Breast Cancer Screening Methods Research Articles

<p>Breast Self-Examination Practice and Associated Factors Among Secondary School Female Teachers in Gammo Gofa Zone, Southern, Ethiopia</p>

IntroductionNowadays, breast self-examination (BSE) is a breast cancer screening method that identifies breast mass by the woman herself. However, it is not widely practiced due to various problems. This study aimed to assess the magnitude of BSE practice and associated factors among female secondary school teachers in Gammo Gofa Zone, South Ethiopia.MethodsAn institution-based cross-sectional study was conducted among 247 female secondary school teachers, from March 1 to 30, 2018. Participants were selected using the lottery method. A self-administered questionnaire was used for data collection. Data were cleaned, coded, and entered into Epi data manager 4.4 and analyzed using SPSS version 21. Binary logistic regression was employed.ResultsOf 82 respondents, 34.3% had ever performed BSE. Among these, only 32 (13.4%) had practiced BSE monthly (regularly). Being knowledgeable on BSE [AOR=2.84, 95% CI (1.41, 5.72)], ever heard about BSE [AOR=2.26, 95% CI (1.07, 4.77)], being married [AOR=4.09, 95% CI (1.64, 10.22)], having less perceived barrier to BSE [AOR=2.62, 95% CI (1.26, 5.46)], having high perceived confidence [AOR=3.63, 95% CI (1.79, 7.39)] and motivation to BSE [AOR=3.29, 95% CI (1.15, 9.45)] were significant predictors of BSE practice.ConclusionIn this study, one in three women had ever practiced BSE, whereas about one in seven women regularly practiced BSE. The main reasons for not practicing BSE were: not knowing how to perform BSE and forgetfulness (for regular practice). Therefore, integrated work on behavioral change communication and interferences that focus on improving knowledge of BSE, and skills on how to perform BSE is needed. Additionally, the identified domains of the health belief model (perceived barrier, perceived confidence, and perceived motivation) may be the most effective strategies that should be considered by Gammo Gofa Zonal health and educational offices.

Incorporating immunohistochemical markers into screening methods for BRCA1-mutated breast cancer.

BRCA1-mutated breast cancer (BC) is responsible for approximately 25% of hereditary breast cancer cases. BRCA1 is a tumor suppressor protein regulating the cell cycle and DNA repair; therefore its dysfunctions play a significant role in carcinogenesis. BRCA1-mutated BC is associated with basal-like phenotype, lack of expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) in addition to frequent TP53 mutations and poor prognosis. Currently used criteria for genetic evaluation of BC for the risk of hereditary mutations are based on patients' age and family history, and therefore are prone to be imprecise or incomplete. This review discusses recently developed sets of immunohistochemical markers, promising independent markers (nestin, ALDH1, FOXO3, claudins, topoisomerase 1, EGFR) and their potential to be incorporated into clinical practice as a support tool in oncological counseling. This approach could be applied as a screening method for cost-effective selection of cases requiring genetic testing or adapted in pathology laboratories with limited access to molecular techniques. Although not all of the described predictor models have been validated yet, they could further improve the performance of BRCA1 screening methods in BC in the near future via increasing the accuracy of criteria for further genetic evaluation.

A Review on Recent Progress in Thermal Imaging and Deep Learning Approaches for Breast Cancer Detection

Developing a breast cancer screening method is very important to facilitate early breast cancer detection and treatment. Building a screening method using medical imaging modality that does not cause body tissue damage (non-invasive) and does not involve physical touch is challenging. Thermography, a non-invasive and non-contact cancer screening method, can detect tumors at an early stage even under precancerous conditions by observing temperature distribution in both breasts. The thermograms obtained on thermography can be interpreted using deep learning models such as convolutional neural networks (CNNs). CNNs can automatically classify breast thermograms into categories such as normal and abnormal. Despite their demostrated utility, CNNs have not been widely used in breast thermogram classification. In this study, we aimed to summarize the current work and progress in breast cancer detection based on thermography and CNNs. We first discuss of breast thermography potential in early breast cancer detection, providing an overview of the availability of breast thermal datasets together with publicly accessible. We also discuss characteristics of breast thermograms and the differences between healthy and cancerous thermographic patterns. Breast thermogram classification using a CNN model is described step by step including a simulation example illustrating feature learning. We cover most research related to the implementation of deep neural networks for breast thermogram classification and propose future research directions for developing representative datasets, feeding the segmented image, assigning a good kernel, and building a lightweight CNN model to improve CNN performance.

