Factors associated with breast cancer screening intention in Kathmandu Valley, Nepal

Breast cancer awareness, knowledge and self-screening intention among females in Northern Border of Saudi Arabia, Arar City

BACKGROUND

Breast cancer is the most common cancer among females, and early detection plays a crucial role in disease management. This study aimed to assess the knowledge, practices, and barriers related to breast self-examination (BSE) and mammography among Saudi women in Arar City, Saudi Arabia.

METHOD

A cross-sectional observational study was conducted using an online Google Form distributed to women in Arar City. The survey collected sociodemographic data and assessed knowledge, practices, and barriers related to BSE and mammography. Statistical analyses were performed using IBM SPSS Statistics version 27.0.1, with significance set at p < 0.05.

RESULTS

The study included 385 females, with women aged 19-25 constituting nearly one-third of the population (n = 118; 30.6%). Most participants were married (n = 217; 56.4%) and held a bachelor's degree (n = 281; 73%). While 84.2% (n = 324) had heard of BSE and 80% (n = 308) demonstrated good knowledge, only 33.5% (n = 129) reported performing BSE. Regarding mammography, only 19.5% (n = 75) reported undergoing screening, despite 65.1% (n = 247) recognizing it as a safe procedure. Educational level (p = 0.018), prior knowledge of BSE (p = 0.009), and history of breast problems (p = 0.027) were significantly associated with higher knowledge scores.

CONCLUSION

While women demonstrated good awareness and knowledge of BSE, its practice remains low, with many unaware of proper techniques, timing, and frequency. Mammography awareness and utilization were also limited, emphasizing the need for targeted educational campaigns to promote early detection and improve screening behaviours.

Determinants of breast cancer screening among women of reproductive age in sub-Saharan Africa: A multilevel analysis

BACKGROUND

Breast cancer is a significant global health issue, responsible for a large number of female cancer deaths. Early detection through breast cancer screening is crucial in reducing mortality rates. However, regions such as Sub-Saharan Africa (SSA) face challenges in identifying breast cancer early, resulting in higher mortality rates and a lower quality of life. Yet, there is a noticeable gap in the literature concerning breast cancer screening. Thus, this study aimed to estimate the pooled prevalence of breast cancer screening and associated factors among women of reproductive age in SSA.

METHODS

A weighted sample of 80,058 reproductive-age women from recent Demographic and Health Surveys in SSA countries was considered for analysis. A multilevel modified Poisson regression model with robust variance was fitted to identify factors associated with breast cancer screening. Four nested models were fitted, and the model with the lowest deviance value was selected. An adjusted prevalence ratio with the corresponding 95% confidence interval was used to measure the strength of the association. Finally, statistical significance was declared at a p-value < 0.05.

RESULT

The pooled prevalence of breast cancer screening among reproductive-age women in SSA was 11.35% (95% CI: 11.14%, 11.56%), with variations ranging from 4.95% (95% CI: 4.61%, 5.30%) in Tanzania to 24.70% (95% CI: 24.06%, 25.33%) in Burkina Faso. Age (20-24, 25-29, 30-34, 35-39, 40-44, and 45-49 years), secondary and higher education, wealth index, media exposure, parity, contraceptive use, pregnancy status, breastfeeding status, and visiting a healthcare facility in the last 12 months were identified as significant positive determinants of breast cancer screening. Conversely, being a rural resident and having a primary education level were found to be negative determinants.

CONCLUSION

This study uncovers a low prevalence of breast cancer screening in SSA countries, despite high associated mortality rates. Emphasizing the significance of targeted interventions, it highlights the crucial need to promote education and awareness regarding the benefits of breast cancer screening, particularly in light of the challenges faced by many women in the region.

Beyond Intention: Barriers to Undergoing a Blood Pressure Check in the South-West Shewa Zone, Ethiopia

BACKGROUND/OBJECTIVES

Hypertension is often asymptomatic, progresses slowly, and leads to multiple secondary diseases. Thus, a regular blood pressure check is recommended. The objective of this study is to assess the intention to undergo a blood pressure check and its associated factors among adults in Southwest Shewa Zone, Ethiopia.

