Cancer Screening Services Research Articles

Regional variations in breast cancer screening uptake and its associated factors in Ghana

Abstract Introduction Timely identification of breast cancer is critical for successful treatment and prevention, reducing its burden. Despite its significance, breast cancer screening services in Ghana are underutilized, with considerable regional variations in uptake rates. We examined the regional differences in breast cancer screening uptake and its associated factors in Ghana. Methods We analyzed data from 15,014 women of reproductive age from the 2022 Ghana Demographic and Health Survey. Spatial mapping illustrated regional variations in screening uptake. Multilevel logistic regression was employed to examine the factors associated with breast cancer screening uptake. Results National breast cancer screening prevalence was 18.4%, with regional variations observed across the 16 regions. Eastern, Western, Brong Ahafo, and Greater Accra had the highest screening uptake. The likelihood of breast cancer screening was higher among women aged 45-49 (aOR = 3.59; 95% CI = 12.52, 5.12), Married women (aOR = 1.44; 95% CI = 1.17-1.77), Higher education, employment, health insurance, recent health facility visits, media access, and wealth index (middle: aOR = 1.45, 95% CI = 1.08, 1.94; richest: aOR = 1.91, 95% CI = 1.36, 2.70). Islamic and African Traditional affiliations decrease screening likelihood (aOR = 0.77; 95% CI = 0.63, 0.95; aOR = 0.46; 95% CI = 0.22, 0.97). Rural residence and specific regions (Ashanti, Oti, Savannah, Upper West) reduce odds, while living in North East increases odds (aOR: 1.86; 95% CI = 1.14-3.03). Conclusions Cost-effective breast cancer screening services are crucial, particularly in rural areas with geographical disparities. Culturally and religiously sensitive protocols are needed to address regional and religious differences. Expanding Ghana’s national health insurance to cover preventive measures like breast cancer screening is essential. Promoting awareness through conventional and digital platforms is crucial for advocating screening. Key messages • Addressing geographical and cultural differences crucial for equitable breast cancer screening in Ghana. • Expanding health insurance and raising awareness vital to promote screening access and reduce disparities.

Strengthening uptake of breast cancer screening services in Tanzania; re-visiting the breast cancer screening messages

BackgroundBreast Cancer remains among the top five cancers responsible for morbidity and mortality globally. For many years, infectious (communicable) diseases were a primary concern in low- and middle-income countries (LMICs) compared to higher-income countries, where non-communicable diseases (NCDs) were already a major concern. However, starting from the early 2000s, the LMICs including Tanzania has witnessed an epidemiological transition being equally affected by NCDs, and breast cancer, is among the prevalent NCDs. While the evidence is vast on the role of breast cancer screening messages in promoting screening, debunking myths, and addressing barriers to the uptake of breast cancer services, context-specific messages are limited. Amidst the changing technology, growth of social media and cultural dynamics, context-specific breast cancer screening messages are needed. We aimed to analyze the breast cancer screening messages from the experiences of women seeking care at Ocean Road Cancer Institute in Tanzania.MethodsAn exploratory qualitative case study adopting in-depth interviews (IDI) and focused group discussion (FGD) was carried out among purposefully selected women aged from 18 years to 65 years seeking care from Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Eighteen women participated in the IDIs, and 16 women participated in FGD. Data analysis followed inductive qualitative content analysis.FindingsThree main categories emerged: the existence of multiple sources of breast cancer screening messages, the strengths and weaknesses of breast cancer screening messages, and clients’ mixed perceptions of breast cancer screening messages.ConclusionThe findings of this study depict that although breast cancer screening promotion messages are regarded as a source of information about cancers, they fall short of completeness and relevance to the otherwise at-risk population and trigger negative perceptions toward screening. Therefore, this study advocates revisiting the breast cancer screening messages, employing participatory approaches to tailor the screening messages and communication media to fit specific audiences. This calls for re-designing both the content of the messages and means of delivery; thus, collaborative efforts are needed.

Applying the Health Belief Model to cervical cancer screening uptake among women in Ethiopia: a systematic reviewand meta-analysis.

