Pathologically confirmed breast cancer in Malawi: a descriptive study: Clinical profile of breast cancer

Kohler, Racquel E.; Moses, Agnes; Krysiak, Robert; Liomba, N. George; Gopal, Satish

doi:10.4314/mmj.v27i1.3

Cited by 21 publications

(18 citation statements)

References 11 publications

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“…This is consistent with findings from a review of pathology reports that nearly half of Malawian breast cancer patients experienced multiple symptoms for over 1 year before being diagnosed [29]. Symptom appraisal and cancer knowledge have been cited as factors of delay and cancer behaviors in studies worldwide [8, 9, 13, 20].…”

Section: Discussionsupporting

confidence: 87%

A framework for improving early detection of breast cancer in sub-Saharan Africa: A qualitative study of help-seeking behaviors among Malawian women

Kohler

Gopal

Miller

et al. 2017

Patient Education and Counseling

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Objective Many women in Africa are diagnosed with advanced breast cancer. We explored Malawian breast cancer patients’ perspectives about their diagnosis and ability to access care to identify help-seeking behaviors and to describe factors influencing delay. Methods We purposively sampled 20 Malawian breast cancer patients to conduct in-depth interviews. Transcripts were double coded to identify major themes of breast cancer help-seeking behaviors and what delayed or facilitated access to care. Results We outlined a breast cancer help-seeking pathway describing decisions, behaviors, and interactions from symptom presentation to receipt of cancer care. Patients were largely unaware of breast cancer and did not immediately notice or interpret symptoms. As symptoms progressed, women inferred illness and sought help from social networks, traditional remedies, and medical care. Economic hardship, distance to the facility, provider knowledge, health system factors, and social norms often delayed reaching the facility, referrals, diagnosis, and receipt of care. Conclusions Social-contextual factors at the individual, interpersonal, and health system, and societal level delay decisions, behaviors, and access to breast cancer detection and appropriate care. Practice Implications A comprehensive approach to improving breast cancer early detection must address public awareness and misconceptions, provider knowledge and communication, and cancer care delivery.

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Section: Discussionsupporting

confidence: 87%

A framework for improving early detection of breast cancer in sub-Saharan Africa: A qualitative study of help-seeking behaviors among Malawian women

Kohler

Gopal

Miller

et al. 2017

Patient Education and Counseling

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“…In our study, finding many participants who reported prevalent breast symptoms during CBE is consistent with our own prior findings of long symptom durations before breast cancer diagnosis in Malawi and extremely low breast cancer awareness among Malawian women. 23 CBE scale-up in Malawi could partially address symptomatic disease and even non-breast conditions in addition to asymptomatic breast disease. This is illustrated by a patient with Kaposi sarcoma diagnosed through our program and brought into care, health impacts of CBE may be greater in settings like Malawi than high-income countries.…”

Section: 4 Discussionmentioning

confidence: 99%

“…22 Patients are typically diagnosed at late stages with long symptom durations before diagnosis. 23 The Malawi Ministry of Health has prioritized early detection of breast and cervical cancer in the national strategic plan. 24 However, no coordinated breast cancer screening program currently exists.…”

Section: 1 Introductionmentioning

confidence: 99%

Clinical breast examination screening by trained laywomen in Malawi integrated with other health services