METHODS

A healthcare-facility-based cross-sectional design was utilized. A standardized questionnaire, adapted from previous research, was administered by trained interviewers. Binary logistic regression analysis was used to determine the factors the intention to undergo blood pressure checks is associated with, utilizing SPSS version 27.

RESULTS

Four hundred twenty-one participants provided a complete response, yielding a 99.7% response rate. Of these participants, 153 (36%) had had their blood pressure checked at some point. The vast majority of the study participants (387, 91.9%) did not know the normal blood pressure range. The median score for intention to undergo blood pressure check was 11 (interquartile range 10-13). Female participants were 59% less likely (adjusted odds ratio [AOR] 0.408, 95% confidence interval 0.208-0.801) to intend to undergo a blood pressure check than male participants. Participants in the poorest wealth quintile were 82% less likely (AOR 0.183, 95% CI = 0.063-0.533) to intend to undergo a blood pressure check than those in the richest quintile. Participants who intended to undergo a blood pressure check had a significantly favorable attitude (t = 10.801, p < 0.001) and lower perceived behavioral control (t = -2.865, p < 0.001) compared with those who had no intention of checking.

CONCLUSION

A high intent to undergo a blood pressure check should prompt healthcare facilities to offer regular blood pressure check-up services. Behavioral change communication interventions should address the attitude and perceived behavioral controls of individuals associated with the intention to undergo a blood pressure check. In doing so, special attention should be given to female and economically disadvantaged populations.

Prevalence of Breast Cancer Screening in Asia: Systematic Review and Meta-Analysis

BACKGROUND

Breast cancer is one of the leading causes of cancer-related mortality among women above 50 years of age. This systematic review and meta-analysis aimed at identifying the prevalence and trend of breast cancer screening among selected Asian countries.

METHODS

We searched three databases including, PubMed, Web of Science, and Scopus using our search terms. Two independent reviewers screened titles and abstracts applying the inclusion and exclusion criteria specified in the PROSPERO (registration ID: CRD42023401516) and any conflicts were resolved through discussion. Two independent reviewers and conflicts also completed the full-text screening, which was solved. Relevant information was extracted in an Excel sheet and random effects meta-analysis was performed to identify the pooled estimate of breast cancer screening in Asia using Stata 17.

RESULTS

We identified 41 studies from 14 selected Asian countries reporting breast cancer screening rates from 2012-2023. The pooled estimate of four countries (China, Iran, Japan, and Korea) with more than three data points on clinical breast examination and mammographic screening showed a screening rate of 24% (95% CI: 0.20 - 0.27) and 18% (95% CI: (0.14 - 0.21) in the last ten years respectively.

CONCLUSION

Most Asian countries do not have sufficient data on breast cancer screening due to a lack of nationally representative surveys or national-level cancer registries. Therefore, it is crucial to strengthen cancer control policies including breast cancer screening programs.

Breast cancer screening motivation among women: an application of self-determination theory

BACKGROUND

Breast cancer is a major health concern worldwide, especially in Vietnam. This study aimed to explore women's motivation for and factors related to breast cancer screening.

METHODS

A mixed-methods study was conducted in Danang, Vietnam, using a convergent parallel approach. This study utilized both quantitative and qualitative methods to gather the data. The quantitative approach involved surveys to assess motivation levels and related factors, including demographic information and experience with breast cancer screening. In-depth qualitative interviews were used to gain deeper insights into participants' perspectives and experiences related to breast cancer screening.

RESULTS

The average motivation score for breast cancer screening was moderate (3.55 ± 0.55). Ethnicity, regular health check-ups, family history of breast cancer, receiving information about breast cancer, and women's health issues have direct relationships with breast cancer screening motivation. According to the qualitative data, three categories emerged: intrinsic motivation, external motivation/internalization, and amotivation. The individual, and sociocultural environmental factors impacted screening motivation.

