Fear Of Mastectomy Research Articles

Breast Cancer-Why We Present Late

Breast cancer incidence is relatively lower in Africa. However, despite its relatively lower incidence, the mortality rate is quite high compared to the west. One of the reasons for the high mortality is late presentation. This prospective study sought to find out the reasons for the late presentation. Materials And Methods: Consecutive patients diagnosed with Breast Cancer at any stage were recruited into the study. A well-structured questionnaire was prepared, oral consent obtained after carefully explaining the purpose of the study. History was taken and physical examination done. The patients were then classified into stages and those in stages III and IV were included in this study. The questionnaires were filled by directly questioning the patients. Data was analyzed by IBM SSPS statistics 24. Result: There were 131/191 (68.6%) respondents who presented late in stages III & IV, all females, with an age range of 25-88 years and a mean of 48.69 (SD 11.35). The highest incidence is in the age range 40-49 with 25.2% (33/131) while the least incidence is found in the age range 80-89 with 4.6% (6/131) only. Of 131 respondents, 75 (57.3%) sought unorthodox help initially when they noticed a problem in their breasts, 4(34.4%) sought some form of orthodox help including visiting health workers at home, going to chemists/ pharmacies while only 11 (8.3%) presented first to our center. Out of 131 respondents, 14.8% (18/131) cited lack of funds, 30.3% (37/131) church/pastors/priests/prayers, 11.5% (14/131) fear of mastectomy, 30.3% (37/131) lack of awareness/knowledge, 39.3% (48/131/) herbal remedy. Other reasons include self-medication, trust in God, hope, etc.

Audit of delayed presentation in breast cancer from a tertiary centre in the Niger Delta, Nigeria

Context: Breast cancer is the most common cause of cancer-related morbidity and mortality in women in developing countries, compounded by delayed presentation. Determining the contemporary reasons for delayed presentation in our environment, is necessary to properly guide enlightenment campaigns, enhance their effectiveness and improve patient survival.Subjects and Methods: A 1-year audit of consecutive histologically-confirmed breast cancer patients presenting to University of Benin Teaching Hospital was done. Socio-demographic data, time to presentation with reasons, stage at presentation were obtained in a proforma and analyzed.Results: 92% of patients had delayed presentation. 270 patients with complete records were included in the study. Mean age of patients was 47.6±11.0years, most were between 40 – 49 years (32.2%). Most patients in the study were married (75.6%), of lower class (52.2%) and had tertiary education (55.9%). Delay of 12 – 15months occurred most (54.8%) with advanced stage disease (Stages 3/4; 73%). Use of alternative medicine accounted for most of the delay (48.9%) while fear of mastectomy (30.4%), financial (6.7%) and referral problems (6.7%) were other common reasons.Conclusion: Delay in presentation is common in our breast cancer patients. Use of alternative medicine, fear of mastectomy, financial issues were common reasons for delay. There should be proper regulation of alternative medical practice to forestall bogus claims of cancer treatment. More affordable and accessible screening centres, insurance coverage of cancer care, alongside enlightenment about effect of delayed presentation and appropriate cancer care in religious houses, amongst traditional rulers and other custodians of cultural practices are required to help mitigate negative beliefs resulting in delayed presentation.

Late Presentation of Breast Cancer in Lower- and Middle-Income Countries

Breast cancer incidence and mortality in low- and medium-income countries has increased and is predicted to rise. Late presentation, associated with poor prognosis, is unfortunately common to most of these countries. This review discusses recent studies and offers recommendations to address pertinent issues raised. Late presentation continues to prevail in many LMICs, worse in sub-Saharan Africa. Socioeconomic and demographic factors play a significant role. The fear of mastectomy is a prominent cause of reluctance to seek treatment. Increasing awareness, clinical breast examination and opportunistic mammographic screening have a role to play in addressing the issue. The provision of health infrastructure and creating access may overcome some of the other factors that sometimes seem unsurmountable. Late presentation of breast cancer in LMICs must be addressed through implementation research and the institution of tailored and innovative approaches.

