crucial need for future comprehensive, well-designed studies to delve into the factors behind survival rate disparities in Southeast Asia and the younger age at diagnosis compared to other regions.

Young Filipino breast cancer patients have worse survival outcomes

Background

In the 2020 GLOBOCAN report, breast cancer is the 3rd most common cause of cancer-related mortality in the Philippines. The incidence of breast cancer in the young (≤40 years) was reported to be higher in the Philippines compared to other Asian countries. Several studies have consistently demonstrated poor survival outcomes in this age group due to its aggressiveness and unique tumour biology. However, data on survival outcomes of young Filipino breast cancer patients remains unknown in the Philippines.

Methods

A retrospective study was performed involving patients with stage I-III breast cancer who underwent definitive surgery from January 2010 to December 2015 at a single-tertiary institution. Patients were grouped according to age (≤40 and >40 years old). Their clinicopathological characteristics, treatment profile and 5-year survival outcomes were analyzed.

Results

A total of 524 Filipino patients (15.1% aged ≤40 years) were included. Younger patients were diagnosed at a higher stage and pathologic grade. A negative hormone receptor, high Ki67 status, and triple negative breast cancer (TNBC) subtypes were also more common among younger patients. The overall breast-conserving surgery rate was low at 8.9%. The use of adjuvant chemoradiotherapy was more common and both 5-year overall survival (OS) and disease-free survival (DFS) were lower (61.1% versus 77.1% and 31.1% versus 66.8%, respectively) in the ≤40-year-old group. In the multivariate analysis, age group, tumour size, and nodal status were significant predictors for DFS. However, only tumour size was significant for OS.

Conclusion

Young Filipino breast cancer patients have demonstrated unique pathologic characteristics with associated lower survival outcomes similar to the published literature. Increasing awareness of cancer screening practices among young women, provision of equitable access to healthcare, and prompt management of breast cancer in the young are crucial.

Social determinants of sex disparities in cancer in Southeast Asia

Sex disparities in cancer exist along the cancer spectrum, ranging from genomic predisposition and behavioral risk factors to access to screening, diagnostics, treatment, and survivorship care. A growing body of research is studying the biological underpinnings of these differences, from cancer risk to tumor biology to treatment response. It is well known, however, that the social determinants of health play a large role across the cancer disease continuum, which encompasses risk, prevention, diagnosis, treatment, survivorship, rehabilitation, and palliative care. Less literature focuses on the gendered disparities that are epidemiologic in nature, especially in Southeast Asia (SEA), a diverse region that is home to nearly 670 million people, where most are lower middle income countries, and where socioeconomic and cultural factors increase cancer risk for women. In this review, we highlight the social drivers of gendered disparities, namely the geographic, environmental, sociocultural, economic, and political forces that contribute to the increased mortality and poorer health outcomes in the region.

G. S, Osman H, Khandaker MU. Awareness level, knowledge and attitude towards breast cancer among staff and students of Hail University, Saudi Arabia

INTRODUCTION

Awareness of screening procedures and illness warning signals is critical for expanding and implementing screening programs in society, which would improve the odds of early identification of breast cancer.

OBJECTIVES

This study aimed to evaluate the knowledge, awareness, attitudes, and practices related to breast cancer risk factors, signs, symptoms and methods of screening among female faculty and students at Hail University in the Kingdom of Saudi Arabia.

METHODS

A cross-sectional study was conducted from January 2021 through February 2021 in the Hail region of Saudi Arabia. A closed-ended questionnaire, which consisted of 37 questions, was distributed online (using a Google Forms link) in both English and Arabic languages. Data was collected from 425 female subjects who participated in the study.

RESULTS

The study showed an overall knowledge level of 46.36% regarding breast cancer. Participants had average knowledge about risk factors, signs, and symptoms, whereas their awareness and practice of breast self-examination and screening methods were weak.

