Predictors of Breast Cancer Screening Uptake: A Pre Intervention Community Survey in Malaysia

Introduction: Despite health education efforts to educate women on breast cancer and breast cancer screeningmodalities, the incidence of breast cancer and presentation at an advanced stage are still a problem in Malaysia.Objectives: To determine factors associated with the uptake of breast cancer screening among women in thegeneral population. Methods: This pre-intervention survey was conducted in a suburban district. All householdswere approached and women aged 20 to 60 years old were interviewed with pre-tested guided questionnaires.Variables collected included socio-demographic characteristics, knowledge on breast cancer and screeningpractice of breast cancer. Univariate and multivariate analysis were performed. Results: 41.5% of a total of381 respondents scored above average; the mean knowledge score on causes and risks factors of breast cancerwas 3.41 out of 5 (SD1.609). 58.5% had ever practiced BSE with half of them performing it at regular monthlyintervals. Uptake of CBE by nurses and by doctors was 40.7% and 37.3%, respectively. Mammogram uptakewas 14.6%. Significant predictors of BSE were good knowledge of breast cancer (OR=2.654, 95% CI: 1.033-6.816), being married (OR=2.213, 95% CI: 1.201-4.076) and attending CBE (OR=1.729, 95% CI: 1.122-2.665).Significant predictors for CBE included being married (OR=2.161, 95% CI: 1.174-3.979), good knowledge ofbreast cancer (OR=2.286, 95% CI: 1.012-5.161), and social support for breast cancer screening (OR=2.312, 95%CI: 1.245-4.293). Women who had CBE were more likely to undergo mammographic screening of the breast(OR=5.744, 95% CI: 2.112-15.623), p<0.005. Conclusion: CBE attendance is a strong factor in promoting BSEand mammography, educating women on the importance of breast cancer screening and on how to conduct BSE.The currently opportunistic conduct of CBE should be extended to active calling of women for CBE.     

Modifiable (Sleeping Pattern and Stress) and Non-Modifiable Risk Factors Associated with Breast Cancer: A Matched Case-Control Study in Delhi,India

Background: An utmost increase of breast cancer burden during the last several decades was reported in Asian countries. Findings from literature confirm that risk factors of breast cancers can be modifiable and non-modifiable in nature. Objective: The present study is designed to identify specific modifiable and non-modifiable risk factors associated with breast cancer. Methods: A matched case-control study was conducted considering 187 cases as women diagnosed with breast cancer and 187 hospital-controls as women without having breast cancer visiting the hospital. Other than standard risk factors, stress is measured using Perceived Stress Scale (PSS) and stress is measured using Pittsburgh Sleep Quality Index (PSQI). Several modifiable and non-modifiable risk factors were assessed using conditional logistic regression to find out significant association with breast cancer. Results: Regular multi-vitamin uptake (OR = 3.38; 95%CI = 1.69 – 6.77; p-value = 0.001), poor sleep (OR = 11.29; 95%CI = 4.36 – 29.25; p-value < 0.001), irregular sleep (OR = 34.11; 95%CI = 10.03 – 115.92; p-value < 0.001) and severe stress (OR = 6.74; 95%CI = 3.06 – 14.81; p-value < 0.001) were found to be the highest odds ratio among all modifiable risk factor of breast cancer. Also, age at first childbirth less than 30 years (OR = 0.44; 95%CI = 0.25 – 0.78; p-value = 0.005) was found protective against breast cancer. Conclusion: In our study, stress, sleeping pattern, and regular multi-vitamin uptake were found to be significant modifiable risk factors of breast cancer. None of the non-modifiable risk factors were found to be significantly associated with the risk of breast cancer.     

