Barriers and Facilitators to Integrating Clinical Breast Examinations With Cervical Cancer Screening Programs in Outpatient Clinics in Western Kenya

PURPOSE Nearly half of Kenyan women with breast cancer present with advanced disease—owing partially to limited patient education and screening limitations in low- and middle-income countries. With increasing access to nurse-led cervical cancer screening (CCS) in government clinics in Kenya, we investigated provider-perceived barriers and facilitators to integrating clinical breast examinations (CBEs) with ongoing CCS programs in Kisumu County, Kenya. METHODS CCS providers within the Ministry of Health Clinics in Kisumu County, Kenya, were recruited to participate in a two-phase, sequential, mixed methods study. Knowledge of CBE guidelines was assessed with a questionnaire. Providers with significant CCS and CBE experience then completed a one-on-one interview discussing barriers and facilitators to integration. RESULTS Sixty-nine providers from 20 randomly selected facilities participated in the survey. Providers all agreed that breast cancer screening was very important. Although 93% said that they routinely offered CBEs, only 22% of these providers screened at least eight of their last 10 patients. Forty-four percent identified four or more of five signs and symptoms of breast cancer, and 33% identified four to five risk factors. Although providers showed enthusiasm for integration of CBEs into their practices, barriers were identified and grouped into four themes: (1) fragmentation of services, (2) staffing shortage and inadequate on-the-job training, (3) limited space and referral system challenges, and (4) limited patient awareness on need for cancer screening. CONCLUSION Addressing providers' concerns by providing routine on-the-job clinical training, improving staffing shortages, strengthening the diagnostic and treatment referral pathway, and increasing patient education are some of the first steps in facilitating integration of CBEs with CCS services in primary care clinics in Kenya.

THE RELATIONSHIP OF CLASS II ADOLESCENT GIRLS KNOWLEDGE ABOUT BREAST CANCER WITH ATTITUDES TO CONDUCT CLINICAL BREAST EXAMINATIONS (CBE) AT SMA N 8 BATAM CITY

In Indonesia, the morbidity rate caused by cancer is still high. Cancer can attack all levels of society regardless of social status, age and gender. According to Mardiana (2010), it is estimated that around 60% of cancer patients are women, especially in vital organs such as the breasts and other organs such as the uterus, ovaries and vagina. Awareness of the importance of understanding what and how breast cancer is very important for early adolescents so that adolescents can detect breast cancer early, detecting breast cancer can be done at health service centers, namely through Clinical Breast Examinations (CBE). This study aims to determine the relationship between knowledge of young women about breast cancer with attitudes to perform Clinical Breast Examinations (CBE). This research is a descriptive study with a cross sectional approach, the sample was taken by accidental sampling technique with a sample of 150 people. The results of the study most of the respondents had poor knowledge about CBE examination, from the results of the Chi-square test, the p value of 0.980 was greater than the p table, which was 0.5, meaning that there was no relationship between the knowledge of young women and the attitude to carry out Clinical Breast Examinations (CBE). The conclusion from the results of the study is that the majority of good knowledge have attitudes in the strong category (30.6%), have good knowledge and have moderate attitudes (9.0%), lack knowledge and have attitudes in the strong category (6.5%), and lack of knowledge has an attitude in the medium category (13.9%).

ASSESSING BREAST DISORDERS AND FEASIBILITY OF BREAST-I LED MACHINE AMONG WOMEN OF RURAL AREA OF CHANDIGARH, INDIA

Background: Breast cancer is the most common cancer in India causing highest cancer deaths in India as per GLOBOCAN 2018. Early diagnosis and treatment helps in improving prognosis and prolonging life. BREAST-i LED machine is one of the technology, for screening breast cancer at early stage. The present study was undertaken to evaluate the feasibility of BREAST-i LED machine to screen breast cancer. Methods: Across-sectional study was conducted on 300 convenient selected women in the age group of 30-60 years. Data was collected by house-to-house survey and all the women in surveyed house were registered for the study. They were interviewed as per the interview schedule comprised of a) Socio-demographic profile b) reproductive profile c) cancer related history and sign/symptoms. . By using BREAST-i LED machine the breast examination was done and the clinical breast examination was done there after to screen any sign of breast cancer. Identified cases were referred for confirmation of diagnosis. The data entry and analysis was done on SPSS (version 20). Results: The majority of the participants were between the age of 40-50years (42%) and majority of them (89.33%) began their menstruation between the age of 11-15 years. More than half (53.66%) had their first pregnancy between the age of 21-30years More than half (58%) had not attained their menopause and 99.3% had no family history of breast cancer. A high level of suspicion of breast cancer using Breast-i-LED instrument was found among four women (1.33%). Same results were observed by clinical breast examinations as well. These women were referred for further confirmation of diagnosis. Conclusion: BREAST-i LED machine can be used in community for quick screening of suspicion of breast cancer.

