Determinants of Breast Cancer Screening Among Reverend Sisters in Kampala Archdiocese, Uganda: A Cross-Sectional Study: Determinants of Breast Cancer Screening

Robert K. Basaza; Judith Kaddu; Emmanuel Otieno; Florence Mirembe

doi:10.32768/abc.202292221-230

Robert K. Basaza ⁽¹⁾, Judith Kaddu ⁽²⁾, Emmanuel Otieno ⁽³⁾, Florence Mirembe ⁽⁴⁾

(1) Save Mothers Program, School of Medicine, Uganda Christian University Mukono, Uganda, Uganda,

(2) Save Mothers Program, School of Medicine, Uganda Christian University Mukono, Uganda, Uganda,

(3) Gudie University Project, Kampala, Uganda, Uganda,

(4) King Caesar International University, Uganda; Save Mothers Program, School of Medicine, Uganda Christian University Mukono, Uganda, Uganda

https://doi.org/10.32768/abc.202292221-230

Issue
Volume 9, Issue 2, May 2022

Submitted
November 19, 2021

Published
March 4, 2022

Keywords:

Breast cancer, breast screening, Reverend Sisters, Uganda

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Abstract

Background: Breast cancer in Uganda is the second commonest cancer in women coming only next to cancer of the cervix. This is the first cross-sectional study to investigate the determinants of self-breast cancer screening among Reverend Sisters in Kampala, the largest Archdiocese of Roman Catholic Church in Uganda. The prevention strategies in this country are still not optimal and the key to prevention is breast screening.
Methods: A cross-sectional analytical study was conducted from September, 2018 to June, 2019. A sample of 310 respondents were interviewed using a semi-structured, self-administered questionnaire. Data was analyzed using logistic regression model.
Results: A majority (96.4%) of the respondents did not do a mammography, 54.1% never practiced breast self-examination (BSE) and 34.2% performed it regularly during bedtime. The reasons for performing BSE included: curiosity (61.9%), having a lump (19%) and carrying out screening (9.5%). Significant predictors of breast cancer screening were ordinary level of education (11 years of education), hearing about breast cancer, different screening methods, and symptoms of breast cancer, usefulness of screening for women, a need for sisters to screen, self-breast examination and mammography. Age and other levels of education were not significantly associated with breast cancer screening.
Conclusion: The Reverend Sisters had a low level of knowledge and a small fraction practiced breast cancer screening. This demands a sustainable interventional strategy of breast health awareness campaign, establishment of appropriate health infrastructure related to precision oncology in Uganda and similar settings.

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References

Jerry DJ, Makari-Judson G, Crisi GM, Dunphy KA. Pregnancy offers new insights into mechanisms of breast cancer risk and resistance. Breast Cancer Res. 2013;15, 312.doi:10.1186/bcr3482.

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a cancer journal for clinicians 2021. 71(3), 209–249. doi:10.3322/caac.21660.

Karbakhsh M. Global Breast Cancer Initiative: an Integrative Approach to Thinking Globally, Acting Locally. Archives of Breast Cancer 2021. doi: 10.32768/abc.20218263-64.

OECD/European Union. Health at a Glance: Europe: State of Health in the EU Cycle, OECD Publishing, Paris 2020. doi: 10.1787/82129230-en.

Wu SC, Chiang MC, Lee YG, Wang MW, Li CF, Tung TH, et al. Long-term survival and prognostic implications of patients with invasive breast cancer in southern Taiwan, Medicine: February 2020 - Volume 99 - Issue 7 - p e19122. doi: 10.1097/MD.0000000000019122.

Ssentongo P, Lewcun JA, Candela X, Ssentongo AE, Kwon EG, Ba DM, et al. Regional, racial, gender, and tumor biology disparities in breast cancer survival rates in Africa: A systematic review and meta-analysis. PLoS ONE. 2019; 14(11): e0225039. doi: 10.1371/journal.pone.0225039.

Ekdahl Hjelm T, Matovu A, Mugisha N, Löfgren J. Breast cancer care in Uganda: A multicenter study on the frequency of breast cancer surgery in relation to the incidence of breast cancer. PLoS One. 2019; Jul 11;14(7): e0219601. doi: 10.1371/journal.pone.0219601.

