Impact of clinical breast examination-based screening program on care pathway, stage at diagnosis, nature of treatment, and overall survival among breast cancer patients in Morocco.

BACKGROUND: This study aimed to indirectly examine whether the implementation of clinical breast examination-based screening program in Morocco has been successful in downstaging and improving survival rates. Breast cancer patients detected through the screening pathway were compared with those detected through self-referral over the same period in terms of cancer stage at diagnosis, tumor characteristics, care delays, and survival. METHODS: A prospective observational study was conducted between April 2019 and August 2020 at two major public oncology centers. RESULTS: A total of 896 women with confirmed breast cancer were recruited (483 were program-referred and 413 were self-referred). The authors did not report any significant difference between the two groups in terms of stage at diagnosis, molecular profile, or histopathological grade. Early-stage cancer (stage I-II) was detected in 55.7% of self-referred participants compared to 55.5% of program-referred participants. Median intervals between symptom recognition, pathological diagnosis, and treatment initiation were not significantly different between the two groups. Similarly, survival after treatment showed no significant difference between patients screened by the program and self-referred patients. The 3-year survival rate after treatment was 94.5% for patients referred through the program and 88.6% for patients not referred through the program (p = .16). CONCLUSIONS: This study highlights the importance of equitable and timely access to high-quality diagnosis and treatment facilities, leading to substantial downstaging and enhanced survival rates. Continued efforts to improve quality and expand coverage to include asymptomatic women will consolidate the health infrastructure gains achieved by the Moroccan breast cancer screening program.

Routine Clinical Breast Examination Is a Low-Yield Practice Among Women at High Risk of Breast Cancer.

BACKGROUND: For women at increased risk of breast cancer, the National Comprehensive Cancer Network (NCCN) guidelines recommend clinical encounters every 6-12 months. While screening mammography has corresponded with a relative risk reduction in breast cancer mortality of approximately 20%, evidence validating clinical breast examination (CBE) as an efficacious screening modality is deficient. Our study aimed to assess the conventional merit of regular CBE for breast cancer detection among individuals at increased risk of breast cancer development. METHODS: Women > 18 years with documented high-risk encounters at Corewell Health West from 1 January 2018 to 31 December 22 were retrospectively reviewed. High-risk criteria included genetic predisposition, 5-year (> 1.7%) or lifetime (> 20%) Tyrer-Cuzick and/or Gail Model risk estimations, thoracic radiotherapy before age 30 years, lobular carcinoma in-situ, or atypical hyperplasia. Patients with a history of breast cancer or bilateral prophylactic mastectomy prior to 2018 were excluded. RESULTS: Of the 9171 cumulative high-risk encounters among 2493 women, only one breast cancer was detected by CBE. CBE resulted in 1 (0.04%) cancer diagnosis compared with 30 (1.2%) detected on screening imaging and 10 (0.4%) self-reported. Of the 30 image-detected cancers, 28 (93.3%) had no detectable clinical findings at the time of preoperative consultation. Self-reported and CBE-detected cancers were more likely to be of higher clinical stage compared with imaging-detected malignancies. CONCLUSIONS: The role of routine CBE as a cancer detection modality in the high-risk patient population appears to be limited. Telemedicine can be offered to individuals who have completed screening imaging but are unable to commit and/or are inconvenienced by in-person high-risk breast cancer assessments.

Knowledge and practice of breast self-examination among breast cancer patients in Damascus, Syria.