Spectral Capacitively Coupled Electrical Resistivity Tomography for Breast Cancer Detection

Early detection of breast cancer is key for a better survival rate, so there are huge demands for a safe and reliable breast cancer screening method, which currently is not available. Earlier studies are showing that the impedance spectroscopy can be an effective discriminator for breast tumor against healthy tissues. Traditional electrical impedance tomography (EIT) has progressed well into clinical stages for such an application with some promising results. But EIT generally operates at low frequencies, ranging typically lower than 1 MHz. Previous research work has suggested that the important information on the tumor impedance spectra exists in the higher frequency domain. Thus, this work focuses on the introduction and the evaluation of a spectral capacitively-coupled electrical resistivity tomography (CCERT) for breast cancer diagnosis. Compared to the traditional EIT, CCERT can reach a much higher frequency domain producing the spectroscopic images in a broader range. This in turns offers improved discrimination of tumors against normal tissues via frequency difference imaging or spectral imaging as it is shown in this paper. Additionally, direct contact between the EIT electrodes and the surface of the body, which causes significant challenges and uncertainties in measured data, is avoided in CCERT inherently a contactless method. In this paper, a 3D in-silico model of the CCERT system is created and solved using the finite element method (FEM) to simulate the forward model for each frequency. The feasibility simulation analysis is conducted based on the existing clinical breast cancer data and a CCERT reconstruction. For the experimental verification, an 8-electrode laboratory phantom was tested with the excitation frequency ranging from 200 kHz to 13 MHz. The simulation and experimental results show the promising potential of this method for breast cancer imaging. The wide-range spectroscopic images provide better discrimination of tumors against healthy tissues through their spectral conductivity profile as well as the rate of changes in spectral conductivity images.

Discussion of Histopathological Findings of 954 Breast Reduction Specimens.

Objectives:Breast reduction is a frequently sought procedure by patients and one of the most commonly performed operations by plastic surgeons. Follow-up of histopathological results after reduction mammoplasty is very important. This study aimed to evaluate the histopathological results of patients undergoing bilateral reduction mammoplasty to determine the incidence of breast lesions and risk factors of high-risk breast lesions.Methods:477 patients who underwent reduction mammoplasty in the plastic surgery department between October 2013 and January 2020 were included in this study. Patients were evaluated according to age, body mass index (BMI), comorbidity factors, tobacco use, family history and histopathological findings.Results:The mean age of patients was 42.43±12.05 years. Body mass index ranged from 23 to 34.6. As for comorbidity factors, 12 patients had hypertension, five patients had asthma and six patients had diabetes mellitus. Seventeen patients (3.6%) were smokers, and 25 (5.2%) patients had a family history of breast cancer. Among the patients, 2.3% were 20 years and under, 17.1% were between 21 and 30 years old, 21.5% were between 31 and 40 years old, 33.1% were between 41 and 50 years old, 18.2% were between 51 and 60 years old, and 7.5% were 60 years and above. 85.4% of histopathological findings consisted of normal breast tissue and nonproliferative breast lesion breast lesions. The incidences of proliferative breast lesions, atypical hyperplasia and in situ lesions were calculated as 5.7%, 2% and 0.4%, respectively. The mean follow-up period was 3.8±1.6 years.Conclusion:Although preoperative breast cancer screening methods are used before the reduction mammoplasty, high-risk lesions may be encountered afterwards. One of the biggest advantages of reduction mammoplasty in addition to psychophysiological recovery is breast cancer risk reduction.