Popli P, Gutterman EM, Omene C, Ganesan S, Mills D, Marlink, R. Receptor-Defined Breast Cancer in Five East African Countries and Its Implications for Treatment: Systematic Review and Meta-Analysis. JCO global oncology 2021; (7), 289–301. doi: 10.1200/GO.20.00398.

World Bank Data: Population in Uganda, 2018. Available from: https://data.worldbank.org/indicator/SP.POP.TOTL

Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikšić M, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018; Mar 17;391(10125):1023-1075. doi: 10.1016/S0140-6736(17)33326-3. (Accessed 29 January 2022)

Galukande M, Wabinga H, Mirembe F, Karamagi C, Asea A. Difference in risk factors for breast cancer by ER status in an indigenous African population. International Scholarly Research Notice: Oncology. 2013; 10:1155. doi: 10.1155/2013/463594.

Kent A. Nuns and contraceptives. Reviews in obstetrics & gynecology, 2012; 5(3-4), e166–e167.

Atuhairwe, C., Amongin, D., Agaba, E. Mugarura S, Taremwa IM. The effect of knowledge on uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda. BMC Public Health 2018;18, 279. doi: 10.1186/s12889-018-5183-5.

World Health Organization. Preventing Cancer, 2021. Available from: https://www.who.int/activities/preventingcancer

Shallo SA, Boru JD. Practice and associated factors among female healthcare workers in West Shoa Zone, Western Ethiopia: a cross-sectional study. BMC Res Notes 2019;12, 637 (2019). doi: 10.1186/s13104-019-4676.

Tolessa L, Sendo EG, Dinegde NG, Desalew A. Risk Factors Associated with Breast Cancer among Women in Addis Ababa, Ethiopia: Unmatched Case-Control Study. Int J Womens Health. 2021; 13:101-110. Published 2021 Jan 18. doi:10.2147/IJWH.S292588.

Atashi HA, Eslami Vaghar M, Olya M, Mirzamohammadi P, Zaferani Arani H, Hadizadeh M, et al. Knowledge, Attitudes, and Practices toward Breast Cancer: among Midwives in a Breast Cancer Educational Seminar in Tehran. Archives of Breast Cancer [Internet]. 2020;29:29-36. doi: 10.32768/abc.20207129-36.

Odikpo LC, Chiejina EN. “Practice and Outcome of Exercise Intervention on Breast Cancer Specific Quality of Life of Breast Cancer Survivors in Nigeria”, Archives of Breast Cancer, 2021; pp. 174–182. doi: 10.32768/abc.202183174-182.

Peintinger F. National Breast Screening Programs across Europe. Breast Care; 2019;14:354-358. doi: 10.1159/000503715.

Kampala Archdiocese: The Archdiocese of Kampala (A Brief History). Available from: https://klarchdiocese.org.ug [Accessed on 27 January 2022].

Martins SO, Folasire OF, Irabor AE. prevalence and predictors of prediabetes among administrative staff of a tertiary health centre, southwestern Nigeria. Annals of Ibadan postgraduate medicine. 2017;15(2), 114–123. doi: Not available.

Kiguli-Malwadde E, Mubuuke RG, Bugeza S, Mutungi B. Mammography: a review of records in the Department of Radiology at a National Referral Hospital in Uganda. Pan African Medical Journal. 2014;18:89. doi: 10.11604/pamj.2014.18.89.3237.

Uganda Breast Cancer Working Group. Breast cancer guidelines for Uganda. African health sciences, 2003;3(1), 47–50. doi: Not available

Uganda Cancer Institute. Breast cancer: Information, Education and Communication Booklet for Health Workers. First Edition December 2017. Comprehensive Community Cancer Programme (CCCP). doi: Not Applicable

Seifu, W., Mekonen, L. Breast self-examination practice among women in Africa: a systematic review and Meta-analysis. Arch Public Health 2021; 79, 149. doi: 10.1186/s13690-02100671-8.

Sayed S, Ngugi AK, Mahoney MR, Kurji J, Talib ZM, Macfarlane SB, et al. Breast Cancer knowledge, perceptions and practices in a rural Community in Coastal Kenya. BMC Public Health 19, 180 (2019). doi: 10.1186/s12889-019-6464-3.

Heiko Schöder and Mithat Gönen, 2007. Screening for Cancer with PET and PET/CT: Potential and Limitations Journal of Nuclear Medicine, 48 (1 suppl) 4S-18S. doi: Not available.

