Breast cancer screening program for risk groups: facts and perspectives

ABSTRACT Objectives: to measure the frequency and compliance of breast cancer screening, according to the risk for this disease. Methods: a cross-sectional study with 950 female users of 38 public Primary Health Care services in São Paulo, between October and December 2013. According to UHS criteria, participants were grouped into high risk and standard risk, and frequency, association (p≤0.05), and screening compliance were measured. Results: 6.7% had high risk and 93.3% standard risk, respectively; in these groups, the frequency and compliance of clinical breast examination were 40.3% and 37.1%, and 43.5% and 43.0% (frequency p=0.631, compliance p=0.290). Mammograms were 67.7% and 35.5% for participants at high risk, and 57.4% and 25.4% for those at standard risk (frequency p=0.090, compliance p=0.000). Conclusions: in the groups, attendance and conformity of the clinical breast exam were similar; for mammography, it was higher in those at high risk, with assertiveness lower than the 70% set in UHS.

Conhecimento, Atitude e Prática dos Enfermeiros sobre Rastreamento do Câncer de Mama no Período Gestacional / Knowledge, Attitude and Practice of Nurses about Screening for Breast Cancer in the Pregnancy Period

Resumo: O objetivo deste artigo foi identificar o conhecimento, a atitude e a prática dos enfermeiros que atuam nas Estratégias de Saúde da Família sobre o rastreamento do câncer de mama no período gestacional. O estudo foi descritivo com abordagem quantitativa utilizou-se o inquérito Conhecimento, Atitude e Prática com 18 enfermeiros da Estratégia de Saúde da Família dos municípios de Pesqueira e Sanharó - PE. Os enfermeiros entrevistados demonstraram conhecimento adequado sobre o rastreamento do Câncer de mama. A atitude frente ao rastreamento durante o pré-natal foi considerada adequada. Com relação à prática, os enfermeiros obtiveram um resultado adequado referente às ações de detecção do câncer de mama, entretanto foi inadequado quanto à realização do exame clínico das mamas. Por fim, o pré-natal configura uma excelente oportunidade para a identificação dos fatores de risco, bem como para o rastreamento através da realização do Exame Clínico das Mamas e de estratégias de conscientização e educação em saúde.---Abstract: The aim of this article was to identify the knowledge, attitude and practice of nurses working in Family Health Strategies on breast cancer screening during pregnancy. The study was descriptive with a quantitative approach, using the Knowledge, Attitude and Practice survey with 18 nurses from the Family Health Strategy in the municipalities of Pesqueira and Sanharó - PE. The nurses interviewed demonstrated adequate knowledge about breast cancer screening. The attitude towards screening during prenatal care was considered adequate. With regard to practice, nurses obtained an adequate result regarding the actions to detect breast cancer, however, it was inadequate in terms of the clinical examination of the breasts. Finally, prenatal care is an excellent opportunity to identify risk factors, as well as for screening through the performance of the Clinical Breast Examination and health awareness and education strategies.

ARE WE DOING ENOUGH IN PROMOTING BREAST CANCER SCREENING: AN EVALUATION OF MALAYSIA BREAST CANCER SCREENING PROGRAM

Breast cancer is the most common cancer affecting women globally. Several ways of breast cancer screening tools are available. This study aims to evaluate Malaysia's breast cancer screening program using the national database based on participation and performance indicators for the past five years. A retrospective cumulative analysis of clinical breast examination and mammogram screening services were performed using the national dataset of 2016-2020 obtained from the Health Informatics Centres, Ministry of Health Malaysia. The performance indicator represents the percentage of breast abnormality detected during clinical breast examination and the proportion of confirmed cancer through mammogram screening. A reduction in the participation rate for clinical breast examination was noted from 2016 (25.8%) to 2020(25.1%). However, a high participation rate in 2019 (29.1%) was noted following active health promotion intervention. The rate of high-risk women who underwent mammogram screening fluctuated by years according to active breast awareness campaign. The average rate of confirmed breast cancer annually was 0.7% and was noted highest in 2020 (1.17%). Improving early diagnosis is an eminent strategy for cancer control in all settings, including strengthening health systems and providing universal health coverage. Successful breast cancer prevention and control programs require intersectoral planning and active community participation. Ensuring sustainability and accessibility of breast cancer screening programs is highly needed. Fostering good collaborative multiagency partnership and community participation for the cancer control program urges an innovative approach through a policy formulation.

