Barriers and facilitators to breast cancer screening among women in Côte d'Ivoire: A qualitative study.

Socioeconomic inequalities in breast and thyroid cancer screening in Korea: A nationwide cross-sectional study

United Nation's Sustainable Development Goals and the World Health Organization's Global Monitoring Framework support a strong global commitment to reducing the high burden of cervical and breast cancers among low- and middle-income countries. Strategies include vaccination, screening, and early diagnosis. Population-based surveys, such as those conducted by the Demographic and Health Surveys (DHS) Program, can collect the information needed to guide cancer control efforts in a standardized comparable manner. We identified and evaluated the breadth of breast and cervical cancer screening information that was collected by the DHS from 1984 through 2015. Then, we determined if these surveys currently provide the specific and measurable data about both the quantity and quality of cancer screening needed to guide national efforts to reduce the overall effects of cervical and breast cancers. We searched the DHS website to identify surveys conducted between the start of the DHS Program in 1984 and November 2015 that included questions about breast and cervical cancer screening. The relevant questions were extracted from the questionnaire, translated into English, and grouped by themes. Of the 90 countries where DHS surveys have been implemented, cervical cancer screening questions were included in 22 countries (24.4%) and breast cancer screening questions in 18 countries (20.0%). The common themes identified were disease knowledge, screening knowledge, screening practice, and screening outcomes. Most countries with survey questionnaires available for review addressed at least one aspect of screening practice (88.9% of cervical and 87.5% of breast), although few countries queried knowledge and outcomes. Questions that assess varied aspects of breast and cervical cancer screening have been incorporated into relatively few DHS surveys. The themes identified could guide the design of a standard set of questions for use in future population-based surveys and enable evaluation beyond the existence of screening, which would include assessment of the quality and impact of cervical and breast cancer screening.

Breast and cervical cancer remain major contributors to the global morbidity and mortality among women, with early detection through screening being the key to prevention. Multiple factors influence the screening uptake, and informal caregiving for a family member with cancer may further influence their engagement in cancer screening. Evidence on breast and cervical cancer screening among women who are informal cancer caregivers remains fragmented. Hence, this scoping review aimed to identify the factors influencing and interventions that enhanced breast and cervical cancer screening, among women who are informal caregivers of cancer patients. Following the JBI methodology for scoping review, a comprehensive search was conducted in PubMed, CINAHL, Web of Science, Embase, Scopus, and grey literature sources. A predefined set of inclusion and exclusion criteria was used to select the studies from across the globe. Data was extracted and narratively synthesised, with supporting tables and diagrams. Nine studies from Asia, Africa, Europe and North America were included. Though some studies reported that caregiving status was linked to greater uptake of breast and cervical cancer screening, lack of knowledge and fear of cancer diagnosis hindered screening for both cancers. Breast cancer screening was higher among older, educated caregivers and female relatives (e.g., sisters), and was facilitated by positive outcome expectations, goal setting, perceived self-efficacy, and social support. Fear of cancer recurrence presented a nuanced association; moderate fear enhanced age-appropriate breast cancer screening, while higher fear led to excessive screening. Cervical cancer screening was hindered by fear of pain, social consequences, cultural beliefs, stigma, privacy concerns, limited access to screening centres, and husbands' hesitancy. A telephonic counselling by a trained nurse enhanced breast cancer screening; no interventions were found that enhanced cervical cancer screening in informal cancer caregivers, indicating a significant research gap. Most identified factors mirrored those reported among the general female population, with limited exploration of caregiving-specific contextual factors, and caregiver-specific interventions for breast and cervical cancer screening remain scarce. Integrating physician-initiated education and counselling, and opportunistic screening during the routine clinical encounters for the cancer patient presents a promising approach to enhance breast and cervical cancer screening among informal cancer caregivers.

