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Rafat Munir Lawis M, Sabir M. Breast cancer awareness among Sudanese females in Omdurman city: 2021. BMC Public Health 2023; 23:1907. [PMID: 37789363 PMCID: PMC10546643 DOI: 10.1186/s12889-023-16833-y] [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: 09/17/2022] [Accepted: 09/25/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed malignancy among women worldwide. In contrast to Europe, it presents generally very late in Africa. As with the rest of Africa, it is the most common primary malignancy of females in Sudan, and generally presents in stage III or IV disease. This study is intended to analyse the level of breast cancer awareness among women of Sudan. OBJECTIVE To assess the level of awareness of breast cancer among Sudanese females, and their attitude towards breast changes. Also, to establish possible associations between several variables: (education level, age, contact with a breast cancer patient, residence) on awareness. METHODOLOGY A descriptive cross-sectional community-based study of 385 females in Omdurman city, selected by convenience sampling. An interview based Arabic version of Breast Cancer Awareness Measure (BCAM) was used. Data was coded and analysed using Statistical Package for Social Sciences (SPSS) v.20. RESULTS A total of 385 females were included, of which 38.7% were 20-30 years, 47.8% were single, 53.8% had university education, 41% of them were currently unemployed, and 54.3% resided in Ummbadda's locality. When asked about the signs and risk factors of breast cancer, 55.06% and 55.8% failed to name any. The cumulative percentage of correct answers of close-ended question about signs, risk factors and Federal Ministry of Health (FMoH) screening program were 42.8%, 30.7% and 44.7% in that order. Only 38.2% knew the right method BSE, 48.2% of them rarely practiced it. 38.2% noticed a change in the breast tissue but didn't visit a doctor. The majority of them, though, said they would see a doctor if they noticed a change in the future. CONCLUSION There is a severe lack of awareness of breast cancer among females of the Sudanese society. Also, there was a clear ignorant attitude practiced by a significant proportion of the candidates. RECOMMENDATIONS Further research, to address the limitations of this study is to be done. FMoH has to improve its media massage and arrange targeted awareness campaigns.
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Affiliation(s)
| | - Mustafa Sabir
- AlNeelain University Faculty of medicine, Khartoum, Sudan
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Momenimovahed Z, Momenimovahed S, Allahqoli L, Salehiniya H. Factors Related to the Delay in Diagnosis of Breast Cancer in the Word: A Systematic Review. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dsouza R, Gaikwad P, Samuel VM, Thomas C. Breast reconstruction following mastectomy in Indian women: a neglected entity. BMJ Case Rep 2022; 15:e248322. [PMID: 35863860 PMCID: PMC9310151 DOI: 10.1136/bcr-2021-248322] [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] [Accepted: 07/14/2022] [Indexed: 11/04/2022] Open
Abstract
Phyllodes tumour is a rapidly growing neoplasm with a propensity to involve the entire breast tissue. In large tumours, the treatment comprises a wide local excision or a mastectomy. A woman in her 20s from rural India presented with complaints of a recurrent left breast lump. The lump progressed to a large size, limiting her social activities and causing depression. On examination, she had a mass occupying almost the entire left breast, with stretched skin, dilated veins and pressure necrosis. There were no palpable axillary nodes. She was offered a wide local excision and reconstruction with a latissimus dorsi pedicled flap. After much discussion and clarification of some misconceptions around breast reconstruction, she underwent the planned surgery. This was followed by adjuvant radiation therapy as the histopathology was consistent with a complex phyllodes tumour with close margins. She was well at 1-year follow-up and led a good family and social life. Breast conservation and reconstruction are seldom offered as part of cancer treatment in India. All women should be offered surgical options that are oncologically safe while preserving body image, and hence healthcare providers must work towards breaking the barriers that prevent breast reconstruction.