Moodley J, Harries J, Scott SE, Mwaka AD, Saji S, Walter FM. Exploring primary care level provider interpretation and management of potential breast and cervical cancer signs and symptoms in South Africa. Ecancermedicalscience 2021. doi:10.3332/ecancer.2021.1298.

Scheel JR, Giglou MJ, Segel S, Orem J, Tsu V, Galukande M, et al. (2020), Breast cancer early detection and diagnostic capacity in Uganda. Cancer, 126: 2469-2480. doi: 10.1002/cncr.32890.

Smith RA, Andrews KS, Brooks D, Fedewa SA, Manassaram-Baptiste D, Saslow D, et al. Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening. CA: a cancer journal for clinicians, 69(3), 184–210. doi: 10.3322/caac.21557.

Pippin MM, Boyd R. Breast Self- Examination. In StatPearls. StatPearls Publishing 2021.

Molaei-Zardanjani M, Savabi-Esfahani M, Taleghani F. Fatalism in breast cancer and performing mammography on women with or without a family history of breast cancer. BMC Women's Health 19, 116 (2019) doi:10.1186/s12905-019-0810-6.

Agboola AOJ, Deji-Agboola AM, Oritogun KS, Musa AA, Oyebadejo TY, Ayoade BA. Knowledge, Attitude and Practice of Breast SelfExamination in Female Health Workers in OlabisiOnabanjo University Teaching Hospital, Sagamu, Nigeria. The International Medical Journal. 2009;8(1):5–10. doi: 10.31436/imjm.v8i1.762.

Munyaradzi D, January J, Maradzika J. Breast cancer screening among women of child-bearing age. Health Care Women Int. 2014;35(7-9):818-27. doi: 10.1080/07399332.2014.920843.

Berens EM, Kaucher S, Van Eckert S, Reder M, Kolip P, Spallek J. Knowledge about mammography screening in Germany by education and migrant status – results of a cross-sectional study (InEMa). Appl Cancer Res 39, 6 (2019). doi: 10.1186/s41241-019-0076-1.

Demirkiran F, Ozgun H, Eskin M, Turk G, Cam R, Ozgun O, et al. A. E Cognition of breast cancer among gestational age Turkish women: a cross-sectional study. APJCP. 2011; 12:277– 82. doi: Not available

Abolfotouh MA, BaniMustafa AA, Mahfouz AA, Al-Assiri MH, Al-Juhani AF, Alaskar AS. Using the health belief model to predict breast self-examination among Saudi women. BMC Public Health. 2015; 15:1163. doi:10.1186/s12889-015-2510-y.

Makurirofa L, Mangwiro P, James V, Milanzi A, Mavu J, Nyamuranga M, et al. Women’s knowledge, attitudes and practices (KAP) relating to breast and cervical cancers in rural Zimbabwe: a cross sectional study in Mudzi District, Mashonaland East Province. BMC Public Health. 2019; 19, 109. doi: 10.1186/s12889018-6333-5.

Gebremariam A, Addissie A, Worku A, Assefa M, Kantelhardt EJ, Jemal A. Perspectives of patients, family members, and health care providers on late diagnosis of breast cancer in Ethiopia: A qualitative study. PLoS One. 2019;14(8): e0220769. Published 2019 Aug 1. doi: 10.1371/journal.pone.0220769.

Khin M, Shwe S, May Oo K, Win L-L. Breast Cancer Awareness in Myanmar. Results of a Hospital-based Study in Mandalay. Archives of Breast Cancer [Internet]. 2021; Apr. 27 [cited 2021 Nov. 7];210-5. doi: 10.32768/abc.202183210-215.

Authors

Robert K. Basaza

Save Mothers Program, School of Medicine, Uganda Christian University Mukono, Uganda

rbasaza@gmail.com (Primary Contact)

Judith Kaddu

Save Mothers Program, School of Medicine, Uganda Christian University Mukono, Uganda

Emmanuel Otieno

Gudie University Project, Kampala, Uganda

Florence Mirembe

King Caesar International University, Uganda; Save Mothers Program, School of Medicine, Uganda Christian University Mukono, Uganda

Basaza RK, Kaddu J, Otieno E, Mirembe F. Determinants of Breast Cancer Screening Among Reverend Sisters in Kampala Archdiocese, Uganda: A Cross-Sectional Study: Determinants of Breast Cancer Screening. Arch Breast Cancer [Internet]. 2022 Mar. 4 [cited 2024 Nov. 21];9(2):221-30. Available from: https://archbreastcancer.com/index.php/abc/article/view/494

