Cancer Awareness Campaign Research Articles

Adherence of Primary Care Physicians to Evidence-Based Recommendations to Reduce Ovarian Cancer Mortality.

Ovarian cancer is the deadliest gynecologic cancer. Receipt of treatment from a gynecologic oncologist is an evidence-based recommendation to reduce mortality from the disease. We examined knowledge and application of this evidence-based recommendation in primary care physicians as part of CDC gynecologic cancer awareness campaign efforts and discussed results in the context of CDC National Comprehensive Cancer Control Program (NCCCP). We analyzed primary care physician responses to questions about how often they refer patients diagnosed with ovarian cancer to gynecologic oncologists, and reasons for lack of referral. We also analyzed these physicians' knowledge of tests to help determine whether a gynecologic oncologist is needed for a planned surgery. The survey response rate was 52.2%. A total of 84% of primary care physicians (87% of family/general practitioners, 81% of internists and obstetrician/gynecologists) said they always referred patients to gynecologic oncologists for treatment. Common reasons for not always referring were patient preference or lack of gynecologic oncologists in the practice area. A total of 23% of primary care physicians had heard of the OVA1 test, which helps to determine whether gynecologic oncologist referral is needed. Although referral rates reported here are high, it is not clear whether ovarian cancer patients are actually seeing gynecologic oncologists for care. The NCCCP is undertaking several efforts to assist with this, including education of the recommendation among women and providers and assistance with treatment summaries and patient navigation toward appropriate treatment. Expansion of these efforts to all populations may help improve adherence to recommendations and reduce ovarian cancer mortality.

The bowel cancer awareness campaign 'Be Clear on Cancer': sustained increased pressure on resources and over-accessed by higher social grades with no increase in cancer detected.

To evaluate the impact of the national 'Be Clear on Cancer' bowel cancer reminder campaign on service and diagnosis at a single UK institution. Secondly, to evaluate the socio-economic background of patients referred before and after the reminder campaign compared with the regional demographic. Suspected cancer 2-week wait patients in the 3 months precampaign, postcampaign and after the reminder campaign were included. Demographics, investigations and diagnosis were recorded. The postcode was used to allocate a National Readership Survey social grade. Three hundred and eighty-three referrals were received in the 3 months precampaign, 550 postcampaign and 470 postreminder campaign. There were significant increases in the monthly referral rates following the campaign (P < 0.001 in both the post- and postreminder periods). Significantly more patients from social grades AB and C1C2 than expected from regional demographics were referred precampaign and after the reminder campaign (P < 0.001 in each case). There were no significant differences between the proportions of patients diagnosed with colorectal cancer in the three study periods (P = 0.710). The 'Be Clear on Cancer' bowel cancer campaign has had a significant sustained impact on resources. It has failed to increase referrals among lower socio-economic grades, leading to an increase in 'worried well' referrals and no change in numbers, or the stage, of colorectal cancers diagnosed.

Evaluating Media Awareness Toward Breast Cancer Awareness Campaigns: A Case Study of Women in Kuwait in 2014.

يتم مواجهة الحالات المتزايدة في مرض سرطان الثدي حول العالم بجهود مختلفة تهدف إلى معرفة طرق تجنب المرض وكيفية علاجه، وتستخدم الحملات التوعوية لنشر الوعي بسرطان الثدي، وزيادة المعرفة به، وتغيير أفكار الأفراد وسلوكياتهم تجاه المرض. تحاول هذه الحملات مواجهة الخوف وبعض العوامل الثقافية التي تخلق العوائق لمواجهة المرض. ولكن العديد من الدراسات السابقة المتعلقة بالحملات التوعوية لسرطان الثدي تركز على قياس تأثير هذه الحملات التوعوية وليس الوعي بوجودها. لذلك، تتطرق هذه الدراسة لسؤال بحثي مختلف: ما مدى وعي الجمهور المستهدف بالحملات التوعوية لسرطان الثدي؟ يحاول هذا البحث دراسة وعي نساء الكويت تجاه الحملات التوعوية لسرطان الثدي وإذا ما كان العمر، المستوى الدراسي والعادات الإعلامية مرتبطة ومسهمة بهذا الوعي. احتوت العينة على 500 امرأة، ووجدت الدراسة مستوى عالياً من عدم الوعي لدى النساء بهذه الحملات. ووجدت أيضاً أن المستوى الدراسي والعادات الإعلامية لم يسهما في وعي النساء بهذه الحملات التوعوية لسرطان الثدي. تشير النتائج إلى أن عامل العمر فقط له علاقة قوية بوعي النساء تجاه هذه الحملات؛ إذ وجد أن الأكبر من حيث العمر لديه وعي أكثر من الأصغر عمراً. هذا الوعي المنخفض تجاه الحملات التوعوية لسرطان الثدي يشير إلى عدم فاعلية الحملات أو عوامل شخصية لدى النساء قد تعوق وعيهن بوجودها.

