Keywords
breast carcinoma
massive screening
Colombia
How to Cite
Abstract
This document presents the results of a participatory diagnosis on barriers and facilitators of access to early detection services for breast cancer in Soledad, Atlántico, which included the participation of representatives of all the actors in charge of the organization and provision of said services. , including patient representatives, developed within the framework of the implementation of the “Pilot Program for strengthening early diagnosis and organized population-based screening in two intermediate cities in Colombia: 2023-2028”, led by the National Institute of Cancerology.
The information collected was analyzed with the thematic analysis technique, and the results were organized and presented using Tanahashi's effective access model. The main results were discussed in light of national and international scientific evidence, analyzed through narrative review, identifying important coherence with results from low- and middle-income country contexts.
The main barriers to availability were limited mammography equipment and lack of trained personnel. The main accessibility barriers were low payment capacity, as well as the affiliation regime. The main barriers to acceptability were the fear of pain and possible diagnosis, as well as the refusal to assume the burden of administrative procedures. The main barrier to contact was the weakness of active recruitment. Finally, the main barrier to effective access was related to the disarticulation of the management of service provision networks among the responsible actors.
1. Caswell-Jin JL, Sun LP, Munoz D, Lu Y, Li Y, Huang H, et al. Analysis of Breast Cancer Mortality in the US - 1975 to 2019. JAMA. 2024 Jan 16;331(3):233-41. https://doi.org/10.1001/jama.2023.25881
2. Bonilla Sepúlveda ÓA. Inequidades en la atención del cáncer de mama en Colombia: revisión sistemática. Medicina UPB. 2022;41(1):29-37. https://doi.org/10.18566/medupb.v41n1.a05
3. Sardi A, Orozco-Urdaneta M, Velez-Mejia C, Perez-Bustos AH, Munoz-Zuluaga C, El-Sharkawy F, et al. Overcoming barriers in the implementation of programs for breast and cervical cancers in Cali, Colombia: a pilot model. JGO. 2019. https://doi.org/10.1200/jgo.19.00054
4. Sharma R. Global, regional, national burden of breast cancer in 185 countries: evidence from GLOBOCAN 2018. Breast Cancer Res Treat [Internet]. 2021;187(2):557-67. https://doi.org/10.1007/s10549-020-06083-6
5. Fitzmaurice C, Abate D, Abbasi N, Abbastabar H, Abd-Allah F, Abdel-Rahman O, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017: A systematic analysis for the global burden of disease study. JAMA Oncol. 2019;5(12):1749-68. https://doi.org/10.1001/jamaoncol.2019.2996
6. Wiesner C, Díaz S, Sánchez O, Puerto D, Bravo LE, Murillo R. Políticas basadas en la evidencia científica: el caso del control del cáncer de mama en Colombia. Revista Colombiana de Cancerología [Internet]. 2020;24(3):103-12. https://doi.org/10.35509/01239015.261
7. Trapani D, Ginsburg O, Fadelu T, Lin NU, Hassett M, Ilbawi AM, et al. Global challenges and policy solutions in breast cancer control. Cancer Treat Rev [Internet]. 2022;104(January):102339. https://doi.org/10.1016/j.ctrv.2022.102339
8. Instituto Nacional de Cancerología. Manual para la detección temprana del cáncer de mama. 2015. 55 p. http://journal.um-surabaya.ac.id/index.php/JKM/article/view/2203
9. Ministerio de Salud y Protección social. Guía de práctica clínica (GPC) para la detección temprana, tratamiento integral, seguimiento y rehabilitación de pacientes con cáncer de mama. Guía No. 19. 2013; 930 p. https://www.minsalud.gov.co/sites/rid/1/Gu%C3%ADa%20de%20Pr%C3%A1ctica%20Cl%C3%ADnica%20%20de%20Cancer%20de%20Mama%20versi%C3%B3n%20completa.pdf
