Breast Cancer Education Research Articles

Different Routes, Similar Destination: Building Breast Care Models in Tanzania, Zambia, and Colombia

Purpose Cancer is becoming an urgent problem in low- and middle-income countries as the global burden of disease shifts from infectious to noncommunicable diseases. Whereas cervical cancer and breast cancer are preventable and treatable, these diseases are the leading causes of women’s cancer deaths in low-resource settings, mostly because of late-stage presentation and limited diagnostic and treatment capacities. Methods Using the Breast Health Global Initiative resource-stratified guidelines and a phased implementation approach, countries with resource constraints have designed and implemented breast cancer interventions that allow for a balanced, efficient, and equitable use of limited resources. Results Tanzania, Zambia, and a rural area of Colombia serve as examples of evidence-based approaches to the implementation of breast cancer control programs, leveraging the successes and experiences of existing care platforms—mostly cervical cancer and HIV—while creating a solid foundation for country ownership and sustainability. Tanzania used a top-down approach, investing in understanding the needs through a breast health care assessment to inform policy and practice, as well as building a national policy framework. Zambia analyzed the successes and experiences of their public Cervical Cancer Prevention Program to introduce breast cancer education, detection, and surgical treatment, and to improve the time of diagnosis for breast cancer using the single-visit approach recommended by WHO for cervical cancer. A rural community in Colombia has focused on mitigating some of the most common barriers that women face during their cancer journey by improving the cancer education of medical personnel, providing technology for early diagnosis, and implementing an outreach and navigation program that has significantly reduced waiting times from screening through diagnosis and treatment. Conclusion What are key characteristics that guarantee success? Country ownership is crucial, with political, institutional, and community ownership; capabilities; and accountability. Under these four dimensions and a phased implementation framework, we explain the approach that civil society, ministries of health, and stakeholders have taken to implement these programs. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Anna Cabanes Research Funding: Pfizer, Genentech, Merk (Inst) Travel, Accommodations, Expenses: Pfizer, Astra Zeneca Mary Rose Giattas Research Funding: Pfizer, Genentech, Merk (Inst) Travel, Accommodations, Expenses: Pfizer, Astra Zeneca Mavalynne Orozco Urdaneta Stock or Other Ownership: Celgene, Johnson and Johnson Armando Sardi Stock or Other Ownership: Celgene, Johnson and Johnson

Student Midwives’ Perspective on Improving Early Diagnosis in Breast Cancer During Antenatal Care

Purpose The incidence of breast cancer in Uganda is estimated at approximately 32.3 per 100,000, with a 5-year survival rate of 56%. Breast cancers present later and have a higher incidence in patients in the child-bearing age group compared with those in high-income countries. Uganda has an ongoing program to train degree-level midwives for extended midwifery roles that are exclusive to practice in Uganda. These midwives are highly motivated and have intimate local knowledge and effective access to the female population with the highest incidence of breast cancers. This work assesses their views on the key reasons women present so late and ideas for system-strengthening measures that will target these reasons, effectively combining antenatal care with breast lump education and diagnosis. Methods Midwifery students in years at Lira University were invited to fill out a questionnaire—with two open and seven structured questions—that was handed out at the ends of lectures and collected the next day. Results One hundred fifty-three questionnaires were returned. In the open question, midwifery students indicated overwhelmingly that the main reason women present late is ignorance. Finance was perceived to be the second factor. Analysis of the stratified question demonstrated that, even with knowledge of breast cancer, women would still be likely to think that a breast lump does not matter, and this factor scored higher than finances, culture, or access to health care. Of respondents, 73% felt that a facility for diagnosis in the community would definitely help women come for treatment. As midwives, 94% would definitely refer a breast lump to a specialist breast clinic if one was available, and on a background of limited health care funding, 90% still felt that time and money should be prioritized toward breast cancer education diagnosis and treatment because of its impact on the community. Conclusion Community midwives are well placed to educate women on breast care in antenatal clinics. This questionnaire demonstrates their perspective on the overriding significance of educating the child-bearing population about breast lumps in addition to cancer education. Therefore, breast lump examination and diagnosis is being taught to the students, community diagnostic facilities are being developed alongside antenatal care (ultrasound and cytology), and a breast lump referral clinic is planned for the new hospital. AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the author.

