Assessing Breast Cancer Awareness in Thai Women: Validation of the Breast Cancer Awareness Scale (B-CAS)

Background: Raising breast cancer awareness is a well-established first line strategy to reduce breast cancer mortality. A properly validated instrument is needed to gain a better understanding of breast cancer awareness. Objective: The objective of this study was to develop and validate an instrument to assess breast cancer awareness in Thai women. Methods: In this study, we develop and evaluate the validity of the Breast Cancer Awareness Scale (B-CAS). Construct validity was evaluated by using exploratory factor analysis and confirmatory factor analysis, and criterion validity was investigated using ROC curves to examine the associations between B-CAS subscales and breast self-examination. Internal consistency and test-retest reliability were also investigated. This validation process employed two independent samples of Thai women aged 20-64 years collected from communities in southern Thailand. Results: In total, 660 Thai women (mean age 41 years) participated in this study. Confirmatory factor analysis demonstrated the construct validity of B-CAS (CFI =0.91; NNFI=0.90; GFI=0.95; AGFI= 0.95; RMSEA=0.044, 95%CI 0.041 to 0.047; P< 0.05). Several of the B-CAS subscales demonstrated strong utility in discriminating between women who do and do not regularly conduct breast self-examination. B-CAS also demonstrated strong internal consistency (Cronbach’s α=0.86) and test-retest reliability. The final version of B-CAS contains 35 items across five domains: knowledge of risk factors, knowledge of signs and symptoms, attitude to breast cancer prevention, barriers of breast screening, and health behaviour related to breast cancer awareness. Conclusion: The breast cancer awareness scale (B-CAS) was shown to have good psychometric properties in Thai women, and is likely to prove useful in studying the epidemiology of breast cancer awareness in Thai women, and evaluating breast cancer prevention programs for raising awareness.     

Breast Cancer Provider Interval Length in Fukushima,Japan, After the 2011 Triple Disaster: A Long-Term Retrospective Study

BackgroundMinimizing the interval from symptom onset to treatment commencement is essential for a favorable outcome among breast cancer (BC) patients. This study examined whether provider interval (time elapsed from first consultation to treatment initiation) lengthened among BC patients after Japan’s 2011 earthquake, tsunami, and nuclear disaster in Fukushima. Factors associated with the length of postdisaster interval and whether the interval was associated with BC stage were also investigated.Patients and MethodsSo-so District (study site) was an area damaged by the 2011 disasters. Data of all BC patients who made their first medical consultation and received initial treatment at the core medical institutions in the area 5 years before or after the disaster were extracted from patient medical records. We used several regression approaches to fulfill our study objectives.ResultsWe included 263 (140 predisaster and 123 postdisaster) patients. After adjustment for covariates, the interval did not significantly change after the disaster compared to before the disaster. Those with 4 or 5 cohabiting family members experienced a shorter interval after the disaster than those with 0 or 1 cohabiting family members (relative length, 0.47; 95% confidence interval, 0.28-0.78). Those with an interval of > 60 days had lower odds of stage III or IV cancer after the disaster than those with an interval of < 30 days (odds ratio, 0.09; 95% confidence interval, 0.01-0.84).ConclusionOverall, provider interval did not lengthen after the disaster. However, those with fewer cohabiting family members might have experienced a longer total interval. Cancer stage may not necessarily reflect the influence of interval on patient outcome.     