Transmissibility of the Campaign for Colorectal Cancer Awareness in Korea Among Twitter Users.

PurposeThe Korean Society of Coloproctology holds its annual colorectal awareness month every September. This study analyzed the users and the contents of Korean tweets regarding colorectal cancer and estimated the transmissibility of the awareness campaign among Twitter users.MethodsProspective data collection was employed to accumulate Korean tweets containing the keywords "colorectal cancer," "colorectal cancer awareness campaign," "gold ribbon," and/or "love handle," from August 1 to September 30, 2014. Twitter users and contents were analyzed, and the credibility of information-sharing tweets throughout the study period was evaluated.ResultsIn total, 10,387 tweets shared by 1,452 unique users were analyzed. As for users, 57.8% were individuals whereas 5.8% were organizations/communities; spambots accounted for a considerable percentage (36.4%). As for content, most tweets were spam (n = 8,736, 84.1%), repetitively advertising unverified commercial folk remedies, followed by tweets that shared information (n = 1,304, 12.6%) and non-information (n = 347, 3.3%). In the credibility assessment, only 80.6% of the information-sharing tweets were medically correct. After spam tweets had been excluded, a significant increase was seen in the percentage of information-sharing tweets (77.1% to 81.1%, P = 0.045) during the awareness campaign month.ConclusionMost Korean tweets regarding colorectal cancer during the study months were commercial spam tweets; informative public tweets accounted for an extremely small percentage. The transmissibility of the awareness campaign among Twitter users was questionable at best. To expand the reach of credible medical information on colorectal cancer, public health institutions and organizations must pay greater attention to social media.

Impact of the United Kingdom national bowel cancer awareness campaigns 2012 on colorectal cancer services and patient survival.

The UK national bowel cancer awareness campaigns in 2012 were intended to improve survival of patients with colorectal cancer (CRC) by raising public awareness and prompting symptomatic individuals to seek medical attention early. The aim of the present study was to compare the number of CRCs diagnosed, tumour stage at diagnosis, survival and number of investigations performed during the campaigns compared with a similar time period in 2011. A retrospective study was carried out of 1439 consecutive referrals through the 2-week wait pathway (2WW) to our colorectal unit during the February and September 2012 campaigns. Patient demographics, number of referrals, investigations performed and newly diagnosed cases of CRC with their respective staging were determined and compared with a group in 2011. Two-year survival was evaluated by Kaplan-Meier statistics. Referrals through the 2WW increased by 55-60% and endoscopic and the number of radiological investigations performed increased by over 70% during the awareness campaigns. Although new diagnoses of CRC nearly doubled, the increase in the patients referred meant the diagnostic yield remained low at 6%. The bowel cancer awareness campaigns did not alter the tumour stage at presentation, as over 50% of patients were diagnosed with Stage 3 and 4 CRC and there was no significant difference in 2-year survival. The UK bowel cancer awareness campaigns appear to have improved public awareness of CRC and encouraged symptomatic individuals to seek urgent medical attention. The increase in 2WW referrals has not translated into better survival for symptomatic patients, partly due to the proportion presenting with advanced disease.