BACKGROUND: Breast cancer (BC) represents an important cause of cancer death, its incidence rate has been rising gradually in the Arab world, and in Syria, BC is the most common cancer and the leading cause of cancer death; its prognosis gets better as we detect it early in its first stages. So, it is very important to implement one or more early detection methods such as Breast Self-Examination (BSE), Clinical Breast Examination (CBE), and mammography. BSE represents an effective method to find out changes in breast structure when they happen. This study investigates the knowledge of BSE and its practice in BC patients. METHODS: A quantitative cross-sectional study in Al-Bairouni hospital in Damascus-Syria was carried out using face-to-face interviews based on a structured questionnaire, which consisted of 4 sections. The data were subjected to statistical analysis using various analytical tests, including the independent t-test, one-way analysis of variance (ANOVA), and Chi-square test. RESULTS: Five hundred patients were interviewed. Only 27.4% of patients had a good knowledge of BSE, 17.4% had average knowledge, and 55.2% had low knowledge of BSE. The factors that have an impact on the knowledge of BSE were: family breast cancer history (first and second-degree relatives), education, and the region of living (between governorates). The effect of knowledge of BSE on its practice was positive. However, only 24.8% of patients have been practicing BSE; the reasons for not practicing BSE were: no one has told the patient about it (64.8% of cases), and the patient does not have any symptoms relating to the breast (21.4%).Breast cancer was identified through breast self-examination (BSE) in 15.6% of cases. CONCLUSION: There is a low degree of knowledge and little practice of BSE among Syrian breast cancer patients. Family breast cancer history, governate, occupation, and level of education had a statistically significant effect on knowledge scores of BSE, unlike age and social status. So, some steps should be taken to increase awareness about BSE among Syrian females.

Knowledge, Attitudes, and Practices Toward Breast Cancer and Breast Cancer Screening Among Arab Females in the Middle East: A Literature Review.

BACKGROUND: Breast cancer is one of the most diagnosed cancers in Arab countries. Lack of knowledge and awareness regarding breast cancer screening has increased the breast cancer-related morbidity and mortality. PURPOSE: This literature review aimed to assess published research papers with a focus on the levels of knowledge, attitude, practice, and barriers of women in Arab countries of the Middle East toward breast cancer and its screening. METHOD: SCOPUS, MEDLINE, and Google Scholar were searched using specific terms for relevant, quantitative, original studies published between 2017 and 2022. All English articles that matched the inclusion criteria were included in this review. Fourteen studies focusing on knowledge, attitudes, and barriers regarding breast cancer were included. Two independent reviewers performed screening and extraction. RESULTS: Among the reviewed studies, a range from 19.6% in Oman to 67% in Saudi Arabia had poor knowledge of breast cancer. Past personal or family history was a well-recognized risk factor (n = 5), and being worried about the results was the most common barrier to screening. Although most women were aware of screening methods, the majority did not practice screening. Social media and the internet were the most used sources of information used by women to obtain knowledge regarding breast cancer and its screening (n = 6). CONCLUSION: Most of the Arab female population had low levels of knowledge, attitudes, and practices regarding breast cancer and its screening. Programs designed to raise awareness are necessary, and more policy changes must take place on the national level in Arab, Middle Eastern countries to address the low knowledge, the negative attitudes, and the limited access to breast cancer screening.

Effectiveness of triennial screening with clinical breast examination: 14-years follow-up outcomes of randomized clinical trial in Trivandrum, India.

BACKGROUND: This study presents the preliminary results of a randomized controlled trial (RCT) initiated in January 2006 in India to evaluate the effectiveness of clinical breast examination (CBE) in reducing breast cancer mortality as compared to a no-screening control group reported significant downstaging in the intervention group. The present manuscript reports long-term follow-up outcomes. METHODS: Women 30-69 years old from 133 intervention clusters and 141 control clusters were invited to participate. Women in the intervention arm underwent three rounds of CBE every 3 years. CBE-positive women were reexamined by a physician, and triple-assessment was performed on those confirmed to have abnormalities. All participants were followed through home visits and linkage with population-based cancer registry. RESULTS: Of the 55,843 eligible women in the intervention arm, 95.7% had CBE at least once and 11.5% were CBE-positive. Breast cancers were diagnosed in 335 participants in the intervention group and 273 in the control group (N = 59,447). Age-standardized incidence rate of early cancer was 30.4 of 100,000 in the intervention and 21.9 of 100,000 in the control group, with a rate ratio (RR) of 1.4 (95% confidence interval [CI], 1.1-1.8). The age-standardized breast cancer mortality rates were 11.3 and 11.1 per 100,000 in intervention and control arms, respectively (RR, 1.1; 95% CI, 0.8-1.5) after 15 years. Five-year breast cancer survival rates were 77.0% in the intervention and 71.2% in the control groups (overall p value = .043). CONCLUSIONS: Triennial CBE screening failed to demonstrate any mortality benefit despite achieving a shift toward earlier stage at detection and improved survival in the intervention arm. CBE is a valuable tool for diagnosis of breast cancer in symptomatic women especially in areas where mammography and/or breast cancer screening programs are not widely available.

