scholarly journals Patient Delay in Breast Cancer Diagnosis in Two Hospitals in Karachi, Pakistan: Preventive and Life-Saving Measures Needed

2020 ◽  
pp. 873-883
Author(s):  
Uzma Shamsi ◽  
Shaista Khan ◽  
Iqbal Azam ◽  
Shaheryar Usman ◽  
Amir Maqbool ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Standard Deviation ◽  
Cancer Education ◽  
Strong Association ◽  
Multivariable Analysis ◽  
Patient Delay ◽  
Medical Consultation ◽  
Breast Lump ◽  
Medical File ◽  
The Mean

PURPOSE Patients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them. METHODS Four hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review. RESULTS The mean (standard deviation) age of patients with breast cancer was 48.0 (12.3) years. The mean (standard deviation) patient delay was 15.7 (25.9) months, with 55.2% of women detecting a breast lump but not seeking a medical consultation because of a lack of awareness about the significance of the lump. A total of 9.4% of the women decided to seek treatment initially using complementary and alternative medicine and traditional treatment; 9.4% of the women presented to a health care provider with a breast lump but no action was taken, and they were wrongly reassured about the lump without mammography or biopsy. For 26% of the women, the delay in presentation was caused by anxiety, fears and misconceptions regarding diagnosis and treatment, and other social factors including possible adverse effects on their relationship with their husband. Multivariable analysis showed a strong association of lower socioeconomic status (odds ratio [OR], 8.11 [95% CI, 2.46 to 26.69]) and late stage of breast cancer (OR, 4.83 [95% CI, 1.74 to 13.39]) with a patient delay of ≥ 3 months. CONCLUSION Patient delay is a serious problem in Pakistan. There is an urgent need for intensive and comprehensive breast cancer education that addresses the myths and misconceptions related to breast cancer.

scholarly journals Patient Delay in Breast Cancer Diagnosis, Its Associated Factors and Stage of Breast Cancer at First Presentation

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 12s-12s
Author(s):  
U. Shamsi
Keyword(s):  
Breast Cancer ◽  
Cancer Diagnosis ◽  
Cancer Education ◽  
Breast Cancer Diagnosis ◽  
Patient Delay ◽  
Disease Stage ◽  
Complementary Alternative Medicine ◽  
Diagnosis Delay ◽  
Breast Cancer Patients ◽  
The Mean

Background: Patients with breast cancer in Pakistan commonly present with advanced disease. An understanding of the factors influencing delays is important to formulate strategies and shorten delays. Aim: The objective of the current study was to evaluate the frequency and magnitude of patient delay in women of Karachi with a diagnosis of breast, and in addition to provide a detailed assessment of the reasons for this delay of breast cancer patients in seeking medical treatment and if there was a relationship between delays and disease stage. Methods: 533 newly diagnosed cases of breast cancer were enrolled and interviewed during the period from Feb 2015 to Aug 2016. Patient delay in breast cancer diagnosis was defined as time from first symptoms until first medical consultation. Results: The mean age of women was 48.2 ± 12.3 years. The mean consultation time was 7 months. The factors associated with delay were welfare hospital (OR= 2.73, 95% CI: 1.85- 4.01), education level of less than grade 8 (OR= 2.97; 95% CI: 1.86- 4.75), poor SES (OR= 4.32, 95% CI: 2.45-7.60), and breast cancer at stage 4 (OR= 6.53, 95% CI: 2.22-19.18). Patient delay was due to lack of awareness about breast cancer (58.1%) thinking that the lump was harmless. There were misconceptions, embarrassment, shame and fears related to treatment and diagnosis of breast cancer among 86 (16.1%) patients. 49 (9.2%) women wasted time in complementary alternative medicine (CAM)/traditional treatment and had other factors like husband reaction to BC, family commitments, financial constraints. Conclusion: Diagnosis delay is very serious problem in Pakistan. Patient delay was significantly associated with the consequent diagnosis of breast cancer at an advanced stage and consequently with a very poor prognosis. This is a preventable problem which if addressed would have a significant impact on reducing the morbidity and mortality of breast cancer in Pakistan. There is an urgent need for intensive and comprehensive breast cancer education, addressing myths and misconceptions, related to breast cancer. there is no conflict of interest

scholarly journals Assessing Risk and Knowledge of Women on Breast Cancer and Providing Lifestyle Advice for the Management of Breast Cancer Risk