Prognostic features of breast cancer differ between women in the Democratic Republic of Congo and Belgium

ObjectivesCompared to European women, breast cancers in African women present at a younger age, with a higher tumor grade and are more often estrogen receptor (ER)/progesterone receptor (PR) negative. We here investigate the histopathological and immunohistochemical characteristics (ER, PR and human epidermal growth receptor 2 (HER2)) and the proportion of triple negative (Tneg) invasive breast cancers from an unselected series of patients diagnosed in Kinshasa, and compare them to a population of Caucasian women with a palpable breast cancer. Materials and methodsFrom 2010 till 2013, during the first breast cancer awareness campaign, organized in Kinshasa, 87 patients were diagnosed with invasive breast cancer. Diagnose was based on core biopsy. The control group consisted of Caucasian women (University Hospitals of Leuven, Belgium) with a palpable mass, diagnosed between 2000 till 2009, treated with surgery of which the histopathological and immunohistochemical characteristics were collected on excision specimens. Each patient in the Kinshasa group was matched based on age and tumor size to one or more patients of the Leuven database. Differences between both groups with respect to hormone receptors (ER, PR, HER2, Tneg) or grade are presented as relative risks (RR). The analysis is based on a log-binomial model accounting for clustering through matching by a random intercept for cluster. Differences between both groups with respect to hormone receptors correcting for grade is performed by the inclusion of grade as a covariate in the model. ResultsAfter adjusting for age, tumor volume and tumor grade, ER was more frequently negative (RR = 0.71, p < 0.001), with a trend in the same direction for PR (RR = 0.87, p = 0.057), and HER2 more often positive (RR = 1.60, p = 0.015) compared to the group from the University Hospitals of Leuven. There was no difference in the proportion of breast cancers being triple negative. Sub-analysis showed that the higher HER2 positive rate was only observed in older patients (≥50y: RR = 2.07, p = 0.007) whereas no difference in HER2 positive rate was found in younger patients (<50y: RR = 1.30, p = 0.358). A higher ER negative rate was observed in both age groups, however more pronounced in older patients (≥50y: RR = 0.64, p = 0.001; <50y: RR = 0.79, p = 0.018). ConclusionBreast cancer in women of Kinshasa presents at younger age and is more aggressive (more frequently ER negative and HER2 positive) compared to Caucasian women and this is more pronounced in older women (>50y). Only the ER results were concordant with the results of two similar studies (comparing an African with a European group), but were different when compared to studies on African-American women with breast cancer. This information is very important considering the treatment option: as more tumors are ER negative, endocrine therapy cannot be given while chemotherapy is often too expensive.

Athletes as PR Spokespeople: the NFL’s “A Crucial Catch” PR Campaign Explored

The results of the present study were presented at the 2015 International Conference on Communication and Management and examined the National Football League’s (NFL) “A Crucial Catch” breast cancer awareness campaign in the United States. Variables included identification with NFL athletes, exposure to the campaign, NFL fanship, and intention to schedule a breast cancer screening (the action promoted by NFL athletes in this PR campaign). Social media outlets and an e-mail listserv of the School of Communication at Rochester Institute of Technology in Rochester, New York, USA were employed to solicit participants ( n=119 ) in a survey. A questionnaire composed of items modified from Brown and Bocarnea’s (2007a) Celebrity-Persona Parasocial Identification Scale to investigate identification with NFL athletes was used. Statistically significant relationships were found between identification with NFL athletes and exposure, identification with NFL athletes and intention to schedule a breast cancer screening, and identification with NFL athletes and NFL fanship. NFL fanship was also significantly related to exposure to the campaign. Implications for future studies analyzing PR campaigns produced by the NFL and FIFA are suggested.

Cervical Cancer Knowledge, Perceptions and Screening Behaviour Among Female University Students in Ghana.

Cervical cancer is becoming a leading cause of death among women in developing countries. Nevertheless, little is known regarding knowledge and perception of cervical cancer and screening behaviour particularly among female tertiary students in Ghana. This study sought to examine the knowledge and perceptions of cervical cancer and screening behaviour among female students in the University of Cape Coast and Ghana Institute of Management and Public Administration in Ghana. A cross-sectional survey design was adopted for the study. Systematic and stratified random sampling techniques were used to select 410 participants for the study. The study found that the participants lacked knowledge on specific risk factors and symptoms of cervical cancer. Also, even though the participants had a fair perception of cervical cancer, they had a poor cervical cancer screening behaviour. Awareness of cervical cancer was significantly influenced by religious affiliation while cervical cancer screening was significantly determined by the working status of the participants. Specific knowledge on cervical cancer and its risk factors as well as regular screening behaviour is paramount to the prevention of cervical cancer. Consequently, the University Health Services should focus on promoting regular cervical cancer awareness campaigns and screening among the students particularly, females.

The impact of national cancer awareness campaigns for bowel and lung cancer symptoms on sociodemographic inequalities in immediate key symptom awareness and GP attendances.