Comparison of the performance of machine learning algorithms in breast cancer screening and detection: A protocol.

Background: Breast Cancer (BC) is a known global crisis. The World Health Organization reports a global 2.09 million incidences and 627,000 deaths in 2018 relating to BC. The traditional BC screening method in developed countries is mammography, whilst developing countries employ breast self-examination and clinical breast examination. The prominent gold standard for BC detection is triple assessment: i) clinical examination, ii) mammography and/or ultrasonography; and iii) Fine Needle Aspirate Cytology. However, the introduction of cheaper, efficient and noninvasive methods of BC screening and detection would be beneficial.Design and methods: We propose the use of eight machine learning algorithms: i) Logistic Regression; ii) Support Vector Machine; iii) K-Nearest Neighbors; iv) Decision Tree; v) Random Forest; vi) Adaptive Boosting; vii) Gradient Boosting; viii) eXtreme Gradient Boosting, and blood test results using BC Coimbra Dataset (BCCD) from University of California Irvine online database to create models for BC prediction. To ensure the models’ robustness, we will employ: i) Stratified k-fold Cross- Validation; ii) Correlation-based Feature Selection (CFS); and iii) parameter tuning. The models will be validated on validation and test sets of BCCD for full features and reduced features. Feature reduction has an impact on algorithm performance. Seven metrics will be used for model evaluation, including accuracy.Expected impact of the study for public health: The CFS together with highest performing model(s) can serve to identify important specific blood tests that point towards BC, which may serve as an important BC biomarker. Highest performing model(s) may eventually be used to create an Artificial Intelligence tool to assist clinicians in BC screening and detection.Significance for public healthThis study could potentially identify important Breast Cancer (BC) biomarkers based on patients’ routine anthropometric blood data. This will be attempted using correlation-based feature selection algorithm, together with highest performing machine learning model(s) from this study, and publicly available BC Coimbra Dataset from University of California Irvine database. The biomarkers may provide direction for clinicians to explore in future BC clinical trials. Trials will serve to validate biomarkers from this study and could be introduced in clinical settings globally as an easy, cost-effective first step for BC screening and detection. An Artificial Intelligence tool can eventually be created using highest performing model(s). Clinicians can input patient-specific biomarkers into the tool. The tool would output the likelihood of patients having BC, with a certain level of accuracy. This envisioned process could serve to eventually revolutionize the early prediction of BC in patients and consequently, a reduction in BC mortality rate.

Pre and post-hoc diagnosis and interpretation of malignancy from breast DCE-MRI

We propose a new method for breast cancer screening from DCE-MRI based on a post-hoc approach that is trained using weakly annotated data (i.e., labels are available only at the image level without any lesion delineation). Our proposed post-hoc method automatically diagnosis the whole volume and, for positive cases, it localizes the malignant lesions that led to such diagnosis. Conversely, traditional approaches follow a pre-hoc approach that initially localises suspicious areas that are subsequently classified to establish the breast malignancy - this approach is trained using strongly annotated data (i.e., it needs a delineation and classification of all lesions in an image). We also aim to establish the advantages and disadvantages of both approaches when applied to breast screening from DCE-MRI. Relying on experiments on a breast DCE-MRI dataset that contains scans of 117 patients, our results show that the post-hoc method is more accurate for diagnosing the whole volume per patient, achieving an AUC of 0.91, while the pre-hoc method achieves an AUC of 0.81. However, the performance for localising the malignant lesions remains challenging for the post-hoc method due to the weakly labelled dataset employed during training.

