A review of breast cancer awareness among women in India: Cancer literate or awareness deficit?

Health-related quality of life and its determinants among cancer patients: evidence from 12,148 patients of Indian database

BACKGROUND

Cancer survivors experience a decrement in health-related quality of life (HRQoL) resulting from the disease as well as adverse effects of therapy. We evaluated the HRQoL of cancer patients, stratified by primary cancer site, stage, treatment response and associated adverse events, along with its determinants.

METHODS

Data were collected from 12,148 patients, sampled from seven purposively chosen leading cancer hospitals in India, to elicit HRQoL using the EuroQol questionnaire comprising of 5-dimensions and 5-levels (EQ-5D-5L). Multiple linear regression was used to determine the association between HRQoL and various socio-demographic as well as clinical characteristics.

RESULTS

Majority outpatients (78.4%) and inpatients (81.2%) had solid cancers. The disease was found to be more prevalent among outpatients (37.5%) and inpatients (40.5%) aged 45-60 years and females (49.3-58.3%). Most patients were found to be in stage III (40-40.6%) or stage IV (29.4-37.3%) at the time of recruitment. The mean EQ-5D-5 L utility score was significantly higher among outpatients [0.630 (95% CI: 0.623, 0.637)] as compared to inpatients [0.553 (95% CI: 0.539, 0.567)]. The HRQoL decreased with advancing cancer stage among both inpatients and outpatients, respectively [stage IV: (0.516 & 0.557); stage III (0.609 & 0.689); stage II (0.677 & 0.713); stage I (0.638 & 0.748), p value < 0.001]. The outpatients on hormone therapy (B = 0.076) showed significantly better HRQoL in comparison to patients on chemotherapy. However, palliative care (B=-0.137) and surgery (B=-0.110) were found to be associated with significantly with poorer HRQoL paralleled to chemotherapy. The utility scores among outpatients ranged from 0.305 (bone cancer) to 0.782 (Leukemia). Among hospitalized cases, the utility score was lowest for multiple myeloma (0.255) and highest for testicular cancer (0.771).

CONCLUSION

Older age, lower educational status, chemotherapy, palliative care and surgery, advanced cancer stage and progressive disease were associated with poor HRQoL. Our study findings will be useful in optimising patient care, formulating individualized treatment plan, improving compliance and follow-up.

The effectiveness of educational intervention based on the Health Action Model (HAM) in improving breast cancer screening behaviors

INTRODUCTION

Breast cancer disease is known as the most common cancer among women. Lack of knowledge and awareness is a leading cause of breast cancer, and since nearly all women are increasingly susceptible to this disease, training screening behaviors for early detection is proven essential in order to reduce breast cancer mortality. Therefore, the present study was designed to determine the effect of educational intervention based on the Health Action Model in improving breast cancer screening behaviors in women aged 30 to 69 in Kashan, Iran.

METHODS

This quasi-experimental study was conducted on 162 women aged 30-69 years old among the clients of Comprehensive health service centers in Kashan, Iran and they were assigned to intervention and control groups. The research instrument included a questionnaire assessed within three phases: baseline, 3-months, and 6-months, containing Health Action Model (HAM) structures and also three screening behaviors. The intervention consisted of a model-based education package and was carried out over 2 months. To evaluate the effect of the intervention, the mean of model structures and proportion screening behaviors in the third and sixth months were compared with the baseline phase. All analyses were carried out using SPSS, version 22.

RESULTS

The intervention and control groups were homogeneous regarding the structures of the HAM and the proportion of screening behaviors in the baseline phase (p > 0.05). In the 3-month (p < 0.05) and 6-month (p < 0.05) phases, the mean scores of the HAM constructs in the intervention group were found higher compared with the control group. Moreover, the proportion of clinical breast examinations in the intervention group was statistically higher than in the control group in the 3-month (p < 0.001) and 6-month (p < 0.001) phases. In addition, the proportion of mammography performed in the 3-month (p = 0.002) and 6-month (p < 0.001) phases were reported to be higher in the intervention group compared with the control group.

CONCLUSION

Overall, these results provide important insight into the effectiveness of the interventions based on the Health Action Model in promoting breast cancer screening behaviors and the determinants of such behaviors.

Breast self-examination practices among young rural women and its associated knowledge and attitudes in Tirunelveli District, Tamil Nadu

CONTEXT

Breast self-examination (BSE) is a simple and cost-effective screening procedure in downstaging breast tumors.

AIM

To assess the BSE practices and its associated knowledge and attitudes of rural women from Tirunelveli District, Tamil Nadu during the COVID-19 pandemic.

SETTINGS AND DESIGN

A descriptive cross-sectional survey design was employed, and snowball sampling was used to recruit the sample of rural women from Tirunelveli.

MATERIALS AND METHODS

Women ages 18-60 willing to take part were included. Data were collected online through a self-developed questionnaire.

STATISTICAL ANALYSIS

Responses were analyzed using SPSS Version 20. Descriptive statistical analysis was used to present the general details and responses of the rural women through percentages. Using the appropriate tests, the mean differences of the BSE attitudes based on the personal variables were computed using one-way ANOVA.

RESULTS

A total of 433 rural women (Mean age: 29.20 ± 9.35 years) from Tirunelveli responded to the online Knowledge, Attitude and Practice (KAP) questionnaire. Regular health checkups were undergone by 27.48% of women and 9.24% underwent breast cancer (BC) screening in the past. While 68.36% had heard of BC, 61% knew it could be detected in the early stages. Insufficient knowledge regarding BSE techniques was evident among the women. Knowledge about BC was highest among those earning more than 20,001 INR, women aged 36-45, widowed/separated/divorced women, and diploma graduates. Overall, BSE and BC knowledge score was low, with correspondingly low attitudes and practices.

CONCLUSION

Findings showed the KAP among rural Tirunelveli women to be low.

Comprehensive Review of Breast Cancer Consequences for the Patients and Their Coping Strategies: A Systematic Review

BACKGROUND

Women with breast cancer usually face multiple short-term and long-term problems in dealing with their acute and chronic symptoms during and after cancer treatment. However, serious gaps remain in addressing these issues in clinical and public health practice.

METHODS

According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we conducted a systematic literature search from 2000-2021 in electronic databases, including Medline, PubMed, Embase, Scopus, Web of Knowledge, and Google Scholar databases using predefined keywords.

RESULTS

The review identified several significant and interconnected problems in breast cancer patient's treatment and supportive care. The results revealed that these issues are very common among breast cancer patients, and specific attention and serious measures are needed to address these problems. Despite implementing different protocols and programs for covering and addressing these problems, serious gaps still exist in supporting breast cancer patients during clinical and follow-up care.

CONCLUSION

Developing innovative and holistic approaches and programs based on the multifactorial assessment of symptoms are suggested for addressing and covering the multidimensional requirements of this population. Consequently, thorough evaluation, education, treatment, and referrals should be provided for the most common sequelae of these patients by including appropriate medication, exercise, counselling, occupational therapy, and complementary therapies. The present study provides a more comprehensive source of information about breast cancer patient's medical and supportive needs in comparison with individual studies on symptom experiences.

