Since 1988, the International Agency for Research on Cancer has classified alcohol as a Group 1 carcinogen, the highest level of risk. Growing evidence suggests that alcohol increases the risk of several types of cancer including breast, bowel, prostate, and liver, and accounts for a significant proportion of preventable cancers. Despite ample evidence of this relationship, public awareness is less clear. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed 32 studies examining lay awareness of alcohol as a risk factor for cancer in 16 countries. Our results show that awareness appears to be low and varies internationally; it is relatively higher in the United Kingdom, Morocco, and Australia. Methodologic differences in assessment obfuscate cross-country and cross-sample comparisons. In general, people are more likely to endorse alcohol as a risk factor when presented with a list of possible risk factors than when asked to list risk factors in an open-ended format. Attempts to increase awareness have been limited and constitute a significant public health need. We provide potential strategies to increase awareness, such as alcohol bottle labeling and fostering patient/physician discussions regarding the link. Cancer Epidemiol Biomarkers Prev; 27(4); 429-37. ©2018 AACR.

/pdf/awareness-of-the-link-between-alcohol-consumption-and-cancer-2sovykpjsd.pdf

Awareness of the Link between Alcohol Consumption and Cancer across the World: A Review

To be effective, population-based cervical cancer prevention programs must be tailored to meet the needs of the target population. One important factor in cervical cancer screening may include male involvement. To iteratively improve a screening program employing self-collected vaginal swabs for human-papillomavirus (HPV) testing in western Kenya, we examined the role of male partners and community leaders in decision-making and accessing screening services. We carried out 604 semi-structured, in-depth interviews (IDIs) with women and community health volunteers who took part in a multiphase trial of implementation strategies for HPV-based cervical cancer screening. IDIs were coded and themes related to decision-making, screening and treatment barriers, and influence of male partners and community leaders were identified and analyzed. Women experienced both support and opposition from their male partners. Partner support took the form of financial support for transportation and emotional support and encouragement, while opposition ranged from anticipated negative reactions to lack of permission, isolation, and abandonment. Though most women described their own partners as supportive, many felt that other male partners would not be supportive. Most participants believed that increased HPV and cervical cancer knowledge would increase partner support. Women reported a general acceptance of involvement of community leaders in education and screening campaigns, in a setting where such leaders may hold influence over men in the community. There was a clear interest in involving male partners in the cervical cancer prevention process, specifically in increasing knowledge and awareness. Future research should explore the feasibility and effectiveness of engaging male partners in cervical cancer screening and prevention programs.

/pdf/female-perspectives-on-male-involvement-in-a-human-59tcoxtbxa.pdf

Female perspectives on male involvement in a human-papillomavirus-based cervical cancer-screening program in western Kenya

Estimately, 70–80% of cancer cases are diagnosed in late stages in Kenya with breast cancer being a common cause of mortality among women where late diagnosis is the major ubiquitous concern. Numerous studies have focused on epidemiological and health policy dynamics essentially underestimating the determining factors that shape people’s choices and cues to health care service uptake. The study sought to evaluate the knowledge, attitude and health seeking behavior towards breast cancer and its screening in a quest to explain why women present for prognosis and treatment when symptomatic pointers are in advanced stages, impeding primary prevention strategies. Eight focus groups (6–10 members per group) and four key informant interviews were conducted among adult participants from rural and urban settings. Sessions were audio-recorded and transcribed. A thematic analysis of the data was based on the concepts of the health belief model. Data analysis was conducted using NVIVO10. Most women perceived breast cancer as a fatal disease and conveyed fear of having early screening. Rural women preferred self-prescribed medications and the use of alternative medicine for long periods before presenting for professional care on suspicion that the lump is cancerous. Accessibility to equipped health facilities, lack of information to establish effective follow-up treatment and low-income status were underscored as their major health seeking behavior barriers whereas, urban women identified marital status as their main barrier. Key informant interviews revealed that health communication programs emphasized more on communicable diseases. This could in part explain why there is a high rate of misconception and suspicion about breast cancer among rural and urban women in the study setting. Creating breast cancer awareness alongside clear guidelines on accessing screening and treatment infrastructure is critical. It was evident, a diagnosis of breast cancer or lump brings unexpected confrontation with mortality; fear, pain, cultural barriers, emotional and financial distress. Without clear referral channels to enable those with suspicious lumps or early stage disease to get prompt diagnosis and treatment, then well-meaning awareness will not necessarily contribute to reducing morbidity and mortality.