Fatalism in breast cancer and performing mammography on women with or without a family history of breast cancer

BackgroundBreast cancer is the most prevalent cancer in women, and in those with a positive family history, it is important to perform mammography. One of the probable barriers in doing mammography is fatalism.MethodsThis is a descriptive/cross-sectional study conducted on 400 women residing in Isfahan, Iran, randomly selected in 2017. Sampling was done randomly among the enrolled women in Health Integrity System. The data collection tool was a questionnaire regarding the demographic-fertility information and fatalism. The data analysis was done by SPSS software. A P-value < 0.05 was considered statistically significant.ResultsThe results showed that the mean rate of fatalism was 59.5 ± 23.2 in women with the experience of mammography, and 65.9±18.7 in women without the experience. Moreover, the mean rate of fatalism was 73.1±15.2 in subjects with a family history of breast cancer, and 59.3 ± 22.5 in those no family history related to this condition. Accordingly, fatalism was statistically significant associated (P < 0.001) with a family history of breast cancer and experience of mammography. There was no significant relationship between demographic information and fatalism (P > 0.05).ConclusionThe results indicated that fatalism in women with no experience of mammography was higher than in those with a positive history. Regarding the necessity of mammography in women with a family history of breast cancer, the required interventions seem to be essential to changing the viewpoints of women regarding the importance and effect of mammography as a screening method for breast cancer.

Breast Cancer Awareness, Knowledge and Beliefs among Libyan Women

Background: Breast cancer (BC) is the most frequent cancer of women. The high mortality in developing countries is associated with late detection, and lack of knowledge and adequate screening programmes.&#x0D; Aims: To determine breast cancer awareness, knowledge and beliefs among Libyan women.&#x0D; Study Design: A cross-sectional descriptive study.&#x0D; Place and Duration of Study: Between September and October 2016 among a sample of adult women in western Libya.&#x0D; Methods: 1091 woman aged between years were asked to fill a validated questionnaire to investigate their knowledge about the risk factors as well as their awareness and screening behaviours of BC.&#x0D; Results: The majority of women who participated in the study were aware of BC early warning signs and symptoms. Over 90% of the women were able to list at least one symptom of breast cancer correctly. The most frequent warning sign identified was breast lump (91.0%), followed by discharge from the nipples (80.6%). Also, 565 (52.7%) of those surveyed were aware that increasing age was associated with a higher incidence of breast cancer and 747 (68.3%) of the respondents identified positive family history as a risk factor. Moreover, 62% know how to perform self-examination (BSE), and only 59% ever performed BSE. The majority (92%) would seek medical advice if they discovered a mass in the breast whereas, about half of those (59%) would consult a male doctor.&#x0D; Conclusions: Women who participated in this study were fairly informed about BC risks and warning signs; the results appear to reflect growing awareness of women regarding BC screening methods. Health education message should be presented and delivered in a culturally-sensitive manner and tailored to provide simple and clear information and avoid false beliefs and misconceptions about the disease, its screening methods and management options.

Detection of Volatile Organic Compounds (VOCs) in Urine via Gas Chromatography-Mass Spectrometry QTOF to Differentiate Between Localized and Metastatic Models of Breast Cancer

Breast cancer is the most common cancer detected in women and current screening methods for the disease are not sensitive. Volatile organic compounds (VOCs) include endogenous metabolites that provide information about health and disease which might be useful to develop a better screening method for breast cancer. The goal of this study was to classify mice with and without tumors and compare tumors localized to the mammary pad and tumor cells injected into the iliac artery by differences in VOCs in urine. After 4T1.2 tumor cells were injected into BALB/c mice either in the mammary pad or into the iliac artery, urine was collected, VOCs from urine headspace were concentrated by solid phase microextraction and results were analyzed by gas chromatography-mass spectrometry quadrupole time-of-flight. Multivariate and univariate statistical analyses were employed to find potential biomarkers for breast cancer and metastatic breast cancer in mice models. A set of six VOCs classified mice with and without tumors with an area under the receiver operator characteristic (ROC AUC) of 0.98 (95% confidence interval [0.85, 1.00]) via five-fold cross validation. Classification of mice with tumors in the mammary pad and iliac artery was executed utilizing a different set of six VOCs, with a ROC AUC of 0.96 (95% confidence interval [0.75, 1.00]).