CONCLUSION

The current study concluded that public awareness of breast cancer remains relatively low, and Saudi Arabia still needs several public awareness initiatives using mass media, such as television, the Internet, and radio, as well as social media. Special awareness programs should also be held in places where a large number of women can easily be reached, such as colleges, universities, and hospitals.

Fighting Cancer around the World: A Framework for Action

Tackling cancer is a major challenge right on the global level. Europe is only the tip of an iceberg of cancer around the world. Prosperous developed countries share the same problems besetting Europe-and the countries and regions with fewer resources and less propitious conditions are in many cases struggling often heroically against a growing tide of disease. This paper offers a view on these geographically wider, but essentially similar, challenges, and on the prospects for and barriers to better results in this ceaseless battle. A series of panels have been organized by the European Alliance for Personalised Medicine (EAPM) to identify different aspects of cancer care around the globe. There is significant diversity in key issues such as NGS, RWE, molecular diagnostics, and reimbursement in different regions. In all, it leads to disparities in access and diagnostics, patients' engagement, and efforts for a better understanding of cancer.

Acceptability and compliance with a breast cancer prevention campaign in the Northwest Region, Iran

Aim: Breast cancer screening intended to improve survival and treatment outcomes. This study aimed to document the acceptability and compliance of the breast cancer prevention campaigns. Materials & methods: Healthy women aged 35–65 years were recruited from various regions of the Northwest of Iran. All women were invited to participate in self-examination training for the breast and then re-assessed by clinical examination and mammography. Results: A total of 321 healthy women were recruited, and volunteered to undergo at least one breast self-examination. The first and second clinical examinations were conducted on all women. Ultimately, 272 women (84.7%) underwent mammography. The most common barriers to screening were found to be fear of positive results, fear of cancer, lack of knowledge, fear of the mammography procedure and pain, travel distance and costs. Conclusion: The most critical challenge for implementing a breast cancer prevention program was the lack of knowledge and attitude.

The Role of Education in Breast Cancer Beliefs and Screening Practices Among Korean Women - A quantitative study

INTRODUCTION

Cultural beliefs are influential factors that affect breast cancer screening practices among Korean women. The aim of this study was to examine the role of educational levels and compare the cultural beliefs associated with breast cancer screening practices among immigrant Korean women in Australia with those of their counterparts in Korea.

METHODS

A secondary analysis based on data from convenience samples of 245 and 249 Korean women living in Australia and Korea, respectively. Data were collected by the Korean version of Breast Cancer Screening Beliefs Questionnaire.

RESULTS

Educational level has a significant association with Korean women's cultural beliefs about breast cancer and breast cancer screening practices regardless of country of residence.

DISCUSSION

Nurses working in multicultural societies should take cultural beliefs and the role of education into account while designing strategies to promote breast cancer screening practices among immigrant Korean women.

Assessment of the validity and reliability of the Vietnamese version of the Breast Cancer Screening Beliefs Questionnaire

Objective

The aim of this study was to evaluate the cultural adaptability and psychometric properties of the Vietnamese version of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ).

Methods

A total of 253 women aged 18 years and older with no history of breast cancer was included in the analysis.

Results

Confirmatory factor analysis showed an adequate fit for the hypothesized three-factor structure of the original version of the BCSBQ. The results indicated that the frequency of women’s breast cancer screening practices and their educational levels were significantly associated with “Attitudes towards general check-ups”. Demonstrating the Cronbach’s α of the three subscales ranged between 0.79 and 0.85 while the corrected item-total correlations for the hypothesized subscales ranged from 0.38 to 0.74, constituted a result which indicated that the Vietnamese version of the BCSBQ had satisfactory validity and internal consistency.

Conclusions

The Vietnamese version of the BCSBQ is a culturally appropriate, valid, and reliable instrument for examining the beliefs, knowledge, and attitudes about breast cancer and breast cancer screening practices among Vietnamese women living in Australia.