Cervical cancer is a leading cause of cancer mortality globally, especially in Africa, including Ethiopia. This review assesses predictors of cervical cancer screening uptake among Ethiopian-eligible women using the Health Belief Model. Higher education levels, perceived susceptibility, severity, and fewer barriers are associated with increased screening. Effective HBM-based interventions could enhance screening rates, potentially reducing cervical cancer incidence and mortality. The review aimed to synthesize the existing literature on the prevalence of Cervical Cancer Screening Service Uptake and Associated Factors among Eligible Women using the Health belief model in Ethiopia, 2024. This systematic review and meta-analysis searched Google Scholar, PubMed, and the Cochrane Library engine. Key terms such as "Cervical cancer screening", "uptake", "utilization", "factors", "barriers", and "Ethiopia" were used to identify relevant articles. Data extraction utilized a detailed form, and the methodological quality of each study was assessed using the JBI quality appraisal checklist for cross-sectional studies. Statistical analysis was conducted using STATA version 17, and the meta-analysis findings were presented using forest plots and tables. The result of seven studies revealed that the overall prevalence of Cervical Cancer Screening Service Uptake among eligible women in Ethiopia was 21% (95% CI: 15%-27%). Factors independently associated with Cancer Screening Service Uptake included: Knowledge (OR = 4.563, 95% CI: 1.012-4.188), age 30 up to 49 (OR = 4.106, 95% CI: 1.562-6.650), history of STD (OR = 2.59, 95% CI: 1.694-4.486), high perceived susceptibility (OR = 3.814, 95% CI: 2.312-5.316), high perceived severity (OR = 2.603, 95% CI: 2.203-3.003), low perceived barrier (OR = 4.390, 95% CI: 1.331-8.449), high perceived self-efficacy (OR = 4.77, 95% CI: 4.102-5.431), high perceived benefit (OR = 3.67, 95% CI: 1.851-5.489), and education level greater than primary level (OR = 4.497, 95% CI: 3.619-5.375). Cervical cancer is a major public health challenge in Ethiopia. Consequently, there is a pressing need for the governments to formulate comprehensive, multi-sectorial policies and strategies. These initiatives should be designed to address the problem influenced by interconnected factors, to reduce the prevalence of cervical cancer in Ethiopia.

BREATH TEST TO DETECT WOMEN AT LOW RISK FOR BREAST CANCER: POTENTIAL CLINICAL AND ECONOMIC BENEFITS.

A breath test for volatile organic compounds has identified biomarkers associated with breast cancer. We evaluated the potential clinical and economic benefits of a breath test to detect women at low risk for breast cancer by comparing its negative predictive value (NPV) to the NPV of screening mammography. Sensitivity and specificity values for screening mammography were obtained from the Food & Drug Administration Mammography Quality Standards Act; Amendments to Part 900 Regulations Docket No. FDA-2013-N-0134. The high values were sensitivity = 79.0%, specificity = 88.9% and the low values were sensitivity = 66.0%, specificity = 88.9%. In two previous studies of 771 women undergoing mammography, breath testing identified breast cancer with sensitivity=84% and specificity = 68.6% in 178 asymptomatic women, and sensitivity=82% and specificity = 77% in 593 who were symptomatic. These values were projected to a hypothetical screening population of 100,000 asymptomatic women with average breast cancer prevalence of 450/100,000, in order to estimate the NPV and PPV (positive predictive value) for breath testing and screening mammography respectively. Breath test in asymptomatic women: NPV = 99.895% and PPV = 1.19%; in symptomatic women: NPV = 99.895% and PPV = 1.59%. For screening mammography, NPV = 99.83% and PPV = 2.82% (low values), increasing to NPV= 99.89% and PPV = 3.12% (high values). A negative breath test identified 68.3% of the screening population as having low risk of breast cancer, with NPV similar to mammography. Based on Medicare reimbursement rates, elimination of mammography in women with a negative breath test could reduce the annual cost of breast cancer screening by 38.9. In a hypothetical screening population, a negative breath test ruled out breast cancer with the same accuracy as a negative mammogram. A screening breath test could potentially eliminate the need for two thirds of all mammograms and reduce the costs of screening without increasing the risk of false-negative findings. If applied in clinical practice, this approach could potentially reduce the costs and burdens of breast cancer screening services, and benefit women by lessening the discomfort, anxiety, radiation exposure, and costs associated with mammography.

Cervical cancer screening service utilisation and related factors among women on antiretroviral therapy in public health facilities of Asella town, Ethiopia, cross-sectional study

BackgroundCervical cancer is the predominant form of cancer in Ethiopia, accounting for the majority of malignant cases. Women account for two-thirds of cancer-related deaths in the country. Cervical cancer screening (CCS) can help prevent disease development, but screening rates are unacceptably low. The greatest number of women were in the most vulnerable group, and the availability of wheal data on their use of CCSs was limited. This study aimed to evaluate the use of CCS and the factors that influence its use among HIV-positive women receiving antiretroviral therapy at public health facilities.MethodsThis study used a cross-sectional study design. A total of 396 (97.5%) HIV-positive women participated in this study between March 10 and May 30, 2023. Participants enrolled in public health facilities in Asella town were selected through systematic random sampling, and data were collected through on-site interviews using a pretested, structured questionnaire. The data were analysed using the Statistical Package for Social Science, Version 26. Logistic regression analysis was used to identify the determining factors.ResultsThe findings from this study indicated that 30.3% of individuals used cervical cancer screening services. Those women who had knowledge about cervical cancer had a 2.54 times greater likelihood of receiving CCS than those who were not informed (adjusted odds ratio [AOR] = (2.54; 95% confidence interval [CI]: 1.42–4.56). Women with a history of sexually transmitted diseases were twice as likely to use CCS as those without such a history (AOR = 2.05, 95% CI = 1.13–3.73). Furthermore, women with a positive attitude towards CCS were found to be significant predictors of utilisation, showing a greater than threefold greater likelihood of using these services (AOR = 3.21; 95% CI: 1.78–5.81).ConclusionsThe proportion of HIV-positive women who underwent cervical cancer screening (CCS) was significantly lower than the recommended guideline of 80%. To enhance the uptake of screening among women with HIV, healthcare professionals should focus on enhancing awareness about cervical cancer, improving attitudes towards CCS, and advancing knowledge about the disease. Healthcare providers’ collaboration with both government and nongovernmental stakeholders plays a crucial role in addressing the challenges of accessibility and attendance at screening services.