10. Instituto Nacional de Cancerología. Protocolo de control de calidad en mamografía digital directa. Bogotá: INC; 2024; 200 p. https://www.cancer.gov.co/conozca-sobre-cancer-1/publicaciones/protocolo-control-calidad-mamografia
11. Banco Interamericano de Desarrollo. Las ciudades intermedias con mayor potencial en Colombia. Un sistema de identificación. Washington, DC; BID; 2015; 40 p. http://dx.doi.org/10.18235/0009605
12. Secretaría de Salud Departamental del Atlántico. Análisis de situación de salud participativo. Barranquilla; Secretaría Departamental de Salud del Atlántico, 2024. https://ceopruebas.sispropreprod.gov.co/DocumentosASIS2024/ASIS%20Atl%C3%A1ntico%202023%20OK.pdf
13. Tanahashi T. Health service coverage and its evaluation. Bull World Health Organ. 1978;56(2):295-303. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2395571/
14. Organización Panamericana de la Salud. Analizar y superar las barreras de acceso para fortalecer la atención primaria de salud. Washington, DC; OPS; 2023; 106 p. https://iris.paho.org/handle/10665.2/57803
15. Löhr K, Weinhardt M, Sieber S. The “world café” as a participatory method for collecting qualitative data. Int J Qual Methods. 2020;19. https://doi.org/10.1177/1609406920916976
16. Attride-Stirling J. Thematic networks: an analytic tool for qualitative research. Qual Res. 2001;1(3):385-405 https://doi.org/10.1177/146879410100100307
17. Gbenonsi G, Boucham M, Belrhiti Z, Nejjari C, Huybrechts I, Khalis M. Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review. BMC Public Health. 2021; 21(1); 11296 https://doi.org/10.1186/s12889-021-11296-5
18. Edwards AGK, Naik G, Ahmed H, Elwyn GJ, Pickles T, Hood K, et al. Personalised risk communication for informed decision making about taking screening tests. Cochrane Database Syst Rev. 2013;2013(2):1-96. https://doi.org/10.1002/14651858.cd001865.pub3
19. World Health Organization. Global breast cancer initiative implementation framework assessing, strengthening and scaling up services for the early detection and management of breast cancer. 2021; 19 p. https://www.who.int/publications/i/item/9789240067134
20. Akoto EJ, Allsop MJ. Factors influencing the experience of breast and cervical cancer screening among women in low-and middle-income countries: a systematic review. JCO Glob Oncol. 2023;9: e2200359. https://doi.org/10.1200/go.22.00359
21. Srinath A, Van Merode F, Rao SV, Pavlova M. Barriers to cervical cancer and breast cancer screening uptake in low- and middle-income countries: a systematic review. Health Policy Plan. 2023;38(5):509-27. https://doi.org/10.1093/heapol/czac104
22. Pittalis C, Panteli E, Schouten E, Magongwa I, Gajewski J. Breast and cervical cancer screening services in Malawi: a systematic review. BMC Cancer. 2020;20(1). https://doi.org/10.1186/s12885-020-07610-w
23. Gakunga R, Kinyanjui A, Ali Z, Ochieng’ E, Gikaara N, Maluni F, et al. Identifying barriers and facilitators to breast cancer early detection and subsequent treatment engagement in Kenya: a qualitative approach. Oncologist. 2019; 24(12):1549-56. https://doi.org/10.1634/theoncologist.2019-0257
24. Mahmud A, Aljunid S. The uptake of mammogram screening in Malaysia and its associated factors: a systematic review. Med J Malaysia. 2018;73(4):202-11. https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-07610-w
25. Plourde N, Brown HK, Vigod S, Cobigo V. Contextual factors associated with uptake of breast and cervical cancer screening: a systematic review of the literature. Women Health. 2016;56(8):906-25. https://doi.org/10.1080/03630242.2016.1145169