Breast cancer awareness and downstaging practices among adult women in the Gulu City Main Market, Northern Uganda: A cross-sectional study

Background: Breast cancer (BC) is one of the most common cancers that occur worldwide among women. There were more disability-adjusted life years (DALYs) lost to breast cancer among women worldwide than any other cancers, and DALYs occurred in women globally after puberty, with increasing rates later in life. Improvements in breast cancer survival began in the 1980s in countries where early detection programs combined with different modes of treatment to eradicate the invasive form of the disease were practiced. Recent data showed that there was a higher prevalence of breast cancer among women in Northern Uganda than among women in the rest of Uganda.The objective of this study was to determine factors associated with breast cancer awareness, breast self-examination (BSE), clinical breast examination (CBE), and other modalities for screening and early breast cancer detection among adult women in the Gulu main market.Methods: A cross-sectional study was conducted in the Gulu main market in 2020. A total of 98 adult women were recruited for the study by a random sampling method. The questionnaire had an internal validity of Cronbach’s α=0.72. The study was approved by a local IRB. SPSS version 26.0 was used for data analysis, and a p-value less than 0.05 was considered significant.Results: Most participants were 20-29 years 41(41.8%), married 44(44.9%), monthly incomes of >UGX1 million shillings 51(52.2%), Acholi 81(82.7%), Catholics 46(46.9%), vendors 75(76.5%), duration of work in the market (1-10 years) 64(65.4%), primary level of education 39(39.8%), and had 1-2 pregnancies 37(37.8%). The independent factors associated with breast cancer awareness, breast self-examination, and clinical breast examination were vendor (primary occupation) (β=-0.130, t=-2.979, p<0.004), duration of work in the market (1-10 years) (β=-0.186, t=-2.452, p<0.016), and higher level of education (β=-0.091, t=-2.506, p<0.014).Conclusions: Breast cancer awareness and downstaging practices in adult women in the Gulu main market were thought-provoking. Women with better socioeconomic status (higher education, moderate work duration in the market and primarily vendors) in the Gulu main market were more likely aware and practiced breast cancer downstaging activities. There is a need to strengthen publicity on breast cancer-related knowledge for lower-income occupational groups and those with lower education levels to better understand the importance of conducting BSE, CBE, and mammography for early breast cancer detection.

The randomized trial of mammography screening that was not—A cautionary tale

Two randomized trials were conducted in Canada in the 1980s to test the efficacy of breast cancer screening. Neither of the trials demonstrated benefit. Concerns were raised regarding serious errors in trial design and conduct. Here we describe the conditions that could allow subversion of randomization to occur and the inclusion of many symptomatic women in a screening trial. We examine anomalies in data where the balance would be expected between trial arms. “Open book” randomization and performance of clinical breast examination on all women before allocation to a trial arm allowed women with palpable findings to be mis-randomized into the mammography arm. Multiple indicators raising suspicion of subversion are present including a large excess in poor-prognosis cancers in the mammography trial arm at prevalence screen. Personnel described shifting of women from the control group into the mammography group. There is compelling evidence of subversion of randomization in Canadian National Breast Screening Study. Mis-randomization of even a few women with advanced breast cancer could markedly affect measured screening efficacy. The Canadian National Breast Screening Study trials should not influence breast screening policies.