Factors associated with the uptake of clinical breast examination among women of reproductive age in Lesotho: analysis of a national survey.

BACKGROUND: In low-resource settings with weak health systems, the WHO recommends clinical breast examination (CBE) as the most cost-effective breast screening modality for women. Evidence shows that biennial CBE leads to significant downstaging of breast cancer in all women. Breast cancer is the second most common cancer among women in Lesotho with a weaker healthcare system and a low breast cancer screening rate. This study investigated the prevalence and factors associated with the uptake of CBE among women of reproductive age in Lesotho. METHODS: This study used cross-sectional data from the 2014 Lesotho Demographic and Health Survey. A sample of 6584 reproductive-age women was included in this study. We conducted both descriptive and multivariable logistic regression analyses. The study results were presented in frequencies, percentages, and adjusted odds ratios (aOR) with their corresponding confidence intervals (CIs). RESULTS: The prevalence of CBE uptake was 9.73% (95% CI: 8.91, 10.61). Women who were covered by health insurance (aOR = 2.31, 95% CI [1.37, 3.88]), those who were pregnant (aOR = 2.34, 95% CI [1.64, 3.35]), those who had one to three children (aOR = 1.81, 95% CI [1.29,2.52]), and women who frequently read newspapers or magazines (aOR = 1.33, 95% CI [1.02,1.72]) were more likely to undergo CBE than their counterparts. Women who were aware of breast cancer (aOR = 2.54, 95% CI [1.63,3.97]), those who have ever had breast self-examination (BSE) within the last 12 months prior to the study (aOR = 5.30, 95% CI [4.35,6.46]), and those who visited the health facility in the last 12 months prior to the study (aOR = 1.57, 95% CI [1.27,1.95]) were also more likely to undergo CBE than their counterparts. Women residing in the Qacha's-nek region (aOR = 0.42, 95% CI [0.26,0.67]) were less likely to undergo CBE than those in the Botha-bothe region. CONCLUSION: The study found a low prevalence of CBE uptake among reproductive-age women in Lesotho. Factors associated with CBE uptake include health insurance coverage, being pregnant, those who had one to three children, exposure to media, breast cancer awareness, ever had BSE, and those who visited a health facility. To increase CBE uptake, these factors should be considered when designing cancer screening interventions and policies in order to help reduce the burden of breast cancer in Lesotho.

Effectiveness of breast cancer screening interventions in improving screening rates and preventive activities in Muslim refugee and immigrant women: A systematic review and meta-analysis.

PURPOSE: To systematically assess the effectiveness of breast cancer (BC) interventions in improving breast self-examination (BSE), clinical breast examination (CBE), mammogram screening rates, and preventive activities in Muslim refugee and immigrant women. DESIGN: Guided by the Health Belief Model, a mixed method systematic review and meta-analysis was performed using a sequential design. METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA), the Critical Appraisal Skill Program Checklists, and the Joanna Briggs Institute (JBI) methodology for systematic review and meta-analysis. A systematic search of English-language peer-reviewed articles was undertaken in multiple health and social sciences databases from January 1, 2015, to March 31, 2022. Randomized clinical trials and quasi-experimental studies focused on the uptake of BSE, CBE, and mammograms were selected. RESULTS: Fourteen articles were included in the review. Most of the studies relied on quasi-experimental designs and were carried out in the United States of America. The qualitative analysis of BC screening interventions generated three themes: (1) education, (2) access-focused, and (3) cultural and faith-based. The meta-analysis included three randomized control trials and two quasi-experimental studies. The meta-analysis demonstrates the effectiveness of community-led cultural and faith-based interventions in facilitating the completion of CBE and mammography screening. Education on BC and patient navigator interventions are more effectively used in conjunction than standalone interventions, yet community-based cultural and faith-based interventions are the most effective. CONCLUSION: This systematic and meta-analysis review provides evidence on the effectiveness of access-focused and cultural and faith-based interventions in improving BC screening in Muslim refugee and immigrant women. Future research should focus on designing and measuring the effectiveness of cultural and faith-based interventions to increase Muslim refugee and immigrant women's BC screening knowledge and practices. CLINICAL RELEVANCE: This systematic and meta-analysis review demonstrates the need to explore Muslim refugee and immigrant women's cultural contexts for developing culturally sensitive BC screening interventions. Knowledge and practice of BC and religiosity intersect with financial, geographic, and linguistic barriers to decrease participation in screening and preventive activities in Muslim refugee and immigrant women.

