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Daniel S, Venkateswaran C, Singh C, Hutchinson A, Johnson MJ. "So, when a woman becomes ill, the total structure of the family is affected, they can't do anything…" Voices from the community on women with breast cancer in India: a qualitative focus group study. Support Care Cancer 2021; 30:951-963. [PMID: 34420101 PMCID: PMC8636417 DOI: 10.1007/s00520-021-06475-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/27/2021] [Indexed: 11/30/2022]
Abstract
Background Psychological symptoms are common in women with breast cancer and profoundly affect their role in the family and wider community, varying across cultural backgrounds. Breast cancer is becoming the most common cancer among women in India. We aimed to understand the cultural context within which Indian women with breast cancer living in India, experience psychological concerns from the perspectives of healthcare professionals, volunteers and church members. Methods Five focus groups were conducted in South India (clinicians (2 groups)) lay public (3 groups). A topic guide was explored: understanding of breast cancer, experiences of patients with regard to diagnosis and treatment and psychological impact. Groups were audio-recorded and verbatim transcribed. Lay groups were conducted in Malayalam with translation and back-translation. Transcripts were subjected to thematic analysis using “cultural task analysis” as a lens for analysis. Results Forty-five (oncologists (5), nurses (10), church members (16) and community volunteers working in a palliative care unit (14) participated. Three major themes psychosocial issues related to diagnosis, psychosocial impact of cancer treatment and coping with diagnosis and treatment and nine subthemes emerged from the two groups. All described psychological impact on women with breast cancer including body image, change of family role and their need for support. Family and faith were recognised as the major framework providing key support but also significant stress. Clinicians were also concerned about financial implications and issues around early cancer detection. Laypeople and nurses also commented that poor communication and lack of empathy from doctors aggravated distress. Conclusion Clinical and lay communities were aware of the widespread psychological impact affecting women with breast cancer which are amplified by the patriarchal context within which they live, which extends into clinical practice. Family and faith provide a strong support structure and are a cause of distress, as core roles and expectations are challenged by this disease of womanhood.
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Affiliation(s)
- Sunitha Daniel
- General Hospital, Ernakulam, Kochi, India. .,Wolfson Palliative Care Research Centre, University of Hull, Hull, HU6 7RX, UK.
| | - Chitra Venkateswaran
- Department of Psychiatry, Palliative Care and Psycho Oncology, Believers Church Medical College, Thiruvalla, Kerala, India
| | - Charu Singh
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Ann Hutchinson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, HU6 7RX, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, HU6 7RX, UK
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Kassie AM, Abate BB, Kassaw MW, Shiferaw WS. Breast Self-Examination Practice Among Female University Students in Ethiopia: A Systematic Review and Meta-Analysis. Cancer Control 2021; 28:10732748211019137. [PMID: 34169755 PMCID: PMC8236787 DOI: 10.1177/10732748211019137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Breast self-examination (BSE) is one of the most feasible methods of screening for early stages of breast cancer. However, the practice rate is insufficient in many low and middle-income countries including Ethiopia. Hence, this study aimed to estimate the pooled prevalence of BSE practice among female university students in Ethiopia. Methods: PubMed, Cochrane Library, Scopus, and Google Scholar were searched for studies that assessed BSE practice among female students in Ethiopian universities. The study included articles published from January 1st, 2010 to June 16th, 2020. The Cochran’s Q chi-square and the respective I2 test statistics were used to check heterogeneity among the included studies. To assess publication biases, the funnel plot and Egger’s regression tests were employed. Subgroup analysis was done by using different characteristics of studies. Sensitivity analysis was also run to assess the effect of a single study on the pooled outcome. STATA™ Version 14 software packages were employed for data analysis. Results: Sixteen (n = 16) studies with 5,743 participants were included to estimate the pooled prevalence of BSE practice. The prevalence of regular BSE practice reported in the studies ranges from 0% to 26.4%. The estimated pooled prevalence of regular BSE practice among university students in Ethiopia is 11.23% which is very low. The prevalence of BSE practice was high, 13.6% in studies published before 2015, 12.0% among health science students, and 12.6% in studies with a sample size of 384 participants and above. In addition, the estimated pooled prevalence of irregular self-breast-examination practice was 33.28%. Conclusion: The rate of BSE practice among female university students is low. Thus, awareness strategies need to be designed to increase the practice rate among women in the country as BSE is one of the most feasible strategies in early detection of breast cancer if properly implemented.