Background:National campaigns focusing on key symptoms of bowel and lung cancer ran in England in 2012, targeting men and women over the age of 50 years, from lower socioeconomic groups.Methods:Data from awareness surveys undertaken with samples of the target audience (n=1245/1140 pre-/post-bowel campaign and n=1412/1246 pre-/post-lung campaign) and Read-code data extracted from a selection general practitioner (GP) practices (n=355 for bowel and n=486 for lung) were analysed by population subgroups.Results:Unprompted symptom awareness: There were no significant differences in the magnitude of shift in ABC1 vs C2DE groups for either campaign. For the bowel campaign, there was a significantly greater increase in awareness of blood in stools in the age group 75+ years compared with the 55–74 age group, and of looser stools in men compared with women. Prompted symptom awareness: Endorsement of ‘blood in poo' remained stable, overall and across different population subgroups. Men showed a significantly greater increase in endorsement of ‘looser poo' as a definite warning sign of bowel cancer than women. There were no significant differences across subgroups in endorsement of a 3-week cough as a definite warning sign of lung cancer. GP attendances: Overall, there were significant increases in attendances for symptoms directly linked to the campaigns, with the largest percentage increase seen in the 50–59 age group. For the bowel campaign, the increase was significantly greater for men and for practices in the most-deprived quintile, whereas for lung the increase was significantly greater for practices in the least-deprived quintile.Conclusions:The national bowel and lung campaigns reached their target audience and have also influenced younger and more affluent groups. Differences in impact within the target audience were also seen. There would seem to be no unduly concerning widening in inequalities, but further analyses of the equality of impact across population subgroups is warranted.

The role of tentative decisions and health concepts in assessing information about mammography screening

Breast cancer awareness campaigns and screening programs are important public health issues. In order to deepen women’s knowledge about mammography screening, a balanced presentation of arguments is considered to be relevant. Yet, little is known about how women process this information and assess pro and contra arguments, which, in turn, can be embedded in different health paradigms. The aim of this experimental study was to determine the impact of both women’s pre-formed, tentative decisions about whether to participate in mammography screening and of their individual health concepts on their assessment of different arguments about mammography screening. The results showed that women who would tend at the outset to participate in mammography screening rated information about advantages as more relevant than information about disadvantages – in contrast to women who did not intend to participate. In addition, the greater the fit was between women’s individual health concepts and the health concept presented in the arguments, the more they considered the information presented to be relevant. We conclude that presenting balanced information about mammography screening does not guarantee balanced processing of that information. Health professionals need to be aware of people’s prior beliefs and of the health paradigm in which information is embedded.

Assessment of Breast Cancer Screening Practices among Women of Reproductive Age in Benin City, Edo State

Breast cancer is becoming very prevalent in developing countries including Nigeria which is now being bedeviled by the twin public health challenge of both communicable and non-communicable diseases. Aims: This study was conducted to assess breast cancer knowledge and screening practices among women of reproductive age in Benin City, with a view to improving breast cancer screening practices and minimize late presentation and attendant consequences. Study Design: A descriptive cross sectional study design was utilized for this study. Place and Duration of Study: This study was carried out in Central Hospital in Benin City, Edo State between September and December, 2013. Methodology: This study was health facility based involving researcher administration of semistructured questionnaires to 235 consenting women of reproductive age (15-49years) attending immunization clinics in Benin City. The data collected were analyzed using IBM Statistical Package for Sciences (SPSS) version 22.0 with statistical significance set at p< 0.05 and 95% Confidence Interval. Results: The mean age and parity of respondents studied were 28.8±7.4 years and 2.19±1.85 Original Research Article Obi AI; IJTDH, 6(4): 141-149, 2015; Article no.IJTDH.2015.050 142 children respectively. Two hundred and seventeen (92.3%) of the women studied, were aware of breast cancer with majority 201(92.6%) having poor knowledge of breast cancer. Furthermore, the practice of breast examination was 143 (65.9%) among respondents studied with self-breast examination accounting for 106(74.1%). In relation to breast cancer screening practice, primary level of education (OR=0.323; 95% CI=0.141 – 0.742) was the only significant predictor identified that less likely influenced the practice. Conclusion: This study identified a high awareness with poor level of knowledge on breast cancer among women of reproductive age. The practice of breast examination was high with level of education identified as a significant predictor for breast cancer screening practice. There is need to create and strengthen breast cancer awareness campaign through all available media platforms and in schools not only for improved breast cancer screening practices but very importantly to improve knowledge on its presentation, risk factors and benefits of early detection and treatment for better health outcome.