2021 ◽  
Vol 11 (4) ◽  
Author(s):  
Ghouse Ishrar Shaik Mohammad ◽  
Prasanth Neeluri ◽  
Reddy Gaddi Geetha ◽  
Manasa Madamanchi Ganga
Keyword(s):  
Breast Cancer ◽  
Standard Deviation ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Lifestyle Changes ◽  
Lifetime Risk ◽  
Average Lifetime ◽  
Early Screening ◽  
Cross Sectional ◽  
The Mean

Breast cancer is the most common cancer and is the main cause of cancer mortality among women in the world. Overall, 1 in 28 women is likely to develop breast cancer during her lifetime. Although the mortality rate is decreasing, the incidence is persistently increasing due to urbanization and lifestyle changes. So, there is a need to assess the personal breast cancer risk and increase the knowledge of women on early detection. The present study aims to assess the risk and knowledge of women on breast cancer. The main objective of the study is to identify the women at high risk, to create awareness among women about early screening and detection and to educate lifestyle management to decrease breast cancer risk. A descriptive cross-sectional study was performed during the period of June 2019 to November 2019 in the women attended for mammographic examination. A total of 270 women responded to the study. The results showed that five-year risk is found to be high for 31.1% of women and low for 68.8% of women with a mean of 1.4 and the standard deviation is 1.24. About 14.81% of women were found to have strong lifetime risk and 30.37% of women had average lifetime risk and 54.81% women had usual lifetime risk. The mean lifetime risk of the women is 16.09 and the standard deviation is 10.2. The majority of the participants have low knowledge on breast cancer; BSE, and mammography i.e., 80% of them were lack of knowledge. The mean knowledge score is 6.34 and the standard deviation is 5.45. The women who had high five-year and strong lifetime risk are eligible for breast cancer prevention and management approaches. The women with moderate lifetime risk were advised with regular screening and Breast Self-Examination practices.

scholarly journals Phenotype and Treatment of Breast Cancer in HIV-Positive and -Negative Women in Cape Town, South Africa

2016 ◽  
Vol 2 (5) ◽  
pp. 284-291 ◽  
Author(s):  
Lizanne Langenhoven ◽  
Pieter Barnardt ◽  
Alfred I. Neugut ◽  
Judith S. Jacobson
Keyword(s):  
Breast Cancer ◽  
South Africa ◽  
Standard Deviation ◽  
Systemic Chemotherapy ◽  
Hiv Positive ◽  
Hiv Status ◽  
Cd4 Cell Count ◽  
The Mean ◽  
Cd4 Cell ◽  
Hiv Negative

Purpose An estimated 5.9 million people in South Africa are infected with HIV. Because antiretroviral therapy has made infection with HIV a treatable, chronic condition, HIV-infected individuals are now surviving to middle and older age. We investigated the implications of HIV status for breast cancer in South Africa. Methods We compared clinical and demographic characteristics of women newly diagnosed with a first primary breast cancer at Tygerberg Hospital, Cape Town, South Africa, from January 2010 to December 2011 by HIV status. We then compared HIV-positive patients with HIV-negative controls, matched 2:1 on age and ethnicity, with respect to chemotherapy regimens, toxicities, completion of systemic chemotherapy, and changes in CD4 cell count. Results Of 586 women with breast cancer, 31 (5.3%) were HIV positive, 420 (71.7%) were HIV negative, and 135 (23%) were untested for HIV. Women with HIV were younger than other women (P < .001). The groups did not differ in regard to stage at presentation, histologic subtype, tumor grade, nodal involvement, or hormone receptor positivity. More than 84% of patients who initiated systemic chemotherapy, regardless of HIV status, completed it without serious toxicity. Among HIV-positive patients receiving chemotherapy, the mean baseline CD4 cell count was 477 cells/µL (standard deviation, 160 cells/µL), and the mean nadir was 333 cells/µL (standard deviation, 166 cells/µL). Conclusion HIV-infected women were younger at breast cancer diagnosis than HIV-negative women but otherwise similar in phenotype and completion of chemotherapy. Longer term follow-up is needed to evaluate the effects of HIV, antiretroviral therapy, and chemotherapy on the survival and quality of life of patients with breast cancer.

scholarly journals Student Midwives’ Perspective on Improving Early Diagnosis in Breast Cancer During Antenatal Care

2018 ◽  
Vol 4 (Supplement 3) ◽  
pp. 24s-24s
Author(s):  
Judy Mella
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Antenatal Care ◽  
Access To Health Care ◽  
Conflicts Of Interest ◽  
Cancer Education ◽  
Breast Cancers ◽  
Breast Lump ◽  
Female Population ◽  
Child Bearing