Integrated cervical cancer screening uptake and associated factors among women attending primary care services at public health centres in Addis Ababa, Ethiopia: a multicentre cross-sectional study

BackgroundCervical cancer (CC) is a major health problem in Ethiopia. Integrated healthcare approaches have been suggested as a way to increase access to and utilisation of screening services. Limited data...

Predictors of Cervical Cancer Screening Uptake among Healthcare Providers in Siaya County, Kenya

Context: Cervical cancer ranks as the second most frequent cancer among women in Kenya and the second most frequent cancer among women between 15 and 44 years of age. Cases of cervical cancer among health professionals have equally been on the rise. Aim: This study sought to establish the proportion of healthcare providers who have undergone cervical cancer screening and examine individual and health system predictors that influence cervical cancer screening uptake among healthcare providers. Methods: The study was conducted in Siaya County hospitals and adopted analytical cross-sectional study design. Quantitative data was collected using a structured self-administered questionnaire from 186 healthcare providers working at six level four hospitals in Siaya County. In addition, key informant interviews were conducted involving the in charge (6 healthcare providers) of the six hospitals selected. SPSS software version 28 was used for statistical analysis of quantitative data at 95% CI; p = 0.05. Multivariate logistic regression analysis was done for all the independent variables with p < 0.02 in the model to determine predictors of uptake of cervical cancer screening. Qualitative data were organized into themes and coded according to the study objectives. Results: The results show that only 77.4% of the healthcare providers had gone for the screening. There was a significant association (OR: 0.4; 95% CI: 0.2 – 0.8; p = 0.009) between age and uptake of cervical cancer screening. Further results showed that perceived susceptibility (OR: 0.2; 95% CI: 0.1 – 0.6; p = 0.003) and self-efficacy (OR: 0.3; 95% CI: 0.1 – 0.6; p = 0.0008) significantly associated with the uptake of cervical cancer screening services. As for the health system predictors that influence the uptake of cervical cancer screening, availability of transportation (OR: 4.4; 95% CI: 1.5 – 13.2; p = 0.004) and acceptability (OR: 5.0; 95% CI: 1.7 – 15.0; p = 0.001) had a significant association with the uptake of cervical cancer screening services. Conclusion: Only 77.4% of healthcare providers have been screened for cervical cancer. Perceived susceptibility, self-efficacy, availability of transportation, and acceptability were the main predictors of uptake of cervical cancer screening services. The study recommends routine awareness and sensitization programs about cervical cancer screening among healthcare providers on special days.

Cervical cancer screening adoption behaviours among Nigerian women in academics: using a health belief model

BackgroundCervical Cancer is the commonest and one of the leading causes of death from cancer among women in developing countries. Screening has been shown to reduce morbidity and mortality from the illness, yet its uptake is low. This study investigated the pattern of utilization and preferences relating to the adoption of cervical screening among female postgraduate students at the University of Ibadan.MethodologyThe study was a descriptive cross-sectional survey involving the use of a multi-stage sampling technique to recruit 372 women undergoing postgraduate studies (20–52 years with a mean age of 27.3 ± 5.4) at the University of Ibadan, Nigeria. A pretested semi-structured, self-administered questionnaire was used for data collection and the coded data were analyzed using SPSS (version 20).ResultsOnly 4.0% of the respondents had been screened for Cervical Cancer at the time of study while 86.3% expressed their desire to be screened if given the opportunity. Most participants showed a favourable perception with 70.4% disagreeing that cervical cancer is a mild disease and 50.5% agreeing that the benefits of cervical cancer screening outweigh the stress of the screening procedure. Female doctors (73.2%) topped the list of health professionals’ respondents who preferred to conduct the screening. A majority (70.7%) of the respondents preferred these screenings to be done during antenatal clinic visits. There is a significant association (p.value = 0.0007) between cervical cancer screening behaviors and sexual activity among women.ConclusionPoor utilization of Cervical cancer screening services is seen among Nigerian women undergoing postgraduate studies but a high willingness to utilize the services in the future with consideration to professionals delivering the service and specific locations where it can be obtained. The poor rate of cervical cancer screening from the study depicts the large extent to which cases of this cancer go without being detected till the advanced stages. Rolling out more screening strategies that will explore different service delivery points/preferences as highlighted in the study is needed for larger coverage.

Mastalgia and Why It Should Be Evaluated With Imaging in Areas Where Use of Breast Cancer Screening Services are Unsatisfactory.