Analysis of 46 cases of malignant jaw tumours in Calabar, Nigeria.

Background:The occurrence and distribution of malignant jaw tumours differs across the globe because of differences in geographical, cultural, racial, and socioeconomic factors. The aim of this study was to determine the types and pattern of malignant jaw tumours in Calabar, located in South-South Nigeria.Materials and Methods:The histopathologic results, as well as demographic and clinical information of all consecutive patients diagnosed of having a malignant jaw tumour at the Oral and Maxillofacial Unit of University of Calabar Teaching Hospital, Calabar, Nigeria from January 2000 to December 2013 was retrospectively collected and analyzed.Results:A total of 46 (25.1%) out of the 180 cases of jaw neoplasms seen over the 14 year period were malignant. There was a slight male predominance with a ratio of 1.7:1 and the age ranged from 4 to 70 years, mean (standard deviation) 34.6 (4.56) years. The most common malignant lesion was squamous cell carcinoma (SCC) (n = 20; 43.5%), followed by Burkitt lymphoma (n = 8; 17.4%). The gender distributions of the lesions were significant, with more SCC seen in females in a ratio of 1.5:1 in relation to males. Osteosarcoma (n = 6; 13%) and rhabdomyosarcoma (n = 4; 8.7%) were observed only in males and females, respectively. About half of the lesions occurred in the mandible (47.8%). The age distribution of lesions was significant (P < 0.001), with SCC frequently seen in the sixth and seventh decades while Burkitt's lymphoma and rhabdomyosarcoma were seen around the first decade. Clinical presentations ranged from swelling (n = 31), pain (n = 26), loosed teeth (n = 15), toothache (n = 11) to missing teeth (n = 9) among others and occurring either singly or in two or more combinations. The duration of symptoms on presentation ranged from 1 to 46 months, mean 21.7 (13.12) months and this was not different for male or female (P > 0.05).Conclusion:Oral cancer awareness campaign and advocacy is necessary to steer the awareness of the population on the need for regular dental visits, early recognition, and the dangers associated with late presentation of orofacial malignancy.

The Impact of Community-Based Awareness Campaigns on the Early Breast Examination among Women at King Faisal University

Background and Objective: Breast cancer (BC) is the most common cancer between females in Saudi Arabia, the eastern area ranked as the first in the incidence rate. As the breast cancer awareness movement has expanded, majority of the new cases are still diagnosed in a later stage. This study aimed to evaluate the impact of breast cancer awareness campaigns on the knowledge and practice of early breast examination (EBE) which consisted of breast-self examination (BSE), clinical breast examination (CBE) and mammography, among women at King Faisal University. Methodology: A cross-sectional study carried out at King Faisal University, Al-Hassa city on a sample of 300 adult females from different urban and rural areas. A pre-tested, self-administered questionnaire was distributed to the participants. The questionnaire contains questions about: socio-demographic factors, awareness campaigns, practice and knowledge of breast cancer and early screening methods. Results: The age of the participants ranged from 16 to 60 years; 53% of the participants have attended campaigns; and 47% have never attended. Regarding the practice of BSE, CBE and mammography, the results were 8.8%, 3.3%, and 4.3%, respectively. The results show a significant relation between attending campaigns and good level of practice and knowledge. Conclusion and Recommendation: The findings indicate a great impact of the community-based awareness campaigns on the practice of EBE. The study recommends a multilevel intervention for every age group, specially the age group that at risk.

