Breast Cancer Disparities Among Women in Low- and Middle-Income Countries

Ginsburg, Ophira; Rositch, Anne F.; Conteh, Lesong; Mutebi, Miriam; Paskett, Electra D.; Subramanian, Sujha

doi:10.1007/s12609-018-0286-7

Cited by 34 publications

(61 citation statements)

References 61 publications

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“…Barriers to care should be identified and addressed. These are complex and multifactorial, including structural, sociocultural, personal, and financial factors that can influence a woman's opportunities to seek and receive care 14 . Even when a patient seeks care soon after the onset of symptoms (ie, early presentation ), this does not always translate into an early diagnosis.…”

Section: Implementation Phasesmentioning

confidence: 99%

Breast cancer early detection: A phased approach to implementation

Ginsburg

Yip

Brooks

et al. 2020

Cancer

379

208

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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.

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Section: Implementation Phasesmentioning

confidence: 99%

Breast cancer early detection: A phased approach to implementation

Ginsburg

Yip

Brooks

et al. 2020

Cancer

379

208

View full text Add to dashboard Cite

show abstract

“…In high income countries, high visibility public health efforts and advocacy groups have made breast cancer screening programs and education campaigns successful. In low-and middle-income countries (LMICs) incidence and mortality is on the rise and breast cancer is the most common cause of cancer deaths among women [1]. In Tanzania, breast cancer incidence is projected to increase 82% by 2030 [2].…”

Section: Introductionmentioning

confidence: 99%

Understanding women’s perspectives on breast cancer is essential for cancer control: knowledge, risk awareness, and care-seeking in Mwanza, Tanzania

et al. 2020

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Background: Breast Cancer is the most common cancer in women worldwide. Since 2008, Mwanza, Tanzania, has worked to provide comprehensive cancer services through its Zonal consultant hospital. New national guidelines focused on clinical breast exam requires that women be aware of and seek care for breast concerns. Therefore, this study aims to understand breast cancer awareness in Mwanza and describe women-level barriers, care-seeking behavior, and perspectives on breast cancer. Methods: A community-based survey was administered to conveniently sampled women aged 30 and older to assess women's perspectives on breast cancer and care-seeking behavior. Results: Among 1129 women with a median age of 37 (IQR: 31-44) years, 73% have heard of cancer and 10% have received breast health education. Women self-evaluated their knowledge of breast cancer (from 1-none to 10extremely knowledgeable) with a median response of 3 (IQR: 1-4). Only 14% felt they knew any signs or symptoms of breast cancer. Encouragingly, 56% of women were fairly-to-very confident they would notice changes in their breasts, with 24% of women practicing self-breast examination and 21% reporting they had received a past breast exam. Overall, 74% said they would be somewhat-to-very likely to seek care if they noticed breast changes, with 96% noting severity of symptoms as a motivator. However, fear of losing a breast (40%) and fear of a poor diagnosis (38%) were most frequent barriers to care seeking. In assessing knowledge of risk factors, about 50% of women did not know any risk factors for breast cancer whereas 42% of women believed long term contraceptive use a risk factor. However, 37% and 35% of women did not think that family history or being older were risk factors, respectively. Conclusions: The success of efforts to improve early diagnosis in a setting without population-based screening depends on women being aware of breast cancer signs and symptoms, risks, and ultimately seeking care for breast concerns. Fortunately, most women said they would seek care if they noticed a change in their breasts, but the low levels of cancer knowledge, symptoms, and common risk factors highlight the need for targeted community education and awareness campaigns.

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“…6 The reasons for these poor survival rates are complex and cut across 'individual, interpersonal, organisational, community and policy issues'. [7][8][9] The lack of early detection programmes in LMICs means that in many countries, as many as 75% of women with breast cancer present at an advanced stage (ie, clinical stage III or IV) resulting in worse outcomes. 10 Second, even when breast cancers are detected early, treatment options are often limited, or otherwise less accessible, when compared with HICs.…”

Section: Bmj Global Healthmentioning

confidence: 99%

Community health workers and early detection of breast cancer in low-income and middle-income countries: a systematic scoping review of the literature

et al. 2020

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BackgroundBreast cancer is the leading cause of female mortality in low-income and middle-income countries (LMICs). Early detection of breast cancer, either through screening or early diagnosis initiatives, led by community health workers (CHWs) has been proposed as a potential way to address the unjustly high mortality rates. We therefore document: (1) where and how CHWs are currently deployed in this role; (2) how CHWs are trained, including the content, duration and outcomes of training; and (3) the evidence on costs associated with deploying CHWs in breast cancer early detection.MethodsWe conducted a systematic scoping review and searched eight major databases, as well as the grey literature. We included original studies focusing on the role of CHWs to assist in breast cancer early detection in a country defined as a LMIC according to the World Bank.Findings16 eligible studies were identified. Several roles were identified for CHWs including awareness raising and community education (n=13); history taking (n=7); performing clinical breast examination (n=9); making onward referrals (n=7); and assisting in patient navigation and follow-up (n=4). Details surrounding training programmes were poorly reported and no studies provided a formal cost analysis.ConclusionsDespite the relative paucity of studies addressing the role of CHWs in breast cancer early detection, as well as the heterogeneity of existing studies, evidence suggests that CHWs can play a number of important roles in breast cancer early detection initiatives in LMICs. However, if they are to realise their full potential, they must be appropriately supported within the wider health system.

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Breast Cancer Disparities Among Women in Low- and Middle-Income Countries

Cited by 34 publications

References 61 publications

Breast cancer early detection: A phased approach to implementation

Breast cancer early detection: A phased approach to implementation

Understanding women’s perspectives on breast cancer is essential for cancer control: knowledge, risk awareness, and care-seeking in Mwanza, Tanzania

Community health workers and early detection of breast cancer in low-income and middle-income countries: a systematic scoping review of the literature

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