Barriers to Mammography Screening in Nigeria: A Survey of Two Communities With Different Access to Screening Facilities

Purpose Breast cancer outcomes are poor in most low- and middle-income countries. This is a result, in part, of delayed presentation. Critical to improving this gloomy picture is the promotion of breast cancer screening programs; however, designing a formidable screening program requires obtaining necessary background data. This survey evaluates breast cancer screening practices and barriers in two Nigerian communities with different geographic access to screening facilities. Methods We administered a 35-item questionnaire to women age 40 years and older—1,169 participants (52.6%) in the Ife Central Local Government, where mammography services are offered, and 1,053 (47.4%) in the Iwo Local Government, where there are no mammography units. Information on breast cancer screening practices and barriers to mammography screening were compared between the two communities. Results Most women had heard of breast cancer (Ife, 94%; Iwo, 97%), but few have had any form of breast cancer screening recommended to them—37.7% of Ife respondents and 36.6% of Iwo respondents. Few women were aware of mammography (Ife, 11.8%; Iwo, 11.4%), whereas mammography uptake was 2.8% Ife respondents and 1.8% in Iwo respondents, despite the latter offering mammography services. Awareness and practice of mammography were not statistically different between the two communities ( P = .74 and P = .1 for Ife and Iwo, respectively). Lack of awareness was the most common reason cited for not undergoing mammography in both communities. Cost was also identified as a barrier, as only 20% of respondents could afford mammography. Despite being offered at little or no cost, uptake of clinical breast examination (CBE) was poor in both communities—27.4% in Iwo and 19.7% in Ife; however, the majority were willing to participate in a routine CBE-based breast cancer screening program. Conclusion Access without awareness and community mobilization does not guarantee use of breast cancer screening services. Given the above findings, a comprehensive breast health program that incorporates awareness creation, routine CBE-based screening, and selective mammography is currently underway in a selected Nigerian community. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the author

Download Full-text

Psychological predictors of intention and avoidance of attending organized mammography screening in Norway: applying the Extended Parallel Process Model

BMC Women s Health ◽

10.1186/s12905-021-01201-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anna Ivanova ◽

Ingela Lundin Kvalem

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Mammography Screening ◽

Psychological Factors ◽

Process Model ◽

Parallel Process ◽

Extended Parallel Process Model ◽

Screening Programs ◽

Response Efficacy

Abstract Background Mammography screening is the main method for early detection of breast cancer in Norway. Few studies have focused on psychological determinants of both attendance and non-attendance of publicly available mammography screening programs. The aim of the current study, guided by the Extended Parallel Process Model, was to examine how psychological factors influence defensive avoidance of breast cancer screening and intention to attend mammography. Methods Cross-sectional survey data from a community sample of women living in Norway aged ≥ 18 (N = 270), and without a history of breast cancer, was collected from September 2018 to June 2019 and used to investigate the relationships between the Extended Parallel Process Model (EPPM) constructs and two outcomes: defensive avoidance of breast cancer screening and intention to attend mammography within the next two years. After adjusting for confounding factors, the hierarchical multiple linear regression analyses was conducted to assess the ability of the independent variables based on the EPPM to predict the two outcome variables. Significance level was chosen at p < 0.05. Results Multivariate analyses showed that defensive avoidance of breast cancer screening was predicted by lower perceived susceptibility to breast cancer (β = − 0.22, p = 0.001), lower response efficacy of mammography screening (β = − 0.33, p = 0.001), higher breast cancer fear (β = 0.15, p = 0.014), and checking breasts for lumps (β = − 0.23, p = 0.001). Intention to attend mammography within the next two years was predicted by higher response efficacy of mammography screening (β = 0.13, p = 0.032), having a lower educational level (β = − 0.10, p = 0.041), and regular previous mammography attendance compared to never attending (β = 0.49, p = 0.001). Conclusions The study revealed that defensive avoidance of breast cancer screening and intention to attend mammography were not predicted by the same pattern of psychological factors. Our findings suggest future health promotion campaigns need to focus not only on the psychological factors that encourage women’s decision to attend the screening, but also to counter factors that contribute to women’s decision to avoid it.

