Breast Cancer Screening Uptake Research Articles

Feasibility of universal breast cancer risk assessment in a diverse, publicly insured obstetrician gynecology clinic.

e13759 Background: Breast cancer is the most diagnosed cancer among women in the United States. Established breast cancer risk assessment (BCRA) tools can estimate a woman’s lifetime risk and inform the need for enhanced breast screening which can improve cancer-associated morbidity and mortality. Currently, critical disparities exist both in breast cancer prognosis and screening uptake. We aimed to evaluate the feasibility of routine BCRA in a diverse, publicly insured obstetrician gynecology clinic. Methods: All patients presenting to the obstetrician gynecology clinic were offered a BCRA using the Tyrer Cuzick (TC) risk model. Patients completed paper surveys and the information was input into the TC model to generate lifetime risk estimates. Printed evidence-based management guidelines were reviewed with and provided to those at ≥ 20% lifetime breast cancer risk and shared with the patient’s provider. Results: Between June 2023 and February 2024, 300 patients were approached and 208 (69.3%) completed the survey. One hundred seven (51.4%) survey respondents were presenting for obstetrical care and 101 (48.6%) for gynecologic care. Respondents had a median age of 33 years (IQR: 12). Ninety-six (46.2%) responding patients self-identified as Hispanic, 45 (21.6%) as Black, 25 (12.0%) as Asian, 28 (13.5%) as Non-Hispanic White, and 14 (6.7%) did not identify in these categories. One hundred eighty-nine (90.9%) survey respondents were publicly-insured. Ten (4.8%) patients were assisted by an interpreter. Overall, 12 (5.8%) patients had an elevated lifetime breast of breast cancer, defined as ≥ 20% based on the TC model (6 (50.0%) among obstetrical patients and 6 (50.0%) among gynecology patients). All patients at elevated risk were referred to a genetics clinic for counseling on options for enhanced breast surveillance. Conclusions: As leaders in women’s cancer care, gynecologic oncologists can lead and support programs to identify those women at highest risk for cancer, especially among historically underserved populations. Our feasibility study demonstrated that 69.3% of patients were willing to complete a BRCA and this tool identified 5.8% of patients to have a significantly elevated lifetime breast cancer risk. Providers should consider incorporating such tools in gynecologic oncology and obstetrical/gynecology clinics.

Perceived barriers and factors influencing uptake of breast cancer screening among women: a population-based cross-sectional study

Breast cancer (BC) screening plays a major role in the prevention of BC through early detection and timely treatment. This study aims to determine the level of uptake of BC screening and associated factors. A community-based analytical cross-sectional study was conducted in Dodoma City, Tanzania from July to December 2020. The study included women aged 8 years and above without a known history of breast cancer. Multivariable logistic regression was used to determine the socio-demographic factors associated with BC screening. P value < 0.05 was considered significant. A total of 354 study participants were included in the present study. The mean age of participants was 31.0 ± 11.8 years. The majority of study participants (67.5%, n = 239) were aware of BC screening. However, only (35.3%, n = 125) reported to have ever practised BC screening. Breast self-examination was the most (16.4%, n = 58) frequently used method for BC screening among study participants. Lack of knowledge of all methods of BC screening was the barrier that was perceived by the vast majority (60.2%, n = 213) of the study participants. Having low family income was the only predictor of failure to practice BC screening. In this study, most of the women were aware of BC, however, few of them had undergone breast cancer (BC) screening at the time of the interview. The study also found that the main barrier to BC screening was the lack of knowledge about BC among the study participants. Immediate measures are necessary to increase women's awareness of BC. Such as community sensitization on the importance of screening, can help improve the uptake of BC screening and the early detection of BC.

Two-Year-Span Breast Cancer Screening Uptake in Japan after the COVID-19 Pandemic and Its Association with the COVID-19 Vaccination.

There is limited information on whether the COVID-19 pandemic was associated with decreased breast cancer screening uptake and if COVID-19 vaccination was associated with an increase in screening uptake. Our study explored the uptake of breast cancer screening in Japan after the COVID-19 pandemic and assessed its association with the COVID-19 vaccination. We analyzed data from the Japan COVID-19 and Society Internet Survey (JACSIS), a web-based prospective cohort survey, and we included 6110 women without cancer history who were aged 40 to 74 years that participated in the 2012 and 2022 surveys. We examined the regular breast cancer screening uptake before and after the pandemic and employed a multivariable Poisson regression model to seek any association between COVID-19 vaccination and screening uptake. Of 6110, 38.2% regularly participated in screening before the pandemic and 46.9% did so after the pandemic. Individuals unvaccinated due to health reasons (incidence rate ratio (IRR) = 0.47, 95% CI: 0.29-0.77, p = 0.003) and for other reasons (IRR = 0.73, 95% CI: 0.62-0.86, p < 0.001) were less likely to undergo screening compared to fully vaccinated individuals. There was no long-term decrease in breast cancer screening uptake after the pandemic in Japan. Vaccination was linked to increased uptake, but there was no dose relationship.