107: Lung cancer – You can avoid it, get it, survive it; an evaluation of the Irish Cancer Society's annual lung cancer awareness campaign from 2011 to 2013

107: Lung cancer – You can avoid it, get it, survive it; an evaluation of the Irish Cancer Society's annual lung cancer awareness campaign from 2011 to 2013

Pharmacy lung cancer awareness campaign boosts referrals to GPs

Pharmacy lung cancer awareness campaign boosts referrals to GPs

Breast Cancer Screening Among. Women in Northern Nigeria: What We Know and What We Do

Breast cancer is the most common cancer which occurs rapidly among women in the developing countries that previously enjoyed low incidence of the disease. Nigerian women experience advanced stages of breast cancer when little or no benefit can be derived from any form of therapy. This study, therefore, examined what women know and do on breast cancer screening in Kaduna state of Northern Nigeria. Four hundred (400) women between ages 20-60 years with no diagnosis of breast cancel; from five selected ward clusters around Sabon Gari Local Government Area in Kaduna were recruited for the study. Using questionnaires, complemented with 10 in-depth interviews, the study obtained information on knowledge and practices of breast cancer and screening. The study respondents are aware of breast cancer and major source of information is media and the Internet. However; 40% of the respondents had poor knowledge of signs and symptoms, risk factors and treatment options of breast cancer Practice of Breast Self Examination (BSE) Has high bur only 34.3% admitted to carrying out the procedure monthly. Twenty four percent of the respondents had Clinical Breast Examination (CBE) while 9% had done mammography. There is a positive significant relationship (p&lt;0.001) between what women know and do about breast cancer screening. indicating poor knowledge of breast cancer resulting to low practice of the screening among the respondents. There is the need to introduce strategies by the government and policy makers to improve healthcare services that call enable women access the health facilities for breast cancer screening. Male role should also be incorporated into the mainstream of cancer awareness campaigns especially in Northern Nigeria

Responding to symptoms suggestive of lung cancer: a qualitative interview study

BackgroundLate diagnosis of lung cancer can impact on survival rates. Patients delay seeking help for a number of reasons. This study explored symptom appraisal and help-seeking decisions among patients referred...

Awareness of symptoms and risk factors of ovarian cancer in a population of women and health care providers

Objectives: Despite ovarian cancer awareness campaigns, awareness among women and health care providers is understudied and likely poor. The objective of this study was to determine the level of awareness among a sample of women and providers and compare these two populations.

The mediation of social influences on smoking cessation and awareness of the early signs of lung cancer.

BackgroundWhilst there has been no clear consensus on the potential for earlier diagnosis of lung cancer, recent research has suggested that the time between symptom onset and consultation can be long enough to plausibly affect prognosis. In this article, we present findings from a qualitative study involving in-depth interviews with patients who had been diagnosed with lung cancer (n = 11), and people who were at heightened risk of developing the disease (n = 14).MethodsA grounded theory methodology was drawn upon to conduct thematic and narrative based approaches to analysis.ResultsThe paper focuses on three main themes which emerged from the study: i) fatalism and resignation in pathways to help-seeking and the process of diagnosis; ii) Awareness of smoking risk and response to cessation information and advice. iii) The role of social and other networks on help-seeking. Key findings included: poor awareness among participants of the symptoms of lung cancer; ambivalence about the dangers of smoking; the perception of lung cancer as part of a homogenisation of multiple illnesses; close social networks as a key trigger in help-seeking.ConclusionsWe suggest that future smoking cessation and lung cancer awareness campaigns could usefully capitalise on the influence of close social networks, and would benefit from taking a ‘softer’ approach.

Perilous equations? Empowerment and the pedagogy of fear in breast cancer awareness campaigns

Breast cancer awareness campaigns are the major strategy used by public institutions and private organizations to empower women about breast cancer. Yet, drawing on my own research and observations as an academic and activist over the past 9 years in Spain, I argue that these mainstream campaigns are often unaware of, or oversimplify, conceptualisations of empowerment. I illustrate my argument with examples from Spain and North America. I show how the specific goal of empowerment aims to persuade women to comply with biomedical recommendations which include behaviour change and treatment-seeking. Towards this end, their main approach focuses on the use of coercive fear-mongering tactics, including misleading information and exaggeration of data on incidence, mortality, survival and treatment efficacy. A further problem is that they allude to assumptions about the reasons for women's compliance: stereotypical moral and gendered responsibilities for one's health and family as well as fear of a horrible death. Some justify this particular use of fear by appealing to the need to target women with a simplified, high-impact message. However, there is evidence that fear creates unnecessary social psychosis and further distorts the decision-making process, conflicting with empowerment intent. I argue that there is an urgent need to stimulate debate about how to improve breast cancer awareness campaigns and propose an alternative approach, grounded in a critical pedagogy paradigm- a model of critical health literacy based on a patient-centred approach that aims to develop critical consciousness and reflection of the social factors that affect breast cancer.