Abstract IS-3: IS-3 Overcoming obstacles to breast conservation surgery in Malaysia

Abstract The rates of breast conservation in breast cancer can vary from 75% in highly developed countries where mammographic breast screening programmes has led to detection of small tumours, to 0% in low income countries where there are no early detection programmes and women present with large tumours. Mastectomy is the only choice in countries where there are no radiation therapy facilities, an essential component of breast conservation surgery (BCS). Malaysia is a high middle income country in South East Asia, with population of 31 million and an incidence of breast cancer of 38.9 per 100 000. According to the International Atomic Energy Agency, 78.9% of the population in Malaysia have access to radiation facilities, so access to radiation does not pose a major barrier to BCS. However BCS is only suitable for women who present with small tumours. In Malaysia, 40-60% of women present with Stage 3 and 4 breast cancer, with a mean size of 4 cm. Hence the majority of patients are not suitable for BCS. In a tertiery urban institution, the BCS rate was reported as 22%. Early detection programmes are essential to improve the rates of BCS. However before any early detection programme can be implemented, the public must know the benefits of early detection. Early detection consists of screening for asymptomatic disease by mammography, and downstaging of symptomatic disease. Population-based mammographic screening is not recommended in low and middle income countries, where there have been no randomized controlled trials on mammographic screening to determine effectiveness in reducing breast cancer mortality, and may not be cost-effective in a country with a lower incidence of breast cancer. Malaysia does not have a population-based mammographic breast screening programme; however there are opportunistic programmes where mammograms are provided free of charge. Despite this, several surveys showed that only 5-15% of eligible women in Malaysia had a screening mammogram done. In addition, the same surveys show that women have poor knowledge of the signs and symptoms of breast cancer. Barriers to early detection (and treatment) appear to be at an individual level. A qualitative study on the reasons for late presentation showed that fear of mastectomy, a fatalistic attitude, belief in alternative therapy and poor decision making were seen in women who present late. Deconstructing why women present with advanced cancer and default treatment would provide opportunities for intervention, such as developing materials to assist in decision making and providing culturally sensitive educational materials. An important message is that early detection save lives and save breasts because BCS will be possible. Malaysia is a multi-ethnic country made up of three main races, ie, Chinese, Malays and Indians. Although there is no difference in overall survival between BCS and mastectomy, there are ethnic differences in BCS rates, with the Chinese women opting for mastectomy, with the misconception that more surgery gives them a better change of cure. In conclusion, the most important obstacle to BCS is the large size of the tumour. Psychosocial and cultural barriers to early detection and treatment programmes need to be addressed to reduce the mastectomy rate. Citation Format: Yip CH. IS-3 Overcoming obstacles to breast conservation surgery in Malaysia [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr IS-3.

Breast cancer screening practices amongst female tertiary health worker in Nnewi.

Breast cancer in Nigeria and other developing countries is characterized by late presentation and poor outcome due to ignorance, superstition, self-denial, fear of mastectomy, and unavailability of treatment facilities. The mortality of breast cancer in Western world is decreasing due to early detection and better management. This study aims at accessing the knowledge, attitude, and practice of breast cancer screening among female tertiary health workers. A cross-sectional descriptive study carried out using a structured, pretested, self-administered questionnaire to assess the knowledge, attitudes, and practice of breast cancer and screening methods among female health workers. The mean age of respondents was 31.70 ± 7.62 years. The level of awareness of breast cancer screening methods was high: 158 (98.75%), 127 (79.4%), and 144 (90.0%) for breast self-examination (BSE), clinical breast examination (CBE), and mammography, respectively. However, only 47 (35.9%), 36 (22.5%), and 3 (1.9%) correctly practiced BSE, CBE, and mammography, respectively. The level of education and occupation showed significant correlations with the knowledge and practice of breast cancer screening methods. Breast cancer screening still needs to be promoted to improve the attitude and practice among both health workers and general population.

Determinants of Late Presentation and Histologic types of Breast Cancer in Women Presenting at a Teaching Hospital in Kumasi, Ghana

