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.

Knowledge, Attitude and Preventive Practice towards Breast Cancer among Women Visiting Public Health Facility, Saudi Arabia

Background: Breast cancer is the highest burden of disease in high and low income countries and it is the leading cause of disability and death. Knowledge is important predictor of breast cancer. The objective of this study is to determine the knowledge, attitude and practice regarding breast cancer among women visiting public health facilities in Hail, Saudi Arabia. Method: It’s was a cross-sectional study in the leading public sector hospital and 127 study participants were selected through stratified random sampling technique. Validated and structured questionnaire used. Study participants who scored greater than or equal to mean valued were considered good knowledge, positive attitude and safe practice. Chi square test was used to cross tabulation between socio-demographic characteristics and knowledge, attitude and practice score. Results: Over all 18.1%, 47.2% and 52% of study participants had good knowledge, positive attitude and safe practice for prevention of breast cancer respectively. More than two third (89%) of participants were stated that breast cancer was not curable disease, more than half (67.7%) of were heard about mammogram. Only 10.2% were belief that screening was essential to breast cancer for early diagnosis. More than two third (69,9%) were not practice self breast examination and 69% were stated that fear of disease was major barrier to mammogram test. Conclusion: The knowledge level among communities member of female regarding breast cancer was in-appropriate. Majority of them were not practicing self breast examination. Health education programme through workshops and seminars will be needed to increase the awareness toward breast cancer among females.

Description of Knowledge and Behavior Levels About Breast Examination (Best Self-Examination) in Adolescent Women

Breast self-examination (BSE) is done by feeling and looking at the breast itself to see the possibility of physical changes in the breast. This process is carried out so that all changes that lead to more serious conditions can be detected early. Breasts will generally feel different during menstruation. Before and during this period, most women feel that their breasts are getting tighter and denser. Therefore, women need to do a breast self-examination (BSE) every 1 month, to find out whether there is a change in the shape of the breast from time to time. This study aims to determine the level of knowledge and behavior about breast self-examination (Aware) in young women. The research used is qualitative research using a descriptive observational study design, namely conducting in-depth interviews with 4 informants which are by the interview guidelines. Based on the results of the study, 4 respondents had been interviewed according to the addresses of their respective researchers, respondents according to the characteristics of the study. And respondents have good enough knowledge about breast self-examination (BSE), respondents also behave to check their breasts regularly after menstruation.

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.

Intersectional social-economic inequalities in breast cancer screening in India: analysis of the National Family Health Survey

Background Breast cancer incidence rates are increasing in developing countries including India. With 1.3 million new cases of cancer been diagnosed annually, breast cancer is the most common women’s cancer in India. India’s National Family Health Survey (NFHS-4) data 2015–2016 shows that only 9.8% of women between the ages of 15 and 49 had ever undergone breast examination (BE). Further, access to screening and treatment is unequally distributed, with inequalities by socio-economic status. It is unclear, however, if socio-economic inequalities in breast examination are similar across population subgroups. Methods We compared BE coverage in population sub-groups categorised by place of residence, religion, caste/tribal groups, education levels, age, marital status, and employment status in their intersection with economic status in India. We analysed data for 699,686 women aged 15–49 using the NFHS-4 data set conducted during 2015–2016. Descriptive (mean, standard errors, and confidence intervals) of women undergoing BE disaggregated by dimensions of inequality (education, caste/tribal groups, religion, place of residence) and their intersections with wealth were computed with national weights using STATA 12. Chi-square tests were performed to assess the association between socio-demographic factors and breast screening. Additionally, the World Health Organisation’s Health Equity Assessment Toolkit Plus was used to compute summary measures of inequality: Slope index for inequality (SII) and Relative Concentration Indices (RCI) for each intersecting dimension. Results BE coverage was concentrated among wealthier groups regardless of other intersecting population subgroups. Wealth-related inequalities in BE coverage were most pronounced among Christians (SII; 20.6, 95% CI: 18.5–22.7), married (SII; 14.1, 95% CI: 13.8–14.4), employed (SII: 14.6, 95%CI: 13.9, 15.3), and rural women (SII; 10.8, 95% CI: 10.5–11.1). Overall, relative summary measures (RCI) were consistent with our absolute summary measures (SII). Conclusions Breast examination coverage in India is concentrated among wealthier populations across population groups defined by place of residence, religion, age, employment, and marital status. Apart from this national analysis, subnational analyses may also help identify strategies for programme rollout and ensure equity in women’s cancer screening.