Late-Stage Diagnosis and Associated Factors Among Breast Cancer Patients in South and Southwest Ethiopia: A Multicenter Study

BackgroundBreast cancer is a leading cause of cancer death in women in low- and middle-income countries, largely because of late-stage diagnosis. Yet studies are very limited in the Ethiopian context. Therefore, we determined the occurrence of late-stage disease and associated factors in selected public hospitals in south and southwest Ethiopia.Patients and MethodsA 5-year retrospective cross-sectional study was conducted on breast cancer patient medical records from January 2013 to December 2017 in 6 hospitals. Multivariable logistic regression was performed to identify factors associated with late-stage disease (stage III and IV). Adjusted odds ratios (AOR) with 95% confidence intervals were used. P < .05 was considered statistically significant.ResultsOverall, 426 breast cancer patients were identified, and 72.5% were diagnosed with late-stage disease. The mean ± standard deviation patient age was 42.8 ± 13.4 years. Factors associated with late diagnosis were patient delay in seeking care (AOR = 2.50; 95% confidence interval [CI], 1.51-4.16); health system delays (AOR = 1.62; 95% CI, 1.02-2.59); female sex (AOR = 3.46; 95% CI, 1.50-7.98); rural residence (AOR = 2.37; 95% CI, 1.45-3.86); chief complaint of breast lump (AOR = 3.01; 95% CI, 1.49-6.07); and history of comorbidities (AOR = 1.72; 95% CI, 1.02-2.91).ConclusionThe majority of patients were diagnosed with late-stage diagnosis of breast cancer. Patient delays in seeking care, health system delays, being female, rural residence, and patient comorbidities were associated factors. These findings provide evidence that efforts to increase public and health provider awareness to promote early breast cancer diagnosis, particularly in rural areas, are needed in south and southwest Ethiopia.     

Breast Cancer Screening Knowledge and Perceived Health Beliefs among Immigrant Women in Korea

Purpose

Recently, through international marriage, immigrant women have rapidly increased throughout Korea. This study was performed to identify health beliefs and practices related to breast cancer screening in immigrant women in Korea.

Methods

A cross-sectional survey was carried out between March and July 2012, and study population included immigrant females from six other Asian countries (Cambodia, China, Japan, Mongolia, Vietnam, and the Philippines). We surveyed 197 women and categorized them into four groups according to home countries. The questionnaire consisted of 55 items, including demographic and socioeconomic factors, breast cancer-related knowledge regarding risk factors and symptoms, beliefs and attitudes towards health and breast cancer, perceived susceptibility, barriers, and benefits of screening.

Results

Japanese participants were significantly older and had resided in Korea for more years than other country-of-origin groups (all p<0.001), and showed higher screening rates without statistical significance (p=0.392). In multivariate analysis, country of origin showed a significant correlation with knowledge (p=0.001), positive beliefs (p=0.002), and perceived benefits (p=0.025) of breast cancer screening. The group with the lowest household income showed a significantly lower score of perceived benefits (p=0.022). Through analysis to identify factors affecting participation in screening mammography, we found that education level (p=0.009), occupation status (p=0.006), and Korean language fluency (p=0.002) were independent predictors for screening behavior.

Conclusion

This study identified conditions related to breast cancer screening knowledge, perception, and behavior of immigrant women in Korea. The results reflect the need for increased social aids to remove barriers to medical services and more educational programs to facilitate higher rates of screening.     

Awareness Level about Breast Cancer Risk Factors,Barriers, Attitude and Breast Cancer Screening among Indonesian Women

Background: Globally, breast cancer is the second most common cancer in women and is a leading cause of mortalityin Indonesia. Raising awareness of breast cancer is particularly important to help at risk women seek medical treatmentfor this disease. This study aimed to comprehensively investigate the Indonesian women’s level of knowledge aboutbreast cancer risk factors, barriers, attitude and breast cancer screening. Methods: This population-based cross-sectionalstudy administered the breast cancer awareness Indonesian scale (BCAS-I) to 856 Indonesian women. Samples wereselected in rural and urban combinations from three provinces by stratified random sampling. The ordinal logisticmodel was used to investigate the clustering effect of the participant’s characteristics in this study. Results: Of thewomen, 62% lived in rural areas and 38% lived in urban areas. Living in an urban area was significantly associatedwith a lower knowledge of the risk factors. However, living in an urban area was significantly associated with betterattitudes and healthier behaviours related to breast cancer awareness. Women with higher education levels had 70%worse attitudes toward breast cancer awareness. Women living South of Sumatera, women living in Yogyakarta, andunmarried women were 5.03, 3.84, and 1.56 times as likely to have higher perceived barriers, respectively. Conclusion:Urban women had a poorer level of knowledge of breast cancer risk factors compared to women living in more ruralareas. The result of this study may reflect inadequate breast cancer awareness campaigns or a lack of breast cancerawareness campaigns. These findings suggest that additional education programs aiming to increase awareness andeducate the public are needed.     