An Updated Insight into Phytomolecules and Novel Approaches used in the Management of Breast Cancer

Breast cancer is a widespread condition that kills more women from cancer-related causes than any other type of cancer globally. Women who have estrogen-dependent, initial metastatic breast cancer frequently receive treatment with surgery, radiation therapy, and chemotherapy. They may also get more specialized treatments like tamoxifen or aromatase inhibitors (anastrozole or letrozole). The World Health Organisation reported in 2012 that by 2030, breast cancer will be more common worldwide. There are several phytochemicals, such as isoflavones, coumestans, lignans, and prenylflavonoides. Isoflavones have been shown in studies to prevent the spread of breast cancer and to trigger apoptosis. Targeting BCs in metastatic breast cancer may be made possible by combining well-formulated phytochemicals in nanoparticles or other novel drug delivery agents with currently accepted endocrine and/or conventional chemotherapies. Cell signaling, regulation of cell cycles, oxidative stress action, and inflammation could be positively impacted by phytoconstituents. They have the ability to alter non-coding RNAs, to prevent the proliferation and regeneration of cancer cells. The availability of novel approaches helps in disease targeting, safety, effectiveness and efficacy. The current literature helps to know the available drugs i.e. phytoconstituents or novel drug delivery like nanoparticle, microsphere, micelles, liposomes and neosomes. The literature has been taken from PubMed, Google Scholar, SciFinder, or other internet sites.

State of cancer care in India and opportunities for innovation

Cancer is one of the leading causes of morbidity and mortality in India. Despite recent medical and technological advances, the cancer burden in India remains high and continues to rise. Moreover, substantial regional disparities in cancer incidence and access to essential medical resources exist throughout the country. While innovative and effective cancer therapies hold promise for improving patient outcomes, several barriers hinder their development and utilization in India. Here we provide an overview of these barriers, including challenges related to patient awareness, inadequate infrastructure, scarcity of trained oncology professionals, and the high cost of cancer care. Furthermore, we discuss the limited availability of cancer clinical trials in the country, along with an examination of potential avenues to enhance cancer care in India. By confronting these hurdles head-on and implementing innovative, pragmatic solutions, we take an indispensable step toward a future where every cancer patient in the country can access quality care.

Barriers and enablers of breast cancer screening among women in East Africa: a systematic review

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.

A Cross-Sectional Study on the Epidemiology of Newly Diagnosed Breast Cancer Patients Attending Tertiary Care Hospitals in a Tribal Preponderant State of India: Regression Analysis

INTRODUCTION

Breast cancer (BC) is globally prevalent and the leading cause of death due to cancer in females. Due to changes in risk factor profiles, improved cancer registration, and cancer detection, its incidence and death rates have risen over the past three decades. Both modifiable and immutable risk factors for BC make up a sizable portion of the total risk factors.  Methodology: This was a hospital-based cross-sectional study carried out in the Department of Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi. Consecutive sampling was done with a complete enumeration of all newly diagnosed cases of breast cancer >15 years old. Those who consented to participate and those who were extremely ill, deaf, or dumb were excluded from the study.

RESULTS

A total of 88 patients were included. Maximum patients diagnosed with breast cancer belonged to the age group of 40-50 years (37.5%), Hindu by religion (76.1%), non-tribal (80.68%), illiterate (89.8%), married (98.9%), housewives (92%), and of class IV socio-economic status (SES) (65.9%).

CONCLUSION

Regular training of Sahiya (the local name of Accredited Social Health Activist (ASHA) in Jharkhand), empowerment of screening clinics for cancer, and upgraded diagnostic facilities for timely referral should be stressed upon.

Co-Creation of Breast Cancer Risk Communication Tools and an Assessment of Risk Factor Awareness: A Qualitative Study of Patients and the Public in India

BACKGROUND

Low awareness of BC and its associated risk factors causes delays in diagnosis and impacts survival. It is critical to communicate BC risk to patients in a format that they are easily able to understand. Our study aim was to develop easy-to-follow transmedia prototypes to communicate BC risk and evaluate user preferences, alongside exploring awareness of BC and its risk factors.

METHODS

Prototypes of transmedia tools for risk communication were developed with multidisciplinary input. A qualitative in-depth online interview study was undertaken using a pre-defined topic guide of BC patients (7), their relatives (6), the general public (6), and health professionals (6). Interviews were analyzed using a thematic approach.

FINDINGS

Most participants preferred pictographic representations (frequency format) of lifetime risk and risk factors and storytelling using short animations and comic strips (infographics) for communicating genetic risk and testing: "In a short time, they explained it very well, and I liked it". Suggestions included minimizing technical terminology, decreasing the delivery speed, "two-way dialogue", and using local "language for different locations". There was low awareness of BC, with some understanding of age and hereditary risk factors but limited knowledge of reproductive factors.

INTERPRETATION

Our findings support use of multiple context-specific multimedia tools in communicating cancer risk in an easy-to-understand way. The preference for storytelling using animations and infographics is a novel finding and should be more widely explored.

Anti-proliferative, apoptosis inducing, and antioxidant potential of Callistemon lanceolatus bark extracts: an in vitro and in silico study

The present study reports anticancer and antioxidant activities of Callistemon lanceolatus bark extracts. Anticancer activity was studied against MDA-MB-231 cells. Antioxidant assessment of the chloroform and methanol extracts showed considerable free radical scavenging, metal ion chelating, and reducing power potential. Chloroform extract exhibited potent inhibition of cancer cell proliferation in MTT assay (IC₅₀ 9.6 μg/ml) and promoted programmed cell death. Reactive oxygen species (ROS) generation, mitochondria membrane potential (MMP) disruption ability, and nuclear morphology changes were studied using H₂-DCFDA, JC-1, and Hoechst dyes, respectively, using confocal microscopy. Apoptotic cells exhibited fragmented nuclei, increased ROS generation, and altered MMP in dose- and time-dependent manner. Chloroform extract upregulated the BAX-1 and CASP3 mRNA expression coupled with downregulation of BCL-2 gene. Further, in silico docking of phytochemicals present in C. lanceolatus with anti-apoptotic Bcl-2 protein endorsed apoptosis by its inhibition and thus corroborated the experimental findings. Obatoclax, a known inhibitor of Bcl-2 was used as a reference compounds.

Breast Cancer Awareness and Associated Factors among Women in Pakistan: A Cross-Sectional Descriptive Study

OBJECTIVE

Breast cancer is a highly prevalent cancer in females worldwide, with new cases around one million every year. In Pakistan, cancer of breast is the most common carcinoma in diagnosis, with one in nine females. Due to high burden of breast cancer in Pakistan, presented work purposes to investigate knowledge and awareness of breast carcinoma, its symptoms, and risk factors among Pakistani women, which play an important part in the early diagnosis of breast cancer.

METHODS

A sample of 1000 females were approached generally from universities, hospitals, public places, local markets, rural areas and other cities for on-site data collection through face-to-face interviews and online data collection through telephonic interviews in Pakistan using the Breast Cancer Awareness Measure (BCAM). By using SPSS V. 25.0, the information  provided by the individuals first changed in awareness scores and was then analyzed.

RESULTS

The study displayed, that mainstream participants lacked knowledge of breast carcinoma (63.2%) and the importance of its screening tools (64.7% and 83.2% lacked knowledge of mammography and BRCA tests respectively) for early detection. Almost 45% of respondents never noticed a change in their breasts. Most participants were unaware about breast cancer development is age-related and lifetime risk. Slightly more than 50% of the participants of the study were not knowledgeable regarding modifiable risk factors of breast carcinoma. A commonly known symptom was Breast lump by 53% of the respondents. Association was determined between demographic variables and breast cancer knowledge scores. Only 37.4% of respondents were found to be knowledgeable regarding breast cancer.

CONCLUSION

BCAM is a productive instrument to assess awareness of breast carcinoma in females. The study indicated awareness of breast cancer is suboptimal in the population of Pakistan. Efforts should be made by public awareness campaigns and broadcasting of information about breast cancer and health education to increase awareness of risk factors.