/pdf/determinants-of-breast-cancer-early-detection-for-cues-to-4gciwn9v53.pdf

Determinants of breast cancer early detection for cues to expanded control and care: the lived experiences among women from Western Kenya

Background Early detection and prompt access to quality treatment and palliative care are critical for good breast cancer outcomes. Interventions require understanding of identified barriers and facilitators to care. A hermeneutic phenomenological approach, whose purpose is to describe feelings and lived experiences of participants, can expand the existing scope of understanding of barriers and facilitators in accessing breast cancer care in Kenya. Methods This is qualitative research applying focus groups and a hermeneutic phenomenological approach to identify barriers and facilitators to breast cancer care from the knowledge, perceptions, and lived experiences of women with and without a diagnosis of breast cancer in Kenya. We conducted four focus group discussions with 6-11 women aged 30-60 years in each. Groups were classified according to breast cancer diagnosis and socioeconomic status. The transcribed discussions were coded independently by two investigators. Together they reviewed the codes and identified themes. Results The key barriers were costs, inadequate knowledge, distance to health facilities, communication with health providers, medicines stockouts, long waiting periods, limited or no counseling at diagnosis, patient vulnerability, and limited access to rehabilitation items. Facilitators were dependable social support, periodical access to subsidized awareness, and early detection services and friendly caregivers. We found no marked differences in perceptions between groups by socioeconomic status. Conclusion There is need for targeted awareness and education for health providers and the public, early detection services with onsite counseling and cost mitigation. Support from the society and religious organizations and persons may be leveraged as adjuncts to conventional management. Further interpretations are encouraged. Implications for practice Continuing cancer education for health providers in technical skills for early detection, treatment, and survivorship care, as well as nontechnical skills like communication, and an understanding of their patients' preferences and socioeconomic status may guide individualized management plans and positively affect patient experiences. Patients and the general public also need education on cancer to avoid misconceptions and inaccuracies that perpetuate fear, confusion, delayed presentation for treatment, and stigma. Critical analysis of the cancer care value chain and processes, development, and implementation of interventions to reduce costs while streamlining processes may improve client experiences.

Identifying Barriers and Facilitators to Breast Cancer Early Detection and Subsequent Treatment Engagement in Kenya: A Qualitative Approach.

Breast Cancer is the most common cancer in women worldwide. Since 2008, Mwanza, Tanzania, has worked to provide comprehensive cancer services through its Zonal consultant hospital. New national guidelines focused on clinical breast exam requires that women be aware of and seek care for breast concerns. Therefore, this study aims to understand breast cancer awareness in Mwanza and describe women-level barriers, care-seeking behavior, and perspectives on breast cancer. A community-based survey was administered to conveniently sampled women aged 30 and older to assess women’s perspectives on breast cancer and care-seeking behavior. Among 1129 women with a median age of 37 (IQR: 31–44) years, 73% have heard of cancer and 10% have received breast health education. Women self-evaluated their knowledge of breast cancer (from 1-none to 10-extremely knowledgeable) with a median response of 3 (IQR: 1–4). Only 14% felt they knew any signs or symptoms of breast cancer. Encouragingly, 56% of women were fairly-to-very confident they would notice changes in their breasts, with 24% of women practicing self-breast examination and 21% reporting they had received a past breast exam. Overall, 74% said they would be somewhat-to-very likely to seek care if they noticed breast changes, with 96% noting severity of symptoms as a motivator. However, fear of losing a breast (40%) and fear of a poor diagnosis (38%) were most frequent barriers to care seeking. In assessing knowledge of risk factors, about 50% of women did not know any risk factors for breast cancer whereas 42% of women believed long term contraceptive use a risk factor. However, 37% and 35% of women did not think that family history or being older were risk factors, respectively. The success of efforts to improve early diagnosis in a setting without population-based screening depends on women being aware of breast cancer signs and symptoms, risks, and ultimately seeking care for breast concerns. Fortunately, most women said they would seek care if they noticed a change in their breasts, but the low levels of cancer knowledge, symptoms, and common risk factors highlight the need for targeted community education and awareness campaigns.

