Breast Cancer Symptoms Research Articles

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.
 Aims: To determine breast cancer awareness, knowledge and beliefs among Libyan women.
 Study Design: A cross-sectional descriptive study.
 Place and Duration of Study: Between September and October 2016 among a sample of adult women in western Libya.
 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.
 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.
 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.

A mixed methods, community-based investigation on women's cancer awareness in Haiti.

Despite a high number of cases, the awareness of breast and cervical cancer in Haiti and other low and middle-income countries (LMICs) remains relatively unknown. The objective of the research was to understand perceptions and attitudes towards breast and cervical cancer in Haiti through community-engaged research. We report Haitians perceptions of breast and cervical cancer symptoms, diagnosis, complications, treatment, community support and access to medical services. Five non-governmental Haitian organisations performed a large survey across the country of Haiti in 2015. The survey and focus groups addressed demographics, reported knowledge of women's cancer, infrastructural issues and barriers to care, communication and media channels. The mixed quantitative and qualitative surveys with open- and closed-ended questions were administered to 414 participants aged 13-65 (75% of whom were women). A separate, smaller survey on community support and gender-based violence was conducted in 50 breast cancer patients and survivors as well. The quantitative data indicate low levels of knowledge about cancer across all geographic regions of the country amongst men and women. After coding participants' qualitative responses as "accurate" or "not accurate", we determined the percentage of accurate responses related to knowledge. Data are reported broken down by geographic region, education, economic status and sex. Approximately one in five respondents reported knowing how a woman contracts breast or cervical cancer. Only 30% reported to know complications of breast cancer and 22% the complications of cervical cancer. When asked if they knew where to get a test for breast cancer, 20% said yes and 33% said they knew where to get a test for cervical cancer. The wealthiest and best educated generally had the most knowledge, but the poorest consistently had the second best. Forty percent of cancer patients reported to be victims of on-going gender-based violence. Further investigation should be undertaken examining the role of gender-based violence and to address the knowledge of the working poor.

Abstract 2429: Social Support as a Moderator in the Relationship between Intrusive Thoughts and Psychological Symptoms among Spanish-speaking Latinas with Breast Cancer

Abstract Background: Intrusive thoughts are associated with higher levels of psychological symptoms and impaired quality of life in the year after breast cancer treatment. To our knowledge, no studies have examined social support as a potential moderator between intrusive thoughts about breast cancer and psychological symptoms among Latinas. This study aims to assess the moderating effects of different dimensions of social support on the association between intrusive thoughts and psychological symptoms among Spanish-speaking Latina breast cancer survivors. Methods: Analyses were performed using baseline data from a randomized control trial of a stress management intervention delivered to 151 Spanish-speaking Latinas with non-metastatic breast cancer. Survey measures on intrusive thoughts, four dimensions of social support (emotional/information, tangible, affectionate, and positive social interaction), and psychological symptoms (depression, anxiety, and somatization) were obtained at baseline via a structured survey. Information on age, time since diagnosis, breast cancer treatment, surgery type, breast cancer stage, history of depression and marital status was obtained via medical records review and served as covariates. Generalized linear models were used to investigate bivariate and multivariate associations and to explore moderation effects of the four dimensions of social support. Results: In the bivariate models, intrusive thoughts were associated with more depressive (β=0.024, p=0.0014), anxiety (β=0.047, p<.0001) and somatization symptoms (β=0.019, p = 0.0036). In multivariable models, intrusive thoughts remained strongly associated with anxiety symptoms (β=0.132, p=0.0001). In contrast, the effects of intrusive thoughts on depressive and somatization symptoms was attenuated in the multivariate models. Receiving affectionate social support was found to moderate the relationship between intrusive thoughts and anxiety symptoms (β=-0.022, p=0.0055). No dimension of social support was found to have a moderating effect in the relationship between intrusive thoughts and either depressive or somatization symptoms. Conclusions: Our findings indicate that social support, particularly affectionate support, had a protective effect on anxiety symptoms among Spanish-speaking Latinas with breast cancer experiencing intrusive thoughts. Affectionate social support is a possible protective factor that can be developed and encouraged in socio-behavioral interventions for this vulnerable population. Citation Format: Cristian Escalera, Anna Maria Napoles, Jasmine Santoyo-Olsson, Carmen Ortiz. Social Support as a Moderator in the Relationship between Intrusive Thoughts and Psychological Symptoms among Spanish-speaking Latinas with Breast Cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2429.