Breast Cancer Screening in Semi-Rural Malaysia: Utilisation and Barriers

Breast cancer (BC) is the commonest cancer in Malaysia. Delayed diagnosis is a significant cause of BC mortality in the country. Early diagnosis and screening are vital strategies in mortality reduction. This study assessed the level of utilisation and barriers for breast self-examination (BSE), clinical breast examination (CBE) and mammogram in a semi-rural population in Malaysia and compared these across the different ethnic groups. This cross-sectional study was conducted among women aged 40 years and above, embedded within a health and demographic surveillance site (HDSS) in Segamat, Malaysia. Trained data collectors collected data on screening and barriers during home visits. Study participants (n = 250) were aged 59.4 ± 10.9 years and represented Malaysia’s three major ethnic groups. Practice of regular BSE, CBE uptake (ever) and mammogram (ever) was 23.2%, 36% and 22.4%, respectively. Regular BSE practice was highest in the Malay ethnic group and least among the Chinese. Regular CBE was very low in all ethnic groups (<5%). Mammogram uptake was highest among Chinese (34.4%), followed by Indians (30.4%) and Malays (16.6%). After adjusting for other socio-demographic variables, Malay ethnicity was positively associated with regular BSE (adjusted OR = 5.26, 95% CI 2.05, 13.50) and negatively associated with having had a mammogram (adjusted OR = 0.3, 95% CI 0.15, 0.57). Lower education was negatively associated (adjusted OR = 0.36, 95% CI 0.17, 0.74) with mammogram attendance (ever). Emotional and financial barriers were the most reported types of barriers, specifically, fear of diagnosis (74.8%), cost of diagnosis (69.6%) and fear of losing a breast (66.4%). Malay women more commonly reported most barriers compared to other ethnic groups. Screening uptake was low among semi-rural women in Malaysia. Implementing culturally appropriate interventions that consider ethnic differences is crucial to empowering women to engage in BC screening initiatives in these communities.

MRI in the Setting of Neoadjuvant Treatment of Breast Cancer

Neoadjuvant therapy may reduce tumor burden preoperatively, allowing breast conservation treatment for tumors previously unresectable or requiring mastectomy without reducing disease-free survival. Oncologists can also use the response of the tumor to neoadjuvant chemotherapy (NAC) to identify treatment likely to be successful against any unknown potential distant metastasis. Accurate preoperative estimations of tumor size are necessary to guide appropriate treatment with minimal delays and can provide prognostic information. Clinical breast examination and mammography are inaccurate methods for measuring tumor size after NAC and can over- and underestimate residual disease. While US is commonly used to measure changes in tumor size during NAC due to its availability and low cost, MRI remains more accurate and simultaneously images the entire breast and axilla. No method is sufficiently accurate at predicting complete pathological response that would obviate the need for surgery. Diffusion-weighted MRI, MR spectroscopy, and MRI-based radiomics are emerging fields that potentially increase the predictive accuracy of tumor response to NAC.

Knowledge and Practice of Breast Cancer and Its Screening Methods among Girls Attending an Engineering College in Ahmednagar

The rising incidence rate of breast cancer at a younger age is an alarming sign that future mothers will need to be empowered to recognise breast cancer warning symptoms at an early stage. Aim and Objectives: To assess the knowledge and practice breast cancer and its screening methods, to determine the relationship between knowledge and practice, and its association with demographic variables among engineering girls. Method: Quantitative research approach with cross sectional study conducted at engineering College of Ahmednagar, 100 engineering girls of various branches participated in the study. Responses were recorded on a pretested questionnaire and self-reported practices through online mode and participants were agreed to participate in the study. Knowledge aspects consisted general information of breast cancer, risk factors and signs and symptoms, whereas self-reported practice for breast self-examination, clinical breast examination and mammography. Data was analysed with mean, SD, Chi Square test and Karl Pearson Co-efficient correlation. Result: Mean age of participants was 21 years. Maximum girls from 34% Information and Technology and 25% Electronics and Telecommunication. Maximum engineering girls had good 62% to average 22% and 16 % poor knowledge. Majority 63% had poor and 36 % average breast cancer screening practices measures. Poor practices for breast self-examination followed by clinical breast examination and mammography. Knowledge was directly associated with education of mothers and Source of information is associated with practises with a significance level of p < 0.05. Knowledge and practises had a positive correlation of “r” =.270. Conclusion: engineering girls had average knowledge and poor practices of breast cancer screening measures. Knowledge was directly associated with education of mothers and source of information were significantly associated with practices. Future mothers should be empowered through hands on training for breast self-examination and enhanced BSE and CBE will help for early detection for breast cancer among younger girls in future.