/pdf/understanding-women-s-perspectives-on-breast-cancer-is-1ru8z9wg1z.pdf

Understanding women's perspectives on breast cancer is essential for cancer control: knowledge, risk awareness, and care-seeking in Mwanza, Tanzania

AIM: To explore lay perceptions of causes, severity, presenting symptoms and treatment of breast cancer.

METHODS: In October-November 2012, we recruited men and women (18 years and older) from households and health facilities in three different parts of Western Kenya, chosen for variations in their documented burdens of breast cancer. A standardized and validated tool, the breast cancer awareness measure (BCAM), was administered in face-to-face interviews. Survey domains covered included socio-demographics, opinions about causes, symptoms, severity, and treatment of breast cancer. Descriptive analyses were done on quantitative data while open-ended answers were coded, and emerging themes were integrated into larger categories in a qualitative analysis. The open-ended questions had been added to the standard BCAM for the purposes of learning as much as the investigators could about underlying lay beliefs and perceptions.

RESULTS: Most respondents were female, middle-aged (mean age 36.9 years), married, and poorly educated. Misconceptions and lack of knowledge about causes of breast cancer were reported. The following (in order of higher to lower prevalence) were cited as potential causes of the condition: Genetic factors or heredity (n = 193, 12.3%); types of food consumed (n = 187, 11.9%); witchcraft and curses (n = 108, 6.9%); some family planning methods (n = 56, 3.6%); and use of alcohol and tobacco (n = 46, 2.9%). When asked what they thought of breast cancer’s severity, the most popular response was “it is a killer disease” (n = 266, 19.7%) a lethal condition about which little or nothing can be done. While opinions about presenting symptoms and signs of breast cancer were able to be elicited, such as an increase in breast size and painful breasts, early-stage symptoms and signs were not widely recognized. Some respondents (14%) were ignorant of available treatment altogether while others felt breast cancer treatment is both dangerous and expensive. A minority reported alternative medicine as providing relief to patients.

CONCLUSION: The impoverished knowledge in these surveys suggests that lay education as well as better screening and treatment should be part of breast cancer control in Kenya.

Lay perceptions of breast cancer in Western Kenya

Objectives : To conduct clinical breast cancer screening in three sites in Western Kenya and explore community barriers to screening uptake Design : Cross-sectional study Setting : Western Kenya specifically, Mosoriot, Turbo, and Kapsokwony Subjects : Community members (18 years and older) who did not attend the screening events Outcome Measure : The outcome measure was having heard about the breast cancer screening events Both structured and open-ended questions were used for data collection Item frequency, correlations, and content analyses were performed Results : A total of 733 community members were surveyed (63% women, median age 33 years, IQR=26-43) More than half (55%) of respondents had heard about the screening but did not attend The majority of those who had heard about this particular screening had knowledge of screening availability in general (45% vs 25%, p<0001) Only 80% of those who heard and 60% of those who had not heard of the screening event had previously undergone clinical breast exam (p=020) Reasons for not attending the screening event were personal factors, including busy schedule (410%), perceived low personal risk (127%), lack of transport (42%), as well as health facility factors such as poor publicity (144%) and long queues (87%) Conclusion : Barriers to breast cancer screening uptake were associated with inadequate publicity, perceived long waits at event and busy lives among community women

/pdf/barriers-to-uptake-of-breast-cancer-screening-in-kenya-5e2tfeval7.pdf

Barriers to uptake of breast cancer screening in Kenya

Background: Increasingly, evidence is emerging from developing countries like Kenya on the burden of loss to follow-up care after a positive cervical cancer screening/diagnosis, which impacts negat...

Loss to Follow-Up in a Cervical Cancer Screening and Treatment Program in Western Kenya

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Lay perceptions of breast cancer in Western Kenya

Lay perceptions of breast cancer in Western Kenya

Barriers to uptake of breast cancer screening in Kenya

Loss to Follow-Up in a Cervical Cancer Screening and Treatment Program in Western Kenya