PENGARUH PENDIDIKAN KESEHATAN DENGAN MEDIA AUDIO VISUAL TERHADAP PENGETAHUAN REMAJA PUTRI TENTANG PEMERIKSAAN PAYUDARA SENDIRI (SADARI)

Pendahuluan: Kanker payudara merupakan penyakit dengan angka kejadian yang cukup tinggi di berbagai negara dan memiliki resiko kematian yang tinggi jika ditangani secara terlambat. Pemeriksaan payudara sendiri (SADARI) dapat dilakukan untuk mendeteksi gejala kanker payudara secara dini sehingga dapat mengurangi resiko kematian. Penelitian ini bertujuan untuk mengetahui adanya pengaruh pendidikan kesehatan dengan media audio visual terhadap pengetahuan remaja putri tentang pemeriksaan payudara sendiri (SADARI) di SMAN 1 Kuta Utara. Metode: Metode penelitian ini menggunakan pre eksperimental dengan one group pre-post test design. Sampel pada penelitian ini berjumlah 33 siswi yang dipilih menggunakan teknik purposive sampling. Hasil: Pengukuran pengetahuan siswi dalam pre test didapatkan hasil 17 orang (51,5%) berpengetahuan kurang dan 16 orang (48,5%) bepengetahuan cukup. Pada hasil post test pengetahuan didapatkan peningkatan yaitu 20 orang (60,6%) berpengetahuan baik dan 13 orang (39,4%) berpengetahuan cukup. Diskusi: Hal ini disebabkan karena siswi telah mendapatkan perlakuan berupa penyampaian informasi melalui pendidikan kesehatan dengan media audio visual tentang SADARI yang telah diberikan oleh peneliti.

Symptom awareness measures for breast and cervical cancer in sub-Saharan Africa: A scoping review

Background: In sub-Saharan Africa (SSA), breast cancer is the most commonly diagnosed cancer among women, while cervical cancer remains the leading cause of cancer death. Women often fail to recognise or misinterpret possible symptoms, so breast and cervical cancer symptom awareness information can promote timely help-seeking behaviour, diagnosis and start of treatment. Aim: To identify tools that have been utilised to measure breast and cervical cancer symptom awareness in SSA and to establish if such tools have been validated in SSA populations. Methods: A scoping review of articles published between January 1997 and February 2017, written in English and describing primary research in breast and/or cervical cancer symptom awareness-related topics in SSA contexts, was undertaken across five databases. The approach was supported by Colquhoun et al.’s methodological framework for scoping reviews. Results: A total of 41 studies were included from 11 SSA countries. Almost half (20/41) used breast and/or cervical cancer symptom awareness tools but did not report on tool validation processes. The rest (21/41) made reference to some tool validation, yet only two reported a detailed account of their tool validation processes. One explored lay perceptions of breast cancer, while the other sought to establish the validity and reliability of a UK tool in a Kenyan context. Conclusion: The findings point to the dearth of comprehensively validated and culturally relevant tools to measure breast and cervical cancer symptom awareness in the SSA context. They have informed the development and validation of an African Women Awareness of CANcer (AWACAN) tool, which can support the development and evaluation of interventions relevant to the SSA context.

Knowledge and practice of breast self-examination among undergraduate students in Bahir Dar University, North-West Ethiopia, 2016: A cross-sectional study.

Breast cancer is the most common cancer in women worldwide, with nearly 1.7 million new cases diagnosed each year which accounts 12% of all new cancer cases and 25% of all cancers in women. Breast self-examination offers women the best opportunity for reducing breast cancer deaths. From a total of 222 respondents about 190 (85.6%) heard about breast selfexamination. One hundred forty-three (75.3%) had good knowledge about sign and symptoms of breast cancer and 47 (24.7%) had poor knowledge about the sign and symptoms of breast cancer. From total respondents of the study 120 (54.1%) practiced breast self-examination. Breast selfexamination practice is relatively frequent problem in Bahir Dar University, health science students. Negligence, forgetfulness and lack of knowledge are the main factors for poor practice of breast self-examination. Public health education using the media, clubs and leaflet could significantly reduce poor practice of breast self-examination and increases early detection of breast lump.

Factors Associated with Breast Cancer Awareness in Thai Women.

