bluuebunny/crossref_metadata_2025_split huggingface dataset:
Training to Improve the Quality of Early Detection of Breast Cancer in Low-Resource Settings
Authors: Bain Carolyn , Butrón Maria Teresa Núñez , Castillo Vanesa , Larios Wilfredo , Tsu Vivien , Balassaninan Ron 
Published: October 2018

Purpose Breast cancer (BC) is the most common cancer among women in Latin America, yet many countries lack the capacity to provide early detection and diagnostic services. In Peru, mammograms are not readily available in secondary cities, and 57% of women who are diagnosed with BC are diagnosed with stage III and IV disease. To bring services to women in a northern region of Peru, PATH collaborated with Peruvian health institutions at the local, regional, and national levels to design and implement a strategic algorithm with which to increase the early detection of BC in the absence of mammography. Here, we evaluate the impact of training on the quality of clinical breast exam (CBE), ultrasound triage, and fine-needle aspiration (FNA) sampling and the reading of FNA biopsy for triage-positive women. Methods Two hundred twenty-four midwives and 15 doctors were included in two-step training in Trujillo, Peru. CBE trainings were performed using anatomic models and patient exams in 2-day sessions. Team discussion with trainers was used to improve skills. Doctors’ trainings for FNA sampling were led by two international expert pathologists in 2014 and by a Peruvian expert pathologist in 2016. Then in 2017, 43 pretraining and 50 post-training FNA biopsy samples were evaluated for adequacy and quality of diagnosis. Results Since the trainings, 14,223 women have received CBE on an opportunistic basis. Midwives refer abnormal cases (n = 281) for follow-up. All doctors felt well trained for CBE and FNA, whereas five of 15 doctors perceived the need for additional ultrasound training. Quality assessment revealed that the adequacy of FNA samples improved from 26% pretraining to 37% post-training. Of the 43 FNA samples, a low concordance with reviewers was observed in the detection of suspicious/carcinoma (6.9% v 13.9%), whereas full concordance was observed after the training, although the numbers were small. Conclusion In Peru, CBE remains an acceptable and feasible approach if complemented with ultrasound triage and FNA biopsy. Additional efforts are needed to increase coverage through a structured program. Training and continuous monitoring are essential for quality assurance. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Ronald Balassanian Stock or Other Ownership: Cerus Corp ($400.00)
Improving Access and Adherence to Endocrine Therapy With Nurse-Based Intervention
Authors: Getachew Sefonias , Addisse Adamu , Taylor Lesley , Kantelhardt Eva J. 
Published: October 2018

Purpose The majority of women with breast cancer from low-income countries, including Ethiopia, present with advanced clinical stage disease, which results in limited and difficult therapeutic options and high mortality rates. In Ethiopia, breast cancer is the most common cancer. We found that 70% of breast cancer cases in Ethiopia are hormone receptor positive. Endocrine therapy is one of the treatment options recommended for breast cancer but that is highly underutilized in the country. Recommendations on interventions to improve uptake and adherence to therapy exist, but studies that have assessed the feasibility of implementing these are limited. Our study (n = 107) in rural Ethiopia revealed an estimated 53% 2-year survival rate in patients who underwent surgery only. In our pilot study, of 51 eligible patients 26 initiated therapy and one half of those adhered after 1 year. Our study aims to evaluate the effectiveness of using a trained breast nurse navigator to improve patient adherence to tamoxifen therapy among patients with breast cancer in rural Ethiopia. Methods A cluster randomized intervention trial is being carried out in rural hospitals in southwestern Ethiopia from February 2018 to June 2019. We use hospitals in clusters as the units of randomization. The sample size includes four per intervention arm and control arm, with each cluster comprised of approximately 15 patients. Before intervention, all patients in the hospitals will receive tamoxifen therapy free of charge. Hormone receptor status of the breast cancer specimen will be determined before the initiation of therapy or throughout the course of therapy. The primary outcome of this trial is adherence to endocrine therapy on the basis of objective and subjective measures. Data will be collected with a prospective repeated measures approach. Analysis will be based on an intention-to-treat principle. Results The trial aims to provide evidence on the effectiveness of the breast nurse intervention to improve adherence to long-term endocrine therapy and answer the following research question: does the nursing intervention improve long-term treatment adherence by patients to endocrine therapy compared with those who receive usual care services? Conclusion These data are essential to maximize the impact of trained nurse-based interventions on adherence to endocrine (tamoxifen) therapy among patients with breast cancer on follow-up. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Eva J. Kantelhardt Travel, Accommodations, Expenses: Daiichi Sankyo Oncology Europe
Subtype of Breast Cancer in Lao People’s Democratic Republic: A Study in a Limited-Resource Setting
Authors: Luangxay Thitsamay , Virachith Siriphone 
Published: October 2018