Background: In Puerto Rico (PR), breast cancer was reported to be the leading cancer among women, accounting for approximately 31% of new cancer cases and 52% of cancer deaths. Mammography screening can reduce mortality approximately 20% by detecting breast cancer at early stages, for which less aggressive treatments and therapies are available. There is little published data regarding factors in PR that could explain mammography non-adherence and if those factors are different between previously screened and never screened women. Objectives: To analyze factors associated with breast cancer screening non-adherence between never screened and previously screened, but not currently adherent women. Methods: Cultivando La Salud is a breast and cervical cancer screening promotion program originally designed for low-income Hispanic women over 50 years old that was minimally adapted for Hispanic woman over 21 years old living in PR. The main objectives of Cultivando La Salud PR were to: (1) evaluate the effectiveness of Cultivando La Salud PR, an evidence-based educational intervention aimed to increase breast and cervical cancer screening tests; (2) increase breast and cervical cancer screening tests among women participants in the study; (3) increase the capacity of a community-based organization in the implementation and evaluation of evidence-based interventions in cancer prevention. Women were eligible to participate in Cultivando La Salud PR if they were non-adherent to breast cancer screening (women age 40 years or older that reported not having a mammography in the past year) or non-adherent to cervical cancer screening (women age 21 years or older that reported not having a Pap test in the last three years) and in good health. This program took place in Canóvanas, a municipality of PR, during the 2012-2013 year period. For purpose of this analysis, only data from not-adherent women to breast cancer screening guidelines (n=301) were used. Statistical Analysis: Descriptive statistics were performed to characterize the study population. Bivariate analysis was used to assess breast cancer screening non-adherence (never screened vs. previously screened women) as the dependent variable and variables who achieved statistical significance (p <0.05) in the bivariate analysis were then included in an age-adjusted logistic regression model. Age-adjusted Prevalence Odds Ratio (POR) with their 95% confidence intervals were also calculated. Results: Data from the baseline survey indicated that 22.0% of the participants older than 40 years old never had a mammography. Never screened women were 4 times more likely to report having Mi Salud, a governmental healthcare plan (age-adjusted POR=4.1, 95%CI:1.3-7.5) and were 3 times more likely to have a family income of less than $15,000 than women previously screened but not adherent (age-adjusted POR=3.1, 95%CI:1.3-7.5). Never screened women were also approximately 3 times more likely to report not having an usual place for receiving routine health care (age-adjusted POR=2.9, 95%CI:1.5-5.3) and were 2 times more likely to have not have a Pap test in the last three years (age-adjusted POR=2.3, 95%CI:1.2-4.3). Discussion: Never screened women reported significant socioeconomic disparities that might be affecting mammography screening practices. A better understanding of the barriers that prevent breast cancer screening in this group will help in the design of educational interventions and public health policies targeted to increase mammography rates in PR. Citation Format: Aleli M. Ayala-Marin, Vivian Colon-Lopez, Camille Velez, Natalie Fernandez-Espada, Maria E. Fernandez. Never screened: Understanding breast cancer nonadherence in Puerto Rico. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B70. doi:10.1158/1538-7755.DISP13-B70

Hispanics are the fastest growing minority group in the United States (US). In the US, breast cancer (BC) is the most frequently diagnosed cancer among Hispanic women. Differences observed in BC risk by Hispanic origin may be due to variations in the exposure to known BC risk factors. However the heterogeneity of the prevalence of BC risk factors among Hispanic subgroups has not been characterized. We sought to assess differences in BC screening and the distribution of BC risk factors among US Hispanic women by subgroups using data from the 2012 National Health Interview Survey. We compared modifiable BC risk factors (body mass index, physical activity, alcohol use, and smoking) and BC screening (mammogram use) among Hispanic subgroups (Mexican American, South/Central American, Caribbean American, Other Hispanic) using multinomial logistic regression. After adjusting for several confounders, South/Central American women were less likely (OR=0.76; 95% CI: 0.57-1.02) and women from Other Hispanic origin were more likely (OR=1.49; 95% CI: 0.90-2.46) to be obese compared to Mexican Americans. Also, compared to Mexican Americans, women of Other Hispanic origin were more likely to be former and current smokers (OR=1.38; 95% CI: 0.77-3.56; OR=3.52; 95% CI: 2.03-6.11, respectively). Caribbean American women were 49% (OR=0.51; 95% CI: 0.35-0.74) less likely to meet the national guidelines for physical activity as compared to Mexican American women. Among women aged 40 years and older, Caribbean American women were 40% (OR=1.40; 95% CI: 1.07-1.83) more likely to have had a mammogram in the past 12 months as compared to Mexican Americans. These data demonstrate important breast cancer risk factor differences among Hispanic subgroups. The current findings will be useful for developing interventions targeted to reduce the burden of BC among Hispanic women. Citation Format: Mary Vanellys Diaz-Santana, Katherine W. Reeves. Breast cancer risk factors and screening practices among Hispanics subgroups in the United States. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B34.