Background:Breast cancer is the most common cancer in women worldwide. In south-east Asia, both the incidence and mortality rates of breast cancer are on the rise, and the latter is likely due to the limited access to large-scale community screening program in these resource-limited countries. Breast cancer awareness is an important tool which may, through increasing breast self-examination and the seeking of clinical examination, reduce breast cancer mortality. Investigating factors associated with breast cancer awareness of women is likely to help identify those at risk, and provide insights into developing effective health promotion interventions. Objective:To investigate factors associated with breast cancer awareness in Thai women. Methods:A cross-sectional sample of Thai women aged 20-64 years was collected during August to October, 2015 from two provinces of southern Thailand (Surat Thani and Songkla). A questionnaire including the Breast Cancer Awareness Scale along with demographic characteristics was administered and Proportional Odds Logistic regression was then used to investigate factors associated with breast cancer awareness. Results:In total, 660 Thai women participated in this study. Factors most often associated with the various breast cancer awareness domains were age and rurality. While rural women had poorer knowledge of breast cancer signs and symptoms, they also had lower levels of perceived barriers and considerably better breast cancer awareness behaviors. Conclusion:Despite lower knowledge of breast cancer risk factors and no evidence of better knowledge of signs and symptoms, we found rural Thai women had considerably better breast cancer awareness behavior. This may be due to these women’s lower levels of perceived barriers to breast cancer screening services. Indeed this suggests, at least in Thai women, that interventions aimed at lowering perceived barriers rather than enhancing disease knowledge may be more successful in engaging women with breast cancer screening services and increasing breast self-examination.

Content validity of the National Comprehensive Cancer Network \u2013 Functional Assessment of Cancer Therapy \u2013 Breast Cancer Symptom Index (NFBSI-16) and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form with advanced breast cancer patients

BackgroundThe purpose of this study is to evaluate the content validity of the National Comprehensive Cancer Network – Functional Assessment of Cancer Therapy – Breast Cancer Symptom Index (NFBSI-16) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10b among patients with hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2-) advanced breast cancer.MethodsCognitive debriefing interviews sought to evaluate patients’ ability to read, understand, and meaningfully respond to the questionnaires, as well as to evaluate the questionnaires’ relevance in the target patient population. Interviews were conducted by telephone and lasted approximately 90 min. Audio recordings were transcribed, anonymized, and analyzed using qualitative data analysis software.ResultsFifteen cognitive debriefing interviews were conducted with women (mean age 66.0 years [standard deviation = 12.4]). Patients reported metastases in the bone (86.7%), liver (20.0%), lung (13.3%), skin (6.7%), and lymph node (6.7%) (not mutually exclusive). All patients for whom data were available demonstrated understanding of the instructions and the recall period of the NFBSI-16 (n = 14/14, 100.0%) and the PROMIS (n = 14/14, 100.0%). Greater than 90% of patients demonstrated understanding of each of the items in the NFBSI-16 and the PROMIS. Greater than 70% of patients demonstrated understanding of the response options of the NFBSI-16, > 90% understood response options of PROMIS Items 1–6, and ≥ 50% understood response options of PROMIS Items 7–10. Conceptual relevance was supported for most items in both questionnaires based on patients’ reports of experiencing the concepts as part of their breast cancer experience.ConclusionsThe results of the cognitive debriefing interviews provide evidence that the NFBSI-16 and PROMIS Physical Function Short Form 10b have content validity in the HR+/HER2- advanced breast cancer patient population. Patients may benefit from additional instructions at the point the response options reverse direction in the PROMIS.

Diagnostic and treatment delays in young women with breast cancer.