Need assessment for the content of educational programs about breast cancer from the viewpoint of unaffected women

BACKGROUND

Breast cancer is the most common cancer among females, and early diagnosis is possible in case the patients seek medical attention on time. For this to come true, they must know about the existence and risks of the disease and be aware of the appropriate attitude and actions toward prevention or early diagnosis. However, we see that women have unanswered questions about these issues. In this study, we sought to investigate healthy women's information needs about breast cancer from their own perspective.

METHODS

This prospective study was carried out by using the maximum variation sampling, and theoretical saturation to reach sample saturation. Women who came to different clinics of Arash Women's Hospital (except the Breast Clinic) during two months were entered in the study. Participants were asked to write down all the questions and subjects they would like to be explained in a breast cancer educational program. The questions were reviewed and categorized after every fifteen consecutive forms were filled until there was not even one new question. Afterwards, all the questions were reviewed and matched based on their similarity and repeated items were eliminated. Finally, questions were organized according to their common topics and the range of details they comprised.

RESULTS

Sixty patients were included in the study, and 194 questions were gathered and categorized according to common scientific terms, resulting in 63 questions in 5 categories.

CONCLUSIONS

Many studies have been conducted on breast cancer education, but none have addressed healthy women's personal queries. This study outlines the questions of unaffected women about breast cancer that need to be addressed in educational programs. The results can be used for development of educational material at community level.

TRIAL REGISTRATION

This study was conducted as the preliminary phase of a study approved in Tehran University of Medical Sciences (Approval Code 99-1-101-46,455) and by the Ethics Committee of the University (Ethical Code IR.TUMS.MEDICINE.REC.1399.105).

Multisystem Imaging Recommendations/Guidelines: In the Pursuit of Precision Oncology

With an increasing rate of cancers in almost all age groups and advanced screening techniques leading to an early diagnosis and longer longevity of patients with cancers, it is of utmost importance that radiologists assigned with cancer imaging should be prepared to deal with specific expected and unexpected circumstances that may arise during the lifetime of these patients. Tailored integration of preventive and curative interventions with current health plans and global escalation of efforts for timely diagnosis of cancers will pave the path for a cancer-free world. The commonly encountered circumstances in the current era, complicating cancer imaging, include coronavirus disease 2019 infection, pregnancy and lactation, immunocompromised states, bone marrow transplant, and screening of cancers in the relevant population. In this article, we discuss the imaging recommendations pertaining to cancer screening and diagnosis in the aforementioned clinical circumstances.

Does women's empowerment and their socioeconomic condition affect the uptake of breast cancer screening? Findings from NFHS-5, India

BACKGROUND

Screening for breast cancer results in early diagnosis of the disease and improves survival. However, increasing participation of women in screening programs is challenging since it is influenced by socioeconomic and cultural factors. This study explores the relationship of socioeconomic and women empowerment factors with breast cancer screening uptakes in the states and union territories of India.

METHODS

We used summary reports of secondary data from all the states and union territories based on the fifth wave of the National Family Health Survey in India. This ecological study compares the uptake of breast cancer screening across states of India. We considered socioeconomic status (SES) and women empowerment status (WES) indicators from the survey as independent variables and state-wise breast cancer screening uptake as dependent variables for studying their association. The determinants of breast cancer screening were calculated using a simple linear regression model.

RESULTS

We found that socioeconomic status and women empowerment status moderately correlated with breast cancer screening uptake (correlation coefficient 0.34 and 0.38, respectively). States with higher rates of literacy among women and of women who had their own bank accounts that they decided how to use reported higher uptake of breast cancer screening (p = 0.01 and 0.03, respectively). However, the correlation was not uniform across all the states. The states of Chandigarh, Delhi, Telangana, and Karnataka showed lower participation despite a higher percentage of literate women and women with their own bank accounts.

CONCLUSION

This study indicates that women's literacy and having their own bank account may moderately improve their participation in cancer screening. However, higher SES and WES did not translate into better screening in many of the states. More research is needed, especially for states which had low screening uptake despite relatively higher rates of women empowerment.

A comparative analysis of features and outcome of breast cancer in younger versus older women: A single center experience from Eastern Indian subcontinent

Purpose

Globally, breast cancer is the leading malignancy in females. Indeed, Asian cohorts show prevalence of breast cancer among women with ages below 40 years. Moreover, these younger cases are globally characterized by poorer prognostic features as well as survival outcomes, than older sufferers with ages above 40 years. Despite this, comparative analyses between older and younger cohorts are sparse from India, where data from the country's eastern part falls shortest. This study attempted a comprehensive analysis of breast cancer between these two cohorts representing the Eastern Indian subcontinent.

Methods

Documenting retrospective case-files registered between 2010 and 2015, 394 cases of younger (<40 years) and 1250 older (≥40 years) sufferers of primary breast cancer were noted. The relevant features and follow-up information were also retrieved. Kaplan-Meier analyses were performed to evaluate the survival outcome.

Results

The data, in general, revealed a high percentage of younger sufferers from Eastern Indian regions. Moreover, this younger cohort showed poor survival. Among the younger cohort, cases with poor pathological features (triple negative, node-positive, grade III) were proportionately higher than the older cohort. Indeed, survival among these categories scored significantly low, compared to the older cohort.

Conclusion

This Eastern Indian subcontinental data matched the analyses from other parts of India as well as Asian data and clearly showed the prevalence of younger sufferers of breast cancer with poor clinico-pathological features and survival outcomes.

Impact

Analyzing age-based features and outcomes from Eastern India, this study provides data in supplementing Indian and Asian scenarios of breast cancer.

Mammography and Digital Breast Tomosynthesis in Granulomatous and Nongranulomatous Mastitis

INTRODUCTION

Digital Mammography (DM) is extensively used for breast imaging however, lesion visibility is often limited by overlapping tissues, which affects lesion characterization. Digital breast tomosynthesis (DBT) reduces the effect of overlapping tissues and helps in revealing obscured findings. We aimed to describe the mammographic findings in granulomatous and non-granulomatous mastitis and assess the utility of adjunctive DBT in lesion characterization.

MATERIALS AND METHODS

DM and DBT images of histo-pathologically diagnosed cases of granulomatous (GM) and non-granulomatous mastitis (NGM) were reviewed according to the BI-RADS lexicon. Presence of contiguous/ interconnected lesions, tubular densities, interspersed hypodensities/fat densities within the involved areas were also assessed. The perceived utility of adjunct DBT was scored from 0-2.

RESULTS

Of 33 reviewed patients (24 GM, 9 NGM; median age 39 years, range 24-78); 13/33 (39.4%) were under 35 years of age. DBT detected masses in 24/33 (72.7%), whereas only 15/33 (45.4%) were visible on DM alone. Contiguous or inter-connected lesions were found in 10/33 (30.3%) cases. Tubular extensions were seen in 14 cases and interspersed hypodensities in 15. None of the enlarged lymph nodes had irregular shape or indistinct margins or loss of fatty hilum. DBT was able to categorize more lesions as BIRADS 4a or below, as compared to DM alone.

CONCLUSIONS

Mammographic presence of multiple contiguous iso-dense masses, reniform contour of axillary lymph nodes with preserved fatty hilum despite a large area of breast involvement favour a benign etiology; especially if DBT reveals tubular extensions or lesions with inhomogenous low density areas within.

The human immune cell simulated anti-breast cancer nanorobot: the efficient, traceable, and dirigible anticancer bio-bot

Background

Various types of cancer therapy strategies have been investigated and successfully applied so far. There are a few modern strategies for improving drug selectivity and biocompatibility, such as nanoparticle-based drug delivery systems. Herein, we designed the traceable enzyme-conjugated magnetic nanoparticles to target human breast cancer cells by simulating the innate immune cell’s respiratory explosion response.