Women's health beliefs and uptake of breast cancer screening in Malaysia.

OBJECTIVES: This study investigated women's health beliefs, the use of breast cancer (BC) screening services, and the factors that potentially influence uptake of screening. METHODS: Face-to-face interviews were conducted with a randomly selected community sample of 992 women (>40 years old) in Selangor State, Malaysia. RESULTS: Approximately 35% of women received a clinical breast examination (CBE) and 27% had a mammogram within the last 1 to 2 years. The regression analyses indicated that Chinese ethnicity has higher perceived susceptibility to BC compared to Malay ethnicity (mean 7.74, SD: 2.75; 95% CI 0.09, 1.03) whilst a lower perceived susceptibility was observed in women aged ≥70 years (mean 6.67, SD: 3.01; 95% CI -1.66, -0.24) compared to women aged 40-49 years. Indian Malaysian women (mean 16.87, SD: 2.59; 95% CI 0.12, 1.01) and women who had received a CBE (mean 16.10, SD:2.35; 95% CI 0.18, 0.89) were more likely to have higher perceived benefits scoring. Indian ethnicity, secondary education and tertiary education, top 20% income group, past history of CBE and mammogram uptake were significantly associated with lower barriers scoring. CONCLUSIONS: There is a need to target BC screening uptake improvement programmes towards communities in which women experience disadvantages related to income, education, employment, and, in particular, to tailor programmes to take into consideration differences between ethnic groups regarding their beliefs about cancer screening.

Learning the breast examination with Physical Exam Teaching Associates: development and evaluation of the teaching setup. An action research approach.

Learning how to perform the clinical breast examination (CBE) as an undergraduate medical student is an important though complex activity, due to its intimate nature. A Physical Exam Teaching Associate (PETA) - based teaching session addresses this issue and is well founded in literature, though detailed information regarding its development is missing. In this study, we address this gap by providing a comprehensive description of the design and development of a PETA-based session for teaching the CBE. A qualitative study according to the principles of action research was done in order to develop the teaching session, using questionnaires and focus groups to explore participants' experience. PETAs were recruited, trained and deployed for teaching the CBE to medical students in a small-scale, consultation-like setup. Next, the session was evaluated by participants. This sequence of actions was carried out twice, with evaluation of the first teaching cycle leading to adjustments of the second cycle. Students greatly appreciated the teaching setup as well as the PETAs' immediate feedback, professionalism, knowledge and attitude. In this study, we successfully designed a PETA-based session for teaching the CBE to undergraduate medical students. We recommend using this strategy for teaching the CBE.

Breast cancer screening practices and associated factors among Chinese-Australian women living in Sydney: A cross-sectional survey study.

This study aimed to investigate breast cancer screening practices and associated factors among Chinese-Australian women. A cross-sectional quantitative survey method including convenience and snowball sampling was used to recruit 115 Chinese-Australian women living in Sydney, using a self-administered survey. In all, 69.8% of participants reported recent clinical breast examinations and 73.3% had mammograms. Age, religion, employment status, and length of residence were associated with having a clinical breast examination. Income was related to having a mammogram. Associations between knowledge of breast cancer, cancer-related beliefs, and screening participation were found. Length of residence in Australia was the strongest predictor of having a clinical breast examination and mammogram. The most common barrier to mammography was if women felt that doctors did not recommend it to them. Chinese-Australian women need to be educated about awareness of their usual breast health to be aware of any changes, especially if women are not eligible for mammography or have difficulty in accessing health services. Tailored programs, improving screening experiences, and minimizing perceived barriers are needed to promote early detection of breast cancer among Chinese-Australian women.