Factors Associated with Demand for Medical Cannabis Use among Breast Cancer Patients in Northern Thailand: A Cross-Sectional Study

Objective: Breast cancer is the leading cause of death among women worldwide. Although modern treatments are recognized as effective, they often cause side effects. In Thailand, medical cannabis (MC) was legalized in 2019 with limited research on demand for its use. Therefore, this study aimed to identify factors associated with demand for MC among breast cancer patients in the North of Thailand as a target group. Methods: This cross-sectional analytical study administered multistage random sampling to recruit 432 breast cancer patients in northern Thailand. Ethical approval and signed written informed consents were obtained from the patients, prior to the study. A standardized, self-administered structured questionnaire was used to obtain the sociodemographic characteristics, clinical characteristics, social support, attitudes toward MC, knowledge about MC, health literacy about MC, and questions on demand for MC use. The scores from all questionnaires were converted to percentages before analysis. Result: A total of 173 (40%) of patients with breast cancer reported demand to use MC. The factors that were significantly associated with demand to use MC included had high levels of health literacy about MC (adj.OR = 4.96; 95% CI: 2.77 to 8.87), higher levels of social support (adj.OR =4.56; 95% CI: 2.20 to 9.42), higher monthly household income (adj.OR =4.02; 95% CI: 2.33 to 6.94), and positive attitudes toward MC use (adj.OR = 3.52; 95% CI: 1.91 to 6.52) when controlling for effects of other covariates. Conclusion: We found substantial demand for MC use among breast cancer patients. Health literacy, social support, monthly household income, and attitudes about MC were significantly associated with demand for MC use. Therefore, improving health literacy, social support, and attitudes about MC, especially among breast cancer patients, could help increase demand for MC as a complementary and alternative medicine alongside cancer treatment.     

Association of symptoms and breast cancer in population‐based mammography screening in Finland

The study purpose was to assess association of symptoms at screening visits with detection of breast cancer among women aged 50–69 years during the period 2006–2010. Altogether 1.2 million screening visits were made and symptoms (lump, retraction, secretion etc.) were reported either by women or radiographer. Breast cancer risk was calculated for each symptom separately using logistic regression [odds ratio (OR)] and 95% confidence intervals (CIs). Of the 1,198,410 screening visits symptoms were reported in 298,220 (25%) visits. Breast cancer detection rate for women with and without symptoms was 7.8 per 1,000 and 4.7 per 1,000 screening visits, respectively, whereas lump detected 32 cancers per 1,000 screens. Women with lump or retraction had an increased risk of breast cancer, OR = 6.47, 95% CI 5.89?7.09 and OR = 2.19, 95% CI 1.92–2.49, respectively. The sensitivity of symptoms in detecting breast carcinoma was 35.5% overall. Individual symptoms sensitivity and specificity ranged from, 0.66 to 14.8% and 87.4 to 99.7%, respectively. Of 5,541 invasive breast cancers, 1,993 (36%) reported symptoms at screen. Breast cancer risk among women with lump or retraction was higher in large size tumors (OR = 9.20, 95% CI 8.08–10.5) with poorly differentiated grades (OR = 5.91, 95% CI 5.03–6.94) and regional lymph nodes involvement (OR = 6.47, 95% CI 5.67–7.38). This study was done in a setting where breast tumors size is generally small, and symptoms sensitivity and specificity in diagnosing breast tumors were limited. Importance of breast cancer symptoms in the cancer prevention and control strategy needs to be evaluated also in other settings.     

Risk factors for breast cancer among women in Bhopal urban agglomerate: a case-control study

Background: Breast cancer is the most common cancer in females worldwide, and the second leading cause of cancer deaths in women. The incidence is on the rise in India, and breast cancer is the second most common malignancy in Indian women. Objective: To assess the risk factors for breast cancer patients living in Bhopal. Study Design and Method: This case-control study was conducted in Bhopal urban agglomerate for a period of a year from October 2008 to August 2009. Demographic data and reproductive risk factor related information was collected using a structured questionnaire with analyses by Epi-info and SPSS 16. Results: A history of oral contraceptive pill use (OR=2.77, 95% CI: 1.15-6.65), history of not having breastfeeding (OR=3.49, 95% CI:1.22-9.97), over weight (OR=0.11, 95%CI:0.02-0.49), obese women ( OR=0.24, 95%CI: 0.06-0.88) and family history of breast cancer (OR=3.89, 95% CI: 1.01-14.92) were associated significantly with the occurrence of breast cancer on multivariate analysis. Conclusions: The findings of the present study suggests that positive family history of breast cancer and history of using OCP may be the epigenetic factors promoting the occurrence of breast cancer while breastfeeding reduces the possibility of acquiring breast cancer.     