Purpose Three main treatment markers—estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) —are not routinely tested as a result of a lack of infrastructure of health care facilities. Quality control with which to validate these tests is also not available, and patients or their families have to pay for additional examination cost. Without hormonal receptor and HER2 status, treatment decisions are based on clinical finding; therefore, it is almost impossible to select patients who will benefit from therapy. Currently, none of the related research has ever been published in Lao People’s Democratic Republic. Methods From 2013 to 2016, formalin-fixed, paraffin embedded tissue blocks of 76 patients with primary breast cancer were retrieved at the University of Health Sciences (Vientiane, Lao People’s Democratic Republic). Patient information and previous histologic reports were reviewed. Immunohistochemistry was performed using antibodies against estrogen receptor, progesterone receptor, HER2/neu, and the protein encoded by the MKI67 gene (MIB-I). Results Mean age of patients was 49 years, with a majority of histologic type of invasive ductal carcinoma, not otherwise specified (90.7%). Proportions of each subtype were as follows: hormone receptor positive and HER2 negative, 44.7%; hormone receptor positive and HER2 positive, 3.9%; hormone receptor negative and HER2 positive,13.2%; and triple negative, 38.2%. Of patients, 40.8% were estrogen receptor positive and 47.4% were progesterone receptor positive. More than one half had poorly differentiated cancer (65.8%), followed by moderately differentiated cancer (34.2%). Tumors presented with pT2 (60.5%), followed by pT3 (25.0%) and pT4 (7.9%). Conclusion Breast cancer among Lao women is characterized by a large percentage of the triple-negative subtype as well as by being less susceptible to hormonal receptors. Most of our patients presented with locally advanced stage. HER2-positive and triple-negative breast cancer must be further investigated. To provide adequate care, basic pathology services should be the first requirement in Lao People’s Democratic Republic. Our findings could provide fundamental, useful data for a national policy to control breast cancer in the future. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.
Student Midwives’ Perspective on Improving Early Diagnosis in Breast Cancer During Antenatal Care
Authors: Mella Judy 
Published: October 2018

Purpose The incidence of breast cancer in Uganda is estimated at approximately 32.3 per 100,000, with a 5-year survival rate of 56%. Breast cancers present later and have a higher incidence in patients in the child-bearing age group compared with those in high-income countries. Uganda has an ongoing program to train degree-level midwives for extended midwifery roles that are exclusive to practice in Uganda. These midwives are highly motivated and have intimate local knowledge and effective access to the female population with the highest incidence of breast cancers. This work assesses their views on the key reasons women present so late and ideas for system-strengthening measures that will target these reasons, effectively combining antenatal care with breast lump education and diagnosis. Methods Midwifery students in years at Lira University were invited to fill out a questionnaire—with two open and seven structured questions—that was handed out at the ends of lectures and collected the next day. Results One hundred fifty-three questionnaires were returned. In the open question, midwifery students indicated overwhelmingly that the main reason women present late is ignorance. Finance was perceived to be the second factor. Analysis of the stratified question demonstrated that, even with knowledge of breast cancer, women would still be likely to think that a breast lump does not matter, and this factor scored higher than finances, culture, or access to health care. Of respondents, 73% felt that a facility for diagnosis in the community would definitely help women come for treatment. As midwives, 94% would definitely refer a breast lump to a specialist breast clinic if one was available, and on a background of limited health care funding, 90% still felt that time and money should be prioritized toward breast cancer education diagnosis and treatment because of its impact on the community. Conclusion Community midwives are well placed to educate women on breast care in antenatal clinics. This questionnaire demonstrates their perspective on the overriding significance of educating the child-bearing population about breast lumps in addition to cancer education. Therefore, breast lump examination and diagnosis is being taught to the students, community diagnostic facilities are being developed alongside antenatal care (ultrasound and cytology), and a breast lump referral clinic is planned for the new hospital. AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the author.
Impact of a Targeted Free Mammography Screening Program for Underprivileged Women in Malaysia
Authors: Nair Viji , Nazri Viji Dina , Lau Angela , Hashim Rozita , Ratnasingham Clare , Munisamy Murallitharan 
Published: October 2018