Methods

The human immune cell simulated anti-breast cancer-nanorobot (hisABC-NB) was produced by conjugating the mouse-derived iNOS and human-originated MPO enzymes on the folate-linked chitosan-coated Fe3O4 nanoparticles. The synthesized nanoparticles were functionalized with folic acid as the breast cancer cell detector. Then, the hisABC-NB’s stability and structural properties were characterized by studying Zeta-potential, XRD, FTIR, VSM, FESEM, and DLS analysis. Next, the selectivity and anti-tumor activity of the hisABC-NB were comparatively analyzed on both normal (MCF-10) and cancerous (MCF-7) human breast cells by analyzing the cells’ survival, apoptotic gene expression profile (P53, BAX, BCL2), and flow cytometry data. Finally, the hisABC-NB’s traceability was detected by T2-weighted MRI imaging on the balb-c breast tumor models.

Results

The hisABC-NB significantly reduced the MCF-7 human breast cancer cells by inducing apoptosis response and arresting the cell cycle at the G2/M phase compared with the normal cell type (MCF-10). Moreover, the hisABC-NB exhibited a proper MRI contrast at the tumor region of treated mice compared with the non-treated type, which approved their appropriate MRI-mediated traceability.

Conclusion

The hisABC-NB’s traceability, dirigibility, and selective cytotoxicity were approved, which are the three main required factors for an efficient anticancer compound. Therefore, it has the potential to be used as an intelligent safe anticancer agent for human breast cancer treatment. However, several in vitro and in vivo studies are required to clarify its selectivity, stability, and safety.

Behavioral interventions towards knowledge and awareness of reproductive cancer care: A study on select Indians using an online survey

BACKGROUND

The behavioral aspects of human beings influence the incidences of cancer cases directly and indirectly. The factors like positive thinking and motivation were found to change the behavior toward knowledge and awareness of cancer. The main objective of the study is to assess the knowledge and awareness of select Indians about reproductive cancer.

MATERIALS AND METHODS

The online survey method assessed various components of knowledge and awareness about reproductive cancer. A Google Form has been distributed through social media platforms such as e-mail, Instagram, Facebook, and WhatsApp. The coded data has been computed in SPSS (version 25) by IBM (USA) for the analysis. Univariate and bivariate data analysis has been drawn to justify the objective.

RESULTS

Nearly 68 percent of the respondents were aware of reproductive cancer. Among them, 17 percent know about cervical cancer, and 12.5 percent have awareness about breast cancer. Electronic and print media (41.2 percent) were major sources of information about reproductive cancer. Nearly 48 percent of respondents reported that multiple sexual partners and poor sexual hygiene were risk factors for reproductive cancer. Around 57 percent of respondents reported reproductive cancer is preventable, 59 percent knew about cancer screening, and 63.5 percent knew the treatment process. The gender of the respondents was associated (p-value = 0.002) with awareness of reproductive cancer. It has been found that there is a significant association between knowledge of screening tests and the treatment process of reproductive cancer. The marital status of respondents is strongly associated (p-value = 0.000) with the awareness of reproductive cancer.

CONCLUSION

The factors like knowledge of reproductive cancer and awareness proceed as an important role in cancer prevention. A gender-neutral cancer awareness program is needed to increase cancer awareness irrespective of marital status.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Insights on possible interplay between epithelial-mesenchymal transition and T-type voltage gated calcium channels genes in metastatic breast carcinoma

Breast cancer (BC) is the most common life-threatening malignancy amongst women with high incidence worldwide. In Egypt, it is the most known malignancy amongst females. Epithelial-mesenchymal transition (EMT) participates in breast tumors’ invasiveness, and metastasis, but the process is poorly understood. The involvement of voltage-gated calcium channels signaling in EMT has not yet been fully explored. Therefore, the aim of this study was to investigate the possible role of T-type calcium channels in metastasis and EMT among breast cancer patients. The study was carried out on 48 female breast cancer patients who were divided into two groups; metastatic and non-metastatic. qRT-PCR was employed to measure the expression of EMT marker genes (N- cadherin, E-cadherin, Snail, Vimentin and T-type VGCCs genes (CACNA1G, CACNA1H, and CACNA1I). The results of the present study revealed differential expression of the EMT marker genes in blood and tissue of non-metastatic and metastatic breast cancer patients, with a clear tendency for the mesenchymal markers to be significantly elevated in metastatic patients as well as malignant tissues taken from non-metastatic patients as compared to their paired tumor adjacent normal (TAN) tissue. Both CACNA1H and CACNA1I (T-type VGCCs oncogenes) were significantly elevated in blood of metastatic patients when compared to non-metastatic ones. In contrast, CACNA1G (tumor suppressor) exhibited a significant decrease in metastatic patients. The strong correlation between the expression of T-type VGCCs and mesenchymal marker genes in metastatic breast cancer patients casts light on the role of T-type VGCCs in metastasis and their involved in tumor invasiveness.

Worldwide review with meta-analysis of women's awareness about breast cancer

OBJECTIVE

To summarize the awareness levels of breast cancer (BC) worldwide and investigate factors associated with BC awareness to determine differences in awareness between China and other countries.

METHODS

This systematic review followed the PRISMA guidelines and included 92 articles up to July, 2021. We calculated percentages for BC awareness levels and conducted subgroup analysis and cumulative meta-analysis.

RESULTS

A total 84% (95% confidence interval [95%CI]: 78-90%) of women knew about BC; however, only 51% (95%CI: 37-66%) and 40% (95%CI: 24-56%) of women were aware of BC symptoms and BC risk factors, respectively. The most commonly known BC symptom was breast lump (71%, 95%CI: 62-80%), and BC family history was the most well-known BC risk factor (61%, 95%CI: 54-69%). Subgroup analysis showed lower awareness levels among Chinese and Asian women than women from other countries. Cumulative meta-analysis showed no obvious progress in BC awareness levels over time. We investigated 15 awareness-related factors, the most frequent of which were education level (61.8%), occupation (29.4%), and age (26.5%).

CONCLUSION

BC awareness levels remain low. Improving BC awareness is critical, especially in developing countries.

PRACTICE IMPLICATIONS

Effective education programs are urgently needed to improve women's BC awareness.

Ethiopian women's breast cancer self-examination practices and associated factors. A systematic review and meta-analysis

BACKGROUND

Breast neoplasm is the most frequently diagnosed and the leading cause of cancer death in the vast majority of the countries. Breast cancer self-examination is a check-up of a woman does at home to look for changes or problems in the breast tissue. The benefit of early recognition is for early treatment that is more effective, higher long-term survival rates and better quality of life. The aim of this review was to determine the pooled prevalence of breast cancer self-examination practice and identify its associated factors among Ethiopian women.

METHODS

Google Scholar, PubMed, Science Direct, web of science, and Cochrane Library were used for search of articles. This review includes thirty four articles conducted in Ethiopia between 2011 and 2020. The review contains 14,908 women to determine the ever pooled prevalence of breast cancer self-examination practice. Health workers and students made up 28.35% of the total participants. Data were extracted using a standardized data extraction format prepared in Microsoft Excel and analyzed with Stata 14. To assess heterogeneity I² test were used. A random effect meta-analysis model was used to estimate the pooled breast cancer self-examination (BCSE) practice of Ethiopian women. Moreover associated factors were also assessed.