Mastalgia or breast pain is a very common symptom in women attending breast clinic. The aim of this study was to evaluate whether imaging for mastalgia leads to cancer detection in an area where routine breast cancer screening services are underutilized. This prospective study was performed between 1st March 2021 to 31st January 2023 at a tertiary care academic institution of central India. All patients underwent through clinical examination by a surgeon. Then patients were referred for ultrasound and/or X-ray mammography (MMG) depending on age. Cancer detection rate was calculated. The final cohort consisted of 176 patients with mastalgia and without any abnormality on clinical breast examination. Sixteen patients had mass lesion on radiology and core needle biopsy resulted as infiltrating duct carcinoma in 7 patients and benign phylloides tumor in one patient. Overall case detection rate for cancer was 4%. The breast cancer detection rate in patients presenting with mastalgia was low. However, in the absence of routine mammographic screening in the Indian general population, these would have been missed. Hence, diagnostic assessment for mastalgia is an appropriate strategy in countries where routine screening MMG is lacking.

Abstract A140: Stool-Based Colorectal Cancer Screening During the COVID-19 Pandemic in a Safety-Net Setting: A Mixed-Methods Study

Abstract Purpose: The COVID-19 pandemic resulted in a marked decrease in preventative screening services for colorectal cancer, especially for more involved procedures like colonoscopies. Nationally, some health systems turned to more socially distanced options such as fecal immunochemical tests (FIT) and guaiac fecal occult blood tests (gFOBT). This study aimed to examine the effects of pandemic protocols on FIT and gFOBT utilization in a large municipal safety-net setting. Methods: This mixed methods study examined primary care visits in Los Angeles County’s municipal safety-net system. Semi-structured interviews were conducted with key stakeholders at multiple levels of the organization. These insights were combined with analysis of structured Electronic Health Record data on orders and procedure codes for completed colorectal cancer screening, including screening colonoscopies and FIT/gFOBT tests within the Los Angeles County health system’s ambulatory care and hospital-based providers, in order to explore trends in colorectal cancer screening during the pandemic. Results: Pre-pandemic, stool tests such as FIT and gFOBT were already the dominant initial screening modality for colorectal cancer in the health system. Across the system, FIT/gFOBT rates decreased during the initial wave of the pandemic and took significant time to recover to pre- pandemic levels. System stakeholders noted significant challenges with utilization of stool sample modalities as a screening method during the pandemic, including poor return rates and patient hesitancy to come in person to receive or return tests. Efforts were made to improve upon utilization, for example implementing distribution of stool tests like the FIT via mail. Rates of screenings may also have been affected by the increase in use telehealth services during the pandemic, by which providers often communicated with patients to order FIT/gFOBT tests during the period. Conclusion: Socially distanced approaches to colorectal cancer screening were an attractive solution for safety-net health systems looking to continue preventative care efforts in a pandemic setting. Our study highlights unique challenges exacerbated by the pandemic that should be considered in the context of future utilization of these screening modalities. In the post-pandemic term, emphasis on FIT/gFOBT utilization, in combination with lessons learned during the pandemic, could help to overcome delays in screening precipitated by COVID-19 by decreasing barriers to access for vulnerable populations (e.g. transportation access, work flexibility) in comparison to endoscopy. Citation Format: Willow Pastard, Cameron Kaplan, Chun Nok Lam, Laura Solano, Sonali Saluja, Sarah Axeen, John Thacker, Todd Schneberk, Jennifer Tsui. Stool-Based Colorectal Cancer Screening During the COVID-19 Pandemic in a Safety-Net Setting: A Mixed-Methods Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A140.

Abstract C175: Implementing cervical cancer screening services in women living with HIV in Trinidad and Tobago

Abstract Background: Women constitute 50% of people living with HIV, and cervical cancer (CCA) is among the top cancers for incidence and mortality, in the Caribbean. Women living with HIV (WLWH) are more susceptible and vulnerable to cancer due to their immune-compromised status. There is a pressing need for clinic-based CCA prevention in WLWH. Objective: A preliminary quality improvement evaluation of pilot CCA screening (Pap smear) targeting WLWH in Trinidad and Tobago from July 2020 to September 2021. Methodology: The electronic health information system from a large clinic was used to abstract Pap testing data. No personal identifiers were collected from the system to protect the privacy of individuals and abide by Trinidad and Tobago’s data protection law. Evaluation of quality improvement of interventions approach was applied. Descriptive analyses were conducted using SPSS. Results: A total of 242 WLWH attended the women's clinic (WHC) from July 2020 to September 2021. The average age was 41.2 (age range: 20-72). Most (78.9%) reported sexual activity initiation between 15-29 years old, and 2 in 3 (66.1%) had sexual activity in the last 12 months. Among our participants, 67.8% were Afro-Caribbean, 20.7% were Mixed, and 5.8% were East Indian. The majority of WLWH completed at least secondary education (69.8%). Almost half were single (49.6%), and 59.5% were employed/self-employed. Additionally, 11.6% of patients reported a family history of CCA. The WHC provided Pap test to 91.7% of WLWH, 69.3% had normal Pap test results, 9.2% had abnormal Pap test results, and 0.4% were diagnosed with CCA in situ. Additionally, 8.6% found infections including Candida Albicans, Actinomyces, and Trichomoniasis. For those with abnormal Pap tests, timely follow-up care was provided to prevent further illnesses and cervical dysplasia. WLWH with cervical cancer in situ were scheduled/referred to treatments to prevent CCA progression. Discussion: A women’s clinic approach to CCA screening was successful in providing Pap tests and promoting timely diagnostic and therapeutic care to prevent CCA. We thus recommend an implementation and dissemination science approach to create strategies for adopting, implementing, sustaining and disseminating clinic-based CCA screening and HPV-related cancer prevention to reduce cancer-related morbidity and mortality among WLWH. Citation Format: Jonathan Edwards, Gaole Song, Selena Todd, Tessa Galindo, Sharon Soyer, Gregory Boyce, Kamilah Thomas-Purcell, Jarrett Sharlene, Diadrey-Ann Sealy, Kathy-Ann Pate-Robinson, Kimlin Ashing, Jeffrey Edwards, Nyla Lyons. Implementing cervical cancer screening services in women living with HIV in Trinidad and Tobago [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C175.