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Affiliation(s)
- Royson Dsouza
- General Surgery, ASHWINI Gudalur Adivasi Hospital, Vellore, India
| | - Pranay Gaikwad
- Department of General Surgery Unit 1, Christian Medical College Hospital, Vellore, India
| | - Vasanth Mark Samuel
- Department of General Surgery Unit 1, Christian Medical College Hospital, Vellore, India
| | - Cecil Thomas
- Department of General Surgery Unit 1, Christian Medical College Hospital, Vellore, India
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Blackmore T, Chepulis L, Rawiri K, Kidd J, Stokes T, Firth M, Elwood M, Weller D, Emery J, Lawrenson R. Patient-reported diagnostic intervals to colorectal cancer diagnosis in the Midland region of New Zealand: a prospective cohort study. Fam Pract 2022; 39:639-647. [PMID: 34871389 PMCID: PMC9295611 DOI: 10.1093/fampra/cmab155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES New Zealand (NZ) has high rates of colorectal cancer (CRC) but low rates of early detection. The majority of CRC is diagnosed through general practice, where lengthy diagnostic intervals are common. We investigated factors contributing to diagnostic delay in a cohort of patients newly diagnosed with CRC. METHODS Patients were recruited from the Midland region and interviewed about their diagnostic experience using a questionnaire based on a modified Model of Pathways to Treatment framework and SYMPTOM questionnaire. Descriptive statistics were used to describe the population characteristics. Chi-square analysis and logistic regression were used to analyse factors influencing diagnostic intervals. RESULTS Data from 176 patients were analysed, of which 65 (36.9%) experienced a general practitioner (GP) diagnostic interval of >120 days and 96 (54.5%) experienced a total diagnostic interval (TDI) > 120 days. Patients reporting rectal bleeding were less likely to experience a long TDI (odds ratio [OR] 0.34, 95% confidence interval [CI]: 0.14-0.78) and appraisal/help-seeking interval (OR, 0.19, 95% CI: 0.06-0.59). Patients <60 were more likely to report a longer appraisal/help-seeking interval (OR, 3.32, 95% CI: 1.17-9.46). Female (OR, 2.19, 95% CI: 1.08-4.44) and Māori patients (OR, 3.18, 95% CI: 1.04-9.78) were more likely to experience a long GP diagnostic interval. CONCLUSION NZ patients with CRC can experience long diagnostic intervals, attributed to patient and health system factors. Young patients, Māori, females, and patients experiencing change of bowel habit may be at particular risk. We need to increase symptom awareness of CRC for patients and GPs. Concentrated efforts are needed to ensure equity for Māori in access to screening, diagnostics, and treatment.
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Affiliation(s)
- Tania Blackmore
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Lynne Chepulis
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Keenan Rawiri
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Jacquie Kidd
- Auckland University of Technology, Auckland, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Melissa Firth
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Mark Elwood
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - David Weller
- Centre for Population Health Studies, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Jon Emery
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
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Nnaji CA, Ezenwankwo EF, Kuodi P, Walter FM, Moodley J. Timeliness of diagnosis of breast and cervical cancers and associated factors in low-income and middle-income countries: a scoping review. BMJ Open 2022; 12:e057685. [PMID: 35121607 PMCID: PMC8819798 DOI: 10.1136/bmjopen-2021-057685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Addressing the barriers to early breast and cervical cancer diagnosis in low and middle-income countries (LMICs) requires a sound understanding and accurate assessment of diagnostic timeliness. This review aimed to map the current evidence on the time to breast and cervical cancer diagnosis and associated factors in LMICs. DESIGN Scoping review. SOURCES MEDLINE (via PubMed), Cochrane Library, Scopus and CINAHL. ELIGIBILITY CRITERIA Studies describing the time to diagnosis and associated factors in the context of breast and cervical cancer in LMICs published from 1 January 2010 to 20 May 2021. STUDY SELECTION AND DATA SYNTHESIS Two reviewers independently screened all abstracts and full texts using predefined inclusion criteria. The review was reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Evidence was narratively synthesised using predefined themes. RESULTS Twenty-six studies conducted across 24 LMICs were included in the review, most (24/26) of which focused on breast cancer. Studies varied considerably in their conceptualisation and assessment of diagnostic time, events, intervals and delays, with a minority of the studies reporting the use of validated methods and tools. Patient-related intervals and delays were more frequently evaluated and reported than provider-related and health system-related intervals and delays. Across studies, there were variations in the estimated lengths of the appraisal, help-seeking, patient and diagnostic intervals for both cancers and the factors associated with them. CONCLUSIONS Despite the significant burden of breast and cervical cancer in LMICs, there is limited information on the timeliness of diagnosis of these cancers. Major limitations included variations in conceptualisation and assessment of diagnostic events and intervals. These underscore the need for the use of validated and standardised tools, to improve accuracy and translation of findings to better inform interventions for addressing diagnostic delays in LMICs.
