Barriers, facilitators, and strategies for improving breast cancer screening in Ukraine.
Authors: Dzhemiliev Ali , Kizub Darya Aleksandrovna , Vus Vadym , Beznosenko Andriy , Kopetskyi Viacheslav , Guivaniuk Inesa , Semeniv Solomiia , Melnitchouk Nelya 
Published: June 2023

e18769 Background: Because of Russia’s invasion of Ukraine, many cancers are diagnosed at later stages, resulting in renewed emphasis on preventive medicine. To this end, we explored barriers and facilitators of breast cancer screening in Ukraine. Methods: A survey exploring factors that may influence breast cancer screening was distributed through the Primary Care Physician Facebook group in Ukraine. Chi-Squared and Student’s t-tests tested association between discrete and continuous variables, respectively. Linear and logistic regression were used to test independent association. Results: 150 surveys were completed. Respondents’ mean age was 36.6 years (SD 11.6); 127 (84%) were female. 124 (83%) worked in public primary care clinics. Respondents were from 25 (92%) of 27 regions of Ukraine. 110 (73%) were familiar with Ministry of Health (MOH) Order 504 guidelines for breast cancer screening. 103 (64%) had a clinical breast exam (CBE) and 34 (21%) a screening mammography. Breast cancer screening was done via mammography by 134 (84%), via CBE by 93 (58%), and via CBE referral by 86 (57%). Fifty-six (36%) referred 1-3 patients per month to mammography, 46 (30%) referred 4-10, 25 (16%) 11-20. CBE screening was done for 1-10 patients per month by 86 (56%), 11-20 patients by 27 (18%), and 21-40 by 18 (12%). Factors independently associated with patient number having CBE screening per month included daily patient volume, having had a CBE, mammography availability; awareness of MOH 504 and patient pathways, and United States/Europe screening recommendations (latter three p < 0.1). In addition to the above, factors independently associated with performing CBE screening also included participation in seminars about breast cancer screening and comfort with performing a CBE. Factors independently associated with number of patients referred to mammography per month included daily patient volume, having undergone a mammography, and mammography availability. In addition to the above, factors independently associated with mammography referral also included awareness of MOH 504 and patient family history. (All p < 0.05) Barriers to screening included insufficient knowledge among patients (81, 54%), fear of cancer treatment (71, 47%), lack of money for cancer treatment (50, 33%), insufficient training for primary care physicians (84, 56%), insufficient mammography equipment (39, 26%), and insufficient screening recommendation in primary care (38, 25%). Breast cancer screening could be expanded via collaboration with oncologists (64, 42%), training about breast cancer screening (60, 40%), breast cancer educational materials for patients (56, 37%), and automating screening referrals via electronic health records (50, 33%). Conclusions: Factors associated with breast cancer screening included knowledge, personally undergoing screening, and resource availability. Results are limited by online convenience sampling.