C72: Changing patterns of socioeconomic inequalities in women cancer screening in South Korea with ten years follow-up of nationwide cross-sectional study

Breast cancer is frequently diagnosed in Arab women living in Qatar. Al Amal Hospital in Doha reported that 20% of cancer cases receiving treatment in 2007 involved the treatment of breast cancer among women. Early detection and treatment can reduce breast cancer morbidity and mortality rates significantly. However, Arab women are often diagnosed at advanced stages of breast cancer. Funded by the Qatar National Research Fund - National Priorities Research Program, we are undertaking a three-phase research program for which the goals are; (1) to understand the breast health experience of Arab women in Qatar, (2) identify and implement strategies that assist women to participate in breast cancer screening activities, and (3) evaluate, facilitate, and sustain the participation of Arab women in breast cancer screening. In phase I of the research program we will conduct two studies. Study 1: This quantitative cross-sectional survey will investigate the participation rate of Arab women in breast cancer screening, their knowledge about breast cancer, barriers and facilitators to participation. Using a structured questionnaire, we will conduct face-to-face interviews with Arab women aged 35 and over in three different cities in Qatar (Doha, Al Wakrah, and Al Khor). Convenient sampling will be used to recruit 753 participants. Descriptive and inferential statistics will be performed using SPSS. Study 2: This qualitative study will gain insight on; 1) how Arabic women view and participate in breast cancer screening activities, 2) how social, cultural, historical, and economic influences affect breast cancer screening for Arab women, the access to screening services, and social support networks in place, and 3) what intervention strategies will increase awareness of early detection and participation in breast cancer screening among Arab women. Purposive sampling will be used. Qualitative in-depth interviews will be individually conducted with Arab women, men, and healthcare providers. Qualitative data analysis will be performed. Although the results are not available at the present time, we will discuss how the information obtained from both the quantitative and qualitative studies will be used to develop culturally appropriate and effective intervention strategies and services to meet the preventative care needs of Arab women living in the State of Qatar with the aim of decreasing the seriousness and prevalence of breast cancer among them.

Breast cancer is the most common type of cancer among women in the Philippines. Philippines has one of the highest breast cancer mortality rate and the lowest mortality-to-incidence ratio in Asia. This study has three objectives: 1) explore Filipino women's knowledge, attitudes toward, and practices of breast cancer and cancer screening, 2) examine if an educational program increases women's intention to seek future breast cancer screening, and 3) examine associations between demographic variables and breast cancer screening practices. A total of 944 women from two urban areas (Calasciao and Tacloban City) and one rural area (Sogood) of the Philippines participated in this cross-sectional study. Study participants attended an educational program and completed study questionnaires regarding demographics, knowledge about, and practices of breast self-exams, clinical breast exams and mammography as well as reported barriers toward future screening. The results showed a disparity between knowledge of routine breast cancer screening and actuals screening behaviors. Following breast health education and screening programs, participants reported greater intention to adhere to recommended breast cancer screening guidelines. The multivariate analyses showed that education level is a significant predictor for CBE and mammography uptake in current study. This study has implications for breast cancer control among women in low-resources settings. Designing and implementing effective educational programs that increase women's awareness about breast cancer and promote screening uptake are important steps to reduce the burden affected by breast cancer among women in the Philippines and other South Asian low- to middle-income countries.

BackgroundThe variation in breast cancer incidence rates across different regions may reflect disparities in breast cancer screening (BCS) practices. Understanding the factors associated with these screening behaviors is crucial for identifying modifiable elements amenable to intervention. This systematic review aims to identify common factors influencing BCS behaviors among women globally.MethodsRelevant papers were sourced from PubMed, Scopus, Embase, and Google Scholar. The included studies were published in English in peer-reviewed journals from January 2000 to March 2023 and investigated factors associated with BCS behaviors.ResultsFrom an initial pool of 625 articles, 34 studies (comprising 29 observational and 5 qualitative studies) with 36,043 participants were included. Factors influencing BCS behaviors were categorized into nine groups: socio-demographic factors, health status history, knowledge, perceptions, cultural factors, cues to action, motivation, self-efficacy, and social support. The quality appraisal scores of the studies ranged from average to high.ConclusionsThis systematic review highlights factors pivotal for policy-making at various levels of breast cancer prevention and assists health promotion professionals in designing more effective interventions to enhance BCS practices among women.