What factors influence the uptake of bowel, breast and cervical cancer screening? An overview of international research.

For cancer screening programmes to be effective in early detection it is important that those invited can access screening services and understand the benefits of participation. A better understanding of the factors that matter to potential participants of cancer screening programmes can assist in developing strategies to increase current uptake. We conducted an overview of systematic reviews to answer the question: What factors influence the uptake of cancer screening services (breast, bowel and cervical) in high-income countries? A thematic approach supported by tabular summaries and qualitative heat maps was used to categorize factors, described as 'barriers' or 'facilitators'. A total of 41 systematic reviews met the criteria for inclusion. The barrier with the greatest number of 'hot spots' across all three screening programmes was a fear of the unknown regarding a possible diagnosis of cancer or abnormal screening results, followed closely by a general lack of knowledge surrounding cancer screening programmes. The greatest collective facilitator to uptake was recommendation by a healthcare provider to attend screening. Across all factors 'trust' and 'building trusted relationships' can be seen as integral to the success of cancer screening programmes and must be reflective of collaborative efforts to mitigate barriers and enhance facilitators to uptake. There is future scope to consider interventions that (i) increase demand for screening services, (ii) reduce barriers to uptake of services and/or (iii) are relevant to the healthcare system and those providing services.

Abstract PO3-10-08: Long-term uptake rate of a breast cancer screening program in Fukushima, Japan, following the 2011 Triple Disaster: a retrospective observational study

Abstract Introduction There has been a growing concern over the past few years about the effects of disasters and crises on breast cancer screening, an argument that has been further enhanced by the novel coronavirus disease 2019 (COVID-19) pandemic. However, little is known about how crises might affect the long-term uptake of breast cancer screening programs. This study aimed to clarify the long-term trend of breast cancer screening program uptake in Minamisoma City following the 2011 Triple Disaster in Fukushima, Japan (earthquake, tsunami, and nuclear disaster), and to evaluate the factors associated with this uptake. Material and Methods This study retrospectively analyzed data from the Basic Resident Registry and Breast Cancer Screening Program in Minamisoma City following the Triple Disaster. We calculated the annual breast cancer screening uptake rate for women aged 40–74 years who were of an even-numbered age at the end of each fiscal year and the incidence of at least one instance of uptake of the breast cancer screening initiative during the biennial intervals. We further performed cross-sectional and longitudinal regression analyses for the biannual screening uptake and investigated its associated factors. Results Breast cancer screening participation rates were 19.8% and 18.2% in 2009 and 2010, respectively. They decreased to 4.2% in 2011, and gradually increased thereafter, reaching the pre-disaster level of 20.0% in 2016. Similar but longer decrease of the uptake was observed in the biannual screening uptake rate. No pre-disaster screening uptake between 2009 and 2010, those living alone, or those who were evacuated, were factors that were found to be associated with non-uptake of the breast cancer screening program following the 2011 disaster. Conclusion This study showed a long-term decline in breast cancer screening uptake in the area affected by the Triple Disaster, which was the most severe among those under evacuation, those who were isolated, and those without previous uptake. The insights emerging from this study could be used to increase awareness of this issue and establish potential countermeasures. Nonetheless, we lack a complete understanding of the effects and variations of disasters on cancer screening in the affected areas. Therefore, global efforts should be intensified to conduct further studies on this topic. Citation Format: Kenji Gonda, Akihiko Ozaki, Kazunoshin Tachibana, Masahiro Wada, Hiroaki Saito, Yudai Kaneda, Yoshitaka Nishikawa, Michio Murakami, Kei Hirai, Hiromichi Ohira, Toyoaki Sawano, Tomohiro Kurokawa, Masaharu Tsubokura, Koji Kono, Thoru Ohtake, Seiichi Takenoshita. Long-term uptake rate of a breast cancer screening program in Fukushima, Japan, following the 2011 Triple Disaster: a retrospective observational study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-10-08.