Download Full-text

A limited review of over diagnosis methods and long-term effects in breast cancer screening

Oncology Reviews ◽

10.4081/oncol.2011.11 ◽

2011 ◽

pp. 143-147

Author(s):

Dongfeng Wu ◽

Adriana Pérez

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Early Detection ◽

Breast Cancer Screening ◽

Screening Program ◽

Critical Issue ◽

Long Term Effects ◽

Screening Programs ◽

Probability Modeling

Breast cancer screening programs have been effective in detecting tumors prior to symptoms. Recently, there has been concern over the issue of over-diagnosis, that is, diagnosis of a breast cancer that does not manifest prior to death. Estimates for over-diagnosis vary, ranging from 7 to 52%. This variability may be due partially to issues associated with bias and/or incorrect inferences associated with the lack of probability modeling. A critical issue is how to evaluate the long-term effects due to continued screening. Participants in a periodic screening program can be classified into four mutually exclusive groups depending on whether individuals are diagnosed and whether their symptoms appear prior to death: True-earlydetection; No-early-detection; Over-diagnosis; and Not-sonecessary. All initially superficially healthy people will eventually fall into one of these four categories. This manuscript reviews the major methodologies associated with the over-diagnosis and long-term effects of breast cancer screening.

Download Full-text

Developing a Breast Cancer Screening Program in Nigeria: Evaluating Current Practices, Perceptions, and Possible Barriers

Journal of Global Oncology ◽

10.1200/jgo.2016.007641 ◽

2017 ◽

Vol 3 (5) ◽

pp. 490-496 ◽

Cited By ~ 4

Author(s):

Olalekan Olasehinde ◽

Carla Boutin-Foster ◽

Olusegun I. Alatise ◽

Adewale O. Adisa ◽

Oladejo O. Lawal ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Low Income ◽

Screening Program ◽

Cross Sectional Survey ◽

Middle Income ◽

Screening Programs ◽

Middle Income Countries ◽

Low And Middle Income

Purpose In low- and middle-income countries like Nigeria, women present with advanced breast cancer at an earlier age. Given the limited resources, development of screening programs that parallel resource capabilities of low- and middle-income countries is imperative. The objective of this study was to evaluate the perceptions, practices, and barriers regarding clinical breast examination (CBE) screening in a low-income community in Nigeria. Materials and Methods A cross-sectional survey of women age 40 years or older in Ife, Nigeria, using multistaged sampling was performed. Information on sociodemographics, knowledge of breast cancer, screening practices, and willingness to participate in CBE screening was obtained using an interviewer-administered questionnaire. Results A total of 1,169 women whose ages ranged from 40 to 86 years (mean age, 47.7 years; standard deviation, 8.79 years) were interviewed. The majority of women (94%) knew about breast cancer, whereas 27.5% knew someone who had had breast cancer, the majority of whom (64.5%) had died of the disease. Of the 36% of women who had breast screening recommended to them, only 19.7% had an actual CBE. Of these, only 6% had it in the last year. The majority of women (65.4%) were willing to have regular CBEs and did not care about the sex of the examiner in most instances. Lack of perceived need was the reason cited by women unwilling to participate. Conclusion The majority of women were aware of breast cancer and knew it as a fatal disease. With the relatively encouraging number of those willing to be examined, a carefully designed CBE program coupled with advocacy to correct uneducated beliefs seems promising.

Download Full-text

Simulated Lifetime Costs of Three Types of Employer-Based, Periodic, Breast Cancer Screening Programs for Working-Age Women

American Journal of Health Promotion ◽

10.4278/0890-1171-9.2.137 ◽

1994 ◽

Vol 9 (2) ◽

pp. 137-146 ◽

Cited By ~ 4

Author(s):