Major failings of trial procedures and quality of screening fatally compromise the results of the Canadian National Breast Screening Studies

Despite overwhelming evidence of a major reduction in deaths, the debate about the efficacy of breast cancer screening has continued for over 50 years. The poor results in the Canadian National Breast Screening Studies (CNBSS) have been used to challenge the benefits shown by the other randomized, controlled trials. They continue to be used in assessing the value of breast cancer screening despite their unblinded allocation process, which first identified women with breast abnormalities and then assigned them on open lists allowing for nonrandom assignment, compromising the trials and rendering their results unreliable. There were, statistically significantly, more women with advanced cancers who were assigned to the screening arm in CNBSS1. The early results for CNBSS1 showed an excess of women dying in the screening arm, and an (otherwise inexplicable) greater than 90%, 5-year survival for the control women. The failure of random assignment also explains why the clinically evident cancers were larger in the screening arms than the cancers in the “usual care” arms, despite the fact that the screened women underwent very intense clinical breast examinations each year by highly skilled examiners. The claim that balanced demographic factors prove random assignment is also false. Nonrandom allocation of a hundred or more women with clinically evident abnormalities would have no detectable influence on the distribution of demographic factors. In summary, policy decisions about mammography should not be influenced by the results of the CNBSS.

Impact of Community-Based Clinical Breast Examinations in Botswana

PURPOSE We evaluated a clinical breast examination (CBE) screening program to determine the prevalence of breast abnormalities, number examined per cancer diagnosis, and clinical resources required for these diagnoses in a middle-income African setting. METHODS We performed a retrospective review of a CBE screening program (2015-2018) by Journey of Hope Botswana, a Botswana-based nongovernmental organization (NGO). Symptomatic and asymptomatic women were invited to attend. Screening events were held in communities throughout rural and periurban Botswana, with CBEs performed by volunteer nurses. Individuals who screened positive were referred to a private tertiary facility and were followed by the NGO. Data were obtained from NGO records. RESULTS Of 6,120 screened women (50 men excluded), 452 (7.4%) presented with a symptom and 357 (5.83%) were referred for further evaluation; 257 ultrasounds, 100 fine-needle aspirations (FNAs), 58 mammograms, and 31 biopsies were performed. In total, 6,031 were exonerated from cancer, 78 were lost to follow-up (67 for ≤ 50 years and 11 for > 50 years), and 11 were diagnosed with cancer (five for 41-50 years and six for > 50 years, 10 presented with symptoms). Overall breast cancer prevalence was calculated to be 18/10,000 (95% CI, 8 to 29/10,000). The number of women examined per breast cancer diagnosis was 237 (95% CI, 126 to 1910) for women of age 41-50 years and 196 (95% CI, 109 to 977) for women of age > 50 years. Median time to diagnosis for all women was 17.5 [1 to 32.5] days. CBE-detected tumors were not different than tumors presenting through standard care. CONCLUSION In a previously unscreened population, yield from community-based CBE screening was high, particularly among symptomatic women, and required modest diagnostic resources. This strategy has potential to reduce breast cancer mortality.