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Affiliation(s)
- Chukwudi A Nnaji
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
- Cancer Research Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Elochukwu F Ezenwankwo
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
- Cancer Research Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Paul Kuodi
- Department of Public Health, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Fiona M Walter
- Wolfson Institute of Population Health, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jennifer Moodley
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
- Cancer Research Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
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McCutchan G, Weiss B, Quinn-Scoggins H, Dao A, Downs T, Deng Y, Ho H, Trung L, Emery J, Brain K. Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review. BMJ Glob Health 2021; 6:bmjgh-2020-004213. [PMID: 33531348 PMCID: PMC7868297 DOI: 10.1136/bmjgh-2020-004213] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Starting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment. Methods Mixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate. Results Of 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments. Conclusion Due to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.
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Affiliation(s)
- Grace McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK .,Wales Cancer Research Centre, Cardiff University, Cardiff, UK
| | - Bahr Weiss
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Harriet Quinn-Scoggins
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,PRIME Centre Wales, Cardiff University, Cardiff, UK
| | - Anh Dao
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Tom Downs
- Department of Acute Medicine, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | - Yunfeng Deng
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Ha Ho
- Center for Research, Information and Services in Psychology, Vietnam National University, Hanoi, Vietnam
| | - Lam Trung
- Danang Psychiatric Hospital, Da Nang, Vietnam
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Tesfaw A, Tiruneh M, Tamire T, Yosef T. Factors associated with advanced-stage diagnosis of breast cancer in north-west Ethiopia: a cross-sectional study. Ecancermedicalscience 2021; 15:1214. [PMID: 33912239 PMCID: PMC8057775 DOI: 10.3332/ecancer.2021.1214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Indexed: 11/08/2022] Open
Abstract
Background Breast cancer tumours are the most common malignant tumours among women in Ethiopia. Although advanced-stage diagnosis of breast cancer is a common problem, evidence-based information is lacking about the magnitude and determinants of advanced-stage presentation in north-west Ethiopia. Methods An institution-based, cross-sectional study was conducted at the oncology units of the University of Gondar and Felege Hiwot specialised hospitals. Stages III and IV were considered advanced stage, whereas stages I and II were considered early stages. Data were collected prospectively on newly diagnosed breast cancer patients and entered using the EPI Info version 7.2 and analysed using Statistical Package for the Social Sciences version 23. Multivariable logistic regression was used to identify the determinants of advanced-stage diagnosis of breast cancer. A p-value < 0.05 was used as the cut-off point to select the determinants of the advanced stage. Result About 71.2% of breast cancer patients presented with advanced-stage disease. The median age of patients was 40 years. Rural residence (adjusted odds ratio (AOR) = 1.7; 95% confidence interval (CI): 1.02, 2.96), painless breast lump/wound (AOR = 2.5; 95% CI: 1.45, 4.13), travel distance ≥5 km (AOR = 3.2; 95% CI: 1.72, 5.29), not practising breast self-examination (BSE) (AOR = 2.9; 95% CI: 1.30, 6.52), time to presentation ≥3 months (AOR = 1.4; 95% CI: 1.02, 2.37) and misdiagnosed at first visit (AOR = 1.9; 95% CI: 1.09, 3.59) were determinants of advanced-stage breast cancer. Conclusion Nearly three-quarters of the patients were diagnosed with advanced-stage breast cancer. Not practising BSE, travel distance ≥5 km, rural residence, painless breast wound/lump and being misdiagnosed at first visit were important determinants of advanced-stage diagnosis of breast cancer. Focused awareness creation programmes for the public and increasing cancer diagnostic centres in the country are crucial to downstage breast cancer at presentation.
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Affiliation(s)
- Aragaw Tesfaw
- Debre Tabor University, College of Health Sciences, Department of Public Health, PO Box 272, Debre Tabor, Ethiopia
| | - Mulu Tiruneh
- Debre Tabor University, College of Health Sciences, Department of Public Health, PO Box 272, Debre Tabor, Ethiopia
| | - Tadese Tamire
- Debre Tabor University, College of Health Sciences, Department of Anesthesia, PO Box 272, Debre Tabor, Ethiopia
| | - Tewodros Yosef
- Mizan-Tepi University, Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, PO Box 260, Mizan-Aman, Ethiopia
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Fidan E, Çelik S. Factors affecting medical healthcare-seeking behaviours of female patients according to their stage of being diagnosed with breast cancer. Eur J Cancer Care (Engl) 2021; 30:e13436. [PMID: 33694269 DOI: 10.1111/ecc.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 01/18/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of study was to determine factors affecting the medical healthcare-seeking behaviours of female patients according to their stage of being diagnosed with breast cancer. METHODS This descriptive and correlational study was carried out with 150 women. The data were collected by a survey form, the Body Perception Scale, the Rosenberg Self-Esteem Scale and the Social Appearance Anxiety Scale. RESULTS About 54% of the women were diagnosed with early-stage breast cancer, 68.7% had high self-esteem, and 80% had positive body perceptions, while their social appearance anxiety levels were moderate. The patients with breast cancer at the 4th stage had a high body perception score of 174.00 ± 23.34. Self-esteem was the highest in the patients with stage 2B breast cancer with a value of 0.61 ± 0.91. The highest social anxiety mean score was found in the patients with stage 2A breast cancer as 31.65 ± 12.50. There was no statistically significant difference in the women's sociodemographic characteristics, health and breast cancer history, self-esteem, body perception and social appearance anxiety based on their stages of cancer (p > 0.05). CONCLUSION Nurses' identification of risky individuals in early diagnosis, information for the individual / family and society by planning trainings and raising awareness will contribute positively to the patients' medical health-seeking behaviours.