Breast Cancer Risk by Occupation in Females and Males in Ontario, Canada: Results from the Occupational Disease Surveillance System (ODSS), 1983-2016

Background: While breast cancer is one of the most commonly diagnosed cancers among women, it accounts for fewer than 1% of cancer cases in men worldwide. Few prior studies have been able to study breast cancer in working men. This study uses data from the recently established Occupational Disease Surveillance System (ODSS) to examine risk of breast cancer in both women and men across different occupation groups.Methods: The ODSS was established through the linkage of existing administrative data and contains information on 2,190,246 Ontario workers (1983-2016). Workers were followed up for breast cancer diagnosis in the Ontario Cancer Registry (OCR). Cox-proportional hazard models were used to calculate age-adjusted hazard ratios (HR) and 95% confidence intervals (CI).Results: A total of 17, 865 and 492 breast cancer cases were identified in working women and men, respectively. Across both sexes, statistically significant (p<0.05) elevated risks were observed in management (w: HR 1.57, 95% CI 1.42-1.73; m: HR 2.41, 95% CI 1.24-4.66), administrative and clerical (w: HR 1.16, 95% CI 1.11-1.21; m: HR 1.56, 95% CI 1.13-2.13), and teaching occupations (w: HR 1.49, 95% CI 1.41-1.59; m: HR 2.82, 95% CI 1.40-5.66). Other statistically significant elevated risks were observed in social sciences, nursing and other health, transport and equipment operating, and sales commodity occupations for both sexes.Conclusions: Similar findings were found in women and men that warrant further investigation into job-related factors, such as sedentary behaviour, stress, shift work, and for some occupations, radiation exposure. The findings from this study, if validated in other study samples, may help focus breast cancer prevention and education efforts for both females and males.

An Intervention Tool to Increase Patient-Physician Discussion of Lifestyle Risk Factors for Breast Cancer.

Background: Risk assessment and discussion of lifestyle in primary care are crucial elements of breast cancer prevention and risk reduction. Our objective was to evaluate the impact of a breast cancer risk assessment and education tool on patient-physician discussion of behaviors and breast cancer risk. Materials and Methods: We conducted a randomized controlled trial with an ethnically and linguistically diverse sample of women, ages 40-74, from two primary care practices. Intervention participants completed a tablet computer-based Breast Cancer Risk Assessment and Education (BreastCARE) intervention in the waiting room before a scheduled visit. Both patients and physicians received an individualized risk report to discuss during the visit. Control patients underwent usual care. Telephone surveys assessed patient-physician discussion of weight, exercise, and alcohol use 1 week following the visit. Results: Among the 1235 participants, 27.7% (161/580) intervention and 22.3% (146/655) usual-care patients were high risk for breast cancer. Adjusting for clustering by physician, the intervention increased discussions of regular exercise (odds ratios [OR] = 1.94, 1.50-2.51) and weight (OR = 1.56, 1.23-1.96). There was no effect of the intervention on discussion of alcohol. Women with some college education were more likely to discuss their weight than those with high school education or less (OR = 1.75, 1.03-2.96). Similarly, non-English speakers were more likely to discuss their weight compared with English speakers (OR = 2.33, 1.04-5.22). Conclusions: BreastCARE is a feasible risk assessment tool that can successfully promote discussions about modifiable breast cancer risk factors between patients and primary care physicians.

Role of Family Obligation Stress on Ugandan Women's Participation in Preventive Breast Health.