Abstract 4803: Cancer screening, knowledge, and fatalism among Chinese, Korean, and South Asian residents of New York City

Abstract Background: Asian New York City (NYC) residents have the lowest screening rates by race across cancer type. Past studies indicate heterogeneity within the Asian American population, yet few have examined differences in screening uptake and related factors among Asian ethnic subgroups in NYC. Further, cancer screening knowledge and cancer fatalism have been found to impact cancer screening uptake, and effects vary by race, ethnicity, immigration status, and cancer type. Objective: Our study aimed to examine differences in cancer screening uptake, knowledge, and fatalism among Chinese, Korean, and South Asian NYC adults and to examine the effects of cancer screening knowledge and cancer fatalism on cancer screening uptake. Methods: We used data from NYU Langone Perlmutter Cancer Center’s Cancer Community Health Resources and Needs Assessment survey. The survey was developed and distributed in 10 languages in collaboration with 23 community partners. Data were collected from NYC adults with recruitment strategies focused on immigrant and non-English language preference communities from Oct. 2021 - Dec. 2022. Multivariable logistic and multinomial regression analyses were used to examine differences in breast, cervical, and colorectal cancer (CRC) screening uptake; breast and CRC screening knowledge; and cancer fatalism between Chinese, Korean, and South Asian (Bangladeshi, Pakistani, Asian Indian, and Nepali) adults; and to examine the effects of breast and CRC screening knowledge on breast and CRC screening uptake and cancer fatalism on breast, cervical, and CRC screening uptake (n=1,045). Analyses were restricted by age and sex using United States (U.S.) Preventive Services Task Force guidelines. Results: The sample was 60.0% female with a mean age of 45.7 years; 83.1% of participants were born outside of the U.S., 49.9% of participants were Chinese, 22.8% were Korean, and 27.3% were South Asian. Korean women had 0.52 (95%CI: 0.31, 0.88) times lower odds of Pap test uptake than Chinese women; South Asian adults had 0.44 (95%CI: 0.24, 0.80) times lower odds of CRC screening uptake than Chinese adults. Korean adults had 1.68 (95%CI: 1.17, 2.41) times higher odds of knowing the correct age to begin having mammograms compared to Chinese adults; South Asian adults had 0.66 (95%CI: 0.46, 0.94) times lower odds of knowing the correct age to begin CRC screening compared to Chinese adults. Korean adults had a 0.39 (95%CI: 0.25, 0.63) and 0.22 (95%CI: 0.13, 0.37) times lower odds of some and high cancer fatalism, respectively, compared to Chinese adults. No associations were found between cancer screening knowledge or cancer fatalism and cancer screening uptake. Conclusions: Our study adds to the current literature on the diversity of cancer needs, beliefs, and behaviors among Asian Americans. The findings indicate the need for ethnic-specific cultural tailoring for future cancer screening interventions. Citation Format: Isabel I. Curro, Chloe A. Teasdale, Laura Wyatt, Yousra Yusuf, Victoria Foster, Sonia Sifuentes, Perla Chebli, Julie A. Kranick, Simona C. Kwon, Chau Trinh-Shevrin, Madison N. LeCroy. Cancer screening, knowledge, and fatalism among Chinese, Korean, and South Asian residents of New York City [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4803.

Clinical outcomes of screening and diagnostic mammography in a limited resource healthcare system

IntroductionBreast cancer is a significant public health concern in Jordan. It is the most common cancer among Jordanian women. Despite its high incidence and advanced stage at time of diagnosis, the uptake of breast cancer screening in Jordan is low. This study aims to compare clinical outcomes of both screening and diagnostic mammogram among women in Jordan.MethodsA retrospective cohort of 1005 women who underwent mammography in breast imaging unit in a tertiary hospital in Jordan. It aimed to investigate outcomes of screening and diagnostic mammography. recall rates, clinical manifestations and cancer rates were investigated.ResultsA total of 1005 participants were involved and divided into screening group (n = 634) and diagnostic group (n = 371). Women in the diagnostic group were more likely to be younger, premenopausal, smokers with higher BMI. Among the screening group, 22.3% were labeled with abnormal mammogram, 26% recalled for ultrasound, 46 patients underwent tissue biopsy and a total of 12 patients had a diagnosis of breast carcinoma. Among the diagnostic group, the most commonly reported symptoms were a feeling of breast mass, mastalgia and nipple discharge. Abnormal mammogram was reported in 50.4% of women, a complementary ultrasound was performed for 205 patients. A diagnostic Tru-cut biopsy for 144 patients and diagnostic excisional biopsy for 17 patients were performed. A total of 131 had a diagnosis of carcinoma.ConclusionWith the high possibility of identifying a carcinoma in mammography among symptomatic women and low uptake of screening mammogram, efforts to increase awareness and improve access to screening services are crucial in reducing the burden of breast cancer in Jordan.