Purpose The incidence of breast cancer in Uganda is estimated at approximately 32.3 per 100,000, with a 5-year survival rate of 56%. Breast cancers present later and have a higher incidence in patients in the child-bearing age group compared with those in high-income countries. Uganda has an ongoing program to train degree-level midwives for extended midwifery roles that are exclusive to practice in Uganda. These midwives are highly motivated and have intimate local knowledge and effective access to the female population with the highest incidence of breast cancers. This work assesses their views on the key reasons women present so late and ideas for system-strengthening measures that will target these reasons, effectively combining antenatal care with breast lump education and diagnosis. Methods Midwifery students in years at Lira University were invited to fill out a questionnaire—with two open and seven structured questions—that was handed out at the ends of lectures and collected the next day. Results One hundred fifty-three questionnaires were returned. In the open question, midwifery students indicated overwhelmingly that the main reason women present late is ignorance. Finance was perceived to be the second factor. Analysis of the stratified question demonstrated that, even with knowledge of breast cancer, women would still be likely to think that a breast lump does not matter, and this factor scored higher than finances, culture, or access to health care. Of respondents, 73% felt that a facility for diagnosis in the community would definitely help women come for treatment. As midwives, 94% would definitely refer a breast lump to a specialist breast clinic if one was available, and on a background of limited health care funding, 90% still felt that time and money should be prioritized toward breast cancer education diagnosis and treatment because of its impact on the community. Conclusion Community midwives are well placed to educate women on breast care in antenatal clinics. This questionnaire demonstrates their perspective on the overriding significance of educating the child-bearing population about breast lumps in addition to cancer education. Therefore, breast lump examination and diagnosis is being taught to the students, community diagnostic facilities are being developed alongside antenatal care (ultrasound and cytology), and a breast lump referral clinic is planned for the new hospital. AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the author.

scholarly journals Factors Causing Delays and Barriers to Early Diagnosis and Treatment Among Women With Breast Cancer in Shwe Yaung Hnin Si Cancer Foundation Charity Clinic, Yangon

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 59s-59s
Author(s):  
S. Shwe ◽  
P. Thet Htoon ◽  
T. Win ◽  
M.P. Sin ◽  
E. Zan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Diagnosis ◽  
Cancer Patients ◽  
Structured Interview ◽  
Patient Delay ◽  
Diagnosis And Treatment ◽  
Breast Cancer Patients ◽  
System Delay ◽  
Breast Lump ◽  
Small Breast

Background: Breast cancer is the most common cancer among females in Myanmar but patients often receive treatment rather late. Delays in seeking treatment of breast cancer for a period longer than 3 months, is associated with lower survival. Hence it is important to find out the causes of the delays so that necessary measures may be implemented with a view to improving treatment outcome. Aim: To explore the delays and barriers to early diagnosis and treatment among the breast cancer patients in Yangon. Methods: A mixed method design. All breast cancer patients (total 104) participated in the structured interview and (16) in the Focus Group Discussion (FGD) sessions. Site at Shwe Yaung Hnin Si Cancer Foundation's Charity clinic from September 2017 to February 2018. Results: Some 32.4% had (patient delay - consulted a medical personnel more than 3 months after noticing signs and symptoms), 19.4% had (general practitioner (GP) delay- to refer to cancer specialist) and 44.4% had (hospital or system delay –i.e., treatment delay after first consultation with specialists). Reasons for patient delay were not knowing that painless small breast lump could be serious (37.5%), socioeconomic constraints (18.8%), too busy working (9.4%) too scared (7.8%) and too shy (4.7%). People living in Yangon had 3.8 times less delay than those living outside (OR 3.8, χ2 = 7.4, P < 0.004); those unemployed were 2.4 times less delay than used (OR 2.4, χ2 = 3.77, P < 0.02); negative attitude toward breast lump and being worried had 8 times less chance of patient delay (OR= 8, χ2=19.9, P ≤ 0.0001). Those who perceived that a painless breast lump was serious are 8.8 times less likely to have patient delay (OR 8.8, χ2 = 3.08, P < 0.001). The odds of having GP delay are 3.2 times higher among those having patient delay (OR=3.2, χ2=5.6, P < 0.02). By FGD most of the survivors revealed reasons for delay which were limited information, economic, use of traditional medicine and sociocultural issues. Conclusion: Lack of knowledge was the highest cause of the patient delay, followed by perception, socioeconomic factors and accessibility to health care and so these need to be overcome. The GP delay and system delay need to be further explored to ascertain the exact causes.