The purpose of this study is to determine the role of family obligation stress on Ugandan women's participation in preventive breast health through the receipt of breast cancer education and health check-ups. A validated survey was conducted on a community sample of Ugandan women, providing a multi-item scale to assess preventive breast-health-seeking behaviors and measure family obligation stress (FO; range 6-18). Univariate and multivariate linear regression was used to assess associations between sociodemographic factors and FO. Univariate and multivariate linear regression (used in conjunction with the robust sandwich estimator for standard errors) and probability differences (PDs) were used to evaluate associations between preventive breast-health-seeking behaviors, sociodemographic factors, and FO. A total of 401 Ugandan women ages 25-74 participated in the survey. Most had three or more children in the home (60%) and were employed full time (69%). Higher FO was associated with increasing number of children and/or adults in the household (p < .05), full-time employment (p < .001), and being single (p = .003). Women with higher FO were less likely to participate in breast cancer education (PD = -0.02 per 1-point increase, p = .008) and preventive health check-ups (PD = -0.02, p = .018), associations that persisted on multivariate analysis controlling for sociodemographic factors. Ugandan women with high FO are less likely to participate in preventive breast cancer detection efforts including breast cancer education and preventive health check-ups. Special efforts should be made to reach women with elevated FO, because it may be a risk factor for late-stage presentation among women who develop breast cancer. High family obligation stress (FO) significantly reduces women's participation in preventive health check-ups and breast cancer education. These findings support research in U.S. Latinas showing high FO negatively affects women's health, suggesting that FO is an important factor in women's health-seeking behavior in other cultures. Addressing family obligation stress by including family members involved in decision-making is essential for improving breast cancer outcomes in low- and middle-income countries, such as Uganda.

Stigma Reduction Among African American Women With HIV: UNITY Health Study.

African American women encounter disproportionately high rates of HIV-related morbidity and mortality, which is partially mediated through stigma and its effect on HIV treatment adherence. To assess the effect of the UNITY peer support workshop on HIV-related stigma among African American women living with HIV, compared with a time and attention control group. African American women living with HIV were randomized to the UNITY workshop or a breast cancer education control group. Interventions took place in HIV clinics in Chicago, IL and Birmingham, AL. Participants self-reported HIV-related stigma and social support at baseline, after workshop, and at 4 follow-up visits over 12 months. Two hundred thirty-nine participants (UNITY n = 124; breast cancer education n = 115) were assessed over 1 year. Both arms experienced decreases in mean stigma scores over time. Our model estimated that allocation to UNITY was not associated with a significant difference in stigma points over time. Post hoc analysis suggested that preceding increases in perceived social support are associated with decreased HIV-related stigma in this population. Although UNITY did not significantly reduce HIV-related stigma in this population, our findings suggest that social support may be key to HIV-related stigma reduction.

Abstract A72: [Advocate Abstract:] Community initiatives for all women's health

Abstract My poster will describe four community programs I have established at The Resurrection Project. The first focuses on breast cancer education workshops to address the lack of knowledge, cultural misconceptions, fear, and shame in my community and other underserved communities. The second focuses on breast cancer navigation to address the lack of insurance and cost issues in my community and in other underserved communities. The third focuses on breast cancer survivorship and empowerment to address the need for peer role models in my community and for other underserved communities. The fourth focuses on policy advocacy to address the need for resources for other underserved women. Citation Format: Araceli Lucio. [Advocate Abstract:] Community initiatives for all women's health [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A72.