Introduction: Whether social determinants of health (SDOH) affect US breast and colon cancer screening rates remains unclear. That said, in 2011 the CDC began recording a social vulnerability index (SVI) for all US counties. SVI was designed to capture four SDOH: socioeconomic status (SES), household composition and disability, minority status and language, and housing type and transportation. This retrospective study sought to determine the association of county-level SVI with breast and colon cancer screening rates. Methods: We used publicly available data from the CDC 2018 SVI database to collect SVI scores for every US county. SVI scores range from 0.1 to 1. A lower score indicates low vulnerability, while a higher score suggests high vulnerability. SVI scores were merged with publicly available data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and National Health Interview Survey (NHIS) containing county modeled estimates for breast and colon cancer screening rates. Counties were then divided into < 50th percentile and >= 50th percentile for breast and colon cancer screening. SVI scores and their four SDOH were compared between groups. Statistical significance between groups was assessed at an alpha less than 0.5. Linear regression was used to identify the association between high county-level SVI and the probability of being >= 50th percentile in breast and colon cancer screening. Results: This study involved 3,109 counties. Compared to counties >= 50th percentile in breast cancer screening (n = 1543), those < 50th percentile (n = 1566) were significantly worse off in SES (0.60 ± 0.27 vs. 0.41 ± 0.27), household composition and disability (0.58 ± 0.28 vs. 0.42 ± 0.28), minority status and language (0.51 ± .30 vs. 0.49 ± .28), housing type and transportation (0.53 ± 0.29 vs. 0.46 ± 0.28), and overall SVI (0.58 ± 0.28 vs. 0.42 ± 0.27) (p < .0001). Likewise, compared to counties >= 50th percentile in colon cancer screening (n = 1548), those < 50th percentile (n = 1561) were also significantly worse off in SES (0.63 ± 0.27 vs. 0.38 ± 0.25), household composition and disability (0.59 ± 0.27 vs. 0.41 ± 0.27), minority status and language (0.54 ± .30 vs. 0.45 ± .27), housing type and transportation (0.54 ± 0.29 vs. 0.46 ± 0.28), and overall SVI (0.61 ± 0.28 vs. 0.39 ± 0.27) (p < .0001). High SVI counties compared with low SVI counties were significantly less likely to be >= 50th percentile in breast cancer and colon cancer screening, OR 0.24 (95% CI 0.20 - 0.29) and 0.14 (95% CI 0.12 - 0.18). Finally, county-level SVI percentile correlated negatively with breast and colon cancer screening rates, Pearson coefficient -0.35 and -0.46. Conclusions: This study highlights the significant impact of US county-level SVI on breast and colon cancer screening rates, signaling the need for more effective intervention strategies and allocation of resources to help improve SDOH for our country's most vulnerable citizens. Citation Format: Akhil Mehta, Eric Lau, Gayathri Nagaraj, Hamid Mirshahidi. Association of US county-level social vulnerability index (SVI) with breast and colon cancer screening rates [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3662.

The breast cancer screening controversy and the National Institutes of Health Consensus Development Conference on Breast Cancer Screening for Women Ages 40-49.

Breast cancer is a severe illness that often has fatal consequences. Adherence to the recommendations for breast cancer surveillance is poorly practiced among African American women. The study aimed to identify barriers to preventative screening for breast cancer among African American women (AAW) using a qualitative research design. We explored the influence of personal barriers, stereotypes, socioeconomic status, culture, attitudes, and beliefs on African American women's behavior regarding breast cancer screening. Fourteen African American women were interviewed. Data analysis was completed with Interpretative Phenomenology Approach (IPA). This study's findings demonstrated that African American women perceived the barriers to breast cancer screening include lack of information about available resources, belief that screening cannot change genetic predisposition, embarrassment from exposing the breast for a mammogram, fear of mammograms, and fear of a positive result. These findings may be used to develop interventions to increase AAW's participation in breast cancer screening.

