Addressing the disproportionate breast cancer burden in LMICs: Outcomes from an interventional study evaluating preventing teachings in high schools

Abstract

Abstract Background: The WHO opines that the current disproportionate breast cancer burden and poor outcomes in LMICs fuel global inequalities, which are further compounded by a lack of ‘awareness’ in these regions. Targeting teenage high schoolers in these countries has been mooted as a viable solution. This paper evaluates a Harvard-endorsed initiative to achieve this, in what was a global first. Method: A 12-month, quasi-experimental (pre-and-post-tests) study of three randomly-selected schools in Southeast Nigeria. Exposure to anti-breast cancer teachings with integrated engagement-enhancing measures was the intervention. Results: Compared to 81.3% at baseline, breast cancer awareness was unchanged at one-month post-intervention (OR-1.10; CI 0.96-1.26), but significantly rose to 92.1% at the 12-month mark (OR-0.37; CI 0.26-0.52). Knowledge of breast self-examination (BSE), assessed as a marker of behavioural change, increased steadily. Levels at the baseline were 62.0% and 85.0% lower than that at one (OR-0.38; CI 0.34-0.42) and 12 months (OR-0.15; CI 0.12-0.19), respectively. General, non-specific breast cancer knowledge did not improve over 12 months, but specifics related to early symptoms and risk factors, did. While, over the 12 months, ‘knowledge’ of preventive behaviours was not consistently improved relative to baseline, its actual ‘practice’ increased at both the one (+13.5%) and twelve (+17.3%) month marks, even though its correct timing only improved after 12 months (+6.9%; p=<0.01) and not at one month (+0.8%; p=0.17). Even though knowledge among females was consistently higher than in males at all phases, prolonged intervention (at 12 months) not only allowed males to match females on a few parameters, but also ensured that knowledge reversal, evident among males at the one-month mark, became eliminated. Knowledge among under-15-year-old participants matched that of the older ones on eight of eleven parameters. Conclusion: Provided anti-breast cancer interventions focus on specific, not general, messages, and inbuilt measures that enhance engagement (like the repetition of teachings and the inclusion of exam/assessment techniques) are in place, targeting high schools appear reasonably impactful on knowledge and preventive practices for all relevant ages and gender. Such outcomes, known to engender better breast cancer outcomes, might hold the keys to finally stemming the inequalities in LMICs.