What Breast Cancer Screening Program do Rural Women Prefer? A Discrete Choice Experiment in Jiangsu, China.

Chinese rural women aged 35-64 years are encouraged to complete breast cancer screening (BCS) free of charge. However, it is challenging to reach a satisfying BCS uptake rate. In this study, rural women's preferences and preferences heterogeneity were measured for the development of strategies to enhance participation in BCS. A cross-sectional survey with a discrete choice experiment (DCE) was conducted via convenience sampling via face-to-face interviews in Jiangsu, China. Six DCE attributes were identified through a systematic literature review; our previous study of Chinese rural women's BCS intentions; a qualitative work involving in-depth interviews with rural women (n = 13), medical staff (n = 4), and health care managers (n = 2); and knowledge of realistic and actionable policy. The D-efficient design was generated using Ngene 1.3.0. A mixed logit model (MXL) in Stata 18.0 was used to estimate the main effect of attribute levels on rural women's preferences. The relative importance and willingness to utilize BCS services (WTU) were also estimated. The heterogeneous preferences were analyzed by a latent class model (LCM). Sociodemographic status was used to predict the characteristics of class membership. The WTU for different classes was also calculated. A total of 451 rural women, aged 35-64 years, were recruited. The MXL results revealed that the screening interval (SI) was the most important attribute for rural women with regard to utilizing BCS services, followed by the level of screening, the attitude of medical staff, ways to get knowledge and information, people who recommend screening, and time spent on screening (TSS). Rural women preferred a BCS service with a shorter TSS; access to knowledge and information through multiple approaches; a shorter SI; a recommendation from medical staff or workers from the village or community, and others; the enthusiasm of medical staff; and medical staff with longer tenures in the field. Two classes named "process driven" and "efficiency driven" were identified by the preference heterogeneity analysis of the LCM. There is a higher uptake of breast cancer screening when servicesare tailored to women's preferences. The screening interval was the most important attribute for rural women in China with a preference for a yearly screening interval versus longer intervals.

Factors associated with uptake of breast and cervical cancer screening among Nepalese women: Evidence from Nepal Demographic and Health Survey 2022.

Breast cancer screening (BCS) and cervical cancer screening (CCS) are integral parts of initiatives to reduce the burden associated with these diseases. In this context, we aimed to determine factors associated with BCS and CCS uptake among Nepalese women aged 30 to 49 years using data from the Nepal Demographic Health Survey (NDHS) 2022. We performed a weighted analysis to account complex survey design of the NDHS 2022. We employed univariable and multivariable logistic regression to determine factors associated with the uptake of BCS and CCS and results were presented as crude odds ratio and adjusted odds ratio (AOR) along with 95% confidence interval (CI). The uptake of BCS and CCS among Nepalese women aged 30 to 49 years were 6.5% and 11.4% respectively. Women from Terai compared to mountain region (AOR = 0.54, 95%CI: 0.31, 0.93) and those engaged in agriculture compared to non-working (AOR = 0.59, 95%CI: 0.42, 0.82) women had lower odds of BCS uptake. Conversely, Dalit women compared to Brahmin/Chhetri (AOR = 2.08, 95%CI: 1.37, 3.16), and women with basic (AOR = 1.49, 95%CI: 1.04, 2.13), secondary (AOR = 1.96, 95%CI: 1.33, 2.88), and higher education (AOR = 2.80, 95% CI: 1.51, 5.19) compared to those with no education had higher odds of BCS uptake. Women from rural areas (AOR = 0.76, 95%CI: 0.61, 0.96), and those living in Bagmati (AOR = 2.16, 95% CI: 1.44, 3.23) and Gandaki (AOR = 2.09, 95%CI: 1.40, 3.14) provinces had higher odds of CCS uptake compared to their urban counterparts and those living in Koshi province, respectively. The odds of CCS increased with age (AOR = 1.06, 95%CI: 1.04, 1.08). Women with secondary education (AOR = 1.47, 95%CI: 1.06, 2.04) had higher odds of CCS uptake compared to those without education. Similarly, married women (AOR = 8.24, 95%CI: 1.03, 66.21), and those with health insurance (AOR = 1.41, 95%CI: 1.08, 1.83) had higher odds of CCS. In conclusion, the uptake of both BCS and CCS was relatively poor among Nepalese women indicating a need for targeted and tailored intervention to increase BCS and CCS uptake.