[Current status of breast cancer undetected by mammography in population-based breast cancer screening and associated factors].

Objective　This study aimed to promote the application of mammography (MMG) screening without performing a clinical breast examination (CBE). It examined population-based screening data, including history taking findings, to elucidate the status of breast cancer cases, detected solely by CBE, and to reveal the factors associated with breast cancer. Through this, it explored alternative methods for evaluating breast cancer cases, undetected by MMG, when CBE is omitted.Methods　The linked anonymized data from women, who underwent breast cancer screening in 2014, 2016, or 2017, were prepared. The data were obtained from the Nishinomiya City database. Breast cancer, undetected by MMG, were defined as breast cancer cases diagnosed by close examination based on CBE only (MMG findings were category 2 or lower, with no abnormalities). To assess the quality of breast cancer screening, process indices were calculated for the overall population, and for patients indicated for close examination based on CBE but not MMG. The association of breast cancer with each factor was statistically analyzed (χ2 test, etc.).Results　In total, 13,504 women underwent breast cancer screening. Close examination was required in 1,247 women (9.2%). Breast cancer was diagnosed in 44 women (3.5%), including four, who had breast cancer undetected by MMG. All of the process indices satisfied the acceptable values. Three of the four women with breast cancer, undetected by MMG, noticed a lump. Breast cancer was significantly associated with "subjective symptoms". The presence of a "lump" and "nipple discharge" were significantly more common in breast cancer patients.Conclusion　Three of the four breast cancer cases, undetected by MMG screening, had a subjective symptom (lump). There was a significant association between subjective symptoms (lump and nipple discharge) and breast cancer. To avoid missing breast cancer, undetected by MMG alone, these symptoms should be especially evaluated in women to compensate for the omission of a CBE. This can be achieved by encouraging women experiencing symptoms to seek consult, performing a thorough history-taking and observation, engaging in multidisciplinary collaboration (communication from medical staff to physicians), and promoting breast awareness.

"Dial of a Clock" Search Pattern for Clinical Breast Examination.

BACKGROUND: Clinical breast examination (CBE) is an integral component of triple assessment for women presenting with symptomatic breast disease. Four common search patterns of CBE are "dial of a clock" (DC), "vertical strips" (VS), "quadrant-wise" (QW), and "concentric circles" (CC). The most sensitive search pattern of CBE has not been established. METHODS: A cross-sectional study was conducted on women with symptomatic breast disease, to measure various diagnostic performance indices of four different search patterns of CBE by a professor, a surgical resident trainee, and a trained nurse. Women were examined one at a time randomly by three examiners. Each examiner examined with four different search patterns of CBE, one method at a time. Any nodularity or lump detected was noted and the findings were compared with breast sonography, which was considered as the gold standard. Statistical analysis was done using STATA 14, SPSS 20, and OpenEpi software for diagnostic test indices. RESULTS: Sixty women (mean age = 39.6) with palpable findings of both breasts were included (n = 120). Most women presented with complaints of breast lump (70%) and mastalgia (27%). Sensitivity was highest for DC as elaborated [% (95% confidence interval)]: DC[73.2 (60-83)] > CC[66 (53-77)] > VS[62.5 (49-73)] > QW[58.9 (45-70)] for professor; DC[64.2 (51-75)] > VS[62.5 (49-73)] > CC[57.1 (44-69)] > QW[57.1 (44-69)] for resident; and DC[82.1 (70- 90)] > VS[78.5 (66-87)] > CC(75 (62-84)] > QW[73.2 (60-83)] for nurse. The minimum sonographic tumor size picked up by DC by all the examiners was 7 mm. CONCLUSIONS: The DC search pattern of CBE demonstrated the highest sensitivity for all the examiners. The trained nurse achieved the highest sensitivity among all the examiners.

Health Beliefs and Breast Cancer Screening Practices Among African American Women in California.