At Least One Standard Deviation Above the Mean

1969 ◽  
Vol 14 (9) ◽  
pp. 470-471
Author(s):  
M. DAVID MERRILL
Keyword(s):  
Standard Deviation ◽  
The Mean

The Estimation of Blood Platelet Survival

1972 ◽  
Vol 28 (03) ◽  
pp. 447-456 ◽  
Author(s):  
E. A Murphy ◽  
M. E Francis ◽  
J. F Mustard
Keyword(s):  
Standard Deviation ◽  
Least Squares ◽  
Experimental Error ◽  
Blood Platelet ◽  
Least Squares Estimation ◽  
Systematic Relationship ◽  
Platelet Survival ◽  
The Mean ◽  
Normally Distributed

SummaryThe characteristics of experimental error in measurement of platelet radioactivity have been explored by blind replicate determinations on specimens taken on several days on each of three Walker hounds.Analysis suggests that it is not unreasonable to suppose that error for each sample is normally distributed ; and while there is evidence that the variance is heterogeneous, no systematic relationship has been discovered between the mean and the standard deviation of the determinations on individual samples. Thus, since it would be impracticable for investigators to do replicate determinations as a routine, no improvement over simple unweighted least squares estimation on untransformed data suggests itself.

Harmonic scalpel versus traditional ligation in axillary dissection for breast cancer: a retrospective multivariate analysis

2020 ◽  
Vol 99 (11) ◽  
Keyword(s):  
Breast Cancer ◽  
Axillary Dissection ◽  
Harmonic Scalpel ◽  
Breast Conserving Surgery ◽  
Seroma Formation ◽  
Nodal Involvement ◽  
Single Centre ◽  
Absorbable Material ◽  
Drain Removal ◽  
The Mean

Introduction: The aim of this pilot retrospective study is to evaluate the complication rate in patients after axillary dissection comparing preparation with harmonic scalpel vs traditional ligation technique, and to analyse risk factors for complications occurrence. Methods: 144 patients with 148 axillary dissections operated in a single centre between January 2014 and 2019 were included into the study. Axillary dissection was performed using harmonic scalpel in 73 and absorbable ligations in 70 cases. Results: Seroma formation was observed in 41 patients (56.2%) in the harmonic scalpel group and in 21 patients (30.0%) in the ligations group (p=0.003). The mean period from the surgery to drain removal was 4.0 days in the harmonic scalpel group and 3.0 days in the ligations group (p<0.001). The mean amount of the drained fluid after mastectomy was 300.9 ml in the harmonic scalpel group and 168.7 ml in the ligations group (p=0.005); after breast conserving surgery, it was 241.9 ml and 107.4 ml, respectively (p =0.023). Conclusion: In comparison with traditional ligations with absorbable material, axillary dissection using harmonic scalpel significantly increases the risk of postoperative seroma formation, prolongs the time from the surgery to drain removal, and increases the amount of drained fluid.ut any suspicion of nodal involvement, hemithyroidectomy is considered to be a sufficient procedure or the method of choice, respectively.

PENGARUH PENDIDIKAN KESEHATAN REPRODUKSI PADA PEER GROUP (TEMAN SEBAYA) TERHADAP PENGETAHUAN DAN PERSEPSI REMAJA TENTANG PENDEWASAAN USIA PERKAWINAN DI SMA NEGERI 1 KECAMATAN NAMORAMBE KAB. DELI SERDANG 2018

2020 ◽  
Vol 1 (2) ◽  
pp. 56-66
Author(s):  
Irma Linda
Keyword(s):  
Standard Deviation ◽  
Health Education ◽  
Reproductive Health ◽  
Peer Group ◽  
Peer Groups ◽  
A Value ◽  
Significant Difference ◽  
Reproductive Health Education ◽  
The Mean ◽  
Adolescent Perceptions

Background: Early marriages are at high risk of marital failure, poor family quality, young pregnancies at risk of maternal death, and the risk of being mentally ill to foster marriage and be responsible parents. Objective: To determine the effect of reproductive health education on peer groups (peers) on the knowledge and perceptions of adolescents about marriage age maturity. Method: This research uses the Quasi experimental method with One group pre and post test design, conducted from May to September 2018. The statistical analysis used in this study is a paired T test with a confidence level of 95% (α = 0, 05). Results: There is an average difference in the mean value of adolescent knowledge between the first and second measurements is 0.50 with a standard deviation of 1.922. The mean difference in mean scores of adolescent perceptions between the first and second measurements was 4.42 with a standard deviation of 9.611. Conclusion: There is a significant difference between adolescent knowledge on the pretest and posttest measurements with a value of P = 0.002, and there is a significant difference between adolescent perceptions on the pretest and posttest measurements with a value of p = 0.001. Increasing the number of facilities and facilities related to reproductive health education by peer groups (peers) in adolescents is carried out on an ongoing basis at school, in collaboration with local health workers as prevention of risky pregnancy.

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