Factors Associated with Breast Cancer Awareness in Thai Women

Background: Breast cancer is the most common cancer in women worldwide. In south-east Asia, both the incidenceand mortality rates of breast cancer are on the rise, and the latter is likely due to the limited access to large-scalecommunity screening program in these resource-limited countries. Breast cancer awareness is an important tool whichmay, through increasing breast self-examination and the seeking of clinical examination, reduce breast cancer mortality.Investigating factors associated with breast cancer awareness of women is likely to help identify those at risk, andprovide insights into developing effective health promotion interventions. Objective: To investigate factors associatedwith breast cancer awareness in Thai women. Methods: A cross-sectional sample of Thai women aged 20-64 yearswas collected during August to October, 2015 from two provinces of southern Thailand (Surat Thani and Songkla). Aquestionnaire including the Breast Cancer Awareness Scale along with demographic characteristics was administeredand Proportional Odds Logistic regression was then used to investigate factors associated with breast cancer awareness.Results: In total, 660 Thai women participated in this study. Factors most often associated with the various breastcancer awareness domains were age and rurality. While rural women had poorer knowledge of breast cancer signs andsymptoms, they also had lower levels of perceived barriers and considerably better breast cancer awareness behaviors.Conclusion: Despite lower knowledge of breast cancer risk factors and no evidence of better knowledge of signs andsymptoms, we found rural Thai women had considerably better breast cancer awareness behavior. This may be due tothese women’s lower levels of perceived barriers to breast cancer screening services. Indeed this suggests, at least inThai women, that interventions aimed at lowering perceived barriers rather than enhancing disease knowledge maybe more successful in engaging women with breast cancer screening services and increasing breast self-examination.     

Breast Cancer in Young Women in Latin America: An Unmet,Growing Burden

Background.

Breast cancer (BC) is the leading cause of malignancy-related deaths among women aged ≤45 years. There are unexplored and uncertain issues for BC in this particular group in Latin America. The aim of this study is to evaluate BC incidence and mortality among young women and related clinicopathological and survivorship aspects in this region.

Materials and Methods.

Data were obtained from Globocan 2008 and the International Agency for Research on Cancer''s Cancer Incidence in Five Continents series plus databases. We requested collaboration from the 12 different national cancer institutes in Latin America through SLACOM, the Latin American and Caribbean Society of Medical Oncology, and conducted a systematic literature review to obtain local data regarding the prevalence of BC among young women and their characteristics, outcomes, and survivorship-related issues.

Results.

BC incidence and mortality proportions for Latin American women aged <44 years were higher when compared with those of developed countries (20% vs. 12% and 14% vs. 7%, respectively). We found only a few Latin American series addressing this topic, and prevalence varied between 8% and 14%. Stage II and III disease, high histological grade, and triple-negative and HER2 BC were features frequently observed among young Latin American BC patients.

Conclusion.

The rising incidence and mortality of BC in young Latin American women is a call to action in the region. It is necessary to monitor the epidemiological and clinical data through reliable cancer registries and to consider the implementation of protocols for education of patients and health professionals. This unmet, growing burden must be considered as a top priority of the national programs in the fight against BC, and models of specialized units should be implemented for this particular group of patients to provide better care for this emergent challenge.     