RESULTS

In Ethiopian women, the overall ever and regular pooled breast cancer self-examination practice was 36% (95% CI: 28, 43) and 16% (95% CI: 28, 43) respectively. The ever pooled prevalence for health workers or students was 53% (95% CI: 41, 65), whereas for other participants it was 25% (95% CI: 19, 30). Good knowledge about breast self-examination (AOR: 3.69: 95% CI: 2.70, 5.05), positive attitude towards BCSE (AOR: 2.72: 95% CI: 1.74, 4.24), Getting to know people with breast cancer(AOR: 2.77: 95% CI: 1.51, 5.09), family history of breast cancer (AOR: 2.49: 95% CI: 1.60, 3.88) and personal history of breast cancer (AOR: 2.26: 95% CI: 1.70, 3.01) were associated factors to BCSE practice among Ethiopian women. All of the studies included in this review were conducted in a cross-sectional design was a limitation of this review and meta-analysis.

CONCLUSION

This review and meta-analysis showed the ever and regular pooled prevalence of BCSE among Ethiopian women. More than one third of Ethiopian women ever practiced BCSE. We recommend that awareness creation should be perform in order to tackle the risk of breast cancer.

Prospective Evaluation of Response Outcomes of Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer

Introduction Breast cancer is a global health problem, with more than 1 million cases of breast cancer diagnosed worldwide each year, and is the most common cancer among Indian women. Locally advanced breast cancer (LABC) accounts for 10-20% in the Western world while in India it accounts for 40-50% of all cases. Locally advanced breast cancer is a very common clinical scenario especially in developing countries possibly due to various factors like lack of education and poor socioeconomic status. Women with the locally advanced disease require multimodality therapy and coordinated treatment planning. This study aimed to prospectively study the clinical profile of the LABC patients presenting to our institute and also to evaluate the role of neoadjuvant chemotherapy in downstaging the tumor. Materials and Methods Seventy patients diagnosed with locally advanced breast cancer were enrolled in this prospective study. After thorough preoperative workup, patients were either taken up for upfront surgery or neoadjuvant chemotherapy followed by surgery. Post chemotherapy clinical response of the tumor and postoperative histopathological evaluation of the specimen was performed. Results The mean age of the patients in our study was 45 years. Out of 70 patients, 18 underwent upfront surgery, and 52 received neoadjuvant chemotherapy followed by surgery. A total of 44 cases had a clinical response to chemotherapy with 9% having a complete response. The incidence of margin positivity in the postoperative specimen was significantly lower in patients who received neoadjuvant chemotherapy. Conclusion  Locally advanced breast cancer accounted for the predominant number of breast cancer patients mostly females in their middle age. Neoadjuvant chemotherapy was effective in downstaging the tumor in the majority of cases, although complete clinical response was lower in our study. The rate of margin positivity in mastectomy specimens can also be reduced if chemotherapy is considered prior to mastectomy.

ABCanDroid: A Cloud Integrated Android App for Noninvasive Early Breast Cancer Detection Using Transfer Learning

Many patients affected by breast cancer die every year because of improper diagnosis and treatment. In recent years, applications of deep learning algorithms in the field of breast cancer detection have proved to be quite efficient. However, the application of such techniques has a lot of scope for improvement. Major works have been done in this field, however it can be made more efficient by the use of transfer learning to get impressive results. In the proposed approach, Convolutional Neural Network (CNN) is complemented with Transfer Learning for increasing the efficiency and accuracy of early detection of breast cancer for better diagnosis. The thought process involved using a pre-trained model, which already had some weights assigned rather than building the complete model from scratch. This paper mainly focuses on ResNet101 based Transfer Learning Model paired with the ImageNet dataset. The proposed framework provided us with an accuracy of 99.58%. Extensive experiments and tuning of hyperparameters have been performed to acquire the best possible results in terms of classification. The proposed frameworks aims to be an efficient tool for all doctors and society as a whole and help the user in early detection of breast cancer.

Status of breast cancer screening strategies and indicators in Iran: A scoping review

Background:

Materials and Methods:

Results:

Conclusion:

Understanding Social Media Usage and Engagement among Women to inform Breast Cancer Knowledge and Prevention Practices: Cross - sectional study in Delhi -National Capital Region of India

Background:

Breast cancer is the major concern worldwide and in India too. Lack of awareness is one of the causes of increasing mortality rate in India. Social media is playing an important role in health communication including breast cancer information. In India, number of women are using social media.

Objective:

To explore the impact of social media usage and engagement in enhancing knowledge and practices to prevent breast cancer among women of India.

Methodology:

A cross-sectional study was conducted in Delhi-National Capital Region of India with a sample of 649 women (response rate 83.51%). The questionnaire consisted of three sections. In first section, sociodemographic details (four items) were collected, second section contained five items on social media use and engagement and third part included items on knowledge about risk factors (seven items), symptoms (eight items), and screening (six items) of breast cancer and practice (seven items). Descriptive statistics, Chi-square, Cramer-V test, and structural equation modeling-Analysis of a moment structure were used to identify the relationship between social media engagement and knowledge and practices of women.

Results:

Around 80% (431/542) of women have medium level of social media engagement and 20% are highly engaged. The slope coefficient of the relationship between social media engagement and knowledge is 0.805 and between knowledge and practice is 0.309, Chi-square value is 52.053 and 29.624, Cramer-V statistics is 0.310 and 0.165, respectively, which indicates significant relationship.

Conclusion:

The study result justified significant impact of social media engagement on knowledge and practices of women to prevent breast cancer.

Community perceptions and individual experiences of breast cancer in communities in and around Bangalore, India: a qualitative study

Breast cancer is the most common cause of cancer mortality in India, yet breast cancer literacy remains poor. This study aimed to assess community perceptions and experiences with breast cancer in order to identify and address the gaps in our understanding of the socio-cultural barriers to awareness and care-seeking for breast cancer.

Qualitative focus group discussions and in-depth interviews were conducted among breast cancer survivors and caretakers, health workers, and general population individuals in a tertiary care facility, urban underprivileged community, and rural setting around Bangalore city. Data was thematically analyzed using inductive approach.

Breast cancer awareness was commonly gained through interpersonal relationships or self-experiencing breast cancer, mass media, and medical personnel. The most significant barriers to seeking care for breast cancer were cost of care, lack of female doctors, fears of diagnosis, and death. Stigma of breast cancer was attributed to possible isolation by the community members and misconception that cancer is infectious thereby delaying care-seeking.

This study provides an understanding of what individuals perceive about breast cancer and highlights some important anecdotes from breast cancer survivors who have experienced the full extent of a breast cancer diagnosis in India. The institutional and social barriers brought out by this study may be taken into consideration when planning targeted interventions for breast cancer in India.

Breast Self-Examination Practice and Associated Factors Among Women Attending Family Planning Service in Modjo Public Health Facilities Southwest Ethiopia

Purpose

Breast cancer is the leading cause of cancer death worldwide and the second common cancer overall. Breast self-examination is one of the cheapest methods used for the early detection of breast cancer in asymptomatic women. However, the practice of breast self-examination remains low in Ethiopia. Therefore, this study aimed to assess breast self-examination practice and associated factors among women attending family planning services in Modjo public health facilities in southwest Ethiopia.

Patient and Methods

Facility-based cross-sectional study was conducted in Modjo public health facilities from October 01, 2020, to October 30, 2020. Data were collected from 420 women by using an interviewer-administered structured questionnaire. Variables with a P-value ≤0.2 in the bivariate analysis were included in the multivariable logistic regression model. Results of regression analysis were shown as odds ratio (OR) and confidence intervals (95% CI).

Results

Overall 86 (20.5%) of the participants had ever performed breast self-examination. The odds of breast self-examination practice among women with tertiary level of education were 2.14 [AOR: 2.14; 95% CI: (1.45, 6.74)] times higher compared to those with secondary education. Women who knew breast self-examination were 4.32 [AOR: 4.32; 95% CI: (1.81, 10.81)] times higher odds of breast self-examination practice compared to their counterparts. The odds of breast self-examination practice among women who had a positive attitude were 2.7 [AOR: 2.7; 95% CI: (1.03, 6.91)] times higher compared to women with a negative attitude towards breast self-examination.