Breast cancer screening guidelines differ between organizations, and significant variations in practice patterns exist. Previous evidence suggests that provider-level factors are the greatest contributors to risk assessment and screening practice variability. This study aimed to characterize provider factors associated with breast cancer risk assessment and screening practice patterns, and to assess perceived barriers to providing risk assessment. An online survey was distributed to providers at a single academic institution and to providers publicly via social media (January to August 2022). Respondents in the United States who care for adult women at risk for the development of breast cancer were included. Most of the respondents in the 143 completed surveys were white/Caucasian (79%) females (90%) age 50 years or younger (79%), and whereas 97% discuss breast cancer screening with their patients, only 90% order screening mammograms. Risk factor assessment was common (93%), typically performed at the first visit (51%). Additional training in genetics or risk assessment was uncommon (17%), although the majority were interested but did not have the time or resources (55%). Although most (64%) did not perceive barriers to providing risk assessment or appropriate screening, the most common barriers were time (77%) and education (55%). Barriers were more common among family practice or obstetrics and gynecology (OB/GYN) providers and those who worked in an academic setting (all p < 0.05). Breast cancer risk assessment and screening practices are highly variable. Although time is the major barrier to providing risk assessment, providers also need education. Primary care organizations could partner with breast cancer-focused societies for additional resources.

The most commonly diagnosed cancers among women are breast and cervical cancers, with cervical cancer being a relatively bigger problem in low and middle income countries (LMICs) than breast cancer. The main aim of this study was to asses factors associated with and socioeconomic inequalities in breast and cervical cancer screening among women aged 15-64 years in Botswana. This study is part of the broad study on Chronic Non-Communicable Diseases in Botswana conducted (NCD survey) in 2016. The NCD survey was conducted across 3 cities and towns, 15 urban villages and 15 rural areas of Botswana. The survey collected information on several NCDs and risk factors including cervical and breast cancer screening. The survey adopted a multistage sampling design and a sample of 1178 participants (males and females) aged 15 years and above was selected in both urban and rural areas of Botswana. For this study, a sub-sample of 813 women aged 15-64 years was selected and included in the analysis. The inequality analysis was conducted using decomposition analysis using ADePT software version 6. Logistic regression models were used to show the association between socioeconomic variables and cervical and breast cancer screening using SPSS version 25. All comparisons were considered statistically significant at 5%. Overall, 6% and 62% of women reported that they were screened for breast and cervical cancer, respectively. Women in the poorest (AOR = 0.16, 95% CI = 0.06-0.45) and poorer (AOR = 0.37, 95% CI = 0.14-0.96) wealth quintiles were less likely to report cervical cancer screening compared to women in the richest wealth quintile. Similarly, for breast cancer, the odds of screening were found to be low among women in the poorest (AOR = 0.39, 95% CI = 0.06-0.68) and the poorer (AOR = 0.45, 95% CI = 0.13-0.81)) wealth quintiles. Concentration indices (CI) showed that cervical (CI = 0.2443) and breast cancer (CI = 0.3975) screening were more concentrated among women with high SES than women with low SES. Wealth status was observed to be the leading contributor to socioeconomic inequality observed for both cervical and breast cancer screening. Findings in this study indicate the need for concerted efforts to address the health care needs of the poor in order to reduce cervical and breast cancer screening inequalities.

Breast cancer in Rwanda is a major concern for women's health, as most breast cancer diagnoses are made at an advanced stage. Yet, diagnosis can be done early with breast cancer screening practices. To assess factors influencing breast cancer screening practices among women of reproductive age in South Kayonza District of Rwanda. A quantitative survey was conducted with 246 women between 16 and 49 years of age from four health centres in South Kayonza District. A structured, pretested, and self-administered questionnaire was used to assess the influence of knowledge, health facilities, and socioeconomic and cultural factors on breast screening practices among women in South Kayonza. Among all respondents, 55.5% had moderate knowledge about breast cancer risk factors and 60.2% also had moderate knowledge on the influence of breast cancer screening. While 28% were knowledgeable about Breast Self-Examination (BSE), 16.4% were knowledgeable about Clinical Breast Examination (CBE) and breast ultrasound. Responses about the practice of breast screening in the last two years showed 72% of respondents had never practiced BSE and 81.3% had not used CBE or breast ultrasound scan. The main source of information about breast cancer screening was the radio, used by 30.4% of respondents. Significant relationships were found between age and marital status with breast cancer screening practices. This study revealed low levels of knowledge about breast cancer, breast cancer screening, and practice regarding breast cancer screening. There is a need to promote awareness of breast cancer and create a program, which can influence breast cancer screening knowledge and practice to ultimately improve health among women in south Kayonza.