Introduction: Breast cancer is the most common malignancy in women and the leading cause of cancer deaths worldwide. In Ghana and many parts of Africa more than 50% of breast cancer patients present with advanced stage even though evidence suggests that health education on breast cancer has intensified. Objectives: To determine the socio demographic characteristics of women presenting with breast cancer, pattern of presentation and the association between patients demographic characteristics and stage of presentation. Methods: A prospective cross-sectional study over a period of three months was conducted at the Breast clinic of Komfo Anokye Teaching Hospital, Kumasi, Ghana. Women with histological diagnosis of breast cancer were interviewed using a structured questionnaire. Results: Fifty women with breast cancer were studied with ages between 27 and 75 years with peak between 40-49 years. Majority presented three months after noticing the first symptom, usually a breast lump. Twenty nine (58%) women presented with late stage breast cancer. The commonest histologic type 44(88%) was invasive ductal Carcinoma. There was a strong positive correlation between stage of breast cancer and place of residence (0.4496) but a weak positive correlation between stage of breast cancer and age (0.1684), as was also stage of breast cancer and marital status (0.1143). There was a negative correlation between level of education and stage of presentation (-0.3398). Conclusion: Breast Cancer is common in 40-49 age groups. The incidence of late stage breast cancer is 58% with majority presenting within 7-12 months of onset of first symptoms, mostly breast lumps with invasive ductal carcinoma as the most common histologic type in stage 3. Fear of mastectomy was the main reason for late presentation. Most patients had some knowledge on breast cancer mostly from the radio stations. The stage of Breast cancer was strongly associated with patients’ level of education, residence (distance from facility) and religion.

CARCINOMA BREAST;

Objective: To evaluate the factors responsible for the late presentation of carcinoma of breast in Pakistani women. StudyDesign: Prospective, Cross sectional, Interventional. Setting: Women Medical Complex Sialkot and Surgical Unit II. Aziz Bhatti Shaheed(Teaching) Hospital. Nawaz Sharif medical College, University of the Gujrat. Study. Period: January 2009 to June 2012. Results: A total of87 patients of all age groups with carcinoma of breast were enrolled in this study. Mean age of presentation with breast cancer was 43years. Stage III carcinoma breast was the most common presenting stage seen in 56 (64.36%) women. Socio economic status, delay inpresentation and diagnosis, fear of mastectomy and its social consequences found to be major factors in the late presentation ofcarcinoma of breast. Conclusions: There is need to launch cancer public health campaign mechanisms, should include teaching ofBreast Self Examination (BSE) to patients, Clinical Breast Examination (CBE) to health workers. Strenuous efforts should be made tobreak the vicious cycle of late presentation, poor treatment outcome and reluctance of patients to present to health facilities because ofsocial mindset.

Socio-demographic factors and reasons associated with delay in breast cancer presentation: A study in Nigerian women

We evaluated the effects of selected socio-demographic factors on late presentation and reasons why our breast cancer patients delay reporting for treatment. All female breast cancer patients referred to one of the general surgery out-patient clinics of Lagos State University Teaching Hospital between January 2009 and December 2010 were interviewed. Relevant socio-demographic and clinical data were obtained and reasons for patient delay documented. Univariate and multivariate logistic regression analyses were conducted to calculate odd ratio for delay. A total of 201 patients were enrolled. Mean duration of symptoms was 12.12 months (SD ± 5.18). Delay for more than 3 months before initial medical consultation was observed in 164 patients (81.6%). Increased risk of late presentation was associated with single women (OR = 2.054), primary level of education (OR = 3.059), negative history of benign breast disease (OR = 1.648) and pre-menopause (OR = 1.861). Ignorance of the nature of illness, belief in spiritual healing, fear of mastectomy and belief in herbal treatment were the leading reasons for delay. Women with higher risk of late presentation should be the target group during interventions aimed at raising breast cancer awareness. Reasons for patient delay should also be addressed.

Abstract ED06-02: Breast cancer screening in low- and middle-income countries

Abstract Breast cancer is the commonest cancer in the majority of low and middle income countries (LMIC's). Survival from breast cancer depends on two main factors – early detection and treatment. In LMICs, delayed presentation of breast cancer is a common occurrence. Barriers to early presentation are lack of access to optimal treatment, lack of financial resources, ignorance and psychosocial issues which include fatalism, fear of death, fear of mastectomy, and lack of autonomy on the part of the woman. Downsizing symptomatic disease as well as screening for asymptomatic disease can reduce mortality from breast cancer. Public education and awareness is a key first step as any early detection program is unlikely to succeed unless the public is aware of the potential benefits. The effectiveness and efficiency of screening modalities including screening mammography, clinical breast examination (CBE) and breast self-examination (BSE) are reviewed in the context of resource availability and population-based need. While mammographic screening is the gold standard for early detection of breast cancer, considerations regarding cost-effectiveness and quality assurance of such a program in LMICs is a concern. The identification of a target group for mammography screening in LMICs should be based on the burden of disease in the population, the potential to benefit from screening, and available resources. Although there may be exceptions, in the absence of such information, the preponderance of the evidence suggests that in most countries it would be reasonable to begin a breast cancer screening program by offering mammography every 2 years to women between the ages of 50 and 65. Although two observational studies on BSE provide evidence that this screening modality reduces breast cancer mortality, this has not been confirmed in two randomized trials. Currently, the evidence is not sufficiently conclusive to justify the recommendation for routine CBE in population-based screening programs, because CBE has not been shown to independently decrease breast cancer mortality, although there are current trials to evaluate this modality. It is also important that any screening program be accompanied by the development of resources required for diagnosis and treatment. The success of any early detection program can be measured by cancer stage at diagnosis, and eventually improvement in survival. Citation Information: Cancer Prev Res 2011;4(10 Suppl):ED06-02.