Abstract C178: Uptake of prostate cancer screening services in men living with HIV in Trinidad and Tobago

Abstract Background: Compared to other groups, Black men have a higher incidence and mortality of prostate cancer (PCa). Worldwide, the Caribbean region has one of the highest age-standardized PCa incidences with 76 cases per 100,000 population per year. PCa incidence in predominantly Afro-Caribbean countries ranges from 160 in Barbados to 304 men diagnosed per 100,000 in Jamaica. In Tobago, 10% of adult men over 40yrs were found to be diagnosed with PCa. Additionally, men living with HIV (MLWH) are more susceptible and vulnerable to cancer due to their immune-compromised status. Thus, in the Caribbean, there is a pressing need for clinic-based PCa screening in MLWH. Objective: A preliminary quality improvement evaluation of a prostate cancer screening (PSA test) program targeting MLWH in Trinidad and Tobago from January 2019 to May 2024. Methodology: The electronic health information system from a large clinic was used to abstract prostate cancer screening (PSA) delivery. No personal identifiers were collected from the system to protect the privacy of individuals and abide by Trinidad and Tobago’s data protection law. According to NCCN guidelines, since most of our patients were Afro-Caribbean or Mixed, this study treated all MLWH aged < 75yrs as men with high risk and used 3 ng/mL as the threshold; the threshold was 4 ng/mL for MLWH >75yrs. Evaluation of quality improvement of interventions approach was applied. Descriptive analyses were conducted using SPSS. Results: Between January 2019 and May 2024, a total of 2,442 MLWH were eligible to participate in the PSA screening clinic. The average age was 54.0 (age range: 40- 90). 62.9% were Afro-Caribbean, 17.6% were Mixed, 7.4% were East Indian/Indian, and 0.6% were Caucasian. 45.6% of MLWH completed at least secondary education. 26.2% reported having steady partners and 82.5% reported their sexual orientation was heterosexual. Among all MLWH who attended the clinic, 2,127 (87.1%) were referred for PSA tests and 1,640 (77%) MLWH received their PSA tests. For PSA results collected from participants aged 40-75, 86.6% were ≤ 3 ng/mL and 13.4% were > 3 ng/mL. Additionally, among PSA results of participants aged over 75, 51.9% were < 4 ng/mL and 48.1% were ≥ 4 ng/mL. Discussion: To the best of our knowledge, this study is the first of its kind in the Caribbean region. Among MLWH, PSA screening rate was relatively high at 77%. Not too surprising, the PSA results showed 13% of men under 75 and almost 50% of men over 75 had elevated PSAs requiring confirmatory screening and follow-up. Hence, we conclude that a whole-person care approach that includes cancer prevention with prostate cancer screening can be effective. We thus recommend an implementation and dissemination science approach to create strategies for adopting, implementing, sustaining, and disseminating clinic-based prostate cancer-related prevention to reduce related morbidity and mortality among MLWH within the Caribbean and the Americas. Citation Format: Jonathan Edwards, Gaole Song, Gregory Boyce, Selena Todd, Sharon Soyer, Tessa Galindo, Kimlin Ashing, Jeffrey Edwards. Uptake of prostate cancer screening services in men living with HIV in Trinidad and Tobago [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C178.

Abstract B048: Qualitative analysis of fieldnote and interview data for planning a food bank- based breast cancer screening intervention