Abstract C06: Adapting a breast cancer education program to reach Arab Muslim women

Abstract Breast cancer (BC) is the most common cancer in women in the United States as well as in Arab countries. Yet, Arab women have lower mammography rates than women of other ethnicities. This is due to an array of barriers, including but not limited to lack of knowledge, cultural and linguistic barriers, and fear of discrimination. Moreover, Arab immigrants have been underserved by research and outreach efforts primarily because many Arabs are considered of the White (Caucasian) race. Given that there is a large Arab population in our catchment area (Philadelphia, PA) we customized a breast cancer education program specifically for Arab Muslim women. In the first phase of the project, 10 Arab Muslim women (ages 35 and older) living in Philadelphia were recruited to provide formative feedback regarding the appropriateness and clarity of the presentation. Participants were encouraged to communicate their thoughts, preferences, concerns, and questions surrounding breast health. Even though most participants indicated that they are insured, can find health information easily, and can understand what health professionals say, their discussion conveyed a strong need for breast health education in this community. After analyzing their input, we refined the presentation and evaluated its effectiveness in a second group of Arab Muslim women (n = 21). Knowledge, attitudes, and beliefs surrounding BC were captured at the beginning of the workshop and at the end using a pre/post-test. A paired t-test showed a significant increase in BC knowledge scores after the presentation (93.5%, SD = 8.46) than before the presentation (79.22%, SD = 17.37); t (20) = -4.088, p = 0.001. In addition, there was an improvement in attitudes and intent regarding self-awareness of breast health and mammography screening. To further augment the educational program, an Arab plain-language brochure was developed and reviewed with the participants. Results from Phase I and II will be reviewed during the session, including additional questions asked by participants during the formative evaluation process. The findings from this effort further indicate the need to expand education (and screening) services to this community. Citation Format: Evelyn T. Gonzalez, Alia Salam. Adapting a breast cancer education program to reach Arab Muslim women [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C06.

Abstract B05: An evaluation of a community-based breast education and navigation program: Highlights and lessons learned from the Pitt County Breast Wellness Initiative

Abstract Background: Pitt County is located in a rural disadvantaged part of Eastern North Carolina (ENC) and maintains persistent breast cancer disparities among minority women as compared to their white counterparts. Pitt County has the highest breast cancer mortality rate among minority women in ENC, with breast cancer mortality rates for minority women being twice as high compared to their white counterparts (42.4 vs. 21.9, respectively). Furthermore, minority women are diagnosed at later stages of the disease, with the rate of diagnosis at stage 4 being almost three times higher than white women in Pitt County. The Pitt County Breast Wellness Initiative provides culturally tailored breast cancer education and navigation to age-appropriate screening services for uninsured/underinsured Black and Latina women ages 25 and older. Methods: We conducted a qualitative evaluation to assess the effectiveness of our education and navigation components. We contacted program participants via telephone and administered a structured interview guide. Out of the 85 participants that were both educated by our program and received a free mammogram and clinical breast exam, we reached 60% (n=51) of these women. Results: This funded program has created a network of 20 community-based lay breast health educators, which includes faith leaders, breast cancer survivors, community advocates, and ECU BS in Public Health students. In a span of 2 years, we have educated over 600 women in eastern North Carolina (ENC) on breast health and breast cancer screening guidelines, and navigation services have been provided to 275 women, of whom 230 were given breast health assessments and 85 received a mammogram. We have identified five lessons learned to share in the successful implementation of a community-based cancer screening intervention: (1) community partnerships are critical for successful community-based cancer screening interventions; (2) assuring access to screening and appropriate follow-up should precede interventions to promote increased use of cancer screening; (3) the reduction of access barriers is effective in increasing cancer screening; (4) culturally tailored interventions can overcome barriers to screening for diverse racial/ethnic and socioeconomic groups; and (5) multicomponent interventions that include multiple community-health strategies are effective in increasing screening. Up-to-date results from program participants will be reported during the presentation. Conclusion: Although PCBWI can improve, we have been successful at increasing knowledge and screening for our population. Future community-based interventions must go beyond the overall assessment of effectiveness and expand current understanding of why given strategies are effective and analyze the cost-effectiveness of these strategies, to ensure replicability and sustainability. Citation Format: Essie Torres, Alice Richman. An evaluation of a community-based breast education and navigation program: Highlights and lessons learned from the Pitt County Breast Wellness Initiative [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B05.