231 (PB-138) Poster - Is awareness the most important factor in increasing breast cancer screening uptake?

231 (PB-138) Poster - Is awareness the most important factor in increasing breast cancer screening uptake?

Socio-cultural and financial issues against breast cancer screening behaviour among eligible Indian women: evidence for action.

Breast cancer, a common malignancy in Indian women, is preventable and curable upon early diagnosis. Screening is the best control strategy against breast cancer, but its uptake is low in India despite dedicated strategies and programmes. We explored the impact of socio-cultural and financial issues on the uptake of breast cancer screening behaviour among Indian women. Breast cancer screening-uptake and relevant social, cultural, and financial data obtained from the National Family Health Survey (NFHS) round 5 were used for analysis. We studied 399,039 eligible females to assess their breast cancer screening behavior and determine the impact of socio-cultural and financial issues on such behavior using multivariable logistic regression. Most participants were 30-34-year-old (27.8%), educated to the secondary level (38.0%), and 81.5% had bank accounts. A third (35.0%) had health insurance, and anaemia was the most common comorbidity (56.1%). Less than 1.0% had undergone breast cancer screening. Higher age, education, urban residence, employment, less privileged social class, and access to the Internet and mass media were predictors of positive screening-uptake behavior (p < 0.05). Mothers of larger number of children, tobacco- and alcohol-users, the richer and having health insurance had negative uptake behavior (p < 0.05). A clear impact of socio-cultural and financial factors on breast cancer screening behavior is evident among Indian women. Therefore, apart from the ongoing health system strengthening efforts, our findings call for targeted interventions against prevailing misconceptions and taboos along with economic and social empowerment of women for the holistic success of India's cancer screening strategy.

County Mammogram Uptake can be Predicted from Social Determinants of Health, but Patterns Do Not Hold for Individual Patients.

The objective of this study is to describe patterns in barriers to breast cancer screening uptake with the end goal of improving screening adherence and decreasing the burden of mortality due to breast cancer. This study looks at social determinants of health and their association to screening and mortality. It also investigates the extent that models trained on county data are generalizable to individuals. County level screening uptake and age adjusted mortality due to breast cancer are combined with the Centers for Disease Controls Social Vulnerability Index (SVI) to train a model predicting screening uptake rates. Patterns learned are then applied to de-identified electronic medical records from individual patients to make predictions on mammogram screening follow through. Accurate predictions can be made about a county's breast cancer screening uptake with the SVI. However, the association between increased screening, and decreased age adjusted mortality, doesn't hold in areas with a high proportion of minority residents. It is also shown that patterns learned from county SVI data have little discriminative power at the patient level. This study demonstrates that social determinants in the SVI can explain much of the variance in county breast cancer screening rates. However, these same patterns fail to discriminate which patients will have timely follow through of a mammogram screening test. This study also concludes that the core association between increased screening and decreased age adjusted mortality does not hold in high proportion minority areas. The objective of this study is to describe patterns in social determinants of health and their association with female breast cancer screening uptake, age adjusted breast cancer mortality rate and the extent that models trained on county data are generalizable to individuals.

Effect of Health Education on the Uptake of breast cancer screening among nursing students in Plateau State, Nigeria: A quasi-experimental study

Objective: This study aimed to assess the effect of health education on breast cancer screening uptake among female nursing students in Plateau State, Nigeria. Methods: A quasi-experimental study involving 50 female nursing students that were selected using a systematic random sampling each from the Colleges of Nursing Jos South Local Government Area (LGA) (experimental group) and Jos North LGA (control group) both in Plateau State. The intervention involved health education training in the experimental group only for six (6) weeks. The tool used was a structured questionnaire with Cronbach’s alpha coefficient of 0.782. Data analysis was done using IBM SPSS Version 22. ANOVA was used to compare mean changes in uptake scores as appropriate. Results were presented in tables and p&lt; 0.05 was taken as statistically significant. Results: The mean breast cancer screening uptake scores were 1.00 ± 0.700, 2.46 ± 0.706 and 2.54 ± 0.676 at baseline, one-month and three-month post-intervention respectively among the experimental group with a statistically significant difference in mean uptake score, (F[2, 147] = [77.982], p &lt;0.001) (Effect size, R2=0.515). In the control group, the uptake scores were 1.04 ± 0.755, 1.16 ± 0.738, and 1.26 ± 0.694 at baseline, one month post-intervention and three-month post-intervention respectively. There was no statistically significant difference in mean uptake scores between at least two phases (F [2, 147] = (1.140), p =0.323). Conclusion: Health educational intervention can significantly improve breast screening uptake. There is a need to constantly educate youths on this benefit.