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Affiliation(s)
- Ayelign Mengesha Kassie
- Department of Nursing, College of Health Sciences, 487515Woldia University, Woldia, Ethiopia
| | - Biruk Beletew Abate
- Department of Nursing, College of Health Sciences, 487515Woldia University, Woldia, Ethiopia
| | - Mesfin Wudu Kassaw
- Department of Nursing, College of Health Sciences, 487515Woldia University, Woldia, Ethiopia
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Barriers to mammography screening among racial and ethnic minority women. Soc Sci Med 2019; 239:112494. [PMID: 31513931 DOI: 10.1016/j.socscimed.2019.112494] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 07/04/2019] [Accepted: 08/13/2019] [Indexed: 11/21/2022]
Abstract
RATIONALE Breast cancer is the second leading cause of cancer death among women. Disparities in breast cancer mortality rates adversely affect racial/ethnic minority women. Mammography screening is the most effective early detection method and means of reducing mortality rates. Yet, barriers prevent racial/ethnic minority women from participating in regular screening. OBJECTIVE This review aimed to summarize self-reported barriers to mammography screening in racial/ethnic minority women in studies using open-ended assessments and closed-ended assessments. METHOD Literature searches were conducted in two databases, PsycINFO and PubMed. Barriers were detailed in full by barrier type (psychological/knowledge-related, logistical, cultural/immigration-related, and social/interpersonal) and summarized briefly by race/ethnicity (African American/Black, Asian/Pacific Islander, Hispanic, American Indian/Native American, and Middle Eastern). RESULTS Twenty-two open-ended and six closed-ended studies were identified as eligible for this review. Overall, racial/ethnic minority women identified common logistical and psychological/knowledge-related barriers. Additionally, women reported cultural/immigration-related and social/interpersonal barriers that were closely tied to their racial/ethnic identities. CONCLUSIONS It was concluded that cultural/immigration-related barriers may be the only barrier type that is unique to racial/ethnic minority women. Thus, designing studies of barriers around race and ethnicity is not always appropriate, and other demographic factors are sometimes a more important focus. The variability in 'barrier' definitions, how data were collected and reported, and the appropriateness of closed-ended measures were also examined. This literature may benefit from detailed and strategically designed studies that allow more clear-cut conclusions and better comparison across studies as well as improving closed-ended measures by incorporating insights from investigations using open-ended inquiry.
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Haileselassie W, Mulugeta T, Tigeneh W, Kaba M, Labisso WL. The Situation of Cancer Treatment in Ethiopia: Challenges and Opportunities. J Cancer Prev 2019; 24:33-42. [PMID: 30993093 PMCID: PMC6453587 DOI: 10.15430/jcp.2019.24.1.33] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 01/09/2023] Open
Abstract
Background Less attention is given to cancer treatment and control in Ethiopia. Methods To investigate the challenges and opportunities facing cancer treatment services in Ethiopia. A purposive sampling technique was applied to recruit the study subjects from Black Lion Specialized Hospital Oncology Department. A semi-structured interview guide was used to investigate challenges and opportunities in oncology service in Ethiopia. Data was transcribed and coded by two independent coders and analyzed thematically in reference to the objectives. Results Fifteen professionals from four different disciplines were interviewed on opportunities and challenges facing cancer treatment in Ethiopia. Out of these respondents 3 were senior clinical oncologists while 4 individuals were senior oncology residents. The rest were 2 medical Physicists, 2 radiotherapy technologists and 4 oncology nurses. Majority (80%) of the respondents were males. We demonstrate that the challenges of cancer treatment service in Ethiopia emanate from the patients themselves, the administrating body, the professionals, and the technology limitations. In general, the result of this study was grouped under the following five themes: Customer-related challenges, provider-related challenges, facility-related challenges, technology-related challenges and the opportunities. Conclusions Several assignments are waiting for the policy makers, the professionals, the communities and other concerned bodies to combat the alarmingly growing burden of cancer in Ethiopia. Escalating the awareness of the general population about cancer, expanding well-developed diagnostic and treatment centers, and producing well-trained competent oncology professionals are the forefront challenges in combating cancer in Ethiopia.