Risk factors of breast cancer in north of Iran: a case-control in Mazandaran Province.

INTRODUCTION: Breast cancer is the most common cancer among Iranian women. This study aimed to determine risk factors for breast cancer in the north of Iran. METHOD: A matched case-control study was conducted in Mazandaran province of Iran in 2004 of 250 biopsy proven cases of breast cancer and 500 neighbor controls that were matched by age within a 3 year period. Statistical analysis was carried out using conditional logistic regression with the backward elimination method and crude and adjusted odds ratios with related 95% CIs were estimated with Stata 8.0 software RESULTS: Multivariate analysis showed that higher education (OR=4.70, 95%CI: 1.71-12.88), late menopause (OR=4.18, 95%CI: 2.54-6.88), history of induced abortion (OR=1.62, 95%CI: 1.13-2.31), positive first-degree family history of breast cancer (OR=3.14, 95%CI: 1.37-7.20), and BMI (OR=1.02, 95%CI: 1.01-1.03) were risk factors for breast cancer. Furthermore, having more episodes of full term pregnancy (OR=0.87, 95%CI: 0.80-0.95), longer duration of breast feeding (OR=0.993, 95%CI: 0.989-0.997) and parity more than 2 were shown to be protective factors. CONCLUSIONS: Our study revealed the role of some modifiable determinants of breast cancer that can be focused by public health intervention in the northern community of Iran. Accordingly, the women who have one or more of the following risk factors should take the special attention to risk of breast cancer: obesity, being menopause, positive family history of breast cancer and history of induced abortion. The protective effect of longer duration of breast feeding should be encouraged too.     

Cigarette Smoking and Breast Cancer: a Case-control Study in Serbia

Background: Despite the fact that breast cancer is the most common female cancer worldwide, more than halfof the breast cancer risk factors remained unexplained. The aim of this study was to investigate the associationof cigarette smoking with risk of breast cancer. Materials and Methods: A case-control study was conductedin the Clinical Centre of Kragujevac, Serbia, covering 382 participants (191 cases and 191 controls). In theanalysis of data logistic regression was used. Results: Breast cancer risk was significantly increased in thosewho quit smoking at ≤50 years of age (OR=2.72; 95% confidence interval - 95%CI=1.02-7.27) and in those whoquit smoking less than 5 years before diagnosis of the disease (OR=4.36; 95%CI=1.12-16.88). When smokerswere compared with nonsmokers without passive exposure to smoking, former smoking significantly increasedbreast cancer risk (OR=2.37; 95%CI=1.07-5.24). Risk for breast cancer was significantly increased in those whoquit smoking at ≤50 years of age (OR=3.29; 95%CI=1.17-9.27) and in those who quit smoking less than 5 yearsbefore diagnosis of the disease (OR=5.46; 95%CI=1.34-22.28). Conclusions: These data suggest that cigarettesmoking is associated with an elevated risk of breast cancer among former smokers in Serbia.     