BACKGROUND: African American women continue to have higher mortality rates of breast cancer when compared to other women, and evidence suggests that early detection of breast cancer can lead to favorable outcomes, yet there remains a paucity of literature about health beliefs and the utilization of three screening practices, namely breast self-examination, clinical breast examination and mammography in California, a state that currently has one of the highest breast cancer mortality rates among African American women. PURPOSE: To investigate the relationship between health beliefs and three breast cancer detection practices, e.g. breast self-examination, clinical breast examination, and mammography in a cohort of African American women. METHODS: Using a descriptive correlational design, a convenience sample of two hundred and eighty-two (n = 282) self-identified women from six regional chapters of a national Black women's political organization in California, completed a Demographic Data Questionnaire and Champion's Health Belief Model Scale which assessed the hypothesized relationships of health beliefs and breast cancer detection practices. RESULTS: Among this culturally diverse group of women (49.8% American, 28.8% African, 21.4% West Indian), health motivation was positively related to the practice of BSE and annual physician visitation for clinical breast examinations. Health locus of control was positively related to the practice of BSE. Having relatives and friends who were diagnosed with breast cancer was strongly associated with having a mammogram and annual physician visitation for clinical breast examinations. CONCLUSION: These findings may be used to target and develop interventions that are tailored to the unique characteristics of these diverse women.

The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource-Stratified Phased Implementation: Methods and overview.

BACKGROUND: The Breast Health Global Initiative (BHGI) established a series of resource-stratified, evidence-based guidelines to address breast cancer control in the context of available resources. Here, the authors describe methodologies and health system prerequisites to support the translation and implementation of these guidelines into practice. METHODS: In October 2018, the BHGI convened the Sixth Global Summit on Improving Breast Healthcare Through Resource-Stratified Phased Implementation. The purpose of the summit was to define a stepwise methodology (phased implementation) for guiding the translation of resource-appropriate breast cancer control guidelines into real-world practice. Three expert consensus panels developed stepwise, resource-appropriate recommendations for implementing these guidelines in low-income and middle-income countries as well as underserved communities in high-income countries. Each panel focused on 1 of 3 specific aspects of breast cancer care: 1) early detection, 2) treatment, and 3) health system strengthening. RESULTS: Key findings from the summit and subsequent article preparation included the identification of phased-implementation prerequisites that were explored during consensus debates. These core issues and concepts are key components for implementing breast health care that consider real-world resource constraints. Communication and engagement across all levels of care is vital to any effectively operating health care system, including effective communication with ministries of health and of finance, to demonstrate needs, outcomes, and cost benefits. CONCLUSIONS: Underserved communities at all economic levels require effective strategies to deploy scarce resources to ensure access to timely, effective, and affordable health care. Systematically strategic approaches translating guidelines into practice are needed to build health system capacity to meet the current and anticipated global breast cancer burden.

Effectiveness of clinical breast examination as a 'stand-alone' screening modality: an overview of systematic reviews.

BACKGROUND: There is uncertainty about the effectiveness of clinical breast examination (CBE) and conflicting recommendations regarding its usefulness as a screening tool for breast cancer. This paper provides an overview of systematic reviews that assessed the effectiveness of CBE as a 'stand-alone' screening modality for breast cancer compared to no screening and focused on its value in low- and middle-income countries (LMICs). METHODS: We searched MEDLINE, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews for systematic reviews reporting the effectiveness of CBE published prior to October 29, 2019. The main outcomes assessed were mortality and down staging. The AMSTAR 2 checklist was used to assess the methodological quality of the reviews including risk of bias. RESULTS: Eleven systematic reviews published between 1993 and 2019 were identified. There was no direct evidence that CBE reduced breast cancer mortality. Indirect evidence suggested that a well-performed CBE achieved the same effect as mammography regarding mortality despite its apparently lower sensitivity (40-69% for CBE vs 77-95% for mammography). Greater sensitivity was recorded among younger and Asian women. Moreover, CBE contributed between 17 and 47% of the shift from advanced to early stage cancer. CONCLUSIONS: CBE merits attention from health system and service planners in LMICs where a national screening programme based on mammography would be prohibitively expensive. In particular, it is likely that considerable value would be gained from conducting implementation scientific research in countries with large numbers of Asian women and/or where younger women are at higher risk. REGISTRATION: PROSPERO, registration number CRD42019126798 .