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Affiliation(s)
- Werissaw Haileselassie
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tefera Mulugeta
- Department of Nursing and Midwifery, School of Allied Health Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondemagegnhu Tigeneh
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mirgissa Kaba
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wajana Lako Labisso
- Department of Pathology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Raithatha SJ, Mangalampalli A, Patel M, Kumar D, Tapadiya M. Comparison of two training techniques (mannequin versus flip-chart presentation) of breast self examination of rural women: An interventional study. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Salek R, Shahidsales S, Mozafari V. Changing pattern in the clinical presentation of breast cancer in the absence of a screening program over a period of thirty-three years in Iran. Breast 2016; 28:95-9. [PMID: 27262825 DOI: 10.1016/j.breast.2016.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/06/2016] [Accepted: 05/11/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To survey the proportion of stages at the presentation of the disease without a screening program, among a population of breast cancer patients that is as a representative sample of the country in a distinct period. MATERIALS AND METHODS The population of the current study is found among the female breast cancer patients who were referred to oncology centers in northeastern Iran over a thirty-three-year period from 1980 to 2012. RESULTS Four thousand patients were divided into three time periods consisting of 521 cases from 1980 to 1990, 1178 cases from 1991 to 2001, and 2302 cases from 2002 to 2012. While there was no difference in the proportions of T1 and T3 tumors, T2 tumors showed an increase (P = 0.001) and T4 tumors a decrease (P = 0.000) during these periods. There was no change in the proportion of stage I, however the proportion of stage II had risen (P = 0.000), while that of stage III (P = 0.002), and stage IV (P = 0.000) had fallen. The study's urban and rural populations experienced a similar trend in this respect, with the exception that the rural population exhibited more striking changes during the study's recent years. CONCLUSION After a thirty-three-year follow up on breast cancer in northeastern Iran, it is obvious that this disease is now presented in its earlier stages even in the absence of a screening program. In spite of this, the proportion of T1 disease and those tumors are discovered by a screening program has not significantly changed.
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Affiliation(s)
- Roham Salek
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Madkhali NA, Santin O, Noble H, Reid J. Understanding breast health awareness in an Arabic culture: qualitative study protocol. J Adv Nurs 2016; 72:2226-37. [PMID: 27095563 DOI: 10.1111/jan.12979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 11/28/2022]
Abstract
AIM To explore breast health awareness and the early diagnosis and detection methods of breast cancer from the perspective of women and primary healthcare providers in the Jizan region of the Kingdom of Saudi Arabia. BACKGROUND Although there is a high incidence of advanced breast cancer in young women in the Kingdom of Saudi Arabia, there is no standardized information about breast self-examination, or is there a national screening programme involving clinical breast examination and mammography available. DESIGN Qualitative exploratory study. METHODS Data collection will consist of 36 face-to-face semi-structured interviews: 12 with general practitioners; 12 with nurses at primary healthcare centres and with 12 women who attend the health centres. This study will be carried out in eight states across the Jizan region (four rural and four urban) to reflect the cultural diversity of Jizan. The data will be analysed using thematic content analysis. Research Ethics Committee approval was obtained in June 2015. DISCUSSION While we understand the enablers and barriers to breast health awareness outside of Saudi culture, in the Kingdom of Saudi Arabia, particularly in rural populations such as Jizan, there is a lack of research. This study will add positively to the international knowledge base of this topic. The findings will give evidence and inform policy about women and healthcare providers' experiences in Jizan, in a society where such topics are taboo.