Association between Vegetable,Fruit and Carbohydrate Intake and Breast Cancer Risk in Relation to Physical Activity

Background: Although the nutritional may exert effect on the breast cancer risk, it is not clear whetherthe role diet is the same in sedentary and physically active women. The aim of this study was to evaluate theassociation between fruit, vegetable and carbohydrate intake and the risk of breast cancer among Polish womenconsidering their physical activity level. Materials and Methods: A case-control study was conducted that included858 women with histological confirmed breast cancer and 1,085 controls, free of any cancer diagnosis, aged28-78 years. The study was based on a self-administered questionnaire to ascertain physical activity, dietaryintake, sociodemographic characteristics, reproductive factors, family history of breast cancer, current weightand high, and other lifestyle factors. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimatedin unconditional logistic regression analyses including a broad range of potential confounders. Results: Withcomparison of the highest vs lowest quartile of intake, strong significant associations were observed for totalvegetables (OR=0.37, 95%CI=0.20-0.69 P for trend <0.01 and OR=0.53, 95%CI=0.29-0.96, P for trend <0.02),and total fruits (OR=0.47, 95%CI=0.25-0.87, P for trend <0.05 and OR=0.47, 95%CI=0.24-0.90, P for trend<0.02) among women characterized by the lowest and the highest quartile of physical activity. No associationswere observed for total carbohydrate intake. Additional analysis showed a positive association for sweets anddesert intake among women in the lowest quartile of physical activity (OR=3.49, 95%CI=1.67-7.30, P for trend<0.009) for extreme quartiles of intake comparing to the referent group. Conclusions: The results suggest thata higher consumption of vegetable and fruit may be associated with a decreased risk of breast cancer, especiallyamong women who were low or most physically active throughout their lifetimes. These findings do not supportan association between diet high in carbohydrate and breast cancer. However, a higher intake of sweets anddeserts may by associated with an increased risk of breast cancer among women who were less physically active.     

Breast and colorectal cancer screening and associated correlates among Chinese older women

Objective: To explore the participation rates for breast and colorectal cancer screening and identify associatedcorrelates among elderly women. Methods: Logistic regressions were conducted using data collected in 2006from 1,533 elderly women aged 60 years or above who had completed a screening instrument, the MinimumData Set-Home Care, while applying for long-term care services at the first time in Hong Kong. Results: Theparticipation rates for breast and colorectal cancer screening among frail older Chinese women were 3.7% and10.8% respectively. Cognitive status was inversely associated with the likelihood of participation in screening(breast: OR = 0.66, 95%CI = 0.47-0.94; colon: OR = 0.81, 95%CI = 0.66-0.99), as was educational level withthe likelihood of participation in breast cancer screening (no formal education: OR = 0.20, 95%CI = 0.06-0.61,some primary education: OR = 0.31, 95%CI = 0.10-1.00). Conclusion: The delivery of cancer preventive healthservices to frail older women is less than ideal. Cognitive status and educational level were important factorsin cancer screening behaviour. Tailor-made strategic promotion programmes targeting older women with lowcognitive status and educational levels are needed to enhance awareness and acceptance within this vulnerablegroup.     

Awareness of Breast Cancer among Female Care Givers in Tertiary Cancer Hospital,China

Objective: Breast cancer is a worldwide public health issue and most common cancer diagnosed among women including China, where advanced stages at diagnosis appears to be increasing and an ever-rising incidence twice as fast as global rates. The study was conducted to describe the awareness of breast cancer and associated factors among care giver women in tertiary Cancer Hospital, China. Methods: Institutional based cross-sectional study was conducted among 261 women selected by systematic random sampling. Information provided by the participants was converted into awareness scores for analysis using SPSS version 23. Awareness scores were dichotomized in to ‘good awareness and ‘poor awareness’ taking median score=11 as the cut-off point. Data analysis was performed using the binary logistic regression. A p-value of Result: The study showed that 46.7% of the respondents had good awareness. Breast lump was the most commonly known symptom of cancer by 61.7% of the respondents. Slightly more than half of the study participants acknowledged having a past history of breast cancer, drinking alcohol and having close relative with breast cancer as potential risk factors for breast cancer (63.6%, 58.6%, and 55.6% respectively). Nevertheless, a vast majority of the study participants were unable to appreciate modifiable risk factors of the disease. More than half of the participants had never/rarely checked their breasts and all of the participants wrongly answered breast cancer knowledge age related risk. Awareness level was significantly associated with entertainment preference (OR=3.57; 95%CI=1.71, 7.44) and residence setting areas (OR=2.4; 95%CI=1.04, 5.69). Conclusion: The study indicated suboptimal awareness while entertainment preference and residence setting were significantly associated with awareness level. Public awareness campaigns should be made by dissemination of information about breast cancer through health education and printed Medias with great emphases on women living in rural areas.     