Hybrid Ultrasound Tomography Scanner-a Novel Instrument Designed to Examine Breast as a Breast Cancer Screening Method

Hybrid Ultrasound Tomography Scanner-a Novel Instrument Designed to Examine Breast as a Breast Cancer Screening Method

Attributes, Performance, and Gaps in Current & Emerging Breast Cancer Screening Technologies.

Early detection of breast cancer, combined with effective treatment, can reduce mortality. Millions of women are diagnosed with breast cancer and many die every year globally. Numerous early detection screening tests have been employed. A wide range of current breast cancer screening methods are reviewed based on a series of searchers focused on clinical testing and performance. The key factors evaluated centre around the trade-offs between accuracy (sensitivity and specificity), operator dependence of results, invasiveness, comfort, time required, and cost. All of these factors affect the quality of the screen, access/eligibility, and/or compliance to screening programs by eligible women. This survey article provides an overview of the working principles, benefits, limitations, performance, and cost of current breast cancer detection techniques. It is based on an extensive literature review focusing on published works reporting the main performance, cost, and comfort/compliance metrics considered. Due to limitations and drawbacks of existing breast cancer screening methods there is a need for better screening methods. Emerging, non-invasive methods offer promise to mitigate the issues particularly around comfort/pain and radiation dose, which would improve compliance and enable all ages to be screened regularly. However, these methods must still undergo significant validation testing to prove they can provide realistic screening alternatives to the current accepted standards.

Factors associated with breast cancer screening awareness and practices of women in Addis Ababa, Ethiopia

BackgroundBreast cancer is a global health problem being the most common cancer of women in both developed and under-developed countries. Public and individual awareness can play a vital role in the prevention, early diagnosis and treatment of breast cancer. However evidence is sparse on awareness and practice of breast cancer screening methods used among women of reproductive age in Ethiopia. The present study was designed to determine factors associated with breast cancer screening awareness and practices of women in Addis Ababa.MethodsA facility based cross-sectional study was conducted among women who came for maternal and child health care services to selected public health centers. The participants were interviewed using a structured questionnaire. Following data collection, data entry and analysis was done using Epi-Info version 7and SPSS Version 21 respectively. Cross tabulation of each independent variable with the dependent variable with their 95% confidence interval was done and those variables associated at binary logistic regression with a significance level of 0.2 were entered into multiple logistic regression.ResultsAbout half (53%) of women have heard about breast cancer and 35.5% of women are aware of at least one breast cancer screening method. Among those who are informed about breast cancer screening, 97% indicated that screening improves the chance of survival. Among the common screening methods; self-breast examination, clinical-breast examination and mammographic examination were practiced by 24.3%, 7.6% and 3.8% of respondents, respectively. Women who had high level of income were about 3 times more likely to be aware about breast cancer screening methods, [AOR = 2.5; 95%CI (1.04–-5.91)], while women who attended secondary and tertiary school were 2 and 4 times more likely to practice breast cancer screening methods [AOR = 2.46; 95% CI (1.12–-5.38)] and [AOR = 4.00; 95% CI(1.48–-10.86)] respectively.ConclusionThis study has showed that self-reported breast cancer screening coverage is low. About two-thirds of women had no information about breast cancer screening methods.

Breast Self-Examination: Knowledge and Practice Among Female Textile Workers in Vietnam.