Fear of Mastectomy Associated with Delayed Breast Cancer Presentation Among Ghanaian Women.

Breast cancer is the leading cause of cancer mortality among women globally. Most women in Ghana present with advanced stage disease. The aim of this study is to characterize sociocultural factors associated with delayed presentation. Qualitative study (grounded theory, constant comparative method) using individual in-depth interviews with breast cancer patients seen at the Korle Bu Teaching Hospital in Accra, Ghana. Interviews were conducted in English and three local languages. We achieved theoretical saturation with 31 participants. The mean length of delay reported by patients was approximately 1 year. Five recurrent themes were related to delayed presentation: (a) Women with a confirmed breast cancer diagnosis delay treatment because of the fear of mastectomy due to self and societal stigma; (b) role of the church as a social support system given the societal stigma associated with breast cancer; (c) study participants expressed some awareness of breast cancer, but with varying depths of breast cancer knowledge encompassing both myths and misconceptions about breast cancer; (d) most patients present late because they do not associate a "painless" breast lump with possible breast malignancy; and (e) delayed presentation linked to significant financial burden associated with breast cancer treatment. Despite current efforts to increase breast cancer awareness, the fear of mastectomy remains one of the main reasons for delayed presentation. Successful breast cancer education programs will need to be framed within the broader sociocultural dimensions of femininity that address some of the stigma associated with mastectomy reported in the Ghanaian context. Most women in Ghana present with advanced-stage disease. The aim of this study was to characterize sociocultural factors associated with delayed presentation. Although several quantitative studies have been conducted on delays in presentation in sub-Saharan Africa (SSA), this study is one of the few to identify fear of mastectomy as a reason for delayed presentation. Anecdotal data from current clinical experiences in SSA suggest that this is still an issue that has not been adequately reported and addressed in most SSA countries. The research results presented here will hopefully guide health providers and national organizations in designing breast cancer education programs in Ghana and other parts of SSA.

Evaluating the effectiveness of faith-based breast health education

Objective: In an effort to evaluate the effectiveness of faith-based health promotion programmes in educating African American women about breast cancer knowledge and risks, the local affiliate of a national breast cancer research foundation funded the Genesis Health Project (GHP) Network, a community-designed, culturally competent intervention, to develop, implement and evaluate the Breast Cancer Awareness and Education Program. This article reports on the faith-based education model used and uses evaluation data to determine whether the intervention improved awareness of breast cancer risk, methods for reducing risk, the importance of early detection and the availability of low-cost or free mammograms. Design: Pastoral health messaging and culturally appropriate strategies were used to heighten awareness of breast cancer risks and prevention, promote mammography and early detection, increase awareness of free/low-cost mammography and encourage the adoption of healthier behaviours. Setting: African American churches and collaborators targeting African American women in a mid-sized city in the northeastern USA. Method: Summative evaluations used paper and pencil pre- and post-event surveys, with measures for objectives targeted by the programme to evaluate the impact of activities. Results: Overall, participants in the Breast Cancer Awareness and Education Program showed improvements in general knowledge about breast cancer, higher breast cancer mortality among African American women, warning signs, risks and ways to mitigate risk, and the availability of low-cost or free mammograms. Conclusion: Findings confirm that faith-based health promotion programmes can be effective in helping to educate inner-city African American women about breast cancer and associated risk factors.

Cancer Community Education in Somali Refugees in Nebraska.

Nebraska has one of the highest numbers of refugees per capita in the U.S. A high number of Somalis have resettled in Nebraska due to job opportunities and the low cost of living. In this paper, we report the process and the results of a cervical and breast cancer education program for Somali women conducted through a collaboration among public health, academia, and community entities. The curriculum was built to be suitable for the literacy level and cultural values of this community. Topics include female reproductive anatomy; breast and cervical cancer knowledge and screening; hepatitis C and liver cancer; and preparing for a health screening visit. Two community members trained as lay health workers conducted a pilot and an actual education session. The 2-day education program was attended by 52 women. Qualitative data showed the intervention to be promising for this and other African refugee populations.