Robert I. Griffiths ◽

Claudia B. Griffiths ◽

Neil R. Powe

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Screening Program ◽

Lifetime Cost ◽

Decision Analysis Model ◽

Screening Programs ◽

Mean Lifetime ◽

Lifetime Costs ◽

The Cost

Purpose. To estimate the lifetime cost of three types of employer-sponsored breast cancer screening programs and to identify factors influencing cost. Design. A computerized decision analysis model was constructed to compare lifetime costs of providing breast cancer screening in each of three screening programs: on-site within an employer, mobile unit visiting the employer, and off-site. Subjects. Three hypothetical cohorts of 10,000 female employees 38 years of age at time of first screening. Intervention. A cohort was enrolled in each screening program and received screening from age 38 through age 64. Employees continued to receive benefits related to breast cancer until age 100 or death. Measures. Costs in the model included those for screening, workup for a suspicious mammogram, treatment for breast cancer, short-term losses in employee productivity, and disability due to breast cancer. Approach. The model was used to estimate the mean lifetime cost per employee, to the employer, of the On-Site program. This cost was compared to the cost of the other programs. Results. Mean lifetime cost per employee was $5,485 for the On-Site screening program. This cost was significantly (P<.0001) lower than in the Off-Site program (by $311) or the Mobile program (by $212). The baseline results for the On-Site program were quite sensitive to the cost of screening, the sensitivity and specificity of screening, age at initiation of screening, and the underlying incidence of breast cancer in the population. Conclusion. Employers and other entities should consider these factors such as location and content in selecting the most efficient and effective breast cancer screening program.

Download Full-text

A limited review of over diagnosis methods and long-term effects in breast cancer screening

Oncology Reviews ◽

10.4081/oncol.2011.143 ◽

2011 ◽

Vol 5 (3) ◽

pp. 143 ◽

Cited By ~ 3

Author(s):

Dongfeng Wu ◽

Adriana Pérez

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Early Detection ◽

Breast Cancer Screening ◽

Screening Program ◽

Critical Issue ◽

Long Term Effects ◽

Screening Programs ◽

Probability Modeling

Download Full-text

NF1 Patients Receiving Breast Cancer Screening: Insights from The Ontario High Risk Breast Screening Program

Cancers ◽

10.3390/cancers11050707 ◽

2019 ◽

Vol 11 (5) ◽

pp. 707 ◽

Cited By ~ 3

Author(s):

Nika Maani ◽

Shelley Westergard ◽

Joanna Yang ◽

Anabel M. Scaranelo ◽

Stephanie Telesca ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

High Risk ◽

Breast Cancer Screening ◽

Breast Screening ◽

Screening Program ◽

Type I ◽

Screening Programs ◽

Increased Risk ◽

High Risk Breast

Neurofibromatosis Type I (NF1) is caused by variants in neurofibromin (NF1). NF1 predisposes to a variety of benign and malignant tumor types, including breast cancer. Women with NF1 <50 years of age possess an up to five-fold increased risk of developing breast cancer compared with the general population. Impaired emotional functioning is reported as a comorbidity that may influence the participation of NF1 patients in regular clinical surveillance despite their increased risk of breast and other cancers. Despite emphasis on breast cancer surveillance in women with NF1, the uptake and feasibility of high-risk screening programs in this population remains unclear. A retrospective chart review between 2014–2018 of female NF1 patients seen at the Elizabeth Raab Neurofibromatosis Clinic (ERNC) in Ontario was conducted to examine the uptake of high-risk breast cancer screening, radiologic findings, and breast cancer characteristics. 61 women with pathogenic variants in NF1 enrolled in the high-risk Ontario breast screening program (HR-OBSP); 95% completed at least one high-risk breast screening modality, and four were diagnosed with invasive breast cancer. Our findings support the integration of a formal breast screening programs in clinical management of NF1 patients.

Download Full-text

Molecular profiles of screen-detected breast cancers from a Turkish breast cancer screening program.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e12545 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e12545-e12545

Author(s):

Neslihan Cabioglu ◽

Sibel Ozkan Gurdal ◽

Arda Kayhan ◽

Nilufer Ozaydin ◽

Erkin Aribal ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Triple Negative ◽