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Affiliation(s)
- Emine Fidan
- Faculty of Pharmacy, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Sevim Çelik
- Nursing Department, Bartın University Health Science Faculty, Bartın, Turkey
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Khan NH, Duan SF, Wu DD, Ji XY. Better Reporting and Awareness Campaigns Needed for Breast Cancer in Pakistani Women. Cancer Manag Res 2021; 13:2125-2129. [PMID: 33688255 PMCID: PMC7936924 DOI: 10.2147/cmar.s270671] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/12/2020] [Indexed: 01/04/2023] Open
Abstract
Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer deaths in women globally. In 2018, 2.1 million new cases were reported, with 627,000 deaths. Pakistan has the highest incidence rate of breast cancer among Asian countries: one in every nine women has a lifetime risk of being diagnosed with breast cancer. By reason of many misconceptions about the etiology of the disease and socioeconomic factors, Pakistani women have very low rates of early detection and diagnose breast cancer at advance stages with fewer chances of survival. The key to cure the breast cancer is early diagnosis. The aim of current review is to highlight the factors leading to the delays in early presentation of breast cancer in Pakistani women and to summarize possible recommendations for educating women about early diagnosis along with palliative care facilities for patients suffering from breast cancer. Furthermore, this study appeals to both the general public and government in the belief that better reporting and awareness campaigns may bring more women to clinics for early diagnosis.
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Affiliation(s)
- Nazeer Hussain Khan
- Henan International Joint Laboratory for Nuclear Protein Regulation, Henan University, Kaifeng, Henan, 475004, People's Republic of China.,School of Life Sciences, Henan University, Kaifeng, Henan, 475004, People's Republic of China
| | - Shao-Feng Duan
- Institute for Innovative Drug Design and Evaluation, School of Pharmacy, Henan University, Kaifeng, Henan, 475004, People's Republic of China
| | - Dong-Dong Wu
- Henan International Joint Laboratory for Nuclear Protein Regulation, Henan University, Kaifeng, Henan, 475004, People's Republic of China.,School of Basic Medical Sciences, Henan University College of Medicine, Kaifeng, Henan, 475004, People's Republic of China
| | - Xin-Ying Ji
- Henan International Joint Laboratory for Nuclear Protein Regulation, Henan University, Kaifeng, Henan, 475004, People's Republic of China.,School of Basic Medical Sciences, Henan University College of Medicine, Kaifeng, Henan, 475004, People's Republic of China.,Kaifeng Key Laboratory of Infection and Biological Safety, Henan University College of Medicine, Kaifeng, Henan, 475004, People's Republic of China
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Agodirin OS, Aremu I, Rahman GA, Olatoke SA, Akande HJ, Oguntola AS, Olasehinde O, Ojulari S, Etonyeaku A, Olaogun J, Romanoff A. Prevalence of Themes Linked to Delayed Presentation of Breast Cancer in Africa: A Meta-Analysis of Patient-Reported Studies. JCO Glob Oncol 2020; 6:731-742. [PMID: 32437263 PMCID: PMC7268898 DOI: 10.1200/jgo.19.00402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The prevalence of themes linked to delay in presentation of breast cancer (BC) and their underlying factors vary considerably throughout Africa. Regional differences and trends are largely unreported. The purpose of this research was to provide summary estimates of the prevalence and distribution of the themes and underlying factors linked to delay in the presentation of BC, regional variation, and trends in an effort to identify targets for intervention. DESIGN We screened articles found through PubMed/Medline, African Journal OnLine, Science Direct, Google/Google Scholar, and ResearchGate. We included patient-reported surveys on the reasons linked to delayed presentation under 6 previously identified themes: symptom misinterpretation, fear, preference for alternative care, social influence, hospital-related factors, and access factors. The meta-analytical procedure in MetaXL used the quality-effect model. RESULTS Twelve of the 236 identified articles were eligible for this review. The overall summary estimate of late presentation (> 90 days) was 54% (95% CI, 23 to 85) and was worst in the eastern and central regions. Symptom misinterpretation was the most common theme (50%; 95% CI, 21 to 56), followed by fear (17%; 95% CI, 3 to 27), hospital-related theme (11%; 95% CI, 1 to 21), preference for alternative care (10%; 95% CI, 0 to 21), social influence (7%; 95% CI, 0 to 14), and access-related theme (6%; 95% CI, 0 to 13). The most common factor underlying symptom misinterpretation was mischaracterizing the breast lesion as benign (60%; 95% CI, 4 to 100) which surpassed lack of awareness in the last decade. Misdiagnosis and failure to refer were the dominant hospital-related factors. CONCLUSION Modifiable factors such as mischaracterizing malignant masses as benign, fear, misdiagnosis, and failure to refer were the prevalent factors contributing to delays throughout Africa. These factors are promising targets for intervention.