CONCLUSIONS

This study highlights the motivations behind breast cancer screening among women. Healthcare providers could use these findings to improve screening policies and guidelines and encourage more women to undergo regular screening, ultimately reducing the incidence of breast cancer in the community.

Factors Influencing Time From Diagnosis to Treatment of Breast Cancer and the Impact of Longer Waiting Time on Survival in Kathmandu Valley, Nepal: A Population-Based Study

PURPOSE

Longer time between breast cancer (BC) diagnosis and treatment initiation is associated with poorer survival, and this may be a factor behind disparities in global survival rates. We assessed time to BC treatment in the Kathmandu Valley, Nepal, including factors associated with longer waiting times and their impact on survival.

METHODS

We conducted a retrospective population-based study of BC cases recorded in the Kathmandu Valley Population-Based Cancer Registry between 2018 and 2019. Fieldwork survey through telephone was undertaken to collect additional sociodemographic and clinical information. Logistic regression was performed to identify factors associated with longer time to treatment, and Kaplan-Meier and Cox proportional hazard regression was used to examine survival time and evaluate the association between longer time to treatment and survival.

RESULTS

Among the 385 patients with BC, one third waited >4 weeks from diagnosis to initial treatment. Lower education was associated with longer time to treatment (adjusted odds ratio, 1.63 [95% CI, 1.03 to 2.60]). The overall 3-year survival rate was 88.6% and survival was not associated with time to treatment (P = .50). However, advanced stage at diagnosis was associated with poorer survival (adjusted hazard ratio, 4.09 [95% CI, 1.27 to 13.23]). There was some indication that longer time to treatment was associated with poorer survival for advanced-stage patients, but data quality limited that analysis.

CONCLUSION

In the Kathmandu Valley, Nepal, women with a lower education tend to wait longer from BC diagnosis to treatment. Patients with advanced-stage BC had poorer survival, and longer waiting time may be associated with poorer survival for women diagnosed with advanced-stage disease.

Knowledge, attitude and practices around breast cancer and screening services among women of reproductive age in Turbo sub-county, Kenya

Background

Only 12% of Kenyan women use breast cancer (BC)screening programs. Early identification is critical for reducing the condition's associated morbidity and mortality. Unfortunately, few studies have been conducted on the screening program's implementation and the causes for the low usage rates in Turbo Sub-County, Kenya. The purpose of this study was to learn about women of reproductive age's (WRA) practices, attitudes, and knowledge regarding BC screening programs, as well as to investigate the potential association between lifestyle factors and BC screening service utilization.

Methods

Mixed-method approaches were used in an analytical cross-sectional study design. The study included 317 participants selected randomly. An interviewer-administered questionnaire was used to collect quantitative data while focus group discussion (FGD) and key informant interview (KII) guides were used for collecting qualitative data. The Statistical Package for Social Sciences (SPSS) version 26 was used to manage quantitative data, whereas NVivo version 12 was used to analyze qualitative data. Chi-square, Fisher's exact test, and multiple logistic regression were used to assess the degree of relationship between BC screening service uptake and independent variables. The qualitative data was transcribed verbatim, and the transcripts were automatically coded to generate themes.

Results

The participants' mean age was 30.14 (9.64). Breast cancer screening services were used by 10.21% of the population. Women who were aware of the signs and symptoms of BC were 71.5 times more likely to undergo screening than their counterparts. Similarly, those with positive attitudes toward BC and screening programs were 84 times more likely to get screened than those with negative attitudes. Breastfeeding increased the likelihood of BC screening by OR = 37 (95% CI: 0.00-0.32), physical activity by OR = 37 (95% CI: 0.00-0.25), and chronic illnesses by OR = 37 (95% CI: 0.00-0.17).

Conclusion

Knowledge of signs and symptoms of BC and a positive attitude towards perceived barriers enhanced the probabilities of BC screening. Being physically active, breastfeeding, and having a chronic disease all increased the odds of BC screening uptake. To improve screening rates, it is necessary to provide sufficient information to those who are least likely to be screened.