An SMS and animated video intervention to increase uptake of breast cancer screening: a randomised controlled trial

BackgroundBreast cancer screening attendance in the UK has fallen, and London has the lowest uptake nationally. This study tested the impact of a behavioural science-informed reminder SMS, and animated video intervention on screening uptake. MethodsThis three-armed randomised controlled trial took place in two screening services in London (each service operated across a range of static sites such as hospitals, and mobile sites). We included participants who were registered with GP as female, aged 50–70 years, and not screened in the past 3 years. We excluded those who had opted out of screening messages or were in care. Participants were assigned into three groups via the final two digits of their NHS number (ratio 34:33:33): control group (received usual care reminder), behavSMS group (behavioural science-informed SMS reminder addressing reducing negative emotions and information on health consequences), or behavSMS+video group (behavioural SMS plus link to animation). Researchers were masked to allocation. The SMS and video were co-designed with stakeholders using the Behaviour Change Wheel. Invitation processes changed during the COVID-19 pandemic, and therefore, we did separate analyses for those receiving a timed appointment (n=9027), and an open invitation to book an appointment (n=25 020). Messages were sent 7 days and 1 day before the appointment, plus 7 days after the open invitation letter. Group differences in the primary outcome of attendance within 3 months of invitation (and secondary outcome of booking for open invites) were assessed using χ2, and logistic regression controlling for age, ethnicity, deprivation, and first invitation. This trial is registered with ClinicalTrials.gov, NCT05395871. FindingsRecruitment took place between July 18, and Oct 21, 2022. For timed invitations, 3094 participants were assigned to the control group, 2952 to the behavSMS group, and 2981 to the behavSMS+video group. For open invitations groups sizes were 8654, 8095, and 8271 respectively. Median age was 59 years for participants who received a timed appointment, and 58 years for those who received an open invitation. There were no attendance differences for timed appointments (intention-to-treat analysis): 71·9% (2225/3094) in control group; 69·9% (2064/2952) in behavSMS group; 71·7% (2137/2981) in behavSMS+video group (χ2(2)=3·47, p=0·176), even when controlling for covariates. There were no attendance differences for open invitations either: 7·4% (4104/8654) in control group, 8·3% (3909/8095) in behavSMS group, 48·1% (3978/8271) in behavSMS+video (χ2(2)=1·40, p=0·497), including when controlling for covariates. However, in the per-protocol analysis (of those with valid mobile numbers), intervention groups were more likely to book an appointment: 44·7% (3238/7274) in control group, 46·3% (3121/6744) in behavSMS group, and 46·3% (3199/6910) in behavSMS+video group (χ2(2)=6·01, p=0·050). InterpretationDespite positive stakeholder feedback during co-design, the SMS or SMS+video interventions did not increase breast screening attendance compared with the usual SMS reminder. A limitation is that only 5·8% participants followed the video link. Links within SMS are unlikely to be an effective way to disseminate video content, and alternative options are being explored. FundingNHS England and National Institute for Health and Care Research (NIHR).

Estimated US Cancer Deaths Prevented With Increased Use of Lung, Colorectal, Breast, and Cervical Cancer Screening