The Impact of Reproductive Factors on the Risk of Breast Cancer by ER/PR and HER2: A Multicenter Case-Control Study in Northern and Eastern China

BackgroundPrevious studies have suggested that reproductive factors are associated with breast cancer risk. Breast cancer subtypes have distinct natural characteristics and may also have unique risk profiles. The purpose of this study was to determine whether reproductive factors affect the risk of breast cancer by estrogen receptor (ER)/progesterone receptor (PR) and HER2 status.MethodsA multicenter, case-control study was conducted. There were 1170 breast cancer patients and 1170 age- and hospital-matched females included in the analysis. Self-reported data were collected about lifestyle behaviors, including reproductive factors. Breast cancer cases were categorized subtypes according to ER, PR, and HER2 expression as HR- positive, HER2-enriched, and triple negative breast cancer (TNBC). Multivariable logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsHaving ≤1 child increased risk of HR-positive breast cancer (OR 1.882; 95%CI 1.29-2.74), especially in the premenopausal group (OR 2.212; 95%CI 1.23-3.99). Compared with women who first gave birth after age 30 years, earlier age at first birth decreased the risk of HR-positive breast cancer (≤23 years: OR 0.209; 95%CI 0.14-0.30; 24-29 years: OR 0.256; 95%CI 0.18-0.36; P < .001). Compared with those who had an average breastfed/birth period of more than 2 years, those with an average period less than 6 months had an elevated risk of all subtypes (HR positive: OR 2.690; 95%CI 1.71-4.16, P < .001; HER2-enriched: OR 3.779; 95%CI, 1.62-8.79, P = .001; TNBC: OR 2.564; 95%CI 1.11-5.94, P = .022). For postmenopausal patients, shorter period of lifetime menstrual cycles (≤30 years) had an obviously decreased risk in HR-positive cases (OR 0.397; 95%CI 0.22-0.71), while there was no similar appearance in other molecular subtypes.ConclusionThe results suggest that reproductive behaviors affect risk of breast cancer differently according to ER/PR and HER2 status.     

Is the incidence of advanced‐stage breast cancer affected by whether women attend a steady‐state screening program?

In this cross‐sectional population‐based study, we assessed the incidence of advanced breast cancer based on screening attendance. Women from the Netherlands Cancer Registry were included if aged ≥49 years and diagnosed with breast cancer between 2006 and 2011, and data were linked with the screening program. Cancers were defined as screen‐related (diagnosed <24 months after screening) or nonscreened (all other breast cancers). Two cut‐offs were used to define advanced breast cancer: TNM‐stage (III–IV vs 0–I–II) and T‐stage alone (≥15 mm vs <15 mm or DCIS). The incidence rates were adjusted for age and logistic regression was used to compare groups. Of the 72,612 included women diagnosed with breast cancer, 44,246 (61%) had screen‐related breast cancer. By TNM stage, advanced cancer was almost three times as likely to be at an advanced TNM stage in the nonscreened group compared with the screen‐related group (38 and 94 per 100,000, respectively; OR: 2.86, 95%CI: 2.72–3.00). By T‐stage, the incidence of advanced cancer was higher overall, and in nonscreened women was significantly higher than in screened women (210 and 169 per 100,000; OR: 1.85, 95%CI: 1.78–1.93). Data on actual screening attendance showed that the incidence of advanced breast cancer was significantly higher in nonscreened women than in screened women, supporting the expectation that screening would cause a stage shift to early detection. Despite critical evaluations of breast cancer screening programs, our data show that breast cancer screening is a valuable tool that can reduce the disease burden in women.     