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INTRODUCTION

Breast cancer is the most common cancer among females in both developing and developed countries. 1 2 3 4 It is becoming an important health problem in low and middle-income countries where historically low incidence rate has increased by approximately 5 % per year. 2 In addition, a study by Forouzanfar and colleagues revealed that there was a 3.1% annual increase in breast cancer incidence, with an increased estimated rate of 641,000 cases in 1980 to 1,643,000 cases in 2010. 3 In Palestine, according to the Ministry of Health (MOH), there were 503 new cases in the West Bank in 2017 constituting around 17.2% of all cancer cases. 4 According to the cancer registry in the Gaza strip, there were 684 cases in 2016 constituting around 20.5% of all cancer cases. 5 In addition, the most affected age groups were (45 -54) years, and (55 -64) years old constituting 23%, and 24.6% of all BC cases, respectively. 6 Mammography is considered the first line of investigation of breast cancer. However, studies show a lower sensitivity of mammography with high-density and relatively small breasts. 7 Also, there are some limitations to doing mammography for women under the age 40-50 years old. 8 9 Over the last decade, most analogue mammography screening has changed into full field digital mammography (FFDM) which provides additional benefits for breast screening. 10 Digital mammography increases the detection rate and decreases the number of false positive leads, increasing the effectiveness of screening with sensitivity of over 85% and specificity over 90%. However, the efficacy of mammography varies depending on performance of interpretation radiologist. 11 12 A new digital diagnostic mammography unit was recently introduced at Al Shifa Hospital-MOH. Its role in the initial diagnosis of breast diseases particularly breast cancer has not been studied yet.

This study attempts to explore the accuracy measures of a digital mammography unit in the diagnosis of breast cancer and compare mammography results with final histopathology results. In addition, the study will compare the results of mammography when combined with Ultrasound with the final histopathology results.

METHODS

This study is designed as a cross-sectional prospective hospital base study.

Sample size

This study included all the women who came to the digital mammography unit at Al Shifa Hospital to conduct mammography and were approved to have breast cancer within six months in the period 1.1.2019 to 20.7.2019.

Mammography examination

Mammography machine: All the patients underwent the mammogram on a digitalized mammography system (Fuji film-Amulet Innovality) that has been recently used in the MOH.

Mammographic views: Conventional views (Cranio-caudal (CC and medio-lateral oblique (MLO) views. Additional views (exaggerated CC, spot compression, magnification Views) whenever indicated.

Exposure factors: Automatic exposure used for all patients Compression was applied and respiration was suspended on exposure.

The mammography exams were interpreted by two radiology experts together. The radiologist did not know the impression of the surgeon and the possible diagnosis because in many cases the patients are not examined physically due to the cultural barriers and in some cases the surgeon did not report their clinical impression to the radiologists.

U/S examination

The U/S was performed only as a complementary study, when needed, by an expert radiologist. The radiologist doing the U/S was aware of the results of the previous mammography.

Biopsy

Biopsy reports reviewed were done at the histopathology department at Al Shifa Hospital, NGOs or the private sectors.

Mammography reports with normal, asymmetry, dense breast and benign lesions were classified as mammography with nonmalignant findings. Mammography reports concluded as either suspected malignancy for other investigations or with evidence of malignancy were classified as mammography with malignant findings.

Indicators

We used six indicators to evaluate the diagnostic performance of the system: accuracy, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and the area under the receiver operating characteristic curve (AUC).

Accuracy is described as the ratio of the correct samples distinguished by the classifier to the total samples. The indicators can be described as follows: Accuracy= (TP+TN)/ (TP+TN+FP+FN)*100% Sensitivity = TP/ (TP+FN)*100% Specificity = TN/ (TN+FP) *100% PPV = TP/ (TP+FP) *100% NPV =TN/ (TN+FN) *100% In addition, we used the AUC the area of the ROC (receiver operating characteristic) curve to appraise the performance.

Ethical consideration

Ethical approval was obtained from the Palestinian Health Research Council (PHRC/HC/291/17). Patients' rights and confidentiality of information were ensured. All gathered documents were kept and saved in a private closet.