Increased use of recommended screening could help achieve the Cancer Moonshot goal of reducing US cancer deaths. To estimate the number of cancer deaths that could be prevented with a 10-percentage point increase in the use of US Preventive Services Task Force (USPSTF)-recommended screening. This decision analytical model study is an extension of previous studies conducted for the USPSTF from 2018 to 2023. This study simulated contemporary cohorts of US adults eligible for lung, colorectal, breast, and cervical cancer screening. Annual low-dose computed lung tomography among eligible adults aged 50 to 80 years; colonoscopy every 10 years among adults aged 45 to 75 years; biennial mammography among female adults aged 40 to 74 years; and triennial cervical cytology screening among female adults aged 21 to 29 years, followed by human papillomavirus testing every 5 years from ages 30 to 65 years. Estimated number of cancer deaths prevented with a 10-percentage point increase in screening use, assuming screening commences at the USPSTF-recommended starting age and continues throughout the lifetime. Outcomes were presented 2 ways: (1) per 100 000 and (2) among US adults in 2021; and they were expressed among the target population at the age of screening initiation. For lung cancer, estimates were among those who will also meet the smoking eligibility criteria during their lifetime. Harms from increased uptake were also reported. A 10-percentage point increase in screening use at the age that USPSTF recommended screening commences was estimated to prevent 226 lung cancer deaths (range across models within the cancer site, 133-332 deaths), 283 (range, 263-313) colorectal cancer deaths, 82 (range, 61-106) breast cancer deaths, and 81 (1 model; no range available) cervical cancer deaths over the lifetimes of 100 000 persons eligible for screening. These rates corresponded with an estimated 1010 (range, 590-1480) lung cancer deaths prevented, 11 070 (range, 10 280-12 250) colorectal cancer deaths prevented, 1790 (range, 1330-2310) breast cancer deaths prevented, and 1710 (no range available) cervical cancer deaths prevented over the lifetimes of eligible US residents at the recommended age to initiate screening in 2021. Increased uptake was also estimated to generate harms, including 100 000 (range, 45 000-159 000) false-positive lung scans, 6000 (range, 6000-7000) colonoscopy complications, 300 000 (range, 295 000-302 000) false-positive mammograms, and 348 000 (no range available) colposcopies over the lifetime. In this decision analytical model study, a 10-percentage point increase in uptake of USPSTF-recommended lung, colorectal, breast, and cervical cancer screening at the recommended starting age was estimated to yield important reductions in cancer deaths. Achieving these reductions is predicated on ensuring equitable access to screening.

Using a participatory approach to encourage uptake of breast, colorectal, and cervical cancer screening for Scottish Muslim women: a pilot qualitative study

BackgroundMuslim women use cancer screening less often than the general female population, which puts them at risk of delayed detection. We used an asset-based approach to co-design a faith-based intervention to increase uptake of breast, colorectal, and cervical screening in Scottish Muslim women. MethodsIn this pilot qualitative study, we recruited Muslim women (n=28) of Asian and Arab ethnicity, aged 25–74 years, through snowball sampling from community organisations in Glasgow and Edinburgh. Ten of these women participated in four online workshops in February, 2021, with the aim to codesign the intervention, underpinned by the socio-ecological model and the behaviour change wheel. The final intervention included health education delivered by doctors, testimonials by Muslim women sharing experiences of cancer or screening, and the perspective on cancer screening from a female religious scholar. The intervention was delivered to two groups of eight and ten Muslim women respectively, in March 2021. A week later, the 18 women participated in two focus groups to qualitatively evaluate the intervention. Analyses were conducted thematically. FindingsThemes included barriers to screening, acceptability of content and delivery, attitudinal change, and intervention improvement. Participants believed that lack of awareness was an important barrier to screening. They found the intervention informative. They particularly liked the combination of multiple components, including spirituality, culture, and health education. They valued the faith-based element and highlighted how Islam could facilitate overcoming cultural barriers including social stigma, embarrassment, and modesty, although this could vary with different levels of religiosity. Participants also emphasised that faith-based approaches in isolation would not be enough. They appreciated input of trusted sources such as doctors and religious scholars and were especially drawn to personal narratives. Participants expressed preference for face-to-face delivery and advised using translators to overcome language barriers. InterpretationBarriers to screening are complex. Using faith as an asset, integrated with the socio-ecological model and behaviour change wheel, resulted in a holistic intervention tackling multiple barriers, which appealed to participants. Collaborating with communities and faith leaders can help to develop culturally sensitive interventions that harness positive aspects of faith for better health outcomes. Intervention effectiveness needs more robust investigation, which we are undertaking in a feasibility study with 200 Muslim women in northeast England and Scotland. FundingScottish Inequalities Fund, the Scottish Government.

Intervention recommendations to improve uptake of breast, cervical, and colorectal cancer screening among individuals living with serious mental illness.

Few efforts have been made to inform intervention design for increasing the uptake of cancer screening in individuals living with serious mental illness (ILSMI), who have lower cancer screening rates than the general population. This qualitative study explored ILSMI's and their care team member's (CTM) recommendations on the design of a breast, colorectal, and cervical cancer screening intervention for ILSMI. Twenty-five ILSMI (mean age: 71.4years; 60% female) and 15 CTM (mean age: 45.3years; 80% female) were recruited through purposive sampling.Semi-structured in-depth interviews were used to collect participants' intervention suggestions. Interviews were recorded, transcribed verbatim, and imported into NVivo. Content analysis and the constant comparison method were used to analyze interview data. ILSMI and CTMs provided several salient recommendations. ILSMI should receive disease-specific, logistical, and screening education, and primary care staff should receive education on psychopathology. Mental health providers and patient navigators should be considered as the primary interventionist. The intervention should be delivered where ILSMI receive medical or mental health services, receive community and government services, and/or via various digital media. The intervention should improve the collaboration, communication, and coordination between primary and mental health care. Findings also pointed to the implementation of trauma-informed cancer care and integrated care models comprising mental health care and primary cancer care. These findings bring the skills, knowledge, and expertise of ILSM and their care team to intervention design for increasing colorectal, breast, and cervical cancer screening in ILSMI attending an intensive outpatient program.