Knowledge and practice regarding cancer screening in Nepal: a systematic review and meta-analysis

Background

Cancer screening utilization can aid in the early diagnosis and treatment of cancer. However, the current scenario of the knowledge and practice regarding cancer screening remains unclear as the authors do not have sufficient studies. Hence, the authors conducted this systematic review and meta-analysis to assess the situation of cancer screening utilization and knowledge.

Methods

A systematic literature review was conducted to identify all studies on knowledge and practice regarding cancer screening in the Nepalese population. Data extraction and analysis were done with SPSS and CMA-3.

Results

The authors identified a total of 5238 studies after database searching, and 19 studies were included in a narrative synthesis. Lack of awareness and knowledge was the major barrier in cervical, breast, and testicular cancer screening. In cervical cancer screening, the most common reason for screening was the advice of health personnel in 85% of respondents, and the barrier was lack of awareness in 49.33% of participants.

Conclusion

The knowledge and practice of cancer screening is lacking in Nepal, as shown by our review. More educational and awareness programs, easy access to screening services, and elimination of sociocultural barriers are necessary to increase the utilization of screening services.

The Effect of an Educational Intervention on Breast Cancer Screening of Rural Women: Application of the Theory of Planned Behavior

BACKGROUND

Early diagnosis of breast cancer is a key factor affecting patient survival, so screening can reduce the burden of this disease. The present study aimed to investigate the effect of education based on the theory of planned behavior (TPB) on breast cancer screening in rural women.

METHODS

In this quasi-experimental study, 480 women referring to the health care centers in the cities of Fasa and Shiraz were divided into two groups, intervention (n = 240) and control (n = 240), using cluster random sampling method, in 2021-2022. We randomly selected two health care centers in Shiraz and Fasa and invited them to participate in the study. The demographic information questionnaire and a researcher-made questionnaire based on the TPB were used to collect the data. The intervention included 50-minute sessions on topics such as breast cancer basics, screening methods, barriers to mammography, and the role of peer groups. Data were collected before and 4 months after the intervention.

RESULTS

The results showed no difference between the two groups in awareness, attitude, perceived behavioral control, subjective norms, behavioral intention, and breast cancer screening performance before the intervention. Four months after the intervention, a significant increase was found in the intervention group in awareness (7.46 ± 1.50 to 18.54 ± 1.20), attitude (28.55 ± 4.62 to 58.69 ± 4.35), perceived behavioral control (22.52 ± 3.32 to 40.88 ± 3.84), and subjective norms (20.37 ± 3.34 to 21.99 ± 3.38). Instead, no significant difference in the mentioned constructs (P < 0.05) was observed in the control group.

CONCLUSION

This study demonstrated that TPB-based education enhanced awareness, attitude, perceived behavioral control, subjective norms, and behavioral intention towards breast cancer screening. The TPB empowers women in rural communities to prioritize their health and seek timely breast cancer screening. Continued efforts and improved access to screening services are crucial for improved outcomes.

Intention to Undergo Clinical Breast Examination and Its Associated Factors among Women Attending Rural Primary Healthcare Facilities in South Central Ethiopia

Background

Breast cancer is a global public health problem with higher mortality in developing countries. The Ethiopian National Cancer Control Plan recommends clinical breast examination (CBE) for all women aged >18 years. However, there is low breast examination practice in Ethiopia. Therefore, this study aimed to describe level of intention to undergo CBE and associated factors among women visited selected rural healthcare facilities in south central Ethiopia using Theory of Planned Behavior (TPB).

Methods

This study used facility-based cross-sectional study design. A total of 420 women participated in this study. Interviewer-administered structured questionnaire was adopted from previously published research works and Ajzen's TPB manual. Statistical Package for Social Sciences (SPSS), version 27, was used for analysis. Binary logistic regression model was used to determine factors associated with intention to undergo CBE.

Results

In this study, nine out of ten women had never had CBE. Mean score for intention to undergo CBE was 12.55 (SD ± 3.22; min 5, max 20). Intention to undergo CBE was negatively associated with being in the second and middle wealth quantiles compared to the highest wealth quantile, and with the spouse not being able to read or write compared to having attended formal education. Positive attitude and higher subjective norm had relevant association with intention to undergo CBE.