General Breast Cancer Awareness among Women in Riyadh City

Breast cancer is the most common cancer among women globally as well as in Saudi Arabia. Early diagnosis can improve prognosis and breast self-examination (BSE) may be a cost effective way to achieve this. In Saudi Arabia, only a few studies have been conducted to address breast cancer awareness. Most showed a suboptimal level of understanding. During the last few years, Saudi Arabia has established many national campaigns to increase awareness of the disease and facilitate learning about different diagnostic procedures. This cross-sectional survey study was conducted in accordance to assess the current knowledge and practices of women regarding breast self-examination and mammography screening in Riyadh, Saudi Arabia. The sample comprised of 137 females aged 18 and older. Data were collected using face-to-face interviews with a modified Arabic version of a validated questionnaire and analyzed using SPSS. Similar to previous studies’, the results were suboptimal. Out of the 137, about 54% claimed they are aware of breast cancer and BSE, however, only 62% of them knew how to conduct self-examination. Far fewer were aware of mammography screening (38%). When asked about the source of breast cancer information, most of the women answered awareness campaigns (39%) while school/university and TV (22% each) were the sources for others. This highlights the importance and urgent need for continued awareness campaigns. Moreover, special awareness sessions need to be conducted in institutions like colleges, universities, and hospitals where the proportion of females is higher.     

Breast Cancer Awareness and Associated Factors among Women in Pakistan: A Cross-Sectional Descriptive Study

Objective: Breast cancer is a highly prevalent cancer in females worldwide, with new cases around one million every year. In Pakistan, cancer of breast is the most common carcinoma in diagnosis, with one in nine females. Due to high burden of breast cancer in Pakistan, presented work purposes to investigate knowledge and awareness of breast carcinoma, its symptoms, and risk factors among Pakistani women, which play an important part in the early diagnosis of breast cancer. Methods: A sample of 1000 females were approached generally from universities, hospitals, public places, local markets, rural areas and other cities for on-site data collection through face-to-face interviews and online data collection through telephonic interviews in Pakistan using the Breast Cancer Awareness Measure (BCAM). By using SPSS V. 25.0, the information  provided by the individuals first changed in awareness scores and was then analyzed. Results: The study displayed, that mainstream participants lacked knowledge of breast carcinoma (63.2%) and the importance of its screening tools (64.7% and 83.2% lacked knowledge of mammography and BRCA tests respectively) for early detection. Almost 45% of respondents never noticed a change in their breasts. Most participants were unaware about breast cancer development is age-related and lifetime risk. Slightly more than 50% of the participants of the study were not knowledgeable regarding modifiable risk factors of breast carcinoma. A commonly known symptom was Breast lump by 53% of the respondents. Association was determined between demographic variables and breast cancer knowledge scores. Only 37.4% of respondents were found to be knowledgeable regarding breast cancer. Conclusion: BCAM is a productive instrument to assess awareness of breast carcinoma in females. The study indicated awareness of breast cancer is suboptimal in the population of Pakistan. Efforts should be made by public awareness campaigns and broadcasting of information about breast cancer and health education to increase awareness of risk factors.     

Breast cancer survival in Ethiopia: A cohort study of 1,070 women

There is little information on breast cancer (BC) survival in Ethiopia and other parts of sub‐Saharan Africa. Our study estimated cumulative probabilities of distant metastasis‐free survival (MFS) in patients at Addis Ababa (AA) University Radiotherapy Center, the only public oncologic institution in Ethiopia. We analyzed 1,070 females with BC stage 1–3 seen in 2005–2010. Patients underwent regular follow‐up; estrogen receptor‐positive and ‐unknown patients received free endocrine treatment (an independent project funded by AstraZeneca Ltd. and facilitated by the Axios Foundation). The primary endpoint was distant metastasis. Sensitivity analysis (worst‐case scenario) assumed that patients with incomplete follow‐up had events 3 months after the last appointment. The median age was 43.0 (20–88) years. The median tumor size was 4.96 cm [standard deviation (SD) 2.81 cm; n = 709 information available]. Stages 1, 2 and 3 represented 4, 25 and 71%, respectively (n = 644). Ductal carcinoma predominated (79.2%, n = 1,070) as well as grade 2 tumors (57%, n = 509). Median follow‐up was 23.1 (0–65.6) months, during which 285 women developed metastases. MFS after 2 years was 74% (69–79%), declining to 59% (53–64%) in the worst‐case scenario. Patients with early stage (1–2) showed better MFS than patients with stage 3 (85 and 66%, respectively). The 5‐year MFS was 72% for stages 1 and 2 and 33% for stage 3. We present a first overview on MFS in a large cohort of female BC patients (1,070 patients) from sub‐Saharan Africa. Young age and advanced stage were associated with poor outcome.     

