Clinical Breast Exam Screening Research Articles

Barriers, facilitators, and strategies for improving breast cancer screening in Ukraine.

e18769 Background: Because of Russia’s invasion of Ukraine, many cancers are diagnosed at later stages, resulting in renewed emphasis on preventive medicine. To this end, we explored barriers and facilitators of breast cancer screening in Ukraine. Methods: A survey exploring factors that may influence breast cancer screening was distributed through the Primary Care Physician Facebook group in Ukraine. Chi-Squared and Student’s t-tests tested association between discrete and continuous variables, respectively. Linear and logistic regression were used to test independent association. Results: 150 surveys were completed. Respondents’ mean age was 36.6 years (SD 11.6); 127 (84%) were female. 124 (83%) worked in public primary care clinics. Respondents were from 25 (92%) of 27 regions of Ukraine. 110 (73%) were familiar with Ministry of Health (MOH) Order 504 guidelines for breast cancer screening. 103 (64%) had a clinical breast exam (CBE) and 34 (21%) a screening mammography. Breast cancer screening was done via mammography by 134 (84%), via CBE by 93 (58%), and via CBE referral by 86 (57%). Fifty-six (36%) referred 1-3 patients per month to mammography, 46 (30%) referred 4-10, 25 (16%) 11-20. CBE screening was done for 1-10 patients per month by 86 (56%), 11-20 patients by 27 (18%), and 21-40 by 18 (12%). Factors independently associated with patient number having CBE screening per month included daily patient volume, having had a CBE, mammography availability; awareness of MOH 504 and patient pathways, and United States/Europe screening recommendations (latter three p < 0.1). In addition to the above, factors independently associated with performing CBE screening also included participation in seminars about breast cancer screening and comfort with performing a CBE. Factors independently associated with number of patients referred to mammography per month included daily patient volume, having undergone a mammography, and mammography availability. In addition to the above, factors independently associated with mammography referral also included awareness of MOH 504 and patient family history. (All p < 0.05) Barriers to screening included insufficient knowledge among patients (81, 54%), fear of cancer treatment (71, 47%), lack of money for cancer treatment (50, 33%), insufficient training for primary care physicians (84, 56%), insufficient mammography equipment (39, 26%), and insufficient screening recommendation in primary care (38, 25%). Breast cancer screening could be expanded via collaboration with oncologists (64, 42%), training about breast cancer screening (60, 40%), breast cancer educational materials for patients (56, 37%), and automating screening referrals via electronic health records (50, 33%). Conclusions: Factors associated with breast cancer screening included knowledge, personally undergoing screening, and resource availability. Results are limited by online convenience sampling.

Factors Associated with Initial Mode of Breast Cancer Detection among Black Women in the Women's Circle of Health Study.

Mammogram-detected breast cancers have a better prognosis than those identified through clinical breast exam (CBE) or through self-detection, primarily because tumors detected by mammography are more likely to be smaller and do not involve regional nodes. In a sample of 1,322 Black women, aged 40-75 years, diagnosed with breast cancer between 2002 and 2016, we evaluated factors associated with CBE and self-detection versus screening mammogram as the initial mode of breast cancer detection, using multivariable logistic regression models. Compared with screening mammogram, history of routine screening mammogram (OR 0.20, 95% CI: 0.07, 0.54) and performance of breast self-examination (BSE) (OR 0.31, 95% CI: 0.13, 0.74) before diagnosis were associated with lower odds of CBE as the initial mode of detection, while performance of CBEs before diagnosis (OR 11.04, 95% CI: 2.24, 54.55) was positively associated. Lower body mass index (<25.0 kg/m2 vs. ≥35.0 kg/m2: OR 2.46, 95% CI: 1.52, 3.98), performance of BSEs before diagnosis (less than once per month: OR 4.08, 95% CI: 2.45, 6.78; at least monthly: OR 4.99, 95% CI: 3.13, 7.97), and larger tumor size (1.0-2.0 cm vs. <1.0 cm: OR 2.92, 95% CI: 1.84, 4.64; >2.0 cm vs. <1.0 cm: OR 6.41, 95% CI: 3.30, 12.46) were associated with increased odds of self-detection relative to screening mammogram. The odds of CBE and self-detection as initial modes of breast cancer detection among Black women are independently associated with breast care and breast cancer screening services before diagnosis and with larger tumors at diagnosis.