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Affiliation(s)
- Olayide S Agodirin
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Isiaka Aremu
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Ganiyu A Rahman
- Department of Surgery, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Samuel A Olatoke
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Halimat J Akande
- Department of Radiology, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Adetunji S Oguntola
- Department of Surgery, Lautech Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Sheriff Ojulari
- Department of Physiology, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Amarachukwu Etonyeaku
- Department of Surgery, Obafemi Awolowo Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Julius Olaogun
- Department of Surgery, Ekiti State Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Anya Romanoff
- Breast Surgery, Dubin Breast Center, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY.,Department of Health System Design and Global Health, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY
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Fouladi N, Pourfarzi F, Daneshian A, Alimohammadi S. Mediating Factors in Early Diagnosis of Breast Cancer: from Initial Changes in Health to Breast Cancer Detection. Asian Pac J Cancer Prev 2018; 19:2751-2755. [PMID: 30360602 PMCID: PMC6291050 DOI: 10.22034/apjcp.2018.19.10.2751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Breast cancer is one of the most frequently occurring cancers in women throughout the world. In Iran, according to available reports, 70% of patients with breast cancer are detected at the advanced stages of the disease. Materials and Methods: This study is of descriptive-analytic cross-sectional type.160 female patients was selected. The data in this study was collected via face to face interview using a questionnaire based on the Anderson’s delay model. Data were analyzed using SPSS 22 and the significance level was considered to be 0.05. Results: The results showed that presence of mass was the first symptom in many of women, i.e., 76 cases (47.5%). not only the presence of mass in the breast, but also any other symptom, hadn’t been taken as a serious problem initially by women. Non-improvement of the symptoms and exacerbation of the symptoms was considered as a symptom of illness by patients. After considering the changes as the symptoms of illness, patients had tried to treat the disease through different methods of self-treatment. The failure of the self-treatment in controlling the symptoms, had directed the patients toward seeking for medical services. Out of 160 patients, 49 patients (39.6%) changed the time of their appointment with doctor. 110 cases (68%) out of 160 patients, rather than initiating relevant diagnostic procedure related to the disease, had received non-specific and non-related therapeutic measures. Conclusion: Pondering on the results yields that patient-related delays, resulting from their lack of awareness of the disease, cultural factors, and fear, can only play an important role in postponement of visiting a physician, but in the diagnosis of disease it is the inability of general practitioners in performing differential diagnoses, and making request for related diagnostic measures which can significantly increase the lag time until the onset of the main treatment.