Physicians' Awareness of the Breast Cancer Survivors' Unmet Needs in Korea

PurposePhysicians'' awareness of their cancer patients'' unmet needs is an essential element for providing effective treatment. This study investigated the accuracy of physicians'' awareness of breast cancer survivors'' unmet needs in Korea.MethodsA cross-sectional interview survey was performed among 106 physicians and 320 Korean breast cancer survivors. The Comprehensive Needs Assessment Tool was administered to physicians and cancer survivors after obtaining their written informed consent to participate. Data were analyzed using t-test, analysis of variance, and multiple regression analysis.ResultsThe level of unmet needs was highest in the hospital service domain (mean ± standard deviation: 2.19 ± 0.82), and the top-ranked unmet need item was “wished my doctor to be easy, specific, and honest in his/her explanation” (2.44 ± 0.93). Higher unmet needs were correlated with the presence of a genetic counseling clinic. They were not associated with age, sex, marital status, religion, department, working period, type of institution, number of staff, and number of operations. In multiple regression analysis, the presence of a genetic counseling clinic was associated with a higher level of recognition for psychological problems, social support, hospital service, and information and education needs. Physicians overestimated breast cancer survivors'' unmet needs in all domains, compared to their self-reported unmet needs. The discordance in the perceived unmet needs was highest in the ‘family/personal relationship problems’ domain.ConclusionsPhysicians who treat Korean breast cancer survivors rated the level of unmet needs of breast cancer survivors as highest in the hospital service domain. The presence of a genetic counseling clinic in physicians'' institutions was associated with a higher perception of survivors'' unmet needs. Physicians overestimated the level of unmet needs in Korean breast cancer survivors. Efforts to reduce these discordances are needed to implement optimal survivorship care.     

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.     

Breast Cancer: Awareness and Risk Factors in College-goingYounger Age Group Women in Rajasthan

Objectives: To determine awareness about breast cancer and its risk factors. Study design: Communitybased prospective cross sectional analysis. Setting: College-going younger age group women of Rajasthan, withwomen’s knowledge about breast cancer, risk factors, treatment, detection and preventive modalities as mainoutcome measures. Results: All the respondents had heard of breast cancer. Awareness about breast mass/lumpto be cardinal symptom of breast cancer was true for 65% of respondents. The main early diagnostic modalitymammography was known by 19% of respondents while 49% aware about ultrasonography. Some 28% of thewomen were not aware about self breast examination. Conclusions: Women do have knowledge deficits aboutbreast cancer and various related factors.     

Efficacy of Fulvestrant in Heavily Pretreated Postmenopausal Women with Advanced Breast Cancer: A Preliminary Report

Purpose

Fulvestrant, a potent estrogen receptor (ER) antagonist with a novel mechanism of action, has shown efficacy in pretreated patients with advanced breast cancer. We assessed the efficacy and tolerability of fulvestrant in Korean postmenopausal women.

Methods

Of the 25 candidates identified at Asan Medical Center, Seoul, Korea, six were deemed ineligible due to inadequate baseline and follow-up imaging. The 19 patients included in this retrospective analysis received the approved dose of fulvestrant (250 mg intramuscular injection, once per month) as second- (n=8), third- (n=7), or fourth-line (n=4) endocrine therapy.