Conclusion

The high score for intention to undergo CBE should encourage primary healthcare facilities to offer CBE. Behavioral change communication interventions could address women's attitude, subjective norm, and spouse's education associated with intention to undergo CBE.

Increasing importance of breast cancer in Nepal

Recently, breast cancer cases in Nepal are on the rise, accounting for approximately 16% of all cancer cases, making it the second most common malignancy. Given the dependence of the Nepalese on agriculture, the rampant use of pesticides as well as the presence of arsenic in water supplies might be contributing to this huge rise in cancer cases. Herein, we provide a brief overview of the status of breast cancer, its burden, risk factors, screening and modes of treatment in Nepal.

Estimating the Cancer Treatment Cost for 5 Common Types of Cancer with Separating Out-of-Pocket and Governmental Costs in Afghanistan, 2020

The objective this study was to estimate the cost of cancer treatment services for 5 common types of cancer (Breast, Esophageal, Colorectal, Stomach and lung) by the public sector and patients. This study was a cross-sectional study that conducted using the medical records of patients who were registered in the Jamhuriyat Hospital from 1, 2020 to 12, 2020. The prevalence-based approach was used to estimate the costs of five major cancer types. The data of 769 patients were eligible to include for the analysis. The considered cost of services was obtained from the average cost in 3 private hospitals in Kabul. Also all costs converted in to US dollar using the exchange rate of each USD equaling to AFN 77 in 2020. The data was analyzed using Ms. Excel Program. The total number of patients with 5 types of cancer were 769. Of these, female, in the age group of 40-60 years and were illiterate. The most common cancers based on the cancer treatment services' costs of health services was breast cancer, followed by esophagus, colorectal, stomach and lung. Moreover, the most common cancers based on the cancer treatment services' costs of health services which cancer patients needed was breast cancer, followed by esophagus, colorectal, stomach and lung.  Moreover, total cost of cancer treatment is US$590,662.98, in which Patients paid USD 82,537 of it out-of-pocket. The costs of cancer treatment services for 5 common types of cancer are high which a considerable portion are paid by patients. There is a need for the government to pay more attention to the provision of these services and to increase the centers providing these services and the existing facilities. Also, support of the international community in this process can enable more people to access these services and reduce the economic burden on patients.

Survey on determinants of intention to reduce nasopharyngeal cancer risk: an application of the theory of planned behavior

Background

To have better prognostic outcomes and minimize deaths due to nasopharyngeal cancer, it is vital to understand factors that motivate the public to undertake cancer preventive measures. The study investigated determinants of intention to adopt measures to reduce nasopharyngeal cancer risk using the Theory of Planned Behavior.

Method

A cross-sectional survey was conducted on Malaysians (n = 515) using a questionnaire on attitudes, subjective norm, perceived behavioral control, knowledge of nasopharyngeal cancer, past nasopharyngeal cancer preventive behavior, and intention to adopt preventive measures. The attitudes construct encompassed perceptions of susceptibility, severity, benefits and barriers. Hierarchical regression of mediation effect under structural equation model approach was used to test the theory. The model was re-estimated using the two-stage least square approach by instrumental approach. Next the Maximum Likelihood Estimation-Structural Equation Modeling was conducted to gauge the instrumentation and check the robustness of the model’s simultaneity.

Results

The respondents had moderate knowledge of nasopharyngeal cancer, and reported high levels of perceived risk, perceived severity and perceived behavioral control. The respondents were under little social pressure (subjective norm) to perform nasopharyngeal cancer preventive actions, marginally believed in the benefits of medical tests and reported few barriers. The Partial Least Squares-Structural Equation Modeling results show that the relationship between intention and four independent variables were significant (perceived behavioral control, perceived risk, perceived severity, marital status) at p < .05. Tests of Two-stage Least Square Approach and Maximum Likelihood Estimation-Structural Equation Modeling confirm the four key factors in determining the intention to reduce nasopharyngeal cancer risk. The variance explained by these factors is 33.01 and 32.73% using Two-stage Least Square Approach and Maximum Likelihood Estimation-Structural Equation Modeling respectively. Intention to undertake nasopharyngeal cancer risk-reducing behavior has no significant relationship with subjective norm, attitudes (perceived benefits and barriers to screening), knowledge of nasopharyngeal cancer and past behavior in enacting nasopharyngeal cancer preventive measures. The only demographic variable that affects intention is marital status. Gender, age, race, religion, education level, and income are not significantly associated with intention.