Breast cancer education for schoolgirls: an exploratory study.

Adolescent girls are an important target group for breast cancer education and promoting breast awareness. However, research has not established schoolgirls' perceived importance of breast cancer education or explored factors that may impact engagement. This study aimed to identify schoolgirls' concerns about breast cancer, desire to know more and perceived importance of breast cancer education, and explored associations with demographic factors. Of 2089 schoolgirls (11-18 years) surveyed, 1958 completed all relevant breast cancer questions and demographic factors (ethnicity, school type, breast size, physical activity level and age). χ-Tests assessed associations between demographics, desire to know more and perceived importance of breast cancer. Overall, 44% of schoolgirls reported concerns about breast cancer, 72% wanted to know more and 77% rated the topic as extremely important. Breast size was not associated with wanting to know more about breast cancer. Schoolgirls who wanted to know more about breast cancer were White, from single-sex schools with boys at sixth form, more physically active and older. However, among other ethnic groups, school types and physical activity levels, the proportion of girls who wanted to know more about breast cancer was still high (≥61%). This study provides evidence of the need for breast cancer education for schoolgirls across all school types, irrespective of breast size or physical activity levels. The results highlight the need to be inclusive and engage schoolgirls from all ethnic groups and to promote breast awareness at a young age to ensure effective breast cancer education.

Empowering Latinas to Obtain Breast Cancer Screenings: Comparing Intervention Effects, Part 2

Abstract We compare the effects of breast cancer education and empowerment approaches on non-adherent Latinas' breast health behaviors and dissemination of health information. Methods: The setting for this ongoing, quasi-experimental trial is two Latino, lower income communities in Chicago. Women were recruited via two community-based organizations and snowball sampling. Eligibility criteria were: 1) age of 52–74; 2) lack of screening within past 2 years; 3) no previous breast cancer diagnosis; and, 4) no health volunteerism experience. Women were assigned to a three week group intervention (3 2 hour sessions). The education intervention is administered in East Side/South Chicago and the empowerment intervention is administered in Pilsen/Little Village to avoid contamination effects. The education intervention has 3 sessions focused on early detection and prevention (diet, physical activity). The empowerment intervention has 3 sessions focused on early detection, sharing information with family/friends, and health volunteerism. Navigation is provided if women wish to obtain mammograms. Three questionnaires are given at baseline, post-intervention, and a 6 month follow-up. Results: Among our 68 participants (34 education; 34 empowerment), 87% were born in Mexico; 59% had &amp;lt;9th grade education; 52% had a median household income of &amp;lt;$10K; and, 51% were uninsured. The average age was 61.21 (SD = 6.20). Relative to education participants, more empowerment participants have scheduled mammograms (94% vs. 74%; P = 0.05) and obtained mammograms (77% vs. 38%, P = 0.001). Empowerment participant also spoke to more individuals about breast health relative to education participants (M = 6.24, SD = 5.30 vs. M = 3.00, SD = 3.04, P = 0.003). A greater proportion of engagement participants also spoke about specific types of breast cancer screening (58% vs. 38%, P = 0.01) and discussed breast cancer across multiple settings (58% vs. 24%, P = 0.003). Discussion: The empowerment approach may be particularly effective in changing non-adherent Latinas' screening behaviors and promoting them to become agents of change in their communities. Limitations concern generalizability due a non-probability based sample, and limited ability for causal inferences due to a lack of randomization.