The Role of Vaccination and Screening in Limiting the Worldwide Disease Burden of Preventable Female Cancers: A Review

Cancer represents one of the most common causes of death worldwide. Among women, breast cancer is the most diagnosed cancer and the principal cause of death due to malignant disease, while cervical cancer ranks fourth for both incidence and mortality. The present review aims to analyze the epidemiology of cervical and breast cancer (incidence, mortality, survival rates, and trends). Moreover, the most important primary and secondary preventive strategies (reduction of risk factors, exposure, vaccination, cancer screening) intended to reduce the future burden of cervical and breast cancer, that should be adopted actively and free of charge, were discussed in accordance to more recent and evidence-based findings.

Use of a Paper Checklist to Increase Clinician Adherence to Mammography Screening Guidelines

OBJECTIVE

To increase clinician adherence to mammography screening guidelines.

DESIGN

Quality improvement initiative.

SETTING/LOCAL PROBLEM

At a nurse practitioner-led primary care practice, a chart audit of adherence to American Cancer Society mammography screening guidelines indicated a 12% adherence rate for clinicians writing mammography orders.

PARTICIPANTS

Nurse practitioners providing care to women ages 40 years and older.

INTERVENTION/MEASUREMENTS

The intervention was a screening checklist that was completed by the woman at registration and given to the clinician during the examination. The pre- and postintervention measurement was the percentage of mammogram orders. A Fisher exact test was used to examine changes from pre- to postintervention rates of adherence.

RESULTS

After the intervention, the percentage of women for whom a mammogram was recommended and ordered was 69.6%, compared to 12% from the original chart audit. This change was statistically significant (p = .01).

CONCLUSION

Clinicians must find efficient approaches to improve processes within their practice settings to ensure that preventive care recommendations are made during visits. Although the screening checklist was deemed useful, improvement in adherence rates is still needed, and a paperless system should be initiated.

Educational Opportunities for Down-Staging Breast Cancer in Low-Income Countries: an Example from Tanzania

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.

Breast Cancer Early Detection: An Academic-Community Partnership in the Philippines

A high proportion of patients with breast cancer in the Philippines present at an advanced stage and have a rapid, unfavorable outcome. Providing breast cancer education and early detection to this population is important to help reduce this health disparity. This article describes the impact of a train-the-trainer program, with mission groups traveling to the Philippines to promote female residents' breast cancer awareness, knowledge, and intent for future screening.

The association of D-dimer with clinicopathological features of breast cancer and its usefulness in differential diagnosis: A systematic review and meta-analysis

Background

Studies have shown that D-dimer levels are significantly correlated with the differential diagnosis and clinicopathological features of breast cancer. However, the results are currently limited and controversial. Therefore, we performed this meta-analysis to evaluate the relationship between D-dimer levels and breast cancer.

Materials and methods

The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature, and Wanfang databases were searched to find studies that assessed the association of D-dimer with clinicopathological features of breast cancer and its usefulness in aiding with differential diagnosis. The standardized mean difference (SMD) was applied as the correlation measure.

Results

A total of 1244 patients with breast cancer from 15 eligible studies were included in the meta-analysis. D-dimer levels were higher in the breast cancer group than in the benign (SMD = 1.02; 95% confidence interval [CI] = 0.53–1.52) and healthy (SMD = 1.27; 95% CI = 0.85–1.68) control groups. In addition, elevated D-dimer levels were associated with progesterone receptor-negative tumors (SMD = -0.25; 95% CI = -0.44–-0.05). Similarly, there was a significant correlation between D-dimer levels and tumor node metastasis staging (n = 11, SMD = 0.82; 95% CI = 0.57–1.06) and lymph node involvement (n = 8, SMD = 0.79; 95% CI = 0.50–1.09). In contrast, other clinicopathological factors, including estrogen receptor expression and human epidermal growth factor receptor 2 expression, were not associated with D-dimer levels.

Conclusion

The results of this meta-analysis indicate that plasma D-dimer levels can be used as an important reference for the early identification and staging of breast cancer.