Conclusion

Breast self-examination practice was low within the study area. Tertiary level of education, having Knowledge on breast self-examination and a positive attitude towards breast self-examination were found to have a significant association with breast self-examination practice. Breast self-examination should be promoted by improving awareness and providing special health education for women that had low educational level.

Breast cancer awareness and screening practice amongst health personnel and general population of the littoral region of Cameroon

Introduction

Late diagnosis has been observed as the hallmark of breast cancer in Cameroonian women where over 70% of patients report with either stage III or IV of the disease, with high mortality and dire socioeconomic consequences. The present study was undertaken to assess the awareness of breast cancer, warning signs and screening methods among Health professionals and general population of Douala.

Methods

Participants included in this study were health practitioners and women randomly selected and enrolled in six health facilities in the city of Douala, Littoral Region, Cameroon. A self-administered questionnaire was designed for each group and aimed at assessing their knowledge about breast cancer, warning signs and screening practices. Then, 616 women underwent breast palpation, followed by fine needle aspiration (FNA) when a nodule was found.

Results

Out of a total of 737 participants (121 health personnel and 616 women) interviewed, a majority (96.3%) were aware of the disease with the main source of information being the hospital (76.0%), media (47.1%) and vocational training schools (45.4%) for health personnel; medias (39.9%), health professionals (26.1%) and their entourage (21.9%) for the population. Health workforce presented suitable awareness of the risk factors for breast cancer and its clinical signs even though 37.1% of them had misconceptions and myth-based ideas on the origin of the disease. Both the population and health personnel were aware of the possibility of early screening for breast cancer and cited breast self-examination, clinical breast examination and mammography as screening techniques. Nonetheless, screening practice amongst all women is very poor and mainly due to ignorance, high cost of mammography, together with a lack of mastery of the BSE technique and the fear of actually discovering signs of the disease.

Conclusion

Our findings show lack of awareness and low practice of breast cancer screening amongst women in Douala and highlight the need to raise awareness and provide the right information to the public for early detection of breast cancer.

Risk factors of breast cancer and breast self-examination in early detection: systematic review of awareness among Indian women in community and health care professionals

BACKGROUND

This review aims at evaluating the awareness of risk factors for breast cancer (BC) and the knowledge of breast self-examination (BSE) among Indian women and health care professionals (HCPs).

METHODS

Literature search was conducted on multiple bibliographic databases with restrictions applied to English peer-reviewed journals.

RESULTS

We reviewed 37 published articles on this topic. The mean level of awareness for risk factors such as age at menarche (22.3%), age at menopause (27.1%) and late first pregnancy (34.6%) was low in community. The awareness was better among HCPs; however, there was still room for improvement.Knowledge of BSE varied from very poor (2%) to good (69.8%) in the community setting. The practice was similarly negligible (0%) to moderate (34.9%). Mean knowledge and practice of BSE in HCPs were 77.1 and 55.5%, respectively. A significant difference was noted in knowledge and practice of BSE between community and HCPs (P < 0.05).

CONCLUSIONS

The present review highlights the low level of awareness regarding risk factors for BC and BSE in the community as well as HCPs. Though BSE is not the ideal modality, this seems to be the best alternative for resource-limited settings.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Examination of incidence, mortality and disability-adjusted life years and risk factors of breast cancer in 49 Asian countries, 1990-2019: estimates from Global Burden of Disease Study 2019

BACKGROUND

This study presents an up-to-date, comprehensive and comparative examination of breast cancer's temporal patterns in females in Asia in last three decades.

METHODS

The estimates of incidence, mortality, disability-adjusted-life-years and risk factors of breast cancer in females in 49 Asian countries were retrieved from Global Burden of Disease 2019 study.

RESULTS

In Asia, female breast cancer incidence grew from 245 045[226 259-265 260] in 1990 to 914 878[815 789-1025 502] in 2019 with age-standardized incidence rate rising from 21.2/100 000[19.6-22.9] to 35.9/100 000[32.0-40.2] between 1990 and 2019. The death counts more than doubled from 136 665[126 094-148 380] to 337 822[301 454-375 251]. The age-standardized mortality rate rose marginally between 1990 and 2019 (1990: 12.1[11.0-13.1]; 2019: 13.4[12.0-14.9]). In 2019, age-standardized incidence rate varied from 17.2/100 000[13.95-21.4] in Mongolia to 122.5[92.1-160.7] in Lebanon and the age-standardized mortality rate varied 4-fold from 8.0/100 000 [7.2-8.8] in South Korea to 51.9[39.0-69.8] in Pakistan. High body mass index (5.6%), high fasting plasma glucose (5.6%) and secondhand smoke (3.5%) were the main contributory risk factors to all-age disability-adjusted-life-years due to breast cancer in Asia.

CONCLUSION

With growing incidence, escalating dietary and behavioural risk factors and lower survival rates due to late-disease presentation in low- and medium-income countries of Asia, breast cancer has become a significant public health threat. Its rising burden calls for increasing breast cancer awareness, preventive measures, early-stage detection and cost-effective therapeutics in Asia.

Increasing breast cancer awareness and breast examination practices among women through health education and capacity building of primary healthcare providers: a pre-post intervention study in low socioeconomic area of Mumbai, India

OBJECTIVES

The present study aimed to improve breast cancer (BC) awareness and practices using Information, Education and Communication (IEC) modules and health educational sessions for women and primary healthcare providers in low socioeconomic community of Mumbai.

DESIGN

Pre-post quasi-experimental design.

SETTING

The study was conducted in a lower socioeconomic area of G-South ward of Mumbai, Maharashtra. The baseline and endline survey was conducted using structured interview schedules.

PARTICIPANTS

410 women were selected, aged between 18 and 55 years who were not pregnant, lactating or diagnosed with BC.

INTERVENTION

A health education-based intervention module was developed to educate women through group and individual sessions.

OUTCOMES

Summative indices were constructed to understand the net mean difference in knowledge of signs, symptoms and risk factors. Analysis of variance (ANOVA) and paired t-test were used to check the significant improvement of intervention.

RESULTS

Our results showed statistical significance in difference in mean knowledge scores for both signs and symptoms (mean difference (MD) 4.09, SD 4.05, p<0.00)) and risk factors of BC knowledge (MD 5.64, SD 4.00, p<0.00) among women after intervention. There was a marked improvement in the knowledge of BC among women with low education category. A significant improvement in knowledge of symptoms and risk factors among health workers was also observed. Our interventions resulted in positive change in breast examination practices. The breast self-examination (BSE) practices improved from around 3% to 65% and around 41% additional women went for clinical breast examination after intervention.

CONCLUSIONS

This study found a significant improvement in knowledge of BC signs and symptoms, risk factors and BSE practices among study participants following our health education interventions among these subpopulations. This evidence calls for inclusion of similar interventions through health education and capacity building of primary healthcare providers in national programmes.

Barriers for early detection of breast cancer among South Indian women

Background:

Breast cancer is one of the most common neoplasms in women across the world. Early diagnosis of breast cancer results in reduced morbidity, mortality, and improved quality of life.

Objective:

This study was conducted to identify the barriers among Indian women diagnosed with breast cancer in an advanced stage.

Methods:

A cross-sectional descriptive survey was conducted in a tertiary care teaching hospital, Southern India, among breast cancer patients. A total of 202 women with breast cancer (Stage 3 and 4) were recruited based on the predefined inclusion and exclusion criteria. The data were collected using a demographic proforma and barrier checklist and analyzed using SPSS 16.0 version.