Health education models application by peer group for improving breast cancer screening among Iranian women with a family history of breast cancer: A randomized control trial.

Background: Studies have shown that participation of Iranian women with family history of breast cancer in screening service is low. This investigation has evaluated the effectiveness of health models according to peer group in improving clinical breast exam (CBE) among Iranian women with a family history of breast cancer. Methods: This was a randomized control trial conducted during June and August 2015 in Isfahan. A total of 54 women were assigned into intervention and 53 to control group. Women 20 years or older with an affected relative were included. CBE screening, stage of change screening, knowledge, and belief were considered as outcomes after educational program. Data were analyzed by ANOVA and descriptive statistics by SPSS. Significance level was set at 0.025. Results: Investigation was completed by 98 women; and we considered 22% as effect size. Three months after the intervention, screening practice was 52% in interventional versus 18% in control group (p<0.001). Knowledge and all health belief subscales scores were significantly affected by time factor and time-group interaction (p<0.001). The effect of group factor was significantly related to knowledge score and perceived sensitivity, benefits, and health motivation subscales. Three months after the intervention, most women in the intermediation group were in the action stage of CBE compared to the controls who continued to be in contemplation stage (p<0.001). Conclusion: Peer group interventions, which can be organized by health models, have positive effects on CBE in women with positive history of breast cancer.

Erratum to: Socio-demographic Moderators of Associations Between Psychological Factors and Latinas' Breast Cancer Screening Behaviors.

This study tested whether socio-demographic factors moderated associations between psychological factors and Latinas’ breast cancer screening behaviors. 222 churchgoing Latinas (40–65 years) in San Diego, CA completed surveys assessing socio-demographics (e.g., income and acculturation), psychological factors (e.g., perceived barriers to screening), and cancer screening behaviors. Multilevel models examined associations of socio-demographic and psychological factors (and their interactions) with adherence to annual mammography or clinical breast exam (CBE) screening. Although no main effects were found, there were moderation effects. Acculturation moderated associations between perceived barriers to screening and both screening outcomes, with inverse associations only among the high-acculturation group. Education moderated the relationship between perceived barriers to screening and CBE screening, with an inverse association only among the low-education group. Marital status moderated the relationship between depressive symptoms and CBE screening, with an inverse association only among single/non-partnered participants. Interventions are needed targeting psychological barriers to breast cancer screening among Latinas.

Socio-demographic Moderators of Associations Between Psychological Factors and Latinas' Breast Cancer Screening Behaviors.

This study tested whether socio-demographic factors moderated associations between psychological factors and Latinas' breast cancer screening behaviors. 222 churchgoing Latinas (40-65years) in San Diego, CA completed surveys assessing socio-demographics (e.g., income and acculturation), psychological factors (e.g., perceived barriers to screening), and cancer screening behaviors. Multilevel models examined associations of socio-demographic and psychological factors (and their interactions) with adherence to annual mammography or clinical breast exam (CBE) screening. Although no main effects were found, there were moderation effects. Acculturation moderated associations between perceived barriers to screening and both screening outcomes, with inverse associations only among the high-acculturation group. Education moderated the relationship between perceived barriers to screening and CBE screening, with an inverse association only among the low-education group. Marital status moderated the relationship between depressive symptoms and CBE screening, with an inverse association only among single/non-partnered participants. Interventions are needed targeting psychological barriers to breast cancer screening among Latinas.

Experiences and perceptions regarding clinical breast exam screening by trained laywomen in Malawi.

Despite the increasing burden, breast cancer control in sub-Saharan Africa is insufficient. Late diagnosis and lack of early detection and screening services contribute to high mortality. Clinical breast exam (CBE) screening can be valuable in low-income countries, including use of community health workers and non-health professionals to conduct exams. We assessed experiences of women who underwent CBE screening by trained laywomen in Lilongwe, Malawi, as part of a pilot program. The pilot study invited women attending urban health clinics to a breast cancer educational talk followed by CBE screening by trained laywomen. We purposively sampled participants from the pilot study and interviewed them about the screening experience and future cancer education programs and services. Overall participants had positive experiences and were willing to undergo CBE screening by trained laywomen. Participants were motivated by the educational talk, shared newly acquired cancer knowledge with their social networks, and encouraged others to seek screening. Screened women suggested strategies for future interventions including combining breast and cervical cancer screening, using female providers, partnering with community leaders to increase uptake, and expanding services into the community. Asymptomatic Malawian women accepted CBE screening by trained laywomen and considered breast cancer an important health issue. Women appreciated combined education and screening services and proposed further linkage of breast and cervical cancer screening. Based on our results, training laywomen to educate the public on breast cancer and conduct CBE is a feasible breast cancer control strategy in sub-Saharan Africa.