Data analysis

Data were analyzed using SPSS program version-23. Descriptive statistics and frequency tables were used to describe the main features of the data. The indicators of diagnostic performance of mammography unit alone, and with the combination of US exam were calculated based on histopathology reports using its formulas. The AUC was also drawn. Spearman correlation test was used to examine the correlation between imaging results and histopathological findings. Confidence interval was set at 95% and margin of error at 5%.

RESULTS

Fifty-two women participated in the study. Among them, 8 were 40 years and less, 30 patients were in the age group 41-60 years, and 14 patients were 61 years and more. Also, 84.6% of patients were married at the time of data collection, and only six patients did not have breastfeeding. The majority of participants (39) complained of a breast mass, with other complaints including axilla mass among four participants, nipple discharge among three, pain among four, and breast readiness among two participants. Sixty five of the participants had a right breast problem, and 30.8% of them had a left breast problem. Fifty percent of patients used to perform breast self-exam and the majority of them (84.6%) conducted a clinical breast exam before their referral to the unit. Eight patients had a family history of breast cancer. Baseline characteristics of the participants are shown in Table 1. Of the Fifty-two women, mammography individually detected 40 lesions and missed four lesions, which were subsequently detected by Ultrasound and approved by histopathology results. Four of the forty lesions detected by digital mammography were subsequently proved by Ultrasound and histopathology as nonmalignant findings. Sensitivity, specificity, PPV, NPV, accuracy, and the area under the ROC curve of mammography alone were 94.9%, 66.7%, 90%, 66.7%, 0.771, respectively.

When Ultrasound was used as a complementary to mammography, Sensitivity, Specificity, PPV, NPV, accuracy and the area under the ROC curve were 100%, 76.9%, 90.3%, 100%, 92.7%, 0.917, respectively.

A statistically significant moderate correlation was shown between the results of mammography alone and histopathology results (Spearman correlation= 0.527, P<0.01), and a statistically significant strong correlation between mammography combined with Ultrasound and histopathology results (Spearman correlation = 0.882, P<0.01)

DISCUSSION

Patients with signs and symptoms of breast cancer present for imaging evaluation. However, studies show that mammography is not a perfect tool to detect breast cancer as it misses some tumors in some women, particularly in women at early ages, 13 14 and women with dense breasts. 9 13 14 The significance of combined mammographic and sonographic imaging in symptomatic patients has been previously studied. Also, the sensitivity of the two modalities on 45 participants was studied 9 , which resulted in 90.6% for mammography and 100% for U/S. This figure was 77.7% for mammography and 55.5% for U/S. 15 Also, another study 7 found this value at 81.71% for mammography and 95.53%. Moreover, additional U/S significantly increased the sensitivity of digital mammography from 69.05% to 92.86%. 16 Ultrasound is more sensitive than mammography in detecting lesions in women with dense breast tissue. The sensitivity and diagnostic accuracy among patients <50 years of age and in premenopausal or perimenopausal patients were significantly higher for sonography than for mammography. 7 In our study, four patients were diagnosed with cancer by Ultrasound, which was previously diagnosed as a nonmalignant finding in mammography. In another study, two patients out of nine (22.22%) were diagnosed with cancer in Ultrasound, which was occult in mammography. 15 Regrding the high rate of PPV (90%), the PPV of tests is known to vary with the prevalence of the condition in different settings. 17 This should be considered when interpreting the results and implementing the findings of this study for various groups of patients, and populations with different pretest probabilities of breast cancer.

The strong and statistically significant correlation between combined imaging modalities (mammography and Ultrasound) and biopsy leads us to the conclusion that with the combination of mammography and Ultrasound we can almost achieve the accuracy of fine-needle biopsy in detecting breast malignancy.

CONCLUSION

Mammography is an important tool to detect breast cancer. However, it is not 100% accurate. The combination of mammography and U/S increases the accuracy of detecting malignancy in symptomatic patients. Mammography when combined with Ultrasound yields very significant improvement in sensitivity and specificity for diagnosing different breast lesions.

FUNDING

None.

ETHICAL CONSIDERATIONS

This research was approved by the Palestinian Health council in 2019.

DATA AVAILABILITY

The data used to support the findings of this study are available from the corresponding author upon request.

Al-Shiekh et al. Arch Breast Cancer 2022; Vol. 9, No. 2: 231-235

ROC curves for mammography alone, and combined with U/S

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Determinants of Breast Cancer Screening Among Reverend Sisters in Kampala Archdiocese, Uganda: A Cross-Sectional Study Determinants of Breast Cancer Screening

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