An Affordable and Portable Palpable System for Sensing Breast Tissue Abnormalities

Due to the high cost of equipment and lack of trained personnel, manual palpation is a preferred alternative breast examination technique over mammography. The process involves a thorough search pattern using trained fingers and applying adequate pressure, with the objective of identifying solid masses from the surrounding breast tissue. However, palpation requires skills that must be obtained through adequate training in order to ensure proper diagnosis. Consequently, palpation performance and reporting techniques have been inconsistent. Automating the palpation technique would optimize the performance of self-breast examination, optimize clinical breast examinations (CBE), and enable the visualization of breast abnormalities as well as assessing their mechanical properties. Various methods of reconstructing the internal mechanical properties of breast tissue abnormalities have been explored. However, all systems that have been reported are bulky and rely on complex electronic systems. Hence, they are both expensive and require trained medical professionals. The methods also do not involve palpation, a key element in CBE. This research aims in developing a portable and inexpensive automated palpable system that mimics CBE to quantitatively image breast lumps. The method uses a piezoresistive sensor equipped probe consisting of an electronic circuit for collecting deformation-induced electrical signals. The piezoresistive sensor is made by spraying microwave exfoliated graphite/latex blend on a latex sheet. Lumps can be detected by monitoring a change in electrical resistance caused by the deformation of the sensor which is induced by abnormalities in the breast tissue. The electrical signals are collected using a microcontroller and a pixelated image of the breast can be reconstructed. The research is still in progress, and this report serves as proof of concept testing by pressing the probe with hand pressure and reconstructing the electrical signals using Microsoft Excel. Four maps were created for qualitatively analyzing the result. The pressure maps clearly display areas where pressure was applied, indicating the potential of the probe in detecting breast tissue abnormalities. The pressure maps show the feasibility for using such a sensor for the application in CBE. Furthermore, a sensor such as this is also possible of detecting the depth and size of masses within breast tissue, which, may lead to a more accurate diagnosis. Better manufacturing, accuracy, precision, and realtime data feeds are areas of future consideration for this project. This project involves knowledge and applications from mechanical, electrical, computational, and materials engineering.

Environment as a Breast Cancer-Causing Factors in Urban Women in Indonesia

Environmental influence is one of the important factors in breast cancer incidence because residential and work environments may be potential for breast cancer outcomes. This study aimed to determine residential and workplace environments with the occurrence of women breast cancer in urban areas in Indonesia. This study used data from Non-Communicable Disease (NCD Research) in 2016 which covered 34 provinces in Indonesia. There were 38,790 people to measure the occurrence of breast cancer in women aged 25–64 years. The sample was women who were willing to be interviewed and to conduct clinical breast examinations (Sadanis). The analysis was aimed at finding out the correlation between exposure, residential environment, and workplaces with the occurrence of breast tumor/cancer. The results showed that the risk of breast cancer in women who worked in risky workplaces from the normal state was 1.96 times higher than women who worked in non-risky workplaces (OR=1.96; 95% CI= 1.41 to 2.7; p<0.001). Suspected of tumor/cancer in the residential areas are inversely proportional to those not living close to the mining location (OR=0.86; 95% CI= 0.77 to 0.97; p<0.001). These findings suggest the important role of the environment in breast cancer incidence. Therefore, it is recommended to apply a healthy lifestyle, both physically and spiritually, and provide regular health screening.

Health Beliefs and Breast Cancer Screening Practices Among African American Women in California

Background African American women continue to have higher mortality rates of breast cancer when compared to other women, and evidence suggests that early detection of breast cancer can lead to favorable outcomes, yet there remains a paucity of literature about health beliefs and the utilization of three screening practices, namely breast self-examination, clinical breast examination and mammography in California, a state that currently has one of the highest breast cancer mortality rates among African American women. Purpose To investigate the relationship between health beliefs and three breast cancer detection practices, e.g. breast self-examination, clinical breast examination, and mammography in a cohort of African American women. Methods Using a descriptive correlational design, a convenience sample of two hundred and eighty-two (n = 282) self-identified women from six regional chapters of a national Black women’s political organization in California, completed a Demographic Data Questionnaire and Champion’s Health Belief Model Scale which assessed the hypothesized relationships of health beliefs and breast cancer detection practices. Results Among this culturally diverse group of women (49.8% American, 28.8% African, 21.4% West Indian), health motivation was positively related to the practice of BSE and annual physician visitation for clinical breast examinations. Health locus of control was positively related to the practice of BSE. Having relatives and friends who were diagnosed with breast cancer was strongly associated with having a mammogram and annual physician visitation for clinical breast examinations. Conclusion These findings may be used to target and develop interventions that are tailored to the unique characteristics of these diverse women.