Barriers and enablers of breast cancer screening among women in East Africa: a systematic review

BackgroundBreast cancer is among the most common cancers globally with a projected increase in incidence and mortality in low- and middle-income countries. The majority of the patients in East Africa present with advanced disease contributing to poor disease outcomes. Breast cancer screening enables earlier detection of the disease and therefore reduces the poor outcomes associated with the disease. This study aims to identify and synthesize the reported barriers and enablers of breast cancer screening among East African women.MethodsMedline, Embase, SCOPUS, and Cochrane library were searched for articles published on the subject from start to March 2022 using PRISMA guidelines. Also, forward citation, manual search of references and searching of relevant journals were done. A thematic synthesis was carried out on the “results/findings” sections of the identified qualitative papers followed by a multi-source synthesis with quantitative findings.ResultsOf 4560 records identified, 51 were included in the review (5 qualitative and 46 quantitative), representing 33,523 women. Thematic synthesis identified two major themes – “Should I participate in breast cancer screening?” and “Is breast cancer screening worth it?”. Knowledge of breast cancer and breast cancer screening among women was identified as the most influencing factor.ConclusionThis review provides a rich description of factors influencing uptake of breast cancer screening among East African women. Findings from this review suggest that improving knowledge and awareness among both the public and providers may be the most effective strategy to improve breast cancer screening in Eastern Africa.

EXPLORING PERCEIVED BARRIERS TO BREAST CANCER SCREENING AMONG SAUDI WOMEN IN PRIMARY CARE SETTINGS

Breast cancer is a significant health concern worldwide, including in Saudi Arabia, where it is the most common cancer among women. Despite the importance of early detection through screening, the uptake of breast cancer screening remains relatively low among Saudi women. This study aims to explore the perceived barriers to breast cancer screening among Saudi women in primary care settings. Through qualitative interviews and surveys, factors such as cultural beliefs, lack of awareness, fear of diagnosis, and logistical challenges are investigated. Understanding these barriers is crucial for designing targeted interventions to promote breast cancer screening uptake and improve women's health outcomes in Saudi Arabia.

Effectiveness of a telehealth patient education intervention for breast cancer awareness and screening uptake among Afghan refugee women: a cross-sectional survey and feasibility study

Refugee populations have low levels of cancer awareness, low cancer screening rates, and a high rate of advanced or metastatic cancer at diagnosis. Educational interventions to improve cancer awareness and screening have been successful in other nationality refugee populations but have never been implemented in Afghan refugee populations. We aimed to estimate the level of breast cancer awareness among Afghan refugee women and test the feasibility of a telehealth breast cancer educational intervention to increase breast cancer awareness in this population. A cross-sectional survey of Afghan refugee women residing in Istanbul, Türkiye who had no personal history of breast cancer and who presented to outpatient primary clinics for care between August 1, 2022, and February 10, 2023 was performed. Participant awareness of breast cancer (BC) was assessed using the validated BC awareness tool, Breast Cancer Awareness Measure (BCAM), during a telehealth encounter. After this baseline assessment, a BC educational intervention was administered to each participant during the telehealth encounter. Six months after the initial assessment and education, a follow-up BCAM was administered via telehealth in order to determine the effectiveness of the education intervention. One hundred participants were accrued to the study. Median age was 49 years (range: 40-64). All participants had no formal education, were married, and were not employed. Prior to the educational intervention, BC awareness was low; none of the participants were able to identify some common signs/symptoms and risk factors for BC. Prior to the educational intervention, zero participants had ever had a mammogram or seen a physician for a breast-related concern. Six months after the educational intervention, up to 99 percent of participants (99 of 100 participants) were able to correctly identify common signs or symptoms and risk factors for BC. Six months after the educational intervention, all one hundred participants had accepted the offer of a screening mammogram. A telehealth BC education intervention meaningfully increased BC awareness in Afghan refugee women. This increase in BC awareness was associated with a strong increase in completion of BC screening. Further implementation of educational interventions is warranted in order to increase participant awareness and improve screening rates. Dana Farber Cancer Institute Jay Harris Junior Faculty Research Grant.