Abstract Among individuals and communities with low-income, the experience of food insecurity is associated with greater delays in recommended mammography screening and late-stage breast cancer at diagnosis. Community-based interventions that address barriers to breast cancer screening in diverse communities of women with food insecurity can increase screening uptake, ultimately improving cancer health equity. In partnership with Sacramento Food Bank and Family Services (SFBFS), the largest non-profit provider of social services in Sacramento County, this study identified barriers and facilitators to implementing a breast cancer screening intervention in a food distribution setting, assessing the preliminary acceptability and logistical feasibility of the proposed intervention. Qualitative data about food bank distribution events and the clients served was collected over 24 weeks using participant observation with semi-structured fieldnotes and interviews, then analyzed via directed content analysis guided by the well-defined domains and determinants in the Consolidated Framework for Implementation Research (CFIR) and coded using Dedoose software. Fieldnotes were completed for 12 community food distribution events, and 20 stakeholder interviews were conducted with purposefully sampled food bank staff (N=10) and female clients (N=10) who regularly attend events. The results of this qualitative analysis identified barriers and facilitators to implementation in all CFIR domains, describing current workflows for food distribution events and existing health education efforts, capacity, client engagement logistics and modes of delivery, and resources available or needed to support implementation. Prominent CFIR determinants included characteristics of individuals, specifically the innovation recipients’ capability and motivation to receive a breast cancer screening intervention in this context. Participants often pointed out their awareness of important preventative behaviors such as nutrition while also acknowledging barriers such as time constraints, accessibility of breast cancer screening services, and culturally-specific health beliefs and practices. Determinants in the outer setting, inner setting, innovation characteristics, and process that relate to the overall theme of sustainability were identified as potential barriers including financing, the availability of resources, internal and external pressure to change, and the process of engaging with clients while they are at the food distribution event. Facilitators included buy-in from SFBFS leadership and staff, and the benefit of collaborating with reputable local partners. Intervention format should include tailored messaging that is culturally appropriate and empowers individuals to obtain recommended screening. Content of the intervention should provide interactive assistance that facilitates local support for screening eligibility and services. Overall, there was consensus that promoting breast cancer screening in the food distribution setting was beneficial and welcomed by all stakeholders. Citation Format: Charlotte L. Kerber, Julie HT Dang, Daniel J. Pasillas-Pablo, Jocelyn T. Canty, Laura Fejerman. Qualitative analysis of fieldnote and interview data for planning a food bank- based breast cancer screening intervention [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B048.

Association between the uptake rates of countermeasure-type colorectal cancer screening, new cancer detection indices, and number of municipal public health nurses: An ecological study

Objective We conducted an ecological analysis of the structures and processes of municipalities implementing countermeasure-type colorectal cancer screening services, which are associated with high mortality and morbidity rates. We analyzed the populations' demographic characteristics, number of public health nurses (PHNs), and human base for such services. The process was evaluated using the screening uptake rates for countermeasure-type cancer screening and detection indices.Methods The data included municipal population figures, areas, and national health insurance enrolments, all sourced from a government statistics portal (e-Stat). We obtained the number of PHNs per 100,000 population from PHN activity area surveys, information on municipal colorectal cancer screening from public health centers (PHCs) and health promotion project reports, and cancer detection indices from the National Cancer Registry data. The analysis covered 1,234 municipalities with populations of ≥10,000 and ≥50,000, categorized into three groups based on the presence of PHCs. The internal structures were compared using multiple regression analysis.Results The number of PHNs per 100,000 population was categorized as follows; <50,000 population group (42.9), ≥50,000 population group (24.3), and PHC-present city group (16.4).Among these groups, the mass and individual screening rates were 96.2% and 47.7%, 69.1% and 91.5%, and 83.7% and 69.9%, respectively. The average uptake rates of countermeasure-type screenings and detailed examinations were 10.6-13.7% and 68.4-75.3%, respectively. In both cases, the <50,000 population and PHC-present city groups exhibited high and low values, respectively. However, the proportion of patients with "early cancer" detection was approximately 42% in all groups.Multiple regression analysis, using the countermeasure-type screening uptake rate and colorectal cancer detection indices as dependent variables, revealed that in the <50,000 population group, in which mass screening was prevalent, the number of PHNs was significantly positively correlated with the countermeasure-type screening uptake rate and proportion of "new cancers" detected by screening.Contrastingly, the PHC-present city group showed no correlation between the number of PHNs and countermeasure-type screening uptake rate, but a highly detailed examination uptake rate was significantly positively correlated with the proportion of "early cancer" detection.Conclusion In municipalities without PHCs, countermeasure-type screening uptake rates, particularly mass screening rates, were positively correlated with the number of PHNs and cancer detection indices. In cities with PHCs, in which individual screening was prevalent, the detailed examination uptake rate through countermeasure-type screening was correlated with detection indices.

Barriers and facilitators of cervical cancer screening literacy among rural women with HIV attending rural public health facilities in East Central Uganda: a qualitative study using the integrated model of health literacy