A Mixed Methods Review of Education and Patient Navigation Interventions to Increase Breast and Cervical Cancer Screening for Rural Women

ABSTRACTReviews have assessed studies of breast and cervical cancer screening access and utilization for rural women, but none analyze interventions to increase screening rates. A mixed methods literature search identified studies of breast and/or cervical cancer prevention education and patient navigation interventions for rural women. Rural areas need greater implementation and evaluation of screening interventions as these services address the challenges of delivering patient-centered cancer care to un-/underserved communities. The lack of intervention studies on breast and cervical cancer education and patient navigation programs compared to urban studies highlights the need for validation of these programs among diverse, rural populations.

A Breast Cancer Education Program for D/deaf Women.

Barriers to obtaining breast cancer prevention knowledge and breast cancer screening have been noted among D/deaf women. A randomized controlled trial (RCT) is described that tested a culturally and linguistically tailored breast cancer education program conducted among a racially/ethnically diverse sample of 209 D/deaf women age 40 years or older. The study focused on D/deaf women with no more than a secondary education, a population at relatively high risk for incomplete breast health knowledge and services. This population's inadequate breast cancer knowledge and screening practices and the value of the education program were confirmed. Knowledge increased from -baseline to 12-month follow-up in the intervention group, and in some instances the control group; increased intention to get a mammogram was observed in the intervention group. Possible reasons for the few significant intervention/control group differences at 12 months were examined. Materials from the RCT are available online.

Impact of a Breast Cancer Educational Program on Female University Students' Knowledge, Attitudes, and Practices.

Breast cancer (BC) is a worldwide fatal cancer among females. Efforts fighting against this disease should start with females at younger ages. This study evaluated the effectiveness a BC educational program in promoting female university students' knowledge and attitudes towards BC and practices of breast self-examination (BSE). A pre- and post-test design was used in two phases; pre- and post-intervention phase. A 1-day educational program was conducted with theoretical and practical educational sessions. Participants were evaluated twice (before and 2weeks after the intervention) for the following variables: knowledge regarding BC warning signs, BC risk factors and knowledge in regard to BSE, in addition to their attitudes and practices of BSE. A total of 110 participants were randomized into either intervention (n = 64, 58.2%) or control group (n = 46, 41.8%). Analysis revealed that participants in both groups had relatively low level of knowledge, negative attitudes, and poor practice towards BC and BSE before attending the intervention. Analysis of the post test revealed that participants in the interventional group had significant improvement in knowledge, positive attitudes, and more practice of BSE compared to participants in the control group. The implementation of a BC awareness program had positive effects on the female university students' knowledge, attitudes, and practices regarding BC and BSE. Findings from this study strengthen and reinforce the importance of conducting such awareness programs for this young age group.

Effectiveness of Print and Audiovisual Media in Breast Cancer Education to High-School Students

Background : Breast cancer education could be a non-formal education to achieve a proper understanding about early detection of breast cancer. Optimal results need right methods and instruments. Recently, technology development can be implemented to support the non-formal education process. The purpose of this study was to determine the effectiveness between print and audiovisual media in health education on prevention and early detection of breast cancer. Methods : It was a quasi-experimental study, comparing two intervention and one control groups, which was carried out from August to November 2013. The population was senior high school students in Jatinangor subdistrict West Java, Indonesia. The sample was taken by cluster sampling method; each group consisted of 120 female students. Students from Sekolah Menengah Atas Negeri Jatinangor were given printed media, students from Sekolah Menengah Kejuruan Padjadjaran were given audiovisual media and students from Pesantren Al Ma’soem as control group were not given any intervention. The knowledge of respondents was measured with pre-test and post-test questioner. Mean scores of knowledge were further analyzed by paired and independent t-test. Results : The average of pre-test between intervention and control groups were similar (8.125, 8.725 and 8.450, respectively). The result showed that the average scores of post-test increased compared to pre-test both in the print and audiovisual media group (p=0.001). Conclusions : Print and audiovisual media can increase the knowledge of respondents on prevention and early detection of breast cancer. However, audiovisual media is more effective as a tool for health education especially among teenagers.