Conclusions

In contexts where knowledge of nasopharyngeal cancer is moderate, the factors associated with the intention to reduce risk are perceived risk and severity, perceived behavioral control, and marital status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14073-0.

Oncology clinical practice guidelines usage among physicians in Nepal

OBJECTIVE

Oncology clinical practice guidelines (OCPGs) are systematically developed evidence-based recommendations aimed to guide practitioners in decision making during the diagnosis, management, and treatment of cancer patients under specific circumstances, thereby optimizing clinical outcomes. However, little is known about the implementation of those guidelines in low and middle-income countries including Nepal. This research aimed to identify the type of OCPGs used by Nepalese physicians working in oncology departments and to explore barriers and facilitators affecting their use.

METHODS

Using the total population sampling technique, we conducted an online cross-sectional survey from June 2020 to January 2021 among physicians working in the oncology departments of Nepal. Descriptive analyses were conducted to summarize the research findings.

RESULTS

Out of 171 physicians approached for the study, 102 (59.6%) responded to the questionnaire. The sizable proportions of the participants were a senior group of physicians with 27.5% being consultants, 14.7% senior consultants, and 16.7% professors. The most commonly used guideline was the National Comprehensive Cancer Network guideline of the United States (75.5%) followed by the American Society of Clinical Oncology guideline (44.7%). While only 22.6% of physicians reported using OCPGs every time, more than half (56.9%) highlighted that OCPGs are not feasible to implement in Nepal. Insufficient facilities/equipment, physicians' unwillingness to change their usual practice, inability to discuss research with knowledgeable colleagues, and lack of time were commonly cited barriers.

CONCLUSION

Findings of our study highlighted that the OCPGs developed in high-income countries may not be feasible for low resource settings like Nepal. Comprehensive local OCPGs should be developed considering the available resources, feasibility, and financial constraints of patients. Furthermore, a constant sharing and learning environment should be created to enhance the knowledge of practicing physicians and to promote the proper implementation of evidence-based findings.

Knowledge, awareness, attitudes and screening practices towards breast and cervical cancer among women in Nepal: a scoping review

Aim

Breast and cervical cancers have emerged as major global health challenges and disproportionately affect women in low- and middle-income countries, including Nepal. This scoping review aimed to map the knowledge, attitudes and screening practices for these cancers among Nepali women to improve cancer outcomes and reduce inequality.

Methods

Five electronic databases (CINAHL, Embase, Global Health, PsycINFO and PubMed), grey literature, and reference and citation lists were searched for articles published in English up to June 2021. Articles were screened against inclusion/exclusion criteria, and data from eligible studies were extracted. Results were summarised narratively.

Results

The search yielded 615 articles, 38 of which were included in this scoping review (27 cervical cancer, 10 breast cancer, 1 both cancers). Levels of knowledge regarding breast and cervical varied widely. The main knowledge gaps were misconceptions about symptoms and risk factors, and poor understanding of screening behaviours. Screening practices were mostly inadequate due to socio-cultural, geographical or financial barriers. Positive attitudes towards cervical screening were associated with higher education and increased knowledge of screening modalities. Higher levels of knowledge, (health) literacy and participation in awareness campaigns facilitated breast cancer screening.

Conclusion

Knowledge and screening practices for breast and cervical cancer among Nepali women were poor and highlight the need for awareness and education programmes. Future research should explore community health worker-led awareness and screening interventions for cervical cancer, and programmes to increase the practice of breast self-examination and clinical breast examinations to support early diagnosis of breast cancer.