Repeat Mammography Screening among Low-Income and Minority Women: A Qualitative Study

Regular mammography screening can reduce breast cancer mortality, yet low-income African American and Hispanic women underutilize mammography screening and are often diagnosed at a later stage, resulting in increased mortality. We used qualitative research methods to identify factors influencing regular breast cancer screening among African American and Hispanic women. Predisposing factors (including fear of mastectomy and lack of knowledge), enabling factors (including cost and social support) and a reinforcing factor were identified and categorized utilizing the PRECEDE framework. The study identified factors associated with the decision to complete regular mammography screening, and examined differences between African American and Hispanic women who participated in the interviews. Future research should seek to better understand the influence of family/friends, risk perception, and fatalistic beliefs on the decision to obtain regular mammograms.

Fear of mastectomy: The most common factor responsible for late presentation of carcinoma of the breast in Nigeria

Of 2154 Nigerian breast cancer patients of all ages and socio-economic groups, 87% presented in Stages III or IV and only 13% in Stages I or II. All were questioned on their reasons for not attending hospital sooner. Questionnaires were used and were adequately translated to illiterate patients. The most common reason for delay (963 patients, 44.7%) was fear of mastectomy. Other reasons given include preference for prayer houses or spiritual healing homes in 291 patients (13.5%) a belief that the lesion was inflammatory in 183 (8.5%), preference for native doctors or herbalists in 497 (23.1%) and economic reasons in 220 (10.2%).

Mammography and Breast Cancer Screening

Breast radiography should be performed only with film-screen mammography or xeromammography. At least two views of each breast should be obtained, and for film-screen mammography, at least one of these should be the oblique view. Quality assurance is becoming a significant concern in breast cancer screening. The ACR Mammography Accreditation Program takes into account the qualifications of the personnel, the performance of the x-ray equipment, and a peer review of the final product: the diagnostic image. The mammographic signs of malignancy can be divided into primary, secondary, and indirect. The accuracy of mammography depends on several factors, but the greatest limitation is the density of the breast tissue. Very dense tissue makes detection of breast cancer difficult, and a negative mammogram should never deter one from a biopsy of a clinically suspect mass. New consensus guidelines for breast cancer screening were developed to bring uniformity to the recommendations of the American Cancer Society, the National Cancer Institute, and various professional medical societies. These new guidelines reflect the encouraging results from recent clinical trials, as well as some discouraging reports on breast self-examination and the baseline mammogram. The underutilization of screening mammography is a problem of significant concern to both private and public health agencies. Barriers to mammographic screening include lack of awareness of the benefits of screening, physicians' misconceptions about patient compliance, concerns about radiation risk and overdiagnosis, fear of mastectomy, a perception that a mammogram involves great discomfort, and relatively high cost. Nationwide educational programs are under way to counter misconceptions about mammography, and various strategies are evolving to overcome the other barriers. Sonography is a useful adjunct to mammography for cyst-solid differentiation, but mammography is the only imaging modality effective for the early detection of breast cancer.

Women's attitudes to mastectomy for breast cancer.

One hundred patients who had been subjected to mastectomy for carcinoma were interviewed retrospectively to gauge their attitudes to any physical and/or emotional disabilities relating to their operation or disease. It was found that 40% of the patients had delayed for longer than a month after the onset of symptoms before seeking medical advice, but the reasons for this were not readily forthcoming. However, fear of mastectomy was not a common cause. Anxiety and embarassment due to an absent breast occurred in about one-third of patients, and did not diminish with time. Knowledge and the use of mammary prostheses was far from universal, and disturbingly only two-thirds were counselled in these matters by their medical advisers. Physical complications were common, particularly lymphoedema of the arm, and as expected this was closely related to the type and extent of treatment undertaken.