Ductal Carcinoma ◽

Screening Program ◽

Breast Conservation ◽

Breast Cancers ◽

Luminal A ◽

Screening Programs

e12545 Background: TurkishBahcesehir Breast Cancer Screening Project is a 10-year organized population based screening program carried out in one of the largest counties in Istanbul, Turkey. The aim of this study is to determine the biological features of screen detected breast cancers detected during the initial 4-year study period as an interim analysis. Methods: Between January 2009 and December 2012, a total of 5938 women with ages 40–69 years were recruited in this prospective study. Two-view mammographies were obtained by 2-year intervals, and classified according to Breast Imaging Reporting and Data System of the American College of Radiology (ACR). Patient and tumor characteristics were analysed for those diagnosed with breast cancer. Tumors were stained for estrogen (ER) and progesterone receptors (PR), HER2-neu and Ki-67 by immunohistochemistry. Results: A total of 49 breast cancers (% 0.83) were detected during the study period. The median age was 50 (40-70). The majority of patients (78%) were stage 0 or 1, whereas 23 patients (47%) were <50 age. Of 49 tumors, 38 (78%) were invasive cancers and 11 (22%) were ductal carcinoma in situ. Forty-four patients (90%) underwent breast conservation, whereas 35 patients (75%) had sentinel lymph node biopsy. Of 38 invasive cancers, 24 (63%) were ductal carcinoma and 8 (21%) were lobular cacinoma. Among 31 invasive cancers stained for ER, PR, HER2-neu and Ki67, the majority of them (92%) were hormone receptor positive, whereas 13% were HER2-neu positive and 58% had low Ki67 levels (<14). As molecular subtypes, the majority of them were found to be either luminal A (48%) or luminal B type (42%), whereas other nonluminal HER2 (7%) and triple negative cancers (3%) were less frequently detected. Conclusions: Our findings suggest that the majority of screen-detected breast cancers exhibit either luminal A or B subtype. However, more aggressive subtypes such as nonluminal HER2-neu or triple negative cancers are less likely to be detected by mammographic screening programs, requiring other preventive strategies.

Download Full-text

Development and first application of an audit system for screening programs based on the PRECEDE-PROCEED model: an experience with breast cancer screening in the region of Lombardy (Italy)

BMC Public Health ◽

10.1186/s12889-020-09842-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Danilo Cereda ◽

◽

Antonio Federici ◽

Angela Guarino ◽

Grazia Serantoni ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Screening Program ◽

Monitoring And Evaluation ◽

Software Application ◽

Screening Programs ◽

Program Coordinators ◽

Planning Software ◽

Audit Cycle

Abstract Background High participation and performance are necessary conditions for the effectiveness of breast cancer screening programs. Here we describe the process to define and test a planning software application and an audit cycle based on the PRECEDE-PROCEED model applied to improving breast cancer screening. We developed a planning software application following the phases of the PRECEDE-PROCEED model. The application was co-designed by local cancer screening program coordinators. An audit model was also developed. The revised application and the audit model were tested by all the coordinators of 15 breast cancer screening programs in the region of Lombardy in a 3-day workshop. The project plans produced using the application were compared with those produced in the previous year for clarity and completeness. Results The 9 phases of the PRECEDE-PROCEED model were adapted to screening as follows: 1) identification of program goals (i.e., participation, sensitivity, false positive); 2) epidemiological issues; 3) best practices analysis; 4) evidence-based actions to be implemented in the screening center and the relationships with partners and stakeholders; 5) priority setting and identification of solutions for each issue; 6) definition of indicators; 7) monitoring; 8) evaluation; 9) impact assessment. The application automatically generated reports for each phase. During the audit cycle, the regional health authority negotiated the targets to be reached with local authorities and collected the improvement plans generated by the application. The plans produced after the application was adopted were more standardized and had clearer indicators for monitoring and evaluation compared to those produced in the previous year. Conclusions The software application helps standardize criteria for planning interventions to improve screening programs and facilitates the implementation of the audit cycle.

