When breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered. Cancer 2020;126:2379-2393.
The purpose of this study was to examine the relationships among interpersonal influences (i.e., social support, norms, modeling), behavior-specific cognitions (i.e., self-efficacy, perceived benefits/barriers), competing demands, and physical activity among Taiwanese adolescents (N = 832). The results from structural equation modeling indicated that perceived self-efficacy was the most important predictor of physical activity. Interpersonal influences, when considered in total, had a weak and nonsignificant direct effect on physical activity but had indirect effects on physical activity thorough perceived benefits and perceived self-efficacy. When sources of interpersonal influences were considered separately, parental influences did not have direct effects on physical activity. In contrast, peers did have a significant direct effect on physical activity and also indirect influences on physical activity through perceived self-efficacy. All variables accounted for 30% of the variance in physical activity. Results of this study identify important influences useful to health professionals for promoting physical activity in this population.
This study examined gender differences in the factors related to physical activity in 832 Taiwanese adolescents. Differences in psychosocial and cognitive correlates were noted by gender group. Taiwanese adolescent girls reported lower physical activity self-efficacy and less perceived benefits and more perceived barriers to being active than boys. Girls compared to boys reported significantly more positive social support, modeling, and norms from parents to be active but significantly less social support and norms from their peers. Structural equation modeling was used to test the direct and indirect paths of a model of proposed correlates and physical activity. The results indicated that peer influences had both direct and indirect paths to physical activity for both genders. Among all examined variables, perceived self-efficacy was the strongest correlate of physical activity for these adolescents. The findings of this study provide information relevant to designing physical activity interventions targeted to Taiwanese adolescents.
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