6575 Background: Delays in diagnosis (dx) and treatment (tx) affect breast cancer (BC) outcomes. We sought to identify factors associated with delays among young women, who do not undergo routine screening and often have pregnancy or breastfeeding-related breast changes that may mask a BC. Methods: The Young Women’s Breast Cancer Study is a multicenter, prospective cohort that enrolled 1302 women with newly dx BC age ≤40 between 2006-2016. Women reported the method and timing of cancer detection on the baseline survey. 231 were ineligible or excluded due to missing information. Among those reporting self-detected cancers, using multivariable regression we evaluated factors associated with delays ≥90 days (d) from symptom to presentation (self delay) and presentation to dx (care delay); in stage 0-III BC we evaluated delays ≥60d from dx to tx (tx delay). Results: 1071 eligible women had median age at dx of 37 yrs (17-40) and 74% reported self-detected cancers. Self delay or care delay ≥90d was reported in 17% and 13%, respectively. Factors inversely associated with self delay included pregnancy at dx (vs nulliparous, OR 0.10, CI 0.01-0.78) and perceived financial comfort (vs not, OR 0.62, CI 0.41-0.93). Women dx ≤1 year post-partum who breastfed (vs nulliparous, OR 2.60, CI 1.14-5.93) and those with a family history of breast/ovarian cancer (vs none, OR 1.79, CI 1.00-3.19) were more likely to have a care delay. Age was inversely associated with care delays (OR 0.94, CI 0.89-0.99). Tx delay was reported by 10% (105/1015), and associated with being single (vs partnered, OR 1.61, CI 1.02-2.56 ), non-white (vs white, OR 1.85, CI 1.09-3.13) and having Stage 0 BC (vs stage 1, OR: 3.08, CI 1.65-5.77); women with stage 3 BC (vs stage 1, OR 0.13, CI 0.03-0.56) were less likely to have a tx delay. Conclusions: In this cohort, most young women with BC underwent timely dx and tx initiation. Women dx ≤1 year post-partum who breastfed were more likely to experience a care delay, likely because lactational changes may mask BC signs and symptoms. The associations of perceived financial status with self delay and non-white race with tx delay underscore the need for additional support to ensure timely care for underserved populations with the goal of eliminating disparities in outcomes.

Cancer and breast cancer awareness interventions in an intellectual disability context: A review of the literature.

Women with an intellectual disability (ID) have a similar risk of developing breast cancer as women in the general population yet present with later stage breast cancers, which have poorer outcomes. To identify whether there is a need to develop a breast cancer awareness intervention for women with an ID. Interventions aimed at increasing cancer awareness and breast cancer awareness for people with an ID were identified and critically appraised. Five interventions to increase cancer awareness or breast cancer awareness in people with an ID were identified. The review highlighted the paucity of theoretically underpinned breast cancer awareness interventions specifically aimed at women with an ID. Facilitating breast cancer awareness for women with an ID could potentially lead to earlier presentation of potential symptoms of breast cancer, earlier treatment, better prognosis and ultimately, improved survival. This article establishes that there is a need for an intervention underpinned by theory to increase breast cancer awareness in women with an ID.

Knowledge and practices on breast cancer detection and associated challenges among women aged 35 years and above in Tanzania: a case in Morogoro Rural District.

Background: Breast cancer is the leading cause of cancer-related deaths among women globally including Tanzania. However, timely access to diagnosis remains a challenge due to lack of specialized facilities. Most patients presents with advanced stages of the disease making management impossible. This leads to an increase in breast cancer-related mortality. Little is known about knowledge and practices on breast cancer screening in Tanzania. This study described knowledge and practices on breast-cancer detection and associated challenges among women aged 35 years and above in Morogoro rural District in Tanzania.Methods: This descriptive cross-sectional study was conducted in Lubungo, Newland and Fulwe villages at Mikese ward in Morogoro rural District from June and July 2017. A standardized questionnaire was used to obtain information from 130 study participants regarding breast cancer knowledge and practices. Data were analyzed using (SPSS) software version 23 and descriptive statistics were summarized in frequencies and percentages.Results: One hundred and thirty women were studied, all participants have heard of breast cancer; 71.5% knew the effects of breast cancer; 37.7% knew about the signs and symptoms. The most frequently reported cause and risk factor of breast cancer were putting money under brassiere (30.8%) and fat diet (17.7%) respectively. The participants (73.8%) have never heard of breast self-examination (BSE) as an early detection method of breast cancer hence do not practice it. Lack of knowledge on early signs and symptoms of breast cancer was reported as the main challenge for breast cancer screening (73.8%). The frequently reported source of information about this disease was television/radio programs (83.1%).Conclusion: Most of the women have heard of breast cancer but they lack adequate knowledge on its risk factors, causes, symptoms and effects. The majority of the women do not practice BSE due to lack of knowledge. Efforts to improve women’s knowledge on breast cancer is warranted.

