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      Intention to Undergo Clinical Breast Examination and Its Associated Factors among Women Attending Rural Primary Healthcare Facilities in South Central Ethiopia

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          Abstract

          Background

          Breast cancer is a global public health problem with higher mortality in developing countries. The Ethiopian National Cancer Control Plan recommends clinical breast examination (CBE) for all women aged >18 years. However, there is low breast examination practice in Ethiopia. Therefore, this study aimed to describe level of intention to undergo CBE and associated factors among women visited selected rural healthcare facilities in south central Ethiopia using Theory of Planned Behavior (TPB).

          Methods

          This study used facility-based cross-sectional study design. A total of 420 women participated in this study. Interviewer-administered structured questionnaire was adopted from previously published research works and Ajzen’s TPB manual. Statistical Package for Social Sciences (SPSS), version 27, was used for analysis. Binary logistic regression model was used to determine factors associated with intention to undergo CBE.

          Results

          In this study, nine out of ten women had never had CBE. Mean score for intention to undergo CBE was 12.55 (SD ± 3.22; min 5, max 20). Intention to undergo CBE was negatively associated with being in the second and middle wealth quantiles compared to the highest wealth quantile, and with the spouse not being able to read or write compared to having attended formal education. Positive attitude and higher subjective norm had relevant association with intention to undergo CBE.

          Conclusion

          The high score for intention to undergo CBE should encourage primary healthcare facilities to offer CBE. Behavioral change communication interventions could address women’s attitude, subjective norm, and spouse’s education associated with intention to undergo CBE.

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          Most cited references27

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          Incidence and Mortality and Epidemiology of Breast Cancer in the World.

          Breast cancer is the most common malignancy in women around the world. Information on the incidence and mortality of breast cancer is essential for planning health measures. This study aimed to investigate the incidence and mortality of breast cancer in the world using age-specific incidence and mortality rates for the year 2012 acquired from the global cancer project (GLOBOCAN 2012) as well as data about incidence and mortality of the cancer based on national reports. It was estimated that 1,671,149 new cases of breast cancer were identified and 521,907 cases of deaths due to breast cancer occurred in the world in 2012. According to GLOBOCAN, it is the most common cancer in women, accounting for 25.1% of all cancers. Breast cancer incidence in developed countries is higher, while relative mortality is greatest in less developed countries. Education of women is suggested in all countries for early detection and treatment. Plans for the control and prevention of this cancer must be a high priority for health policy makers; also, it is necessary to increase awareness of risk factors and early detection in less developed countries.
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            Applied logistic regression

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              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. Electronic supplementary material The online version of this article (10.1186/s12992-018-0446-6) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Breast Care (Basel)
                Breast Care (Basel)
                BRC
                BRC
                Breast Care
                S. Karger AG (Basel, Switzerland )
                1661-3791
                1661-3805
                19 July 2023
                December 2023
                : 18
                : 6
                : 464-472
                Affiliations
                [a ]School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
                [b ]Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
                Author notes
                Correspondence to: Bezawit Ketema, bezawitketema@ 123456gmail.com
                Article
                531944
                10.1159/000531944
                10730096
                38125918
                5ac62cf3-c43b-4532-a631-6cff68139aa1
                © 2023 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ( http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                : 18 February 2023
                : 4 July 2023
                : 2023
                Page count
                Tables: 4, References: 28, Pages: 9
                Funding
                This work was supported by the Else-Kroener-Foundation through Martin-Luther-University, Halle-Wittenberg, Germany, grant No. 2018_HA31SP. Funding was received through the German Ministry for Economic and Development Cooperation (BMZ) through the Academic Partnership Initiative of German International Cooperation (GIZ), project No. 81281915. The role of the funder in this study was to provide the required budget for the study.
                Categories
                Research Article

                breast cancer,clinical breast examination,breast cancer screening

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