BackgroundSeveral rural public health facilities in East Central Uganda have sub-optimal, below 50%, levels of uptake of cervical cancer screening services among women with HIV. This is attributed to low cervical cancer screening literacy: limited ability to access, understand, appraise, and apply cervical cancer screening information. This research identified multi-level (health facility, community, interpersonal and individual) barriers, and facilitators of accessing, understanding, and applying cervical cancer screening information among rural women with HIV attending rural public health facilities in East Central Uganda to inform interventions.MethodsWe conducted ten Focus Group Discussions with rural women aged 25–49 years with HIV attending four selected rural public health facilities: thirty women who had ever screened for cervical cancer and thirty women who had never screened for cervical cancer across different age categories. Data was collected using a guide based on the Integrated model of health literacy. Thematic analysis was used for analysis. Competences (accessing, understanding and applying cervical cancer screening information) and categories of factors (health system, community, interpersonal and individual factors) of the integrated model of health literacy were deductively derived whereas barriers and facilitators were deductively derived from women’s statements.ResultsLack of communication materials and inability to access information were health facility and individual barriers of accessing cervical cancer screening information respectively. Facilitators of accessing information were access to information at health facility, community, and interpersonal levels and women’s ability to access information. Barriers and facilitators of understanding cervical cancer information were related to communication materials, provision of health education and women’s concentration during health education. Barriers and facilitators of applying cervical cancer screening information were related to communication and provision of cervical cancer screening services at health facility level, and interpersonal level from peers, partners and other family members as well as women’s ability to: understand information and access to cervical cancer screening services at individual level.ConclusionsThis study emphasizes the influence of multi-level factors on cervical cancer screening literacy among rural women with HIV attending rural public health facilities in East Central Uganda. Improving uptake of cervical cancer screening services among these women requires multi-level interventions.

Women’s empowerment and its influence on the uptake of breast cancer screening in Tanzania: an analysis of 2022 Tanzania demographic health survey data

BackgroundBreast cancer is the second most commonly diagnosed cancer worldwide, with a high mortality rate in developing countries, including sub-Saharan Africa. Screening is one way to ensure early detection and management of breast cancer, and it is influenced by several factors. Education and socio-economic status may also affect the utilization of breast cancer screening services as these impact decision-making. This study aimed to investigate women’s empowerment and its influence on the uptake of breast cancer screening among women in Tanzania.MethodsThis study utilized the 2022 Tanzania Demographic and Health Survey data, and included 4216 women aged 20 to 49 years. Women empowerment variables used include social independence, decision-making, ownership of assets, and attitude towards violence. Statistical Package for Social Sciences version 26 was used for data cleaning and analysis. Descriptive statistics and bivariate analysis were done, including a multivariate logistic regression to assess the level of association between independent variables with breast cancer screening.ResultsFindings indicate that the prevalence of breast cancer screening is 5.2%. Age, education level, literacy, ownership of assets, attitude towards violence, and decision making are associated with ever going for breast cancer screening. Women aged 45 to 49 years (AOR = 6.28, 95% CI = 6.27–6.28), those with secondary or higher education (AOR 1.1, 95% CI = 1.05–1.06), literate women (AOR = 1.13, 95% CI = 1.13–1.13), those who own a house (AOR = 3.08, 95% CI = 3.08–3.09), who jointly decide on their healthcare with partners on healthcare (AOR = 1.18, 95% CI = 1.18–1.19) had significantly higher odds of going for breast cancer screening.ConclusionWomen’s empowerment is significantly associated with the likelihood of engaging in breast cancer screening. Empowered women are more likely to undergo screening. Focus should be on empowering women through education, businesses, and community involvement. Country-specific interventions and breast cancer screening awareness campaigns should include empowerment initiatives to promote screening uptake.

Effectiveness of communication in promoting utilisation of breast cancer screening services among women working in Anganwadi centres.

Breast cancer is the most common cancer among females, worldwide. Cancer screening in developing countries is mainly opportunistic type, characterized by low coverage and over-screening of women with increased access to health care services. This study was thus designed to understand the various factors preventing the participation and utilization of breast cancer screening, thereby study the different approaches for encouraging their participation and also the effectiveness of different ways of communication to Anganwadi Workers (AWW) and Anganwadi Helpers (AWH) in increasing breast cancer screening uptake at cancer screening camps. It was a mixed-method study design among Anganwadi workers and helpers. The study included 376 Anganwadi workers working in Kolar and Bangarpete Talukas. The trained Anganwadi supervisor followed by the respective PHC medical officer (in the intervention group) invited the AWW and AWH for breast cancer screening and only through Anganwadi supervisor (in control group). Those women (AWW and AWH) who did not attend the breast cancer screening camp were listed and contacted through mobile phone to find out the reasons for the same. The data were analysed using SPSS statistics version 22; Chi-square and logistic regression were used to test significance. There were 186 subjects in the intervention and 190 subjects in the control group. The mean (SD) age in intervention and control groups was 43.7 (8.5) and 44.2 (8.7) years, respectively. Amongst the 376 women (AWW and AWH) invited for the breast cancer screening service from both the groups, a total of 238 (63.2%) of them attended screening camp. The screening uptake was more in the intervention group (73.4%) compared with the control group (53.6%). This difference across the two groups (20%) was found to be statistically significant. The sub-category 'anxiety' (31.9%) was reported to be the highest barrier and least was in the sub-category 'no replacement' (4.3%). The sub-categories are also supported by verbatim quotes. The uptake of screening was more in the intervention group (73.4%) compared with the control group (53.6%). This difference of 20% was found to be statistically significant on univariate analysis (P < 0.001). After adjusting for confounders, it was found that both the approaches were equally effective.