Results:

The mean age of the women was 51.5 ± 10.7 years. The majority of them were Hindu (87.6%), housewives (69.8%), with primary education (39.6%). The women have cited several barriers including financial (54.5%), lack of knowledge about breast cancer (49.5%), frightened about diagnostic test result (56.9%), afraid of anticipated surgery (54.5%), and the dearth of accessibility to health resources (52%).

Conclusions:

The presence of barriers in early diagnosis of breast cancer occurs in various contexts and should be recognized and minimized by all health-care providers to reduce the associated health-care cost, morbidity, and mortality.

Fabrication of Calcium Sulfate Coated Selenium Nanoparticles and Corresponding In-Vitro Cytotoxicity Effects Against 4T1 Breast Cancer Cell Line

BACKGROUND

The inhibitory effect of selenium nanoparticles (SeNPs) on cancer cells has been reported in many studies. In this study, the purpose was to compare the in vitro effects of SeNPs and calcium sulfate coated selenium nanoparticles (CaSO₄@SeNPs) on breast cancer cells.

METHODS

CaSO₄@SeNPs and SeNPs were chemically synthesized and characterized with Field Emission Scanning Electron Microscope (FESEM) and energy-dispersive X-ray spectroscopy (EDX). By applying MTT assay, the cytotoxicity effect of both nanomaterials on the 4T1 cancer cells was investigated.

RESULTS

While LD₅₀ of SeNPs on 4T1 cancer cells was 80 μg, the LD₅₀ of CaSO₄@SeNPs was reported to be only 15 μg. The difference between the inhibition rates obtained for SeNPs and CaSO₄@SeNPs was statistically significant (p=0.05). In addition, at higher concentrations (50 μg) of CaSO₄@SeNPs, the cytotoxicity was 100% more than SeNPs alone.

CONCLUSION

According to the result of the present work, it can be concluded that decoration of SeNPs with calcium sulfate leads to an increase in potency by decreasing the effective dose. This effect can be attributed to activation of intrinsic apoptosis signaling and/or pH regulatory properties of CaSO₄@SeNPs. However, further studies are still needed to determine the exact corresponding mechanisms of this synergistic effect.

Impact of Educational Level and Family income on Breast Cancer Awareness among College-Going Girls in Shillong (Meghalaya), India

Background:

Breast cancer (BC) is the most common cancer among women in India and shows an increasing trend. The mammography screening seems unfeasible as a public health service in India. Thus, breast self-examination (BSE), followed by clinical breast examination (CBE), is the affordable method to downstage BC. A cross-sectional study was conducted with senior school and college-going girls in Shillong (Meghalaya) to study the impact of girls’ academic level and family income on breast cancer knowledge and the prevalence of BC’s known risk factors in girls.

Methods:

A self-administered questionnaire was employed to collect relevant information. The data were analysed using statistical software SPSS version 22. The categorical data presented as frequency (%) and the comparison made using Chi-square or Fisher exact test.

Results:

(i) 78.2% girls knew about breast cancer, 19.2% of these were aware of BSE, and 22.9% of BSE knowing ever performed it (ii) Awareness of breast cancer and BSE, and its practice is significantly associated with their academic level and family income (iii) The consumption of alcohol beverages and physical activity of girls was positively associated with educational level and family income (iv) Body mass index (BMI) was weakly associated with family income with an insignificant relationship with academic level (v) oily food consumption related inversely with the level of education irrespective of family income (vi) there was a positive correlation between parents education and family income.

Conclusions:

The results show a severe lack of breast cancer knowledge in senior school and college-going girls under the survey. To spread community awareness, we suggest a public health policy-driven educational intervention through culturally relevant mass/social media on the risk factors of breast cancer and practice of BSE. It is also recommended that dedicated facilities be created for breast cancer early diagnosis in the public health system.

Factors associated with breast cancer awareness and breast self-examination in Fiji and Kashmir India - a cross-sectional study

BACKGROUND

In low-income countries breast cancer awareness (BCA) is essential to reduce the proportion of advanced stage presentations of breast cancer. There is a lack of studies using multivariable techniques to explore factors related to BCA in low-income countries. The objective of this study was to identify to what extent women in Fiji and Kashmir, India have BCA and practice breast self-examination (BSE) as well as factors associated with BCA and BSE.

METHODS

A survey of women aged ≥18 years was conducted in Fiji and Kashmir, India to assess BCA and rates of BSE. Comparison between Fiji and Kashmir was done using student's t-test for continuous data and chi-square for binary data. Factors associated with BCA and BSE were analysed using a multivariable logistic regression for Fiji and Kashmir separately.

RESULTS

Data were collected from 399 and 1982 women in Kashmir and Fiji, respectively. Of 1968 women in Fiji 57% were deemed to have an acceptable BCA compared to only 7.3% of 395 women in Kashmir. Having some education was associated with having BCA with an odds ratio of 4.7 (1.7-13) in Fiji and 10 (1.7-59) in Kashmir. Of 1976 women in Fiji 40% had tertiary education while 40% of 392 women in Kashmir had no education at all. The marital status was similar in both samples (n = 1973 and 395) with 68-69% being married and 21-26% being single. The lack of female doctors or nurses with whom to discuss issues, was perceived as a problem in both countries.

CONCLUSIONS

The key finding is an association between having any level of education and BCA. This correlation was much stronger than for a family history of breast cancer and BCA. Hence, general education to illiterate women may reduce the proportion of women in low-income countries presenting with advanced-stage breast cancer.

Prevalence of Molecular Subtypes of Breast Cancer in India: a Systematic Review and Meta-analysis

In the last two decades, India has witnessed a substantial increase in the incidence of breast cancer and associated mortality. Studies on the prevalence of molecular subtypes of breast cancer in India have reported inconsistent results. Therefore, we conducted a systematic review of observational studies to document the prevalence of molecular subtypes of breast cancer. A complete literature search for observational studies was conducted in MEDLINE and EMBASE databases using key MeSH terms ((molecular classification) OR (molecular subtypes)) AND (breast cancer)) OR (breast carcinoma)) AND (prevalence)) AND (India). Two reviewers independently reviewed the retrieved studies. The screened studies satisfying the eligibility were included. The quality of included studies was assessed using the selected STROBE criteria. The overall pooled prevalence of luminal A, luminal B, HER2-enriched, and triple-negative breast cancer (TNBC) subtypes of breast cancer were 0.33 (95% CI 0.23-0.44), 0.17 (95% CI 0.12-0.23), 0.15 (95% CI 0.12-0.19), and 0.30 (95% CI 0.27-0.33), respectively. Subgroup analyses were performed by mean age of patients, time period, region, and sample size of the study. Among molecular subtypes of breast cancer, luminal A was the most prevalent subtype followed by TNBC, luminal B, and HER2-enriched subtypes. The overall prevalence of TNBC in India is high compared to other regions of the world. Additional research is warranted to identify the determinants of high TNBC in India. Differentiating TNBC from other molecular subtypes is important to guide therapeutic management of breast cancer.

Patterns of Cancer Incidence and Mortality in North- Eastern India: The First Report from the Population Based Cancer Registry of Tripura

BACKGROUND

There is, till date no population-based data regarding cancer patterns in North- Eastern India, dictating the need to understand the epidemiology of cancer in this population for its effective management.