Beliefs and Behavior of Malaysia Undergraduate Female Students in a Public University Toward Breast Self-examination Practice

Background: Breast cancer is the most common cancer and the second principal cause of cancer deaths amongwomen worldwide, including Malaysia. Methods: A cross-sectional study was carried out among 262 femaleundergraduate students in University Putra Malaysia using a validated questionnaire which was developed forthis study. Results: The mean age of respondents was 22±2.3 years. Most of them were single (83.1%), Malay(42.3%) and 20.7% reported having a family history of breast cancer. Eighty-seven (36.7%) claimed they hadpracticed BSE. Motivation and self-efficacy of the respondents who performed BSE were significantly highercompared with women who did not (p<0.05).There was no association between BSE practice and demographicdetails (p<0.05). Logistic regression analysis indicated that women who perceived greater motivation (OR=1.089,95%CI: 1.016-1.168) and had higher confidence of BSE (OR=1.076, 95%CI: 1.028-1.126) were more likely toperform the screening. Conclusions: The findings show that Malaysian young female’s perception regarding breastcancer and the practice of BSE is low. Targeted education should be implemented to improve early detection ofbreast cancer.     

Socio-demographic correlates of participation in mammography: a survey among women aged between 35- 69 in Tehran, Iran

Background: The rates of breast cancer have increased over the past two decades, and this raises concernabout physical, psychological and social well-being of women with breast cancer. Further, few women reallywant to do breast cancer screening. We here investigated the socio-demographic correlates of mammographyparticipation among 400 asymptomatic Iranian women aged between 35 and 69. Methods: A cross-sectionalsurvey was conducted at the four outpatient clinics of general hospitals in Tehran during the period fromJuly through October, 2009. Bi-variate analyses and multi-variate binary logistic regression were employed tofind the socio-demographic predictors of mammography utilization among participants. Results: The rate ofmammography participation was 21.5% and relatively high because of access to general hospital services. Morewomen who had undergone mammography were graduates from university or college, had full-time or parttimeemployment, were insured whether public or private, reported a positive family history of breast cancer,and were in the middle income level (all P <0.01).The largest number of participating women was in the agerange of 41 to 50 years. The results of multivariate logistic regression further showed that education (95%CI:0.131-0.622), monthly income (95%CI: 0.038-0.945), and family history of breast cancer (95%CI: 1.97-9.28) weresignificantly associated (all P <0.05) with mammography participation. Conclusions: The most important issuefor a successful screening program is participation. Using a random sample, this study found that the potentialpredictor variables of mammography participation included a higher education level, a middle income level, anda positive family history of breast cancer for Iranian women, after adjusting for all other demographic variablesin the model.     

Breast Cancer Knowledge and Screening Behaviour among Women with a Positive Family History: A Cross Sectional Study

Background: Breast cancer is the commonest type of cancer among women, and in Malaysia 50-60% of thenew cases are being detected at late stages. Do age, education level, income, ethnicity, relationship with breastcancer patients and knowledge of breast cancer risk factors influence breast screening practices? This studyrevealed interesting but significant differences. Objectives: To assess the knowledge of breast cancer risk factorsand early detection measures among women in a high risk group. Materials and Methods: A cross sectionalsurvey of one hundred and thirty one women relatives of breast cancer patients was carried out. Participantswere selected through purposive sampling, during hospital visits. A self-administered questionnaire was used fordata collection. Results: The majority of the respondents (71%) had poor knowledge of the risk factors for breastcancer. Income, relationship with a patient and practise of breast cancer screening predicted performance ofmammography, R2=0.467, F=12.568, p<0.0001. Conclusions: The finding shows inadequate knowledge of breastcancer risk factors and poor cancer screening practise among women with family history of breast cancer. Poorknowledge and practise of breast screening are likely to lead to late stage presentation of breast cancer disease.Some important predictors of breast cancer screening behaviour among women with positive family historyof breast cancer were identified. An understanding of the strengths and significance of the association betweenthese factors and breast screening behaviour is vital for developing more targeted breast health promotion.     

