背景:乳腺癌是世界上诊断最多的癌症,在低收入和中等收入国家,预后较差。在国内观察到与乳腺癌结果有关的不平等,人口统计学和社会经济地位是主要驱动因素。
目的:本综述旨在汇总来自低收入和中等收入国家的所有可用的关于公共卫生干预措施的证据,这些干预措施可用于减少乳腺癌连续体中的乳腺癌不平等。
方法:该研究是对现有文献的系统回顾和叙述性综合,在2021年9月至10月之间进行的文献检索。搜索于2022年9月重新运行,以更新评论。PubMed,Scopus,Embase,搜索了非洲指数Medicus和LILACS,基于预定的标准。随机对照试验,纳入队列研究和准实验研究进行回顾,而无干预和比较组的研究被排除.JoannaBriggs研究所的清单系列用于对纳入研究的质量评估。与研究设计有关的数据,提取质量控制和干预效果。
结果:共有915项研究被确定用于筛选,21项研究符合筛选标准。只有一项研究专门评估了干预对乳腺癌不平等的影响。多样化,确定了可通过有针对性地应用于弱势亚群来解决乳腺癌不平等问题的多层次干预措施。教育干预被发现在提高筛查率方面是有效的,通过早期表现降低分期,并缩短诊断时间。旨在补贴或消除筛查费用的干预措施提高了筛查率。患者导航被强调为在整个乳腺癌连续体中有效改善结果。
结论:来自系统评价的结果强调了在低收入和中等收入国家的乳腺癌管理中早期发现的重要性。这可以通过各种干预措施来实现,包括人口教育,解决公共卫生服务的障碍,如筛查,特别是在服务不足的人群中。本研究提供了与低收入和中等收入国家相关的公共卫生干预措施的综合数据库,可用于规划和决策目的。该综述的研究结果突出表明,在低收入和中等收入国家旨在减少乳腺癌不平等的干预措施的初步研究中存在重要的研究差距。
背景:PROSPERO注册号:CRD42021289643。
BACKGROUND: Breast cancer is the most diagnosed cancer in the world, with a worse prognosis documented in low- and middle-income countries. Inequalities pertaining to breast cancer outcomes are observed at within-country level, with demographics and socioeconomic status as major drivers.
OBJECTIVE: This
review aims to aggregate all available evidence from low- and middle-income countries on public health interventions that can be utilized to reduce breast cancer inequalities within the breast cancer continuum.
METHODS: The study was a systematic
review and narrative synthesis of available literature, with the literature search conducted between September and October 2021. The search was re-run in September 2022 to update the
review. PubMed, Scopus, Embase, African Index Medicus and LILACS were searched, based on predetermined criteria. Randomized controlled trials, cohort studies and quasi-experimental studies were included for
review, while studies without an intervention and comparator group were excluded. The Joanna Briggs Institute family of checklists was used for quality assessment of the included studies. Data pertaining to study design, quality control and intervention effectiveness was extracted.
RESULTS: A total of 915 studies were identified for screening and 21 studies met the selection criteria. Only one study specifically evaluated the impact of an intervention on breast cancer inequalities. Diverse, multi-level interventions that can be utilized to address breast cancer inequalities through targeted application to disadvantaged subpopulations were identified. Educational interventions were found to be effective in improving screening rates, downstaging through early presentation as well as improving time to diagnosis. Interventions aimed at subsidizing or eliminating screening payments resulted in improved screening rates. Patient navigation was highlighted to be effective in improving outcomes throughout the breast cancer continuum.
CONCLUSIONS: Findings from the systematic review underline the importance of early detection in breast cancer management for low- and middle-income countries. This can be achieved through a variety of interventions, including population education, and addressing access barriers to public health services such as screening, particularly among under-served populations. This study provides a comprehensive database of public health interventions relevant to low- and middle-income countries that can be utilized for planning and decision-making purposes. Findings from the
review highlight an important research gap in primary studies on interventions aimed at reducing breast cancer inequalities in low- and middle-income countries.
BACKGROUND: PROSPERO registration number: CRD42021289643.