Determinants of screening methods utilization among Iraq/Sulaimani women.

PURPOSE: This study aims to find out the participation rate of women in the utilization of screening methods to determine the relationship of sociodemographic health characteristics and breast cancer (BC) awareness with the utilization of screening methods. The authors' study aims to examine the relationship between women's belief and the utilization of screening methods. DESIGN/METHODOLOGY/APPROACH: A cross-sectional study was conducted in three health centers from December 13, 2016 to June 12, 2017. A questionnaire was constructed for data collection about sociodemographic characteristics, screening awareness and medical and health background variables. Additionally, BC awareness measure and champion health belief model scales were used to measure women's perceptiveness about BC. FINDINGS: Despite the awareness among 78.9% of women regarding clinical breast examination (CBE) as a screening method, only 9.5% women utilized it for screening. Due to prescription by physicians for diagnosis of BC, 23.6% women had done mammography at least once in their life. Having jobs and a good education significantly influenced the utilization of CBE as a screening method. The logistic regression analysis found that old age, family history of BC, good knowledge about BC, perceived susceptibility, low rate of perceived barriers to mammography and CBE predicted participation in screening. ORIGINALITY/VALUE: Enhancing knowledge about BC and screening, emphasizing the susceptibility to BC and the benefits of screening will help in better participation. Importance should be given to illiterate and unemployed women.

Improving the competency of medical students in clinical breast examination through a standardized simulation and multimedia-based curriculum.

PURPOSE: Clinical breast examination (CBE) is an important step in the assessment of patients with breast-related complaints. We developed a standardized simulation and multimedia-based (SSMBI) curriculum using current evidenced-based recommendations. This study aimed to determine if SSMBI training resulted in better performance (examination scores and detection of abnormal findings) than the traditional teaching method. METHODS: Novice fourth-year medical students were exposed to the SSMBI curriculum (n = 68) or traditional (n = 52) training. The traditional group was taught by a lecture and attending weekly clinics where they had hands-on experience. The SSMBI group underwent a structured lecture followed by an instructional video and dedicated simulated teaching. Both groups were assessed through a written knowledge exam and an objective structured clinical examination (OSCE). Student's t test and χ2 tests were used to assess differences in CBE technique and knoweldge. RESULTS: Students who underwent SSMBI training had significantly higher numbers of correct answers describing the different steps and justifications of CBE. OSCE performance was significantly higher in the SSMBI group. SSMBI-trained students were more likely to complete all the necessary CBE steps compared to traditionally-trained students (88.2% vs. 28.2%, p < 0.00001). The SSMBI group was also more systematic and more likely to perform adequate inspection, palpation, examination of the nipple-areolar complex, and identify and characterize a palpable lesion (p < 0.05). CONCLUSIONS: Formal SSMBI training is an important asset when teaching medical students how to perform a CBE. Real clinical experience is still necessary to refine this skill and the physician-patient interaction.

Improving early detection of breast cancer in sub-Saharan Africa: why mammography may not be the way forward.

BACKGROUND AND METHODS: The prevention and control of breast cancer in sub-Saharan Africa (SSA) is an increasingly critical public health issue. Breast cancer is the most frequent female cancer in SSA and mortality rates from this disease are the highest globally. Breast cancer has traditionally been considered a disease of high-income countries, and programs for early detection have been developed and implemented in these settings. However, screening programs for breast cancer in SSA have been less effective than in high-income countries. This article reviews the literature on breast cancer in SSA, focusing on early detection practices. It then examines the case for and against mammography and other early detection approaches for breast cancer in SSA. RESULTS: Women with breast cancer in SSA are younger compared with high-income countries. Most women present with advanced disease and because treatment options are limited, have poor prognoses. Delay between symptom onset and healthcare seeking is common. Engagement with early detection practices such as mammography and breast examination is low and contributes to late stage at diagnosis. DISCUSSION: While early detection of breast cancer through screening has contributed to important reductions in mortality in many high-income countries, most countries in SSA have not been able to implement and sustain screening programs due to financial, logistical and sociocultural constraints. Mammography is widely used in high-income countries but has several limitations in SSA and is likely to have a higher harm-to-benefit ratio. Breast self-examination and clinical breast examination are alternative early detection methods which are more widely used by women in SSA compared with mammography, and are less resource intensive. An alternative approach to breast cancer screening programs for SSA is clinical downstaging, where the focus is on detecting breast cancer earlier in symptomatic women. Evidence demonstrates effectiveness of clinical downstaging among women presenting with late stage disease. CONCLUSIONS: Approaches for early detection of breast cancer in SSA need to be context-specific. While screening programs with mammography have been effective in high-income countries, evidence suggests that other strategies might be equally important in reducing mortality from breast cancer, particularly in low-resource settings. There is a strong argument for further research into the feasability and acceptability of clinical downstaging for the control of breast cancer in SSA.

