Recognising socio-cultural barriers while seeking early detection services for breast cancer: a study from a Universal Health Coverage setting in India.

BACKGROUND: Breast cancer is the commonest cancer among women in India, yet the uptake of early detection programs is poor. This leads to late presentation, advanced stage at the time of diagnosis, and high mortality. Poor accessibility and affordability are the most commonly cited barriers to screening: we analyse socio-cultural factors influencing the uptake of early detection programmes in a Universal Health Coverage (UHC) setting in India, where geographical and financial barriers were mitigated. METHODS: Two hundred seventy-two women engaging in an awareness-based early detection program were recruited by randomization as the participant (P) group. A further 272 women who did not participate in the early detection programme were recruited as non-participants (NP). None of the groups were previously screened for breast cancer. Interviews were conducted using a 19-point questionnaire, consisting of closed-ended questions regarding demographics and social, cultural, spiritual and trust-related barriers. RESULTS: The overall awareness about breast cancer was high among both groups. None of the groups reported accessibility-related barriers. Participants were more educated (58.09% vs 47.43%, p = 0.02) and belonged to nuclear families (83.59% vs 76.75%, p = 0.05). Although they reported more fear of isolation due to stigma (25% vs 14%, p = 0.001), they had greater knowledge about breast cancer and trust in the health system compared to non-participants. CONCLUSIONS: The major socio-cultural barriers identified were joint family setups, lower education and awareness, and lack of trust in healthcare professionals. As more countries progress towards UHC, recognising socio-cultural barriers to seeking breast health services is essential in order to formulate context-specific solutions to increase the uptake of early detection and screening services.

Concerns and coping mechanisms of breast cancer survivor women from Asia: a scoping review.

PURPOSE: The incidence of breast cancer has increased significantly in Asia due to epidemiological transition and changes in human development indices. Advancement in medical technology has improved prognosis with a resultant increase in survivorship issues. The effects of breast cancer diagnosis and treatment are influenced by the patient's cultural beliefs and social systems. This scoping review aims to summarise concerns and coping mechanisms of women with breast cancer in Asia and understand gaps in the existing literature. METHODS: We performed a scoping review using the population-concept-context strategy. A systematic search of MEDLINE (PubMed, Web of Science), CINAHL, SCOPUS, and Embase was conducted for studies conducted in Asia on women diagnosed with breast cancer, identifying their concerns and coping mechanisms, published between January 2011 and January 2021. Data from included studies were reported using frequencies and percentages. RESULTS: We included 163 studies, of which most (81%) were conducted in hospital settings. Emotional and psychological concerns were reported in 80% of studies, followed by physical appearance and body-image concerns in 46%. Social support (59%), emotion-based coping (46%), spirituality, and problem-based coping (37%) were the major coping systems documented. CONCLUSION: The mapped literature documented that anxiety, depression, and fear of cancer recurrence dominated women's emotional concerns. Women coped with the help of social support, positive reappraisal, and faith in God and religion. Sensitization of caregivers, including healthcare professionals and family members, to context-specific concerns and inquiry into the patients' available support systems is essential in strengthening breast cancer women's recovery and coping.

Cancer epidemiology literature from India: Does it reflect the reality?

BACKGROUND: The alarming escalation of cancers over infectious diseases in the lower and middle-income countries warrants a better understanding of this epidemiological transition. The epidemiology of cancers in India is sparsely addressed in the literature. Hence, in this manuscript, we present the review done, on research manuscripts, addressing cancer incidence, trends and risk factors from India over the last 12 years. Studies addressing screening, treatment and clinical trials were excluded. METHODS: We evaluated the studies for the theme addressed, study design, sample size, the region of origin and whether it was population or hospital-based study. RESULTS: The studies highlighted a significant shortage of multicenter population-based data in the incidence and risk factors associated with various malignancies in India. Further, we also observed that there was a relative lack of information from the northern and northeastern parts of India. The reviewed articles also indicated the need for a robust design for the studies, large sample size and uniformity in reporting incidence for appropriately drawing conclusions from a study. Reporting of country-specific risk factors with their geographical variations was also sparse. CONCLUSION: Overall, the cancer epidemiology literature from India is sparse. More studies with robust designs representing all parts of the country are currently needed.

Quantification of Invadopodia Formation and Matrix Degradation Activity.

Cancer cells possess a remarkable capacity to dissociate from a primary tumor, invade the surrounding tissues and vasculature, and eventually form metastases in distant organs. This complex and multistep process remains one of the major causes of mortality in cancer patients worldwide. Multiple studies have highlighted the role of actin-rich structures called invadopodia ("invasive feet"), which adhere to the matrix, contain and secrete matrix-degrading proteinases, and apply protrusive forces generated by the actin cytoskeleton, which drive the invasive process. Here, we describe a fluorescent microscopy-based protocol for imaging and quantifying both invadopodia formation and matrix degradation.

Deciphering the involvement of the Hippo pathway co-regulators, YAP/TAZ in invadopodia formation and matrix degradation.

Invadopodia are adhesive, actin-rich protrusions formed by metastatic cancer cells that degrade the extracellular matrix and facilitate invasion. They support the metastatic cascade by a spatially and temporally coordinated process whereby invading cells bind to the matrix, degrade it by specific metalloproteinases, and mechanically penetrate diverse tissue barriers by forming actin-rich extensions. However, despite the apparent involvement of invadopodia in the metastatic process, the molecular mechanisms that regulate invadopodia formation and function are still largely unclear. In this study, we have explored the involvement of the key Hippo pathway co-regulators, namely YAP, and TAZ, in invadopodia formation and matrix degradation. Toward that goal, we tested the effect of depletion of YAP, TAZ, or both on invadopodia formation and activity in multiple human cancer cell lines. We report that the knockdown of YAP and TAZ or their inhibition by verteporfin induces a significant elevation in matrix degradation and invadopodia formation in several cancer cell lines. Conversely, overexpression of these proteins strongly suppresses invadopodia formation and matrix degradation. Proteomic and transcriptomic profiling of MDA-MB-231 cells, following co-knockdown of YAP and TAZ, revealed a significant change in the levels of key invadopodia-associated proteins, including the crucial proteins Tks5 and MT1-MMP (MMP14). Collectively, our findings show that YAP and TAZ act as negative regulators of invadopodia formation in diverse cancer lines, most likely by reducing the levels of essential invadopodia components. Dissecting the molecular mechanisms of invadopodia formation in cancer invasion may eventually reveal novel targets for therapeutic applications against invasive cancer.