Breast self-examination (BSE) is a simple, feasible, and suitable method for breast cancer screening in low–middle setting countries. The aim of this study was to assess the knowledge and practice of BSE among female textile workers in Vietnam. A cross-sectional study was conducted among 1036 female workers, aged 43.9 ± 3.1 years old, who were working in 4 textile enterprises in Hanoi and Ho Chi Minh City, in 2016. Overall, 22.7% of participants showed sufficient knowledge on BSE; 15.2% performed monthly BSE; and 7.7% completely performed all 5 steps of BSE. The prevalence of insufficient BSE knowledge was higher among participants with low level of education (odds ratio [OR]: 1.71; 95% confidence interval [CI]: 1.22-2.39, below vs above secondary school), and those whose husbands were farmers or workers (OR: 1.76; 95% CI: 1.27-2.45, compared to other sectors). This prevalence was, however, negatively associated with receiving information on BSE (OR: 0.16; 95% CI: 0.11-0.23, yes vs no). The prevalence of insufficient BSE practice was also higher among females with husbands who were farmers or workers (OR: 1.67; 95% CI: 1.15-2.43, compared to other sectors). In contrast, it was much lower among participants who had history of breast-related diseases (OR: 0.46; 95% CI: 0.24-0.88, yes vs no), received BSE information (OR: 0.13; 95% CI: 0.08-0.19, yes vs no), and had sufficient overall BSE knowledge (OR: 0.09; 95% CI: 0.06-0.13, yes vs no), compared to those who did not. There was a low prevalence of sufficient BSE knowledge (22.7%) and practice (15.8%) among female textile workers in Hanoi and Ho Chi Minh City. Low level of education and not being provided BSE information were associated with insufficient BSE knowledge and practice among Vietnamese female textile workers. Health education programs are essential to encourage and improve women’s knowledge and practice of BSE.

Women's Cancer Care in Iran.

Breast cancer (BC) and cervical cancer (CC) are the first and fifth common cancers in Iranian women. Although age-standardized incidence rate of BC and CC in Iran is low, the mortality to incidence ratio is high due to late diagnosis. Except an old and a quite comprehensive cancer registry, women’s cancer care encounter many challenges in Iran. Lack of a customized national and inclusive protocol to control cancer care along with the fragmented health system is the first and foremost cancer care challenge. Many high-risk women miss the opportunity of early diagnosis and treatment because of poor knowledge, low accessibility, or affordability to health care, stigma, and spouse negligence. Although the most effective BC screening method is mammography, it is not equally available for all Iranian women. Furthermore, the cost of BC is very high and screening is accompanied by stigmatized sociocultural beliefs. Unfortunately, while Iran has a good primary care system, low coverage of clinical breast examination and poor knowledge of women indicate that this system has not operated effective. Also due to the limited resources, the Pap smear test has not been applied to the majority of Iranian women. Despite the high basic health insurance coverage in Iran, it does not cover diagnostic test and full treatment of cancers which intensified underutilization of cancer care. In conclusion, developing a national policy and guideline for full coverage of early diagnosis of BC or CC should be prioritized. In this regard, health insurance companies should be committed to including BC and CC screening and care for their basic service packages. The second strategy could be training skillful, responsible, and motivated health-care providers. They are able to decrease the stigmatized view of doing mammography. Survivorship care including follow-up care, posttreatment issues, and psychosocial support should also be considered.

A model study of 3-dimensional localization of breast tumors using piezoelectric fingers of different probe sizes.

Mammography is the only Food and Drug Administration approved breast cancer screening method. The drawback of the tumor image in a mammogram is the lack of tumor depth information as it is only a 2-dimensional projection of a 3-dimensional (3D) tumor. In this work, we investigated 3D tumor imaging by assessing tumor depth information using a set of piezoelectric fingers (PEFs) with different probe sizes which were known to be capable of eliciting tissue elastic responses to different depths and tested it on model tumor tissues consisted of gelatin with suspended clay inclusions. The locations of the top and bottom surfaces of an inclusion were resolved by solving a simple spring model using the elastic measurements of the PEFs of different probe sizes as the input. The lateral sizes of an inclusion were determined as the full width at half maximum of the Gaussian fit to the measured lateral tumor elastic modulus profile. The obtained lateral inclusion sizes were in close agreement with the actual values, and the deduced depth profiles of an inclusion also agreed with the actual depth profiles so long as the bottom surface of the inclusion was within the depth sensitivity of the PEF with the largest probe size. This work offers a simple non-invasive method to predict the extent of a tumor in all 3 dimensions. The method is also non-radioactive.