PENGETAHUAN WANITA TENTANG KANKER PAYUDARA

Introduction about breast cancer is very important in order to decrease new cases through the efforts of prevention and early detection to make it easier to recognize the risk factors and symptoms of breast cancer. This community service activities aiming to identify women's ability to detect early breast cancer. This community service activities performed on May to October 2018 in the UPT PUSKESMAS PB SELAYANG II Medan. The method of implementation of community service activities started by measuring the level of knowledge about society and the cadre of breast cancer, followed by the giving of material (counseling) about breast cancer by SADARI. Results dissemination instruments of knowledge work in the area of women's health centers on breast cancer obtained that 30 women (60%) have less knowledge about breast cancer. For it to do a follow-up to train cadres and taught to the community to recognise and assess the risk factors in a sustainable way next taught how about SADARI techniques and further stages need to be done breast exam by using breasligh.

Factors that Correlate with The Health Services Seeking on Breast Cancer Patients

Most cases of breast cancer are found to be in an advanced stage. This is because of the patient delay in coming to health service after the emergence of early symptoms of breast cancer. It is necessary to identify factors that allegedly prevent patients from seeking health services as early as possible. The purpose of this study was to analyze factors related to the search for health services. This research used cross-sectional method. The population of this study was breast cancer patients where the sampling technique using consecutive sampling with the number of samples researched as many as 100 people. Data were obtained through a reliable questionnaire to use (Alpha Cronbach’s questionnaire = 0.92, Alpha Cronbach’s health questionnaire = 0.85). Analysis of this research data using univariate (frequency distribution), bivariate (Chi-Square) and multivariate (logistic regression).The result of bivariate analysis showed that the variables related to health seeking behavior are education (ρ value = 0.02; r = 0.3) and health belief (ρ value = 0.01; r = 0.24). While the variables that most related to health service seeking behavior was health belief (ρ value = 0.02) and OR value 3.46. This could be caused by patient’s health belief in which the patient assumes that the symptoms were not dangerous and the choice of alternative medicine as the first choice and the patient’s fear of treatment due to lack of information that obtained by the patient. It can be concluded that health beliefs are the most correlated factor with health-seeking behavior so it is necessary to consider the prevention efforts of breast cancer especially related to health belief. Community beliefs about routine health checks should be key interventions such as counseling and discussions with the community regarding the importance of routine health screening as part of early detection of disease.

Pathways to care for patients in Pakistan experiencing signs or symptoms of breast cancer

Multiple social and financial barriers exist to breast cancer detection in Pakistan, which may cause a delay in seeking care and the final diagnosis. This analytical study documents the pathways and time courses associated with referral to diagnostic centres to evaluate the clinical signs and symptoms of breast cancer. This report also verifies the association between socio-demographic and clinical indicators concerning the length of time spent before reaching diagnostic facilities. A purposive sample of 200 patients was selected from two tertiary care hospitals in Lahore, Pakistan, for the interviews. Descriptive statistics (that is, percentages, frequencies, and measures of central tendencies) and a multiple linear regression model were used to achieve the study objectives. The descriptive model showed 31–128 days interval between a patient's awareness of a clinical sign or symptom and receiving care. The healthcare system, including traditional healers, took from 7 to 194 days, and the time to diagnosis ranged from 15 to 30 days. Pain severity, larger tumour size, lack of clinical improvement, and the desire to obtain better treatment were reasons given for seeking care, but lack of awareness and fear of financial burden related to accessing healthcare facilities were identified as barriers. Moreover, socio-demographic and other predictive clinical factors were potentially associated with and substantially influenced the likelihood of the increased length of breast cancer patients' time to reach diagnostic centres. In conclusion, referrals by multiple healthcare providers, especially traditional healers and general practitioners, was a significant predictor for delay in diagnosis. Therefore, increased awareness and a responsive healthcare system may reduce the time from the recognition of symptoms to the early detection of breast cancer among women, thus improving outcomes in a developing country.