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Affiliation(s)
| | - Olinda Santin
- School of Nursing and Midwifery, Queens University Belfast, Medical Biology Centre, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queens University Belfast, Medical Biology Centre, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queens University Belfast, Medical Biology Centre, UK
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Motawi TMK, Sadik NAH, Shaker OG, El Masry MR, Mohareb F. Study of microRNAs-21/221 as potential breast cancer biomarkers in Egyptian women. Gene 2016; 590:210-9. [PMID: 26827795 DOI: 10.1016/j.gene.2016.01.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 01/11/2016] [Accepted: 01/20/2016] [Indexed: 12/19/2022]
Abstract
microRNAs (miRNAs) play an important role in cancer prognosis. They are small molecules, approximately 17-25 nucleotides in length, and their high stability in human serum supports their use as novel diagnostic biomarkers of cancer and other pathological conditions. In this study, we analyzed the expression patterns of miR-21 and miR-221 in the serum from a total of 100 Egyptian female subjects with breast cancer, fibroadenoma, and healthy control subjects. Using microarray-based expression profiling followed by real-time polymerase chain reaction validation, we compared the levels of the two circulating miRNAs in the serum of patients with breast cancer (n=50), fibroadenoma (n=25), and healthy controls (n=25). The miRNA SNORD68 was chosen as the housekeeping endogenous control. We found that the serum levels of miR-21 and miR-221 were significantly overexpressed in breast cancer patients compared to normal controls and fibroadenoma patients. Receiver Operating Characteristic (ROC) curve analysis revealed that miR-21 has greater potential in discriminating between breast cancer patients and the control group, while miR-221 has greater potential in discriminating between breast cancer and fibroadenoma patients. Classification models using k-Nearest Neighbor (kNN), Naïve Bayes (NB), and Random Forests (RF) were developed using expression levels of both miR-21 and miR-221. Best classification performance was achieved by NB Classification models, reaching 91% of correct classification. Furthermore, relative miR-221 expression was associated with histological tumor grades. Therefore, it may be concluded that both miR-21 and miR-221 can be used to differentiate between breast cancer patients and healthy controls, but that the diagnostic accuracy of serum miR-21 is superior to miR-221 for breast cancer prediction. miR-221 has more diagnostic power in discriminating between breast cancer and fibroadenoma patients. The overexpression of miR-221 has been associated with the breast cancer grade. We also demonstrated that the combined expression of miR-21 and miR-221can be successfully applied as breast cancer biomarkers.
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Affiliation(s)
| | | | - Olfat Gamil Shaker
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Egypt
| | - Maha Rafik El Masry
- Biochemistry Department, Faculty of Dentistry, October University for Modern Sciences & Arts (MSA), Giza, Egypt
| | - Fady Mohareb
- The Bioinformatics Group, School of Energy, Environment and AgriFood, Cranfield University, Bedford MK43 0AL, UK
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Dey S. Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal. World J Clin Oncol 2014; 5:509-519. [PMID: 25114864 PMCID: PMC4127620 DOI: 10.5306/wjco.v5.i3.509] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/27/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
To review the present status of breast cancer (BC) screening/early detection in low- and middle-income countries (LMICs) and identify the way forward, an open focused search for articles was undertaken in PubMed, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on ResearchGate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer (BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. Notably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of mHealth for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.
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Mahfouz AA, Hassanein MHA, Nahar S, Farheen A, Gaballah II, Mohamed A, Rabie FM, Aftab R. Breast cancer knowledge and related behaviors among women in Abha City, southwestern Saudi Arabia. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:516-20. [PMID: 23797712 DOI: 10.1007/s13187-013-0495-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Breast cancer is the most common malignancy among women in Saudi Arabia. A cross-sectional study was conducted on 1,092 women attending urban primary health care centers in Abha City southwestern Saudi Arabia about breast cancer knowledge, attitudes, and related practices. Only 22.0% heard about mammography, and 41.5% heard about breast self-examination (BSE). More than half of the women in the study identified changes occurring in case of breast cancer and identified risk factors. Only 8.3% were examined by clinical breast examination (CBE), 6.2% were examined by mammography, and 29.7% performed BSE. The study points to the insufficient knowledge of women and the low practice of BSE, CBE, and mammography. Public awareness should be enhanced by all available means including mass media, schools, social gatherings, and waiting areas in primary health care centers. There is an urgent need for continuing medical education programs for health care workers in the region concerning breast cancer.
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Affiliation(s)
- Ahmed A Mahfouz
- Department of Family & Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia.
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Bhikoo R, Srinivasa S, Yu TC, Moss D, Hill AG. Systematic review of breast cancer biology in developing countries (part 1): Africa, the middle East, eastern europe, Mexico, the Caribbean and South america. Cancers (Basel) 2011; 3:2358-81. [PMID: 24212814 PMCID: PMC3757422 DOI: 10.3390/cancers3022358] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 03/21/2011] [Accepted: 04/14/2011] [Indexed: 11/16/2022] Open
Abstract
There has been no systematic appraisal of ethnicity-based variations in breast cancer (BC) biology amongst women from developing countries. A qualitative systematic review was conducted of breast cancer size, stage, grade, histological type, extra-mammary involvement, hormone receptor status as well as patient demographics. This review includes patients from Africa, the Middle East, Eastern Europe, Mexico, the Caribbean and South America. BC in these regions present at an earlier age with large aggressive tumours. Distant metastases are frequently present at the time of diagnosis. African women have a higher frequency of triple negative tumours. Over half of Middle Eastern women have lymph node involvement at the time of diagnosis. Despite experiencing a lower incidence compared to the Ashkenazi Jewish population, Palestinian women have poorer five-year survival outcomes. The majority of women from Mexico and South America have stage two or three disease whilst over sixty percent of women from Eastern Europe have either stage one or stage two disease. The biological characteristics of BC in the Caribbean cannot be fully assessed due to a paucity of data from the region. BC amongst the developing world is characterised by an early peak age of onset with aggressive biological characteristics. Strategies that improve breast cancer awareness, address amenable risk factors and improve early detection are essential.