Experiences and perceptions regarding clinical breast exam screening by trained laywomen in Malawi

Experiences and perceptions regarding clinical breast exam screening by trained laywomen in Malawi

Uptake and Performance of Clinical Breast Exam Screening Program by Trained Laywomen in Malawi

Abstract 2 Background: Breast cancer mortality is high in sub-Saharan Africa (SSA) partly due to limited breast cancer awareness and challenges in early detection. We trained laywomen to promote breast cancer awareness and perform screening - clinical breast exam (CBE) - in urban clinics. This is the first breast cancer screening study in Malawi, and the first study in SSA to assess CBE delivered by laywomen with other health services. Methods: Four laywomen were trained to deliver breast cancer educational talks and conduct CBE. After training, screening was implemented in diverse urban health clinics. Women eligible to undergo CBE were ≥30 years, with no prior breast cancer or breast surgery, and clinic attendance for reasons other than a breast concern. Women with abnormal CBE were referred to a study surgeon. All palpable masses confirmed by surgeon exam were pathologically sampled. Patients with abnormal screening CBE but normal surgeon exam underwent breast ultrasound confirmation. Additionally, 50 randomly selected women with normal screening CBE underwent breast ultrasound, and 45 different women with normal CBE were randomly assigned to surgeon exam. Results: 175 educational talks were delivered to 4,295 people across 5 clinics. Among 1,220 eligible women, 1,000 (82%) agreed to CBE. Lack of time (68%) was the most common reason for refusal. CBE agreement varied across clinics from 71% to 86% (p=0.001). Women who attended the talk were more likely to accept CBE than women who did not (83% vs 77%, p=0.012). Among 1,000 women screened, 7% had abnormal CBE. All 50 women with normal CBE randomized to ultrasound had normal findings. Of 45 women with normal CBE randomized to surgeon exam, 43 had normal surgeon exams and 2 had axillary lymphadenopathy not detected by screening CBE. Sixty of 67 women (90%) with abnormal CBE attended the referral visit. Of these, 29 (48%) had concordant abnormal surgeon exam, and 15 were recommended to have pathologic sampling. Fourteen women had nipple discharge or breast pain identified by both CBE and surgeon exam, which did not require further work-up after surgeon review. Thirty-one women (52%) had discordant normal surgeon exam, all of whom had normal breast ultrasounds. Compared to surgeon exam, sensitivity for CBE by laywomen was 94% (CI 79-99%), specificity 58% (CI 46-70%), positive predictive value 48% (CI 35-62%), and negative predictive value 96% (CI 85-100%). Of 15 women who underwent pathologic sampling, 2 had cytologic dysplasia and are awaiting surgical excision, 7 had fibroadenomas, 2 normal tissue, 1 galactocele, 1 abscess, 1 lymph node with Kaposi sarcoma, and 1 tumoral calcinosis. Conclusions: Uptake of CBE screening in Lilongwe clinics was high. CBE by laywomen compared favorably with surgeon exam, and follow-up was good. Our intervention can serve as a model for wider implementation. Performance in rural areas, effects on breast cancer stage distribution and mortality, and cost-effectiveness require further evaluation. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

The transtheoretical model, health belief model, and breast cancer screening among Iranian women with a family history of breast cancer.

Background:Participation of Iranian women with a family history of breast cancer in breast cancer screening programs is low. This study evaluates the compliance of women having a family history of breast cancer with clinical breast exam (CBE) according to the stage of transtheoretical model (TTM) and health belief model (HBM).Materials and Methods:In this cross-sectional study, we used Persian version of champion's HBM scale to collect factors associated with TTM stages applied to screening from women over 20 years and older. The obtained data were analyzed by SPSS, using descriptive statistics, Chi-square test, independent t-test, and analysis of covariance.Results:Final sample size was 162 women. Thirty-three percent were in action/maintenance stage. Older women, family history of breast cancer in first-degree relatives, personal history of breast disease, insurance coverage, and a history of breast self-examination were associated with action/maintenance stage. Furthermore, women in action/maintenance stages had significantly fewer perceived barriers in terms of CBE in comparison to women in other stages (P < 0.05). There was no significant difference in other HBM subscales scores between various stages of CBE screening behavior (P > 0.05).Conclusion:The finding indicates that the rate of women in action/maintenance stage of CBE is low. Moreover, results show a strong association between perceived barriers and having a regular CBE. These clarify the necessity of promoting national target programs for breast cancer screening, which should be considered as the first preference for reducing CBE barriers.