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Affiliation(s)
- Nasrin Fouladi
- Community Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.,Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
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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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14
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Moodley J, Cairncross L, Naiker T, Constant D. From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study. BMC Cancer 2018; 18:312. [PMID: 29562894 PMCID: PMC5863383 DOI: 10.1186/s12885-018-4219-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/13/2018] [Indexed: 01/07/2023] Open
Abstract
Background Typically, women in South Africa (SA) are diagnosed with breast cancer when they self-present with symptoms to health facilities. The aim of this study was to determine the pathway that women follow to breast cancer care and factors associated with this journey. Methods A cross-sectional study was conducted at a tertiary hospital in the Western Cape Province, SA, between May 2015 and May 2016. Newly diagnosed breast cancer patients were interviewed to determine their socio-demographic profile; knowledge of risk factors, signs and symptoms; appraisal of breast changes; clinical profile and; key time events in the journey to care. The Model of Pathways to Treatment Framework underpinned the analysis. The total time (TT) between a woman noticing the first breast change and the date of scheduled treatment was divided into 3 intervals: the patient interval (PI); the diagnostic interval (DI) and the pre-treatment interval (PTI). For the PI, DI and PTI a bivariate comparison of median time intervals by various characteristics was conducted using Wilcoxon rank-sum and Kruskal-Wallis tests. Cox Proportional-Hazards models were used to identify factors independently associated with the PI, DI and PTI. Results The median age of the 201 participants was 54 years, and 22% presented with late stage disease. The median TT was 110 days, with median patient, diagnostic and pre-treatment intervals of 23, 28 and 37 days respectively. Factors associated with the PI were: older age (Hazard ratio (HR) 0.59, 95% CI 0.40–0.86), initial symptom denial (HR 0.43, 95% CI 0.19–0.97) and waiting for a lump to increase in size before seeking care (HR 0.51, 95% CI 0.33–0.77). Women with co-morbidities had a significantly longer DI (HR 0.67, 95% CI 0.47–0.96) as did women who mentioned denial of initial breast symptoms (HR 4.61, 95% CI 1.80–11.78). The PTI was associated with late stage disease at presentation (HR 1.78, 95% CI 1.15–2.76). Conclusion The Model of Pathways to Treatment provides a useful framework to explore patient’s journeys to care and identified opportunities for targeted interventions. Electronic supplementary material The online version of this article (10.1186/s12885-018-4219-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa. .,Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa. .,SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa.
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa
| | - Thurandrie Naiker
- Department of Radiation Oncology, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa
| | - Deborah Constant
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa
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15
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Liu LY, Wang YJ, Wang F, Yu LX, Xiang YJ, Zhou F, Li L, Zhang Q, Fu QY, Ma ZB, Gao DZ, Li YY, Yu ZG. Factors associated with insufficient awareness of breast cancer among women in Northern and Eastern China: a case-control study. BMJ Open 2018; 8:e018523. [PMID: 29463589 PMCID: PMC5855304 DOI: 10.1136/bmjopen-2017-018523] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To investigate the awareness and knowledge level of breast cancer among Chinese participants. DESIGN Case-control study. SETTINGS This study was based on the database of the minister-affiliated hospital key project of the Ministry of Health of the People's Republic of China that included 21 Chinese hospitals between April 2012 and April 2013. PARTICIPANTS Matched study was designed among 2978 participants with Han ethnicity aged between 25 and 70. PRIMARY AND SECONDARY OUTCOME MEASURES Student's t-test, Pearson's χ2 test, reliability analysis, exploratory factor analysis, and univariate and multivariate logistic regression analyses were performed to know the level of breast cancer knowledge and find the breast cancer awareness-associated factors. RESULTS 80.0% (2383/2978) of the participants had poor awareness level of breast cancer. In-depth knowledge of breast cancer such as early symptoms and risk factors was poorly found among them. Television broadcast and relatives or friends with breast cancers were the main sources of information about breast cancer. Of all participants, 72.8% (2167/2978) had heard about breast cancer as a frequent cancer affecting women, and 63.3% (1884/2978) knew that family history of breast cancer was a risk factor for breast cancer. Over half of them were aware that a breast lump could be a symptom of breast cancer. Multivariate analysis identified the following variables that predicted awareness of breast cancer: young age (OR=0.843, 95% CI 0.740 to 0.961), occupation (agricultural worker) (OR=12.831, 95% CI 6.998 to 23.523), high household social status (OR=0.644, 95% CI 0.531 to 0.780), breast hyperplasia history (OR=1.684, 95% CI 1.273 to 2.228), high behavioural prevention score (OR=4.407, 95% CI 3.433 to 5.657). CONCLUSION Most women were aware of breast cancer as a disease, but their in-depth knowledge of it was poor. More publicity and education programmes to increase breast cancer awareness are necessary and urgent, especially for the ageing women and agricultural workers.
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Affiliation(s)
- Li-Yuan Liu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Yong-Jiu Wang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Fei Wang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Li-Xiang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Yu-Juan Xiang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Fei Zhou
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Liang Li
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Qiang Zhang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Qin-Ye Fu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Zhong-Bing Ma
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - De-Zong Gao
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Yu-Yang Li
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Zhi-Gang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
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