Assessing Breast Cancer Knowledge Among Iranian Physicians

Background: Breast cancer (BC) is one of the most important public health issues; so, knowledge about signs, symptoms, and screening programs has impressive role in BC prevention. Objectives: The objective of this study was measuring general physician’s knowledge regarding BC screening programs. Methods: This cross sectional study was performed among 200 general physicians (GP) of urban and rural areas from Jun to September, 2017 in Hamadan, Iran, using a self-administered semi-structured questionnaire. The data were analyzed by SPSS. Significance level was set at P < 0.05. Results: The mean score of total knowledge on breast cancer screening, risk factors, signs, and symptoms for 23 questions was 15.07 ± 2.4 (max: 20; min: 9), which meant that correct answers were given to more than half of them. In symptom knowledge area, 45.3 of physicians had correct answer to 4 questions, whereas about risk factor, 61.4 recorded correct answer to 8 questions. There was a significant reverse correlation between knowledge about screening programs and age of participants (r =-0.3; P < 0.001), and their years of work experience (r =-0.26; P < 0.001). Conclusions: In the current study, family physician knowledge on breast cancer signs, symptom, and screening programs was insufficient. It is recommended that there should be a well-designed health education program to compensate physicians’ knowledge deficits, especially in older ages in order to raise awareness toward cancer, with emphasis on the role of prevention and screening. Importance of early diagnosis in breast cancer and its high rate in our country are adequate reasons for considering this issue on top of our priorities. © 2019, Author(s).

What symptoms are important to patients? Developing a symptom burden measure for women with breast cancer.

The American Cancer Society predicted that 266,120 women would be diagnosed with breast cancer in 2018. Women experience significant symptom burden in response to tumor and treatment-related adverse effects, particularly in advanced disease. Use of valid and reliable patient-reported outcomes (PRO) symptom measures may assist clinicians in systematically monitoring and managing symptoms. The MD Anderson Symptom Inventory (MDASI) is a brief PRO measure of cancer symptom burden; specific symptoms can be added to the core symptoms to produce disease- and treatment-specific modules. The purpose of this study was to describe the patient symptom experience, define the content domain, and generate items for a breast cancer-specific MDASI module for measuring symptom burden in women with breast cancer. Women with breast cancer were qualitatively interviewed about their experiences of disease and treatment. Descriptive exploratory analysis identified symptoms and symptom interference to define the symptom burden of breast cancer. An expert panel rated the relevance of the identified symptoms to patients with breast cancer. A conceptual model of breast cancer symptom burden was developed from interviews with 36 women (mean age of 57.9years, 86.1% had stages I-III, and 52.8% were on chemotherapy and/or radiation therapy) across the breast cancer disease and treatment trajectory. Thirty-six symptoms and 6 interference categories were identified. Symptoms specific to treatment modalities and breast cancer met the criteria for inclusion in the provisional instrument for psychometric testing. We generated an instrument with content validity for measuring symptom burden specific to women with breast cancer.

Knowledge and Health Seeking Behaviour of Breast Cancer Patients in Ghana.

Background Breast cancer is a major contributor to cancer-related deaths among women worldwide, despite the numerous measures employed to prevent and manage the disease. This study explored the knowledge and health seeking behaviour of breast cancer patients at the Komfo Anokye Teaching Hospital. Methods A descriptive cross-sectional study was conducted at Komfo Anokye Teaching Hospital in Kumasi, Ghana, from June 2014 to July 2014. Thirty-five participants were purposively selected. The responses to questions about their experiences with breast cancer were determined using indepth interviews. Transcripts were coded and analysed using NVIVO version 10.0. Results Participants' knowledge about signs and symptoms of breast cancer after their diagnosis was high but low for risk factors. Screening for breast cancer through self-breast examination was infrequently performed prior to their diagnosis. The patients' first point of care was generally health facilities. Some patients reported late due to misinterpretation of signs and symptoms, cultural influences and fear of losing their breast to surgery, physician delay, health providers' laxity, and disinterest in breast cancer. Men, for example, husbands, decide on where and when breast cancer patients go for treatment. Conclusion There is poor knowledge of the risk factors for developing breast cancer. Patients resorted to the hospital as first options for cure but were generally delayed in doing so. There is the need to create awareness about breast cancer among the general population.