Radiation Therapy Patient Education Review and a Case Study Using the Virtual Environment for Radiotherapy Training System

IntroductionThe emergence of modern learning environments for radiation therapy (RT) education offers innovative opportunities for RT patients. This article presents a descriptive review of the current state of practice for two recently available tools, the “Virtual Environment for Radiotherapy Training” (VERT) and the “Patient Education And Radiotherapy Learning” (PEARL) systems. Subsequently, a case study summarizes the instructional design and development of an RT breast cancer patient education program, with the intention of providing a blueprint for further patient education initiatives that incorporate VERT. MethodsA total of 278 articles were identified for the descriptive review, using academic databases and a grey literature search. After screening for descriptive accounts of patient education interventions using VERT or PEARL, five full articles were retrieved and coded using a data extraction protocol. This information was used to inform the subsequent development of a breast cancer education program using a three-step development model, encompassing (1) consultation process and literature review; (2) program content and instructional process; and (3) program evaluation plan. The VERT integration process within the second stage is the focus of the case study presented. ResultsThe literature search found that methods for the design, delivery, and evaluation of the education programs varied across studies. Positive impacts of VERT and PEARL in patient education have been demonstrated. The development of the 1-hour education program was based on comprehensive, evidence-based learner literature and was designed with the intention of specifically engaging learners with the three-dimensional VERT system. In particular, the VERT integration process aimed to exploit VERT's range of visualization features and draw upon the multidisciplinary nature of radiation cancer care. DiscussionVERT and PEARL offer innovative education opportunities and have been justly recognized as valuable tools for RT patient education. When aligned to an educational framework, rich visual displays offered by VERT and PEARL have the potential to support patient education programs and exploit the advantages of a virtual RT environment. With the increasing accessibility of these tools, the data presented in this article offer information for educators interested in development and evaluation of future patient education programs. Feasibility and economic aspects need to be addressed within local departments, and further research is required to ascertain specific capability of VERT and PEARL in supporting psychological and health-related patient outcomes.

Disparities in Female Breast Cancer Stage at Diagnosis in New Jersey: A Spatial-Temporal Analysis.

Background:Despite improvements in early detection of breast cancer, disparities persist in stage at diagnosis, which is an important prognostic factor.Methods:We used the space-time scan statistic in SaTScan to identify geographic areas and time periods with significantly elevated proportions of female breast cancer diagnosed at the in situ or distant stage in New Jersey. The analyses were conducted with census tracts as the geographic unit of analysis, elliptical spatial windows, 3-year temporal windows, and Poisson models. Statistical significance was determined by 999 Monte Carlo simulations (P < .05); significant clusters were mapped in ArcMap. Breast cancer cases within the clusters were compared with breast cancer cases outside the clusters on demographic, socioeconomic, and clinical factors using the Pearson chi-square test (P < .05). In addition, populations within the clusters were compared with the population outside the clusters on demographic and socioeconomic factors.Results:After exclusions, 126 756 cases of primary female breast cancer diagnosed in 1997 to 2011 from the New Jersey State Cancer Registry were included in the analysis. One distant stage breast cancer cluster was identified in northeastern New Jersey from 1997 through 2011 (n = 26 244, relative risk [RR] = 1.42, P < .001). Two in situ breast cancer clusters were found in northeastern New Jersey from 2004 through 2011 (n = 12 496, RR = 1.35, P < .001) and in central New Jersey from 2006 through 2011 (n = 29 319, RR = 1.24, P < .001). The distant stage cluster contained relatively high percentages of minority and lower socioeconomic status (SES) breast cancer cases and populations, whereas the in situ clusters had relatively low percentages of minority and lower SES breast cancer cases and populations.Conclusion:Although there have been improvements since an earlier study of distant stage breast cancer diagnosed in 1995 to 1997, disparities in stage at diagnosis continue. These findings can be used by our local cancer control partners to target specific populations for interventions such as breast cancer education and mammography screening, as well as by state legislative and public health authorities for resource allocation.