Knowledge, attitudes, and practices related to breast cancer screening among female health care professionals: a cross sectional study.

BACKGROUND: Incidence of breast cancer in the Kingdom of Saudi Arabia (KSA) has increased in recent years. Screening helps in early detection of cancer and early diagnosis and timely treatment of breast cancer lead to a better prognosis. Women in the healthcare profession can have a positive impact on the attitudes, beliefs, and practices of general public. Therefore, it is important that the healthcare workers themselves have adequate knowledge and positive attitudes. We conducted a study to assess the knowledge, attitudes, and practices related to breast cancer screening among female healthcare professionals. METHODS: A cross-sectional study was conducted on female health professional of KFMC (King Fahad Medical City). Data was collected using a pre-designed, tested, self-administered questionnaire. The questionnaire included specific sections to test the participants' knowledge, attitude, and practices related to cervical cancer and its screening. Data analysis was done using descriptive statistics. RESULTS: A total of 395 health care workers participated in this study. The mean age of the participants was 34.7 years. Participants included physicians (n = 63, 16.0%), nurses (n = 261, 66.1%), and allied health workers (n = 71, 18.0%). Only 6 (1.5%) participants had a good level of knowledge of breast cancer and 104 (26.8%) participants demonstrated a fair level of knowledge. Overall, 370 (93.7%), 339 (85.8%), and 368 (93.2%) participants had heard of breast self-examination, clinical breast examination, and mammography, respectively. A total of 295 (74.7%) participants reported practicing breast self-examination, 95 (24.1%) had undergone clinical breast examination, and 74 (18.7%) had ever undergone mammography. CONCLUSION: The knowledge, attitudes, and practices related to breast cancer screening were found to be lower than expected. Active steps are required to develop educational programs for the health care staff, which might empower them to spread the knowledge and positively influence the attitudes of female patients in the hospital.

Hispanic Men and Women's Knowledge, Beliefs, Perceived Susceptibility, and Barriers to Clinical Breast Examination and Mammography Practices in South Texas Colonias.

Breast cancer is the second leading cause of cancer death among women of all ethnicities. Though the disease is not a primary concern within male populations male perceptions and beliefs of breast cancer screening may contribute to a partner's or loved one's decision to engage in regular mammograms or clinical breast examinations. The current study seeks to explore a comparative analysis of breast cancer knowledge, beliefs, susceptibility, and barriers to female breast cancer and breast cancer screening among Hispanic men and women residing in the Colonias of South Texas. Using a multistage systematic sampling design, 2,812 men and women were surveyed from the two South Texas Counties; Maverick and Val Verde. Individuals between the ages of 20 and 75 (n = 2360) were included in the analysis. T-tests and linear regression models were used to examine gender differences in, knowledge, beliefs, susceptibility, and barriers to breast cancer and breast cancer screening. Significant differences were found between males and females across all measures. Regression analysis demonstrates Hispanic women hold more favorable beliefs about breast cancer and early detection, display higher perceived barriers to clinical breast examinations and mammography, and view themselves more susceptible to the development of breast cancer than their male counterparts. Results framed within a cultural context suggest outreach efforts within South Texas Colonias should consider inclusion of male family members in efforts to increase favorable views toward and engagement in regular breast cancer screening.