Knowledge, Attitude, Practice, and Associated Factors of Breast Cancer Self-Examination among Urban Health Extension Workers in Addis Ababa, Central Ethiopia

Background & aim: Breast cancer is one of the leading cancer types among women. In Ethiopia, the knowledge, attitude and practice among health extension workers (HEWs) towards breast cancer self-examination are not well understood. Therefore, this study assessed knowledge, attitude, and practice (KAP) of breast cancer self-examination (BCSE) and associated factors among HEWs. Methods: This cross-sectional study was conducted from October to November 2017 among female HEWs in Addis Ababa, using self-administered questionnaire. Multivariate logistic regression was used to assess factors associated with KAP of the BCSE. Adjusted odds ratio (AOR) with 95% confidence interval (95% CI) was used to assess statistical significance. Results: A total of 453(89.2%) HEWs participated in this study. Close to two-third (64.0%) of the respondents had adequate knowledge on breast cancer signs, symptoms, and practice of BCSE. However, only 146(40.0%) of the respondents practiced BCSE on a monthly basis. The majority (81.0%) of the respondents had a positive attitude towards BCSE. Work experience ranging from one to four years (AOR: 2.8; 95%CI: 1.2, 6.4)and ≥five years(AOR: 2.4; 95%CI: 1.1, 5.7), familiarity with people who had history of breast cancer (AOR: 1.7; 95%CI: 1.1, 2.6),perceived susceptibility (AOR: 1.8; 95 %CI: 1.2, 3.0), and knowledge of BCSE(AOR: 2.3; 95 %CI: 1.4, 3.7) were significant predictors of BCSE. Conclusion: More than half of HEWs had adequate knowledge and attitude towards BCSE; however, only a few put them into practice. With regard to in-service training focusing on severity, consequences and detection methods of breast cancer may enhance the BCSE practices of the HEWs.

Knowledge, Attitudes, and Beliefs About Breast Cancer and Barriers to Breast Self-Examination Among Sikkimese Women

Abstract Objectives: The objectives of this study are to assess women's awareness on breast cancer; and their awareness, attitudes, and barriers to practice of breast self-examination (BSE). Methodology: This cross-sectional study was conducted from May 1, 2015 to June 30, 2015, involving 302 women between 18 and 65 years of age attending the Outpatient Department of Central Referral Hospital, Gangtok. Face-to-face semi-structured questionnaire-based interview was conducted among the participant women, after taking their written consent. Results: Three-fourths of the participants were aware of breast cancer. Eighty percent of the women who had heard about breast cancer were not aware of its risk factors. Forty-six percent of the participants were aware of BSE. Most common source of knowledge was from health professionals. Of the 138 women who were aware of BSE, 41.3% ever practiced BSE. Majority had started BSE between 21 and 45 years of age. Thirty-seven percent of the participants practiced BSE once in a year. Working women and students were found to be twice more likely to practice BSE compared to homemakers. Similarly, women belonging to lower socioeconomic status were 70% less likely to practice BSE than women of affluent class. Conclusions: Knowledge of the breast cancer and BSE practices is poor among indexed Sikkimese reproductive women attending tertiary hospital of Sikkim. There is an urgent need for information on the airwaves and in print, and for education at health centers on warning symptoms of breast cancer and various methods of screening for breast cancer including BSE.

Establishing Cohorts to Generate the Evidence Base to Reduce the Burden of Breast Cancer in Sub-Saharan Africa: Results From a Feasibility Study in Kenya.

PURPOSEBy 2025, Kenya is estimated to experience a two-thirds increase in the incidence of breast cancer. Local research is necessary to generate evidence to inform policy, public health, and medical practice. There have been no longitudinal cohort studies in sub-Saharan Africa of women with and without breast cancer. Our aim is to assess the feasibility of conducting cohort studies in Kenya that consider clinical characteristics, socioeconomic factors, and self-care behaviors.METHODSWe initiated a short-term follow-up cohort study of women with and without a diagnosis of breast cancer with baseline face-to-face data collection and one follow-up interview (at approximately 3 months by telephone). We developed tailored instruments to capture demographics, socioeconomic factors, breast cancer risk, ability to identify breast cancer symptoms, treatments received for breast cancer, and quality of life of survivors.RESULTSWe recruited 800 women between the ages of 20 and 60 years and successfully collected baseline data. Completeness of the data was high for demographic variables, but there was a larger proportion of missing information for specific variables required for assessing breast cancer risk. Respondents were able to complete standardized instruments to assess breast cancer knowledge among those without breast cancer and identification of symptoms among survivors. We were able to successfully contact approximately 80% of the participants for follow-up.CONCLUSIONThis short-term follow-up study provides evidence that women can be successfully tracked and contacted for follow-up in the Kenyan setting and offers lessons to establish future longitudinal cohorts to identify approaches to improve breast cancer outcomes.