26. Adunlin G, Cyrus JW, Asare M, Sabik LM. Barriers and Facilitators to Breast and Cervical Cancer Screening Among Immigrants in the United States. J Immigr Minor Health. 2019;21(3):606-58. https://doi.org/10.1007/s10903-018-0794-6
27. Sharma K, Costas A, Shulman LN, Meara JG. A systematic review of barriers to breast cancer care in developing countries resulting in delayed patient presentation. J Oncol. 2012. https://doi.org/10.1155/2012/121873
28. Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol. 2014;5(3):465-77. https://doi.org/10.5306/wjco.v5.i3.465
29. Azami-Aghdash S, Ghojazadeh M, Sheyklo SG, Daemi A, Kolahdouzan K, Mohseni M, et al. Breast cancer screening barriers from the woman's perspective: a meta-synthesis. Asian Pac J Cancer Prev. 2015;16(8):3463-71. https://doi.org/10.7314/apjcp.2015.16.8.3463
30. Zha N, Alabousi M, Patel BK, Patlas MN. Beyond Universal Health Care: Barriers to Breast Cancer Screening Participation in Canada. J Am Coll Radiol. 2019;16(4):570-9. https://doi.org/10.1016/j.jacr.2019.02.044
31. Sayed S, Ngugi AK, Nwosu N, Mutebi MC, Ochieng P, Mwenda AS, et al. Training health workers in clinical breast examination for early detection of breast cancer in low- and middle-income countries. Cochrane Database Syst Rev. 2023;2023(4):CD012515. https://doi.org/10.1002/14651858.cd012515.pub2
32. Unger-Saldaña K, Miranda A, Zarco-Espinosa G, Mainero-Ratchelous F, Bargallõ-Rocha E, Miguel Lázaro-Leõn J. Health system delay and its effect on clinical stage of breast cancer: Multicenter study. Cancer. 2015;121(13):2198-206. https://doi.org/10.1002/cncr.29331
33. Khan-Gates JA, Ersek JL, Eberth JM, Adams SA, Pruitt SL. Geographic Access to Mammography and Its Relationship to Breast Cancer Screening and Stage at Diagnosis: A Systematic Review. Women’s Health Issues. 2015;25(5):482-93. https://doi.org/10.1016%2Fj.whi.2015.05.010
34. Doede A, Mitchell E, Wilson D, Paganides R, Oliveira M. Kwonledge, beliefs, and attitudes about breast cancer screening in Latin America and the Caribbean: an in-depth narrative review. JCO Glob Oncol. 2018; 4:1-9. https://doi.org/10.1200/jgo.18.00053
35. Unger-Saldaña K, Ventosa-Santaulària D, Miranda A, Verduzco-Bustos G. Barriers and Explanatory Mechanisms of Delays in the Patient and Diagnosis Intervals of Care for Breast Cancer in Mexico. Oncologist. 2018;23(4):440-53. https://doi.org/10.1634/theoncologist.2017-0431
36. Schell LK, Monsef I, Wöckel A, Skoetz N. Mindfulness-based stress reduction for women diagnosed with breast cancer. Cochrane Database Syst Rev. 2019;2019(8):CD011518. https://doi.org/10.1002/14651858.cd011518.pub2
37. Perez-Bustos AH, Orozco-Urdaneta M, Erazo R, Cordoba-Astudillo P, Gallo D, Muñoz-Zuluaga C, et al. A patient navigation initiative to improve access to breast cancer care in Cali, Colombia. Cancer Rep. 2022;5(9). https://doi.org/10.1002/cnr2.1564
38. Houghton N, Bascolo E, Del Riego A. Monitoring access barriers to health services in the Americas: a mapping of household surveys. Rev Panamericana de Salud Pública/Pan American Journal of Public Health. 2020;44. https://doi.org/10.26633/RPSP.2020.96
39. Alejo-Martínez H, Salazar-Hurtado EJ, Poveda-Suárez CA, Puerto-Jiménez DN, Ramírez-Campos F, Roldán-Sánchez OI. Impacto del programa de aseguramiento de la calidad de las mamografías en Colombia. An Radiol Mex. 2014;13(4):369-83. https://www.medigraphic.com/pdfs/anaradmex/arm-2014/arm144e.pdf
40. Koller, T. S. (2021, 23 April). Assessing barriers to effective coverage with health services [Webinar presentation]. PAHO/AMRO webinar series on essential public health functions. Pan American Health Organization. https://www.paho.org/sites/default/files/theadora-koller-assessing-barriers-fesp-april-2021.pdf?utm_source=chatgpt.com
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