Results

At a median follow-up of 7.4 months (range, 1.2-34.8 months), the 19 patients received a median of four cycles (range, 1-34 cycles) of fulvestrant. Median time to progression was 5.5 months (95% confidence interval [CI], 0.4-10.7 months), and median overall survival was 17.9 months (95% CI, 2.7-33.1 months). Among 17 evaluable patients, one (5.3%) achieved a partial response, 10 (52.6%) showed stable disease, and six (31.6%) showed progressive disease. The clinical benefit rate was 26.3%. Four patients (21.1%) reported adverse events, but all were grade 1 or 2.

Conclusion

Fulvestrant was effective and well tolerated in patients with advanced breast cancer who had been previously treated with several lines of endocrine and chemotherapeutic agents.     

Social Disparity in Breast and Ovarian Cancer Incidence in Iran, 2003-2009: A Time Trend Province-Level Study

Purpose

This pioneering study aimed to investigate social disparities in breast cancer (BC) and ovarian cancer (OC) incidence rates among women across Iran''s provinces from 2003 to 2009.

Methods

Provincial level population distribution data pertaining to women were obtained from the Statistical Centre of Iran. Age-standardized incidence rates of BC and OC were gathered from the National Cancer Registry. Human Development Index was used as the provinces'' social rank (SR), and rate ratio and Kunst and Mackenbach relative index of inequality were used to assess social disparities. Annual percentage change (APC) was calculated using joinpoint regression, and Spearman rank correlation was used to examine the association between APC and SR.

Results

It was found that over the study period, annual incidence rates rose by 11.6% and 9.7% for BC and OC, respectively. Social disparities were substantial and stable in favor of provinces with lower SR in Iran, and were more profound for BC than OC. Correlations between APC and SR were small and nonsignificant for both BC and OC.

Conclusion

The results showed that both BC and OC incidence increased in Iran during 2003 to 2009. There were positive associations between BC and OC incidence rates and the provinces'' SR. This study''s recommendations provide valuable information for health resource allocation pertaining to BC and OC control programs across provinces in Iran.     

The Basic Facts of Korean Breast Cancer in 2011: Results of a Nationwide Survey and Breast Cancer Registry Database

Breast cancer is the second most frequent malignancy in Korean women, with a continuously increasing incidence. The Korean Breast Cancer Society has constructed a nationwide breast cancer database through an online registration program. The aim of the present study was to report the fundamental facts on Korean breast cancer in 2011, and to analyze the changing patterns in clinical characteristics and breast cancer management in Korea over the last 10 years. Data on newly diagnosed breast cancer patients, including the total number of cases, age, stage, and type of surgery, for the year 2011 were collected from 84 hospitals and clinics nationwide using a questionnaire survey. Additional data relating to the changing patterns of breast cancer in Korea were collected from the online breast cancer registry database and analyzed. According to nationwide survey data, a total of 16,967 patients were newly diagnosed with breast cancer in 2011. The crude incidence of female breast cancer, including invasive cancer and in situ cancer, was 67 cases per 100,000 women. Analysis of the survey and registry data gave equivalent results in terms of age distribution, stage, and type of surgery. The median age at diagnosis was 50 years, and the proportion of postmenopausal women (51.3%) was higher than that of premenopausal women (48.7%) with breast cancer. The incidence of stage 0 and stage I breast cancer increased continuously over the last 10 years (56.3% in 2011), and breast conserving surgery (65.7%) was performed more frequently than total mastectomy (33.8%). The total number of breast reconstruction surgeries increased approximately 8-fold. We conclude that the clinical characteristics of breast cancer have changed over the past 10 years in Korea, and surgical management has changed accordingly. Analysis of nationwide registry data will contribute to a better understanding of the characteristics of breast cancer in Korea.