Download Full-text

See, Test & Treat: A 5-Year Experience of Pathologists Driving Cervical and Breast Cancer Screening to Underserved and Underinsured Populations

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2016-0094-sa ◽

2016 ◽

Vol 140 (12) ◽

pp. 1411-1422

Author(s):

Barbarajean Magnani ◽

Beth Harubin ◽

Judith F. Katz ◽

Andrea L. Zuckerman ◽

William C. Strohsnitter

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Screening Program ◽

Medical Center ◽

Academic Medical Center ◽

Medical Specialties ◽

Screening Programs ◽

Cancer Screening Program ◽

Current Health Care System

Context.— See, Test & Treat is a pathologist-driven program to provide cervical and breast cancer screening to underserved and underinsured patient populations. This program is largely funded by the CAP Foundation (College of American Pathologists, Northfield, Illinois) and is a collaborative effort among several medical specialties united to address gaps in the current health care system. Objective.— To provide an outline for administering a See, Test & Treat program, using an academic medical center as a model for providing care and collating the results of 5 years of data on the See, Test & Treat program's findings. Design.— Sources include data from patients seen at Tufts Medical Center (Boston, Massachusetts) who presented to the See, Test & Treat program and institutional data between 2010 and 2014 detailing the outline of how to organize and operationalize a volunteer cancer-screening program. Results.— During the 5-year course of the program, 203 women were provided free cervical and breast cancer screening. Of the 169 patients who obtained Papanicolaou screening, 36 (21.3%) had abnormal Papanicolaou tests. In addition, 16 of 130 patients (12.3%) who underwent mammography had abnormal findings. Conclusions.— In general, women from ethnic populations have barriers that prevent them from participating in cancer screening. However, the CAP Foundation's See, Test & Treat program is designed to reduce those barriers for these women by providing care that addresses cultural, financial, and practical issues. Although screening programs are helpful in identifying those who need further treatment, obtaining further treatment for these patients continues to be a challenge.

Download Full-text

Organized Screening Detects Breast Cancer for Vietnamese Women Over 40 Years Old 2017

Journal of Global Oncology ◽

10.1200/jgo.18.95400 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 237s-237s

Author(s):

H. Tran

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Health Workers ◽

Screening Program ◽

Early Stage ◽

Health Examination ◽

Screening Programs ◽

Vietnamese Women ◽

Over 40 Years

Background and context: In the world, breast cancer is the second most common type of cancer, with >1 million cases being diagnosed each year. In Vietnam, according to the cancer registry, there are 12,533 new cases of cancer in 2012 and estimated at 22,612 in 2020. However, breast cancer can be cured if a woman is diagnosed at an early stage. Current screening programs in Vietnam are mainly organized in an active way by health workers, not by the “initiative” of the women. Aim: Community awareness raising on prevention and early detection of breast cancer; breast cancer screening for 10,000 Vietnamese women, especially for high-risk women, disadvantaged women, less chance for periodic health examination; mobilize the commitment of businesses to provide screening for women´s cancer in the regular health check-ups for female employees; make it become lifestyle of women to get screened every year. Strategy/Tactics: Invited women over 40 years old to free breast cancer screening at cancer clinics/hospital in the north, central and south of Vietnam. 100% of the women were clinically examined and free breast ultrasound. Suspected women were provided mammography; in addition, ∼20 companies/businesses were aware the program and invited to join the screening. Program/Policy process: We have registered counters in hospitals that offer screening. Women who care for relatives or visit sick people can register at the counter. In addition, we have a Web site and a hotline for the reception of screening candidates. We have volunteers who were texting to remind women who have been involved in screening from previous years to continue screening this year. To facilitate the screening of women without affecting their daily work as well as those who are far away, free screening was offered on Saturday and Sunday of 4 consecutive weeks. We also went to businesses where the majority of workers are women to organize screening. We have held “Doctor´s Talk” before each screening session. We have invited cancer specialists, celebrities and patients with breast cancer who have been cured of the disease to talk about the prevention of breast cancer. Throughout the talk, 150-200 women were registered to hear the counsel. Outcomes: 10,095 women came for breast screening, with 1126 mammographies, including 50 suspected cases and 11 cases of cancer. The rate of reexamination in 2017 is 9.5% (the rate of women who have screened in 2015 is 1.7%, 2016 is 6.7%, and 1.1% in both 2015 and 2016). What was learned: After 3 years, our project for screening detection of breast cancer was examination for 32,136 Vietnamese woman; mammography for 2851 woman; detected 130 suspected cases of cancer and 25 cases identified cancer. For cancer cases, we recommended and supported them at cancer hospital. In cases of suspicion, we have followed up and reminded them to regularly visit and immediately go to hospital if there are abnormal signs.

Download Full-text