Breast Cancer Knowledge, Attitude and Screening Behaviors Among Hispanics in South Texas Colonias

This study examines breast cancer knowledge, attitudes and screening behaviors of Hispanic women living in the South Texas colonias of Maverick and Val Verde Counties. We used the Health Belief Model to analyze the effects of HBM constructs on clinical breast exam (CBE) and mammogram screening. Using a multistage systematic sampling approach we interviewed women living within these colonias. Logistic regression analysis was used to predict CBE and mammography screening behaviors. The results indicate that knowledge, susceptibility, barriers and source of health information were statistically significant in predicting CBE among these women. In addition, background variables such as marital status and health insurance were also significant in predicting CBE. Findings further indicate that source of health information, barriers, and health insurance significantly predicts mammography screening behaviors. Results suggest that for women living in colonias along the South Texas Border socio-demographic variables play a significant role in CBE and mammography utilization.

The Clinical Breast Exam: A Skill that Should Not Be Abandoned

The clinical breast exam (CBE) is an important tool in the care of women. However, the utility of the screening CBE has been called into question. This article discusses the importance of the CBE as a physical diagnosis tool. Recommendations regarding screening with CBE are reviewed, and evidence surrounding breast cancer screening using CBE is briefly summarized. Clinicians should strive to provide high quality CBEs as part of the general clinical exam for women, particularly those who present with breast complaints, and for patients who choose to have CBE screening. In conclusion, there is a role for the CBE in the care of women, and clinicians should be proficient at performing these exams. Simulation teaching technologies are now available at Department of Veteran Affairs (VA) facilities to enable clinicians to improve their CBE skills.

Heterogeneity in Breast and Cervical Cancer Screening Practices Among Female Hispanic Immigrants in the United States

This study examined differences in cervical and breast cancer (CC and BC) screening among a heterogeneous group of Hispanic women. Data from 247 women (mean age=38.7±13.3) from Mexico, the Dominican Republic, Puerto Rico, and countries throughout Central and South America regarding participation in Pap smears, mammography, clinical breast exam (CBE) and breast self-exams (BSE), CC and BC knowledge, and acculturation were analyzed. Differences in CBE and BSE screening behaviors were found based on country of origin (P<.01). However, after adjusting for the independent variables, only acculturation and knowledge remained significant correlates to BSE and CBE (P<.01). Dominican women had higher BC knowledge scores (P<.01) adhered most to BC screening guidelines. Heterogeneity in BC and CC screening was found among Hispanic sub-groups and suggests that health promotion programs should be tailored appropriately, particularly among recent immigrants.

Screening adherence in BRCA1/2 families is associated with primary physicians' behavior.

This study provides an assessment of long-term breast and ovarian cancer screening behaviors and the variables associated with adherence with screening among women with or at 50% for having a BRCA1/2 mutation. Participants in the study included 112 women (33 mutation carriers and 79 at 50% risk). Data was collected through a mailed questionnaire, which included items to assess screening behaviors in the last 2 years, risk perception, cancer specific distress, adherence determinants, specific barriers, and cancer history. Statistical analysis included descriptive statistics and non-parametric tests to describe bivariate associations and regression analysis. Adherence rates were 72% for annual mammography, 21% for semi-annual clinical breast exam (CBE), 29% for monthly breast self-exam (BSE), and 19% for annual transvaginal ultrasound (US). Only one participant was adherent with semi-annual CA125. Variables that had a significant association (P < 0.05) with at least one screening modality included: a lack of time, marital status, education, cancer history, provider concern, perceived screening utility, confidence in ability to overcome barriers, cancer specific distress, and risk perception. Primary physician behavior, either in terms of screening recommendations or screening performance in the case of CBE, had significant independent association with adherence to mammography, CBE, and US screening recommendations. The results of this study highlight the essential role that primary physicians play in supporting their very high-risk patients' adherence.