Purpose Breast cancer remains the most prevalent cancer among Malaysians today. Almost two thirds of patients are diagnosed in the late stages of disease, stage III to IV, with poorer outcomes. In addition, evidence has also revealed that most of patients who present in these late stages are those from poorer socioeconomic backgrounds. Women from underprivileged backgrounds have been found to have poorer health-seeking behavior, especially in terms of screening for cancer. This is for a number of reasons, such as affordability, distance to health centers, and other socioeconomic factors, which have a large impact, as Malaysia only offers opportunistic screening for breast cancer and not for free. A specific program to provide free mammography screening targeted toward underprivileged Malaysian women was planned and implemented with the aim of improving access to screening and increasing the rate of screening among this specific group of women. Methods Funding for the program was obtained from successful negotiation with a large Malaysian life insurance carrier. To ensure geographic equity, screening services were strategically purchased from 15 hospitals that were spread out across Malaysia. We also built partnerships with various nongovernmental organizations working in the social arena servicing underprivileged groups to reach these groups specifically. The nongovernmental organizations co-organized awareness programs and screening days, together with the National Cancer Society Malaysia, with additional incentivization that included subsidizing transport to mammography centers. Results A total of 5,000 underprivileged women from different geographic localities and ethnicities were screened across Malaysia. Of these, 62% received a mammogram for the first time in their lives, whereas 21% received their first repeat mammogram in more than 3 years. Conclusion A targeted screening program that incorporated a multipronged approach strategy was successful at increasing access to breast cancer screening for underprivileged Malaysian women. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Murallitharan Munisamy Employment: National Cancer Society of Malaysia Stock or Other Ownership: MMPKV Sdn Bhd–operator of Malaysian Primary Care Clinics
Barriers to Mammography Screening in Nigeria: A Survey of Two Communities With Different Access to Screening Facilities
Authors: Olasehinde Olalekan , Alatise Olusegun I. , Arowolo Olukayode A. , Mango Victoria L. , Olajide Olalere S. , Omisore Adeleye D. , Boutin-Foster Carla , Kingham Thoms P. 
Published: October 2018

Purpose Breast cancer outcomes are poor in most low- and middle-income countries. This is a result, in part, of delayed presentation. Critical to improving this gloomy picture is the promotion of breast cancer screening programs; however, designing a formidable screening program requires obtaining necessary background data. This survey evaluates breast cancer screening practices and barriers in two Nigerian communities with different geographic access to screening facilities. Methods We administered a 35-item questionnaire to women age 40 years and older—1,169 participants (52.6%) in the Ife Central Local Government, where mammography services are offered, and 1,053 (47.4%) in the Iwo Local Government, where there are no mammography units. Information on breast cancer screening practices and barriers to mammography screening were compared between the two communities. Results Most women had heard of breast cancer (Ife, 94%; Iwo, 97%), but few have had any form of breast cancer screening recommended to them—37.7% of Ife respondents and 36.6% of Iwo respondents. Few women were aware of mammography (Ife, 11.8%; Iwo, 11.4%), whereas mammography uptake was 2.8% Ife respondents and 1.8% in Iwo respondents, despite the latter offering mammography services. Awareness and practice of mammography were not statistically different between the two communities ( P = .74 and P = .1 for Ife and Iwo, respectively). Lack of awareness was the most common reason cited for not undergoing mammography in both communities. Cost was also identified as a barrier, as only 20% of respondents could afford mammography. Despite being offered at little or no cost, uptake of clinical breast examination (CBE) was poor in both communities—27.4% in Iwo and 19.7% in Ife; however, the majority were willing to participate in a routine CBE-based breast cancer screening program. Conclusion Access without awareness and community mobilization does not guarantee use of breast cancer screening services. Given the above findings, a comprehensive breast health program that incorporates awareness creation, routine CBE-based screening, and selective mammography is currently underway in a selected Nigerian community. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the author
Determinants of Early Cancer Screening Behavior in Nigeria
Authors: Orjiako Tochukwu Charles 
Published: October 2018