METHODS

This is the first report of the Population Based Cancer Registry (PBCR) in Tripura (2010-2014). The protocol involves active collection of data on all cancer cases from Tripura through staff visit in more than 150 sources of incident and mortality registration, government and private hospitals, municipal corporation, etc. and scrutiny, corroboration with existing records. Data was analyzed statistically to understand cancer trends in terms of incidence and mortality across different sites, age groups affected and gender.

RESULTS

A total of 10,251 cases were registered during the period, with overall age-adjusted incidence rates of 75.7 and 54.9 per 100,000 males and females respectively. Crude Incidence Rate (CR) and Age- Adjusted Rate (AAR) was among the lowest reported in India, probably due to associated socio-economic factors. The most prevalent cancers were lung (18.1%), esophageal (8.3%) for men and cervix uteri (17.6%), breast (13.8%) for females. Gall bladder cancer in females was one of the highest in the country. Rate of cancer mortality in the population was quite high and significantly increased with time, probably accounting for dearth in early detection and feasible treatment alternatives.

CONCLUSION

The data suggests that high cancer incidence and mortality are prevalent in the population of Tripura, dictating the need of active tobacco control measures, early detection and awareness drives for effective cancer control.

Opportunities and Barriers to Breast Cancer Screening in a Rural Community in Coastal Karnataka, India: A Qualitative Analysis

Background:

Breast cancer is reported to be the most common cancer among women in India with a high mortality to incidence ratio. Late presentation, driven by lack of awareness and limited accessibility to health services are some of the stated reasons for this. Given this context, this qualitative study was carried out to understand the perception of rural women towards the disease and factors that influenced utilization of available screening services among them.

Methods:

Forty-four rural women aged 20-60 years from a coastal province in southern India participated in four Focus Group Discussions (FGDs) that were conducted to understand their perception, attitudes and barriers towards breast cancer screening. Participants were identified from the community through purposive sampling and constituted of home makers and working women. The FGDs were led by trained facilitators and the discussions recorded. Ideas and concepts that emerged were listed as codes. Related and similar codes were grouped to form six themes.

Results:

Women in the study belonged to low- and middle-income households with a mean age of 42.8 ± 7.8 years and almost all had attended school. Although the respondents exhibited fairly good knowledge about the disease, cultural inhibitions, forgetfulness, economic constraints and apprehension towards tertiary health care facility were some of the barriers reported in the uptake of screening services. Participants hailed the role of female health care providers as motivational figures and stressed the need for easily comprehensible information dissemination strategies besides expecting an equal participation of men in issues involving women’s health.

Conclusion:

Involving cancer survivors as educators and empowering men on women’s health in addition to the felt need of a patient advocate to improve accessibility were some of the highlights of the discussions. Addressing these could go a long way in improving the cancer care continuum in the region.

A meta-analysis and in silico analysis of polymorphic variants conferring breast cancer risk in the Indian subcontinent

Background: Genetic association studies on breast cancer on the Indian subcontinent have yielded conflicting results, and the precise effect of these variants on breast cancer pathogenesis is not known. Methods: Genomic variants, as obtained from selected studies from the Indian subcontinent, were subjected to random-effects and fixed-effect meta-analysis. Functional annotation of the relevant variants was done through a tried and tested in silico pipeline. Results: We found rs4646903/CYP1A1, rs1799814/CYP1A1, rs61886492/GCPII, del2/GSTM1, rs4680/COMT and rs1801394/MTRR to be associated with breast cancer. The del2/GSTM1 holds the association in premenopausal women. Conclusions: This is the first study of its kind from the Indian subcontinent analysing the extent of association of variants across populations followed by their functional annotation in the disease pathway.

A scoping review: Facilitators and barriers of cervical cancer screening and early diagnosis of breast cancer in Sub-Saharan African health settings

To address gaps in access to cervical cancer screening and early diagnosis of breast cancer services in Sub-Saharan African (SSA), this scoping review was conducted to explore facilitators and barriers that exist on the patient-, provider-, and system-level. An extensive literature search was conducted in accordance with scoping review methodology and the Cochrane guidelines. Our search criteria were limited to original research studies conducted in community or clinical settings in SSA within the last 10 years (2010-2020). Themes found from this review included patient knowledge and provider education, access to screening services, trust, health-related behaviors, attitudes, values, and practices, community and social values, health infrastructure, resource allocation, and political will. Identified barriers included lack of knowledge about cervical and breast cancer among patients, gaps in education and training among providers, and lack of resources and health infrastructure at the facility level and within the overall health system. Facilitators included perceived risk of cancer, support and encouragement of the provider, and utilization of novel approaches in low-resource settings by health systems. To better address individual-, provider-, and health system and facility-based facilitators and barriers to care, there is a need for political and financial investment and further research on the health service delivery in specific national health systems, especially in the context of the global campaign to eliminate cervical cancer as a public health problem.

Barriers to Timely Diagnosis and Management of Breast Cancer: Observations from a Tertiary Referral Center in Resource Poor Setting

Breast cancer (BC) is the most common cancer among females worldwide, with over 2 million cases diagnosed every year. In India, it is the most common malignancy overall (15.4%) and accounts for about 27% female cancers. Morbidity and mortality remain high despite improvements in BC therapeutics. Conventionally, a gap of more than 3 months between noticing symptoms and commencing treatment is considered delay in BC management. Delays make BC an important public health problem and lead to poor outcomes. This study aims to identify patient perceived barriers to BC management. A self-designed structured questionnaire consisting of questions pertaining to multiple aspects of BC presentation and management was prepared. The study was conducted from October 2017 to September 2018 and results were analyzed. A delay of 3 months or more was seen in 284 of the 435 patients (65.3%), among which 179 was patient delay, 69 due to provider delay, and 36 due to a combined contribution of both factors. Provider factors were associated with prolonged delay. Misdiagnosis at first consult was the most common factor perceived by patients as a barrier, followed by delay in referral, distance from hospitals, lack of information, financial constraints, and logistic issues. A significant patient and provider delay exists in BC management which prevents effective early therapy. Effective tackling of these barriers may result in the betterment of BC management outcomes. Robust screening, education of patients and providers, and awareness promotion and infrastructure development will be useful in this regard.

Clinical Characteristics and Outcome Trends of Adjuvant Anthracycline and Taxane Regimen for Early Stage Breast Cancer

Background

The anthracycline and taxane-based chemotherapy treatment regimen remains the gold standard for treatment of early stage breast cancer. However, studies examining the effectiveness and use of this treatment regimen in Indian context are limited. This study examined patients treated with anthracycline and taxane-based chemotherapy at a tertiary care cancer center in India.

Methods

Patients with confirmed early stage breast cancer who had undergone primary breast surgery followed by treatment with anthracycline and taxane-based chemotherapy between 2009 and 2015 were included in the study. Data on clinical characteristics and treatment details were collected from the patients’ medical records.

Results

Two hundred sixty-four women were included in the analysis. The median age at presentation was 50 years. Among the 264 women, 40.5% were premenopausal, 1.2% were perimenopausal, and 58.3% were postmenopausal. The number of patients undergoing breast-conserving surgery (BCS) and modified radical mastectomy (MRM) were 35.2% and 64.7%, respectively. Patients with a tumor grade of 1, 2, and 3 were 7.2%, 53.1%, and 39.7%, respectively. Tumors were unifocal in 81.1% and multifocal in 18.2% of patients. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2) positivity was detected in 58.3%, 54.2%, and 3.1% of patients, respectively and 38.6% of patients were triple negative. With a median follow-up of 36.2 months, the invasive disease-free survival rate was 90.9% and mean disease-free survival time was 65.4 ± 1.13 months.

Conclusions

The results of this study confirm the clinical utility of anthracycline and taxane-based chemotherapy regimen as the adjuvant chemotherapy treatment of early stage breast cancer.