A Community-Based Assessment of Knowledge and Practice of Breast Self-Examination and Prevalence of Breast Disease in Southwest Cameroon.

Introduction Despite the rising trend in breast cancer incidence and mortality across Sub-Saharan Africa, there remains a critical knowledge gap about the burden and patterns of breast disease and breast cancer screening practices at the population level. This study aimed to identify socioeconomic factors associated with knowledge and practice of breast self-examination (BSE) as well as assess the prevalence of breast disease symptoms among a mixed urban-rural population of women in the Southwest region of Cameroon. Methods We conducted a household-level community-based study in Southwest Cameroon between January and March 2017, using a three-stage cluster sampling framework. We surveyed 1287 households and collected self-reported data on 4208 female subjects, 790 of whom were household representatives. Each household representative provided information on behalf of all female household members about any ongoing breast disease symptoms. Moreover, female household representatives were questioned about their own knowledge and practice of BSE. Results Women demonstrated low frequency of knowledge of BSE, as 25% (n=201) of household representatives reported any knowledge of BSE; and among these only 15% (n=30) practiced BSE on a monthly basis. Age (aOR: 1.04), usage of Liquid Petroleum Gas fuel, a marker of higher socioeconomic status (aOR: 1.86), and speaking English as a primary language in the household (aOR: 1.59) were significant predictors of knowledge of BSE. Eleven women reported ongoing breast disease symptoms resulting in an overall prevalence of 2.3 cases of breast disease symptoms per 1000 women. Conclusions Socioeconomic disparities in access to health education may be a determinant of knowledge of BSE. Community-based strategies are needed to improve dissemination of breast cancer screening methods, particularly for women who face barriers to accessing care.

Distribution of cervical and breast cancer risk factors in women and their screening behaviours.

Breast cancer and cervical cancer are important causes of cancer-related mortality in women all over the world. The present study was conducted in order to investigate the distribution of cervical and breast cancer risk factors in women and their knowledge and behaviours about cancer screening methods. The study is cross-sectional in nature. It was conducted with the participation of 1,886 women in Turkey. Data were collected through a questionnaire. The knowledge and behaviours of women aged 40 and over about breast cancer or cervical cancer screening methods were investigated according to the education level; results showed that the rates of those who knew and did breast self-examination were significantly lower in illiterate women. Besides, the rates of women who did breast self-examination were significantly lower in those who were aged 40 and over, and the rates of those who had clinical breast examination and Pap smear test were significantly lower in women aged 39 and below (p<0.01). This study identified the most notable breast and cervical cancer risk factors as low education levels, high number of deliveries, short breastfeeding period, obesity and low socio-economic level. For this reason, public health policies should be developed to minimise these risk factors.

Overview of Ten Years (2007-2016) Cervical and Breast Cancer Screening Program in Indonesia