Anxiety disorders in breast cancer: Prevalence,types, and determinants

ABSTRACT

The coexistence of anxiety disorders among women with breast cancer has been linked with delay in diagnosis, treatment abandonment, and poor quality of life. This study investigated anxiety disorders with their determinants among 200 participants with histological diagnosis of breast cancer. A questionnaire was designed to elicit sociodemographic and clinical factors, while the schedule for clinical assessment in neuropsychiatry (SCAN) was used to ascertain the presence of anxiety disorders. The mean age of participants was 49.6 years (SD = 11.2) and more than half (54%) presented with advanced cancers (stages 3 and 4). Anxiety disorder was observed in 38 (19%) of the participants. Low income, absence of previous history of breast cancer, and early stage of breast cancer were the significant determinants of anxiety disorders (p < 0.05). However, only absence of previous history of breast cancer (odds ratio [OR] = 3.460, 95% confidence interval [CI] = 1.200–6.960) and early stage of breast cancer (OR = 1.560, 95% CI = 1.120–2.174) were the determinants of anxiety disorders following logistic regression. We advocate for public awareness to promote early screening. Similarly, there is need to improve access to care and integrate culturally appropriate psychosocial intervention into breast cancer care using the available knowledge on vulnerability factors. Further study on anxiety disorders in breast cancer is indicated.     

Factors Affecting Cervical Cancer Screening Uptake by Hmong Hilltribe Women in Thailand

Background: Cervical cancer is relatively common in Thai women, but the proportion of females receivingPap smear screening is still low. Objective: The purpose of this cross-sectional study was to study factors relatedto cervical cancer screening uptake by Hmong hilltribe women in Lomkao District, Phetchabun Province.Materials and Methods: Interview data were collected from 547 of these women aged 30-60 years living in thestudy area and analyzed using multiple logistic regression. Results: The results showed that 64.9% of the studysample had received screening, and that 47.2% had attended due to a cervical screening campaign. The mostcommon reason given for not receiving screening was lack of time (21.4%). The factors found to be positivelyassociated with uptake (p value <0.05) were as follows: number of years of school attendance (OR=1.56,95%CI:1.02-2.38), animistic religious beliefs (OR=0.55, 95%CI:0.33-0.91), a previous pregnancy (OR=6.20,95%CI:1.36-28.35), receipt of information about cervical cancer screening (OR=2.25, 95%CI:1.35-3.76), andperceived risk of developing cervical cancer (OR=1.83, 95%CI:1.25-2.67). Conclusions: To promote the uptakeof cervical screening, Hmong hilltribe women need to know more about cervical cancer and cervical cancerscreening, and access to screening services should be provided in conjunction with existing everyday services,such as family planning and routine blood pressure monitoring or diabetes services.     

Patient-mediated factors predicting early- and late-stage presentation of breast cancer in Egypt

Objective: Breast cancer fatality rates are high in low‐ and middle‐income countries because of the late stage at diagnosis. We investigated patient‐mediated determinants for late‐stage presentation of breast cancer in Egypt. Methods: A case–case comparison was performed for 343 women with breast cancer, comparing those who had been initially diagnosed at Stage I or II with those diagnosed at Stage III or IV. Patients were recruited from the National Cancer Institute of Cairo University and Tanta Cancer Center in the Nile delta. Patients were either newly diagnosed or diagnosed within the year preceding the study. Interviews elicited information on disease history and diagnosis, beliefs and attitudes toward screening practices, distance to treatment facility, education, income, and reproductive history. Results: Forty‐six per cent of the patients had presented at late stage. Women seen in Cairo were more likely to present at late stages than patients in Tanta (OR=5.05; 95% CI=1.30, 19.70). Women without any pain were more likely to present at later stage (OR=2.68; 95% CI=1.18, 6.08). Knowledge of breast self‐examination increased the likelihood of women to present in early stages significantly (OR=0.24; 95% CI=0.06, 0.94). Conclusions: Despite increasing numbers of cancer centers in Egypt during the past 20 years, additional regional facilities are needed for cancer management. In addition, increasing awareness about breast cancer will have significant long‐term impact on breast cancer prevention. Copyright © 2010 John Wiley & Sons, Ltd.     