Sociodemographic drivers influencing the adoption of Breast Self-Examination amongst women in Kaduna State, Northern Nigeria

Breast cancer is a significant public health concern globally, with a disproportionate impact on women in developing countries such as Nigeria. Early detection through practices like Breast Self-Examination (BSE) is crucial for improving treatment outcomes and survival rates. Breast self-examination is a valuable tool for early breast cancer detection among Nigerian women. This paper examines the current state of BSE practice among Nigerian women, identifying factors influencing its uptake and exploring strategies for enhancing its implementation. A cross-sectional research study was conducted to assess the socio demographic determinants of uptake of breast cancer screening amongst women in Kaduna state. This study which sampled a total of 254 respondents, out of which a larger proportion (48.8%) of the respondents were between the ages of 25-34 years, reveals that 80.3% of respondents have heard about breast cancer. Amongst screening methods known, BSE is most prevalent with 77.5% (203) and 22% (57) of respondent knowing about BSE and mammography respectively with about 68% being aware of how to conduct Breast Self-Examination. A statistical significance was found between constructs of three selected socio-demographic characteristics - Age (p=0.027), level of education (p=0.000), and health insurance (p=0.000) significantly associated with women’s adoption of breast self-examination. Improving access to quality healthcare, including breast cancer screening and counselling services, is essential to accelerating adoption of BSE. Addressing the complex factors influencing BSE practice requires a comprehensive approach that combines education, community engagement, and reducing the financial barrier to accessing mammography services.

Culture, community, and cancer: Understandings of breast cancer from a non-lived experience among women living in Soweto.

Individual perceptions compounded with socio-cultural beliefs and health system factors are key determinants of people's health seeking behavior and are widely cited as the causes of delayed breast cancer diagnosis among women from structurally vulnerable settings. Asking: "how do women with a non-lived experience of cancer understand the disease and, what informs their health seeking behaviors?", we explored individual, sociocultural and health system elements from a conceptual model derived from the Socioecological, Health Belief and Cancer Stigma Frameworks, to understand perspectives of breast cancer in a South African urban community setting. Using a deductive approach, we conducted a qualitative study consisting of 6 focus group discussions among 34 women from Soweto, Johannesburg (aged 35-74 years) and followed-up with 20 semi-structured in-depth interviews. Findings revealed some awareness of breast and other cancers, but confusion and gaps in understanding of the disease, resulting in socio-culturally influenced misperceptions of risks, causes, and outcomes following treatment of breast cancer. This fueled perceptions of profound fear and stigma against people with breast and other cancers. These findings together with participant perceptions of primary healthcare providers being unwelcoming, under-resourced, and insufficiently trained to deal with breast cancer, resulted in women reporting being reluctant to participating in screening/early detection care seeking behavior. They only accessed primary care when experiencing extreme pain or ill-health. Participants suggested as solutions for future interventions, the need for sustained community engagement, harnessing existing clinic and community stakeholders and resources to provide clear and understandable breast cancer information and encouragement for screening uptake. Health literacy gaps surrounding breast cancer fuels socio-culturally influenced misperceptions, fear, stigma, and fatalism among community women from Soweto, South Africa. Women perceive primary care providers of having insufficient knowledge, skills, and resources to provide effective breast cancer screening services. Participants suggested the need for greater community engagement involving primary clinics and existing community stakeholders working hand in hand. Clear, understandable, and consistent information about breast cancer must be regularly disseminated and communities must be regularly encouraged to utilise breast cancer screening services.

Proportion trends, cancer stage, and survival of patients with cancer diagnosed through emergency and nonemergency departments: a nationwide cohort study.

To reduce mortality, the Taiwan government has vigorously promoted free cancer screening and preventive health screening services. Cancers are usually advanced by the time they are discovered in the emergency department. Through this study, we aimed to understand the characteristics of cancer patients diagnosed through the emergency department and thus identify high-risk populations by comparing cancer staging and survival rates in patients diagnosed in the emergency department and those diagnosed in the non-emergency department. The retrospective study enrolled a total of 389,043 patients over the age of 20 who were newly diagnosed with one of the five major cancers (including lung cancer, colorectal cancer, breast cancer, prostate cancer, and oral cancer) between 2008 and 2017 and analyzed their diagnostic pathway, cancer stage at diagnosis, and survival time. Of the study participants, 59,423 patients (about 15.3%) were diagnosed with cancer through the emergency department. We found that a sizable proportion of older people and patients with low education and low incomes were diagnosed through emergency department visits, and those with a health condition comorbidity severity of 3 had the highest proportion diagnosed by the emergency department, advanced stages at diagnosis, and risk of death. These can be classified as high-risk groups. In addition, 76.4% of patients diagnosed in the emergency department had advanced cancer, and the risk of death was 1.46 times higher than that of patients diagnosed in the non-emergency department. Although cancer screening is available, it does not reduce the proportion of patients with advanced cancer who are diagnosed through or at the time of diagnosis in the emergency department. The present study found that the government's cancer screening did not affect the proportion or number of cancers diagnosed through emergency department visits. Therefore, the government should focus on more cancer screening, health education in high-risk groups, and strengthening the link between emergency and oncology departments to reduce the risk of death for patients diagnosed through emergency department visits.