Background: Cervical and breast cancer screening have been national program in Indonesia since 2007. The Ministry of Health of Indonesia in collaboration with provincial and district government developed and implemented the program. Method of cervical cancer screening was visual inspection with acetic acid (VIA) or Papanicolaou test and early treatment with cryotherapy for VIA positive. Meanwhile, method of breast cancer screening was clinical breast examination (CBE). After 10 years of implementation, it need to know how the program was conducted and what the results are. Aim: The study was aimed to know activities and results of cervical and breast cancer screening in 10 years (2007-2016). Methods: Design of the study was descriptive study through literature and data review from related data and information sources. Secondary data were collected from Directorate of Non Communicable Disease Control, Ministry of Health, Directorate of Primary Health Service, and professionals. The study was conducted in November-December 2017. Results: Program of cervical and breast cancer screening was started by pilot project in 2007 by 6 districts of 6 provinces in Indonesia: Jakarta, West Java, Central Java, Jogjakarta, North Sumatera, and South Sulawesi. By April 21, 2008 the program was launched as national program by Indonesian First Lady. Then, the program was developed in all province in Indonesia. Activities conducted to develop the program were training of trainers at national level, trainings at district level, socialization to community, providing services of the screening, monitoring, and evaluation. The screening was provided by trained health care provider (general practitioner and midwife) in primary health centers with referral system to district/municipality hospitals. Target of the program was women aged 30-50 years. Since 2007 till 2016, the program was running in all 34 (100%) provinces, 393 out of 514 districts/municipalities (76%), 3706 out of 9813 primary health centers (38%). Clinical trainers of the program were 366 persons consists of OB/GYN oncologist, OB/GYN surgeon oncologist, surgeon, general practitioners, and midwives. Providers of screening were 8526 persons consists of 2783 general practitioners, and 5743 midwives (2.3 providers per primary health center). There were 375 cryotherapy set for early treatment of VIA positive. The result of ten years cervical and breast cancer screening showed that 1,925,943 women have been screened or 5.15% of target 37.4 million women. It was still lower than target of 20% in 2016. VIA positive 73,453 women (3.8%), suspect of cervical cancer 1739 (1 per 1000), lump/tumor in the breast 4030 women (2.1 per 1000). Conclusion: Cervical and breast cancer screening program was running in all provinces and majority of district/municipalities in Indonesia with adequate human resources, but the coverage of the screening was still low.

Breast cancer screening programme in China: does one size fit all? A cost-effectiveness analysis based on a Markov model

BackgroundIn China, breast cancer is the most frequently diagnosed cancer in women. Marked disparities between urban and rural populations have been reported for breast cancer incidence and survival. In 2009, China launched a breast cancer screening programme for women living in rural areas who were aged 35–64 years and at average risk. The programme used ultrasound combined with clinical breast examination as the primary screening tool. In 2012, breast cancer screening was done by use of ultrasound, and was followed by mammography among women living in urban areas aged 40–69 years, who were high risk and were identified through risk assessment questionnaires. To date, economic evidence is still scarce. This study aimed to analyse the cost-effectiveness of breast cancer screening compared with no screening among women in rural and urban China. MethodsWe developed a Markov model to estimate the lifetime costs and effects, from a societal perspective, for the general population-based cohorts, both in urban China with high incidence of breast cancer and rural China with low incidence of breast cancer. Analyses were done for women in rural areas aged 35 years and women in urban areas aged 40 years. Women who were asymptomatic in the intervention arm were screened every 3 years. Breast cancer in the non-screening arm could only be diagnosed on presentation of symptoms. The main outcome measure was cost per quality-adjusted life-year (QALY) gained with a 3% annual discount. Parameter uncertainty was explored using one-way and probabilistic sensitivity analyses. FindingsCompared with no screening, the rural breast cancer screening programme cost US$186·72 more and led to a loss of 0·20 QALYs because of disutility from false positives. Breast cancer screening among women in rural China is more expensive, with an incremental cost-effectiveness ratio (ICER) of $-916 per QALY, compared with no screening. In urban areas, the breast cancer screening programme cost $84·99 and gained 0·01 QALYs, with an ICER of $6671 per QALY, well below the willingness-to-pay threshold of $23 050 per QALY at three times GDP per capita (2014) in China. The results are shown to be robust through the sensitivity analyses. InterpretationIn a rural setting, which has low breast cancer incidence, screening for asymptomatic disease among the general population using current screening tools is not cost-effective. Priority should be given to ensure that women who are symptomatic have access to diagnosis and treatment at an early stage. In urban China, a high-risk population-based screening method for breast cancer is very likely to be cost-effective compared with no screening. FundingNational Natural Science Foundation of China (71273016 and 71673004).