Breast Cancer Awareness at the Community Level among Women in Delhi,India

Background: To assess women’s awareness from diverse sections of society in Delhi regarding various aspectsof breast cancer (BC) – perceptions, signs and symptoms, risk factors, prevention, screening and treatment.Materials and Methods: Community-level survey was undertaken in association with the Indian Cancer Society(ICS), Delhi during May 2013-March 2014. Women attending BC awareness workshops by ICS were givenself-administered questionnaires before the workshop in the local language to assess BC literacy. Informationprovided by 2017 women was converted into awareness scores (aware=1) for analysis using SPSS. Awarenessscores were dichotomized with median score=19 as cut off, create more aware and less aware categories. Bivariateand multivariate analysis provided P-values, odds ratios (ORs) and 95% confidence intervals (CIs). Results:Broadly, 53.4% women were aware about various aspects of BC. Notably, 49.1% women believed that BC wasincurable and 73.9% women believed pain to be an initial BC symptom. Only 34.9% women performed breast selfexamination(BSE) and 6.9% women had undergone clinical breast-examination/mammography. 40.5% womenhad higher awareness (awareness score > median score of 19), which was associated with education [graduates(OR=2.31; 95%CI=1.78, 3.16), post-graduates (OR=7.06; 95%CI=4.14, 12.05) compared to ≤ high school] andsocio-economic status (SES) [low-middle (OR=4.20; 95%CI=2.72, 6.49), middle (OR=6.00; 95%CI=3.82, 9.42)and upper (OR=6.97; 95%CI=4.10, 11.84) compared to low SES]. Conclusions: BC awareness of women in Delhiwas suboptimal and was associated with low SES and education. Awareness must be drastically increased viacommunity outreach and use of media as a first step in the fight against BC.     

Effects of Socio-economic and Demographic Factors in Delayed Reporting and Late-stage Presentation among Patients with Breast Cancer in a Major Cancer Hospital in South India

Objective: We analyzed the distribution of socio-economic and demographic (SEDs) factors among breastcancer patients and assessed their impact on the stage at diagnosis of the disease and symptom duration. Methods:Data for the year 2006 was collected from the Hospital Based Cancer Registry, Regional Cancer Centre (RCC),Trivandrum, Kerala, India. Patients (n=522) were included if they were from native Kerala state or adjoiningTamil Nadu. SEDS factors included age, residing district, religion, marital status, income, education andoccupation. Other study variables were menopausal status, parity, listed symptoms with duration and stage atdiagnosis. Association between SEDs factors by stage at diagnosis and duration of symptoms was tested usingchi-square statistics, with odds ratios (OR) estimated through logistic regression modeling. Results: Forty-fivepercent were reported at early stages and 53% at late stages. Elevated risks for late stage reporting amongbreast cancer patients were observed for women who were unmarried (OR=3.31; 95%CI: 1.10-9.96), widowed/divorced (OR=1.46; 95%CI: 0.89-2.37), with lower education (OR=2.72; 95%CI: 1.06-7.03 for illiterate womenand OR=2.32; 95%CI: 1.05-5.13 for women with primary school education and OR=2.07; 95%CI: 1.02-4.21 forwomen with middle school education) and post-menopausal women (OR=1.45; 95%CI: 0.97-2.19). Conclusions:This analysis helped to identify the target population group for receiving health education for early detection ofbreast cancer.