Purpose Early detection and improvements and advancements in medicine have contributed to an overall decrease in mortality and morbidity rates that result from cancer diagnoses. Despite this improvement in national and global health status, Nigerians continue to be diagnosed at a later stage and with a more aggressive disease state. This is an important observation given the impact that cancer has on the ability of individuals to function physically, psychologically, and socially within the context of their environment. It is important, therefore, to identify and target specific groups that may be less willing to present for early cancer screening. The aim of this work was to understand the characteristics of Nigerians who are likely or not to present for early cancer screening and to address the use of mechanisms by which we can ensure the timely diagnosis of preventable cancers among Nigerians. Methods Adult Nigerians (N = 144), age 18 to 71 years, presented for clinical breast examination, visual inspection with acetic acid, and prostate-specific antigen test screenings after an awareness exercise. Participants completed survey forms that included a personality inventory, early cancer detection behavior scale, and a demography profile. We used multiple regression and analysis of variance to examine predictive patterns and differences between and within groups. Results Our results indicate that income (β = .18; P < .05) is a significant determinant of early cancer detection behavior, such that higher earners were more likely to go for screening. There were also significant gender differences in current cancer detection behavior between males (mean, 0.15; standard deviation, 0.51) and females (mean, 0.47; standard deviation, 0.80). Males are less likely to engage in early detection behavior (F1,145 = 4.76; P = .03). Data also show differences between older (age > 41 years) and younger (age < 40 years) participants in the intention to screen for cancer, with older participants reporting more willingness to engage in cancer screening. Conclusion Our findings enhance our understanding of the profile of groups who are less likely to screen for cancer. Our results also suggest that awareness campaigns and free screening exercises should target these at-risk groups in Nigeria. AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the author.
An Observational Study Framework to Assess Breast Cancer Control Policy Needs in Low- and Middle-Income Countries
Authors: Thayumanavan Ethan , Duggan Catherine , Blauvelt Barri M. 
Published: October 2018

Purpose Women with breast cancer in low- and middle-income countries (LMICs) have worse health outcomes than their counterparts in high-income countries (HICs). Improved outcomes in HICs are attributable to more rigorous breast cancer control policies, implementation of evidence-based guidelines, and greater national investment in health care. In resource-limited settings, identifying the most effective resource-appropriate policies can be a challenge. The proposed study will provide a framework to identify unmet breast cancer policy and infrastructure needs in LMICs and will aid in the prioritization of key elements of successful breast cancer control programs. Building on previous work, we will develop a framework for policy analysis and conduct a breast cancer policy needs assessment through a comparative analysis of attitudes and preferences for breast cancer control elements in 30 countries. Methods The proposed observational survey-based study will measure and compare attitudes and preferences for breast cancer control across 24 LMICs and six reference HICs from across the six WHO regions, stratifying countries by health care spending and mortality-to-incidence ratios. This study will be a cross-sectional survey of medical, policy, and advocacy experts in breast cancer from each of the selected countries. Research will be conducted in three phases. First, we will conduct key informant interviews of international breast cancer experts. Then we will develop and pilot a survey tool. Finally, we will conduct the full survey in countries. The study will use analysis of variance, conjoint analysis, and best-worst scaling to analyze survey results. Results This study will assess current breast cancer control needs, prioritize elements of a comprehensive breast cancer control plan, and determine attitudes about the potential of emerging technologies to improve breast cancer control. Conclusion This study will facilitate the improvement of health outcomes for women with breast cancer by assessing the specific unmet breast cancer policy and infrastructure needs in LMICs and prioritizing elements to improve breast cancer control programs. The study thus provides a resource-appropriate framework to improve breast cancer control policy, reform, and implementation. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Barri M. Blauvelt Stock or Other Ownership: AstraZeneca, Biogen, Celgene, Ecolab, Elite Pharmaceuticals Consulting or Advisory Role: Boehringer Ingelheim, Novartis