Gutnik¹,

Lee

Msosa

et al. 2016

Journal of Surgical Research

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Background Breast cancer awareness and early detection are limited in sub-Saharan Africa. Resource limitations make screening mammography or clinical breast exam (CBE) by physicians or nurses impractical in many settings. We aimed to assess feasibility and performance of CBE by laywomen in urban health clinics in Malawi. Methods Four laywomen were trained to deliver breast cancer educational talksand conduct CBE. After training, screening was implemented in diverse urbanhealth clinics. Eligible women were ≥30 years, with no prior breast cancer or breast surgery, and clinic attendance for reasons other than abreast concern. Wo men with abnormal CBE were referred to a study surgeon. All palpable masses confirmed by surgeon exam were pathologically sampled. Patients with abnormal screening CBE but normal surgeon exam underwentbreast ultrasound con firmation. Additionally, 50 randomly selected women with normal screening CBE underwent breast ultrasound, and 45 different women with normal CBE were randomly assigned to surgeon exam. Results Among 1,220 eligible women, 1,000 (82%) agreed to CBE. Lack of time (69%) was the commonest reason for refusal. Educational talk attendance was associated with higher CBE participation (83% vs 77%, p=0.012). Among 1,000 women screened, 7% had abnormal CBE. Of 45 women with normal CBE randomized to physician exam, 43 had normal exams and two had axillary lymphadenopathy not detected by CBE. Sixty of 67 women (90%) with abnormal CBE attended the referral visit. Of these, 29 (48%) had concordant abnormal physician exam. Thirty-one women (52%) had discordant normal physician exam, all of whom also had normal breast ultrasounds. Compared to physician exam, sensitivity for CBE by laywomen was 94% (CI 79-99%), specificity 58% (CI 46-70%), positive predictive value 48% (CI 35-62%), and negative predictive value 96% (CI 85-100%). Of 13 women who underwent recommended pathologic sampling of a breast lesion, two had cytologic dysplasia and all others benign results. Conclusions and relevance CBE uptake in Lilongwe clinics was high. CBE by laywomen compared favorably with physician exam, and follow-up was good. Our intervention can serve as a model for wider implementation. Performance in rural areas, effects on cancer stage and mortality, and cost-effectiveness require evaluation.

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“…In Malawi, breast cancer patients are often diagnosed with large tumors more than a year after symptoms initially present [4]. Women face multiple individual, interpersonal, cultural, and system-level barriers which affect access to care and delay diagnosis [5].…”

Section: Introductionmentioning

confidence: 99%

Experiences and perceptions regarding clinical breast exam screening by trained laywomen in Malawi

Kohler

Miller

Gutnik

et al. 2017

Cancer Causes Control

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Purpose Despite the increasing burden, breast cancer control in sub-Saharan Africa is insufficient. Late diagnosis and lack of early detection and screening services contribute to high mortality. Clinical breast exam (CBE) screening can be valuable in low-income countries, including use of community health workers and non-health professionals to conduct exams. We assessed experiences of women who underwent CBE screening by trained laywomen in Lilongwe, Malawi, as part of a pilot program. Methods The pilot study invited women attending urban health clinics to a breast cancer educational talk followed by CBE screening by trained laywomen. We purposively sampled participants from the pilot study and interviewed them about the screening experience and future cancer education programs and services. Results Overall participants had positive experiences and were willing to undergo CBE screening by trained laywomen. Participants were motivated by the educational talk, shared newly acquired cancer knowledge with their social networks, and encouraged others to seek screening. Screened women suggested strategies for future interventions including combining breast and cervical cancer screening, using female providers, partnering with community leaders to increase uptake, and expanding services into the community. Conclusions Asymptomatic Malawian women accepted CBE screening by trained laywomen and considered breast cancer an important health issue. Women appreciated combined education and screening services and proposed further linkage of breast and cervical cancer screening. Based on our results, training laywomen to educate the public on breast cancer and conduct CBE is a feasible breast cancer control strategy in sub-Saharan Africa.

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Pathologically confirmed breast cancer in Malawi: a descriptive study: Clinical profile of breast cancer

Cited by 21 publications

References 11 publications

A framework for improving early detection of breast cancer in sub-Saharan Africa: A qualitative study of help-seeking behaviors among Malawian women

A framework for improving early detection of breast cancer in sub-Saharan Africa: A qualitative study of help-seeking behaviors among Malawian women

Clinical breast examination screening by trained laywomen in Malawi integrated with other health services

Experiences and perceptions regarding clinical breast exam screening by trained laywomen in Malawi

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