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Affiliation(s)
- Riyaz Bhikoo
- Department of Surgery, South Auckland Clinical School, University of Auckland, Auckland 1640, New Zealand; E-Mails: (S.S.); (T.-C.Y.); (A.G.H.)
| | - Sanket Srinivasa
- Department of Surgery, South Auckland Clinical School, University of Auckland, Auckland 1640, New Zealand; E-Mails: (S.S.); (T.-C.Y.); (A.G.H.)
| | - Tzu-Chieh Yu
- Department of Surgery, South Auckland Clinical School, University of Auckland, Auckland 1640, New Zealand; E-Mails: (S.S.); (T.-C.Y.); (A.G.H.)
| | - David Moss
- Department of Surgery, Middlemore Hospital, Auckland 1640, New Zealand; E-Mail: (D.M.)
| | - Andrew G Hill
- Department of Surgery, South Auckland Clinical School, University of Auckland, Auckland 1640, New Zealand; E-Mails: (S.S.); (T.-C.Y.); (A.G.H.)
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Breast cancer in low- and middle-income countries: an emerging and challenging epidemic. JOURNAL OF ONCOLOGY 2010; 2010:490631. [PMID: 21209708 PMCID: PMC3010663 DOI: 10.1155/2010/490631] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 11/13/2010] [Indexed: 11/22/2022]
Abstract
Breast cancer is a major health care problem that affects more than one million women yearly. While it is traditionally thought of as a disease of the industrialized world, around 45% of breast cancer cases and 55% of breast cancer deaths occur in low and middle income countries. Managing breast cancer in low income countries poses a different set of challenges including access to screening, stage at presentation, adequacy of management and availability of therapeutic interventions. In this paper, we will review the challenges faced in the management of breast cancer in low and middle income countries.
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Wadler BM, Judge CM, Prout M, Allen JD, Geller AC. Improving Breast Cancer Control via the Use of Community Health Workers in South Africa: A Critical Review. JOURNAL OF ONCOLOGY 2010; 2011:150423. [PMID: 20936151 PMCID: PMC2948888 DOI: 10.1155/2011/150423] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 08/23/2010] [Indexed: 12/21/2022]
Abstract
Breast cancer is a growing concern in low- and middle-income countries (LMCs). We explore community health worker (CHW) programs and describe their potential use in LMCs. We use South Africa as an example of how CHWs could improve access to breast health care because of its middle-income status, existing cancer centers, and history of CHW programs. CHWs could assume three main roles along the cancer control continuum: health education, screening, and patient navigation. By raising awareness about breast cancer through education, women are more likely to undergo screening. Many more women can be screened resulting in earlier-stage disease if CHWs are trained to perform clinical breast exams. As patient navigators, CHWs can guide women through the screening and treatment process. It is suggested that these roles be combined within existing CHW programs to maximize resources and improve breast cancer outcomes in LMCs.
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Affiliation(s)
- Brianna M. Wadler
- Division of Public Health Practice, Harvard School of Public Health, 677 Huntington Avenue, Landmark 3rd Floor East, Boston, MA 02115, USA
| | - Christine M. Judge
- Division of Public Health Practice, Harvard School of Public Health, 677 Huntington Avenue, Landmark 3rd Floor East, Boston, MA 02115, USA
| | - Marianne Prout
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Talbot Building, Boston, MA 02118, USA
| | - Jennifer D. Allen
- Center for Community-Based Research, Cantor Center for Nursing Research and Patient Care Services, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA
| | - Alan C. Geller
- Division of Public Health Practice, Harvard School of Public Health, 677 Huntington Avenue, Landmark 3rd Floor East, Boston, MA 02115, USA
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