Comparison of three methods to increase knowledge about breast cancer and breast cancer screening in screening mammography patients. Evaluation of effect of self-examination and physical examination on breast cancer. A promoting early presentation intervention increases breast cancer awareness in older women after 2 years: a randomised controlled trial Impact of a primary care based intervention on breast cancer knowledge, risk perception and concern: A randomized, controlled trial. Involving users in the design of a randomised controlled trial of an intervention to promote early presentation in breast cancer: qualitative study Assessing the fidelity of the Kin KeeperSM prevention intervention in African American, Latina and Arab women. A randomised controlled trial of an intervention to promote early presentation of breast cancer in older women: effect on breast cancer awareness Promoting Early Presentation of Breast Cancer in Older Women: Implementing an Evidence-Based Intervention in Routine Clinical Practice Improving Breast Cancer Preventive Behavior among Female Medical Staff: The Use of Educational Intervention based on Health Belief Model. Kin KeeperSM: design and baseline characteristics of a community-based randomized controlled trial promoting cancer screening in Black, Latina, and Arab women. Promoting early presentation of breast cancer: development of a psycho-educational intervention Raising the Breast Health Awareness amongst Women in an Urban Slum Area in Alexandria, Egypt Promoting early presentation of breast cancer: a preliminary evaluation of a written intervention Promoting early presentation of breast cancer by older women: a preliminary evaluation of a one-to-one health professional-delivered intervention. Outcome of screening by clinical examination of the breast in a trial in the Philippines Teaching breast cancer screening via text messages as part of continuing education for working nurses: a case-control study. Effects of a mammography decision-making intervention at 12 and 24 months. Factors associated with breast self-examination among Malaysian women teachers. Issues relating to selective reporting when including non-randomized studies in systematic reviews on the effects of healthcare interventions. An mHealth model to increase clinic attendance for breast symptoms in rural Bangladesh: can bridging the digital divide help close the cancer divide?
RATIONALE AND OBJECTIVES The specific aim of the study was to determine which of several cost-effective interventions is best able to improve the breast cancer knowledge of women who present for screening mammography . MATERIAL S AND METHODS A total of 198 English-speaking women , with no personal or family history of breast cancer , were recruited and r and omized to four groups when they presented to the clinic for a screening mammogram . All women filled in a demographic data form and answered a question naire containing nine questions about breast cancer , risk , and screening to assess their knowledge and perception . Three educational interventions were tested in this study . The first consisted of a brochure , which provided answers to the question naire items and addressed the issues in more depth . The second intervention was an educational conversation with a specially trained mammography technologist . She review ed the subject 's answers to the question naire items correcting and /or clarifying them . The third intervention consisted of the brochure together with the conversation with a trained technologist . There was also a control group that just filled in the study question naire but did not receive an educational intervention . The same question naire was administered by telephone 4 to 6 weeks after the screening experience to all study subjects . Changes in their knowledge and perceptions of breast cancer were measured and compared . RESULTS A statistically significant increase in knowledge was found in all of the three investigated groups compared to the control group . There were no statistically significant differences in the amount of increase between women who underwent different interventions . CONCLUSIONS All three interventions result ed in increased knowledge about breast cancer and screening . No differences in the amount of knowledge increase were found between three interventions tested . The educational brochure seems to represent the most convenient and least costly method to increase knowledge about breast cancer and screening among women who present for screening mammography BACKGROUND Breast cancer is the number one cancer of women in the world . More than 90 % of breast cancers can be cured with early diagnosis followed by effective multimodality treatment . The efficacy of screening by breast self-examination ( BSE ) and breast physical examination ( BPx ) is best evaluated using r and omized screening trials . METHOD A total of 12,660 women aged 35 - 64 years , 6330 in the intervention group and 6330 in the control group , were r and omly selected from four areas of Yazd city , I.R. of Iran . The number of detected cancers along with kind of cancer , staging of cancer , the route of detected cancer and the number of deaths during the first 5 years of the study were collected and analyzed . RESULTS No significance difference between the two groups was seen in respect to socio-demographic and socio-economic variables ( P > 0.05 ) . Subjects in the intervention group had a response rate of 83.5 % for attending the health center and 80.2 % for visiting the assigned surgeon . A total of 31 and 13 new cases of breast cancer were identified in the intervention and control groups , respectively , of which 48.5 % of cases in the intervention group were < 50 yr of age . A significant difference between the cumulative incidence of breast cancer in the two groups with a ratio of 2.4 was observed . CONCLUSION  BSE & BPx  have a significant effect in detecting breast cancers at early stages ( <3 ) suggesting they are effective screening tests with high availability and low costs that can be applied at the community level Background : We have developed the Promoting Early Presentation ( PEP ) Intervention to equip older women with the knowledge , skills , confidence and motivation to present promptly with breast symptoms , and thereby improve survival from breast cancer . The PEP Intervention consists of a 10-min interaction between a radiographer and an  older woman  , supported by a booklet . Our previous report showed that at 1 year , the PEP intervention increased the proportion who were breast cancer aware compared with usual care . Methods : We r and omised 867 women aged 67–70 years attending for their final routine appointment on the National Health Service Breast Screening Programme to receive the PEP Intervention , a booklet alone or usual care . The primary outcome was breast cancer awareness measured using a vali date d question naire asking about knowledge of breast cancer symptoms , knowledge that the risk of breast cancer increases with age and breast checking behaviour . Results : At 2 years , the PEP Intervention increased the proportion who were breast cancer aware compared with usual care ( 21 vs 6 % ; odds ratio 8.1 , 95 % confidence interval 2.7–25.0 ) . Conclusions : The uniquely large and sustained effect of the PEP Intervention on breast cancer awareness increases the likelihood that a woman will present promptly should she develop breast cancer symptoms up to many years later PURPOSE To estimate the effects of a tablet-based , breast cancer risk education intervention for use in primary care setting s ( BreastCARE ) on patients ' breast cancer knowledge , risk perception and concern . METHODS From June 2011-August 2012 , we enrolled women from two clinics , aged 40 - 74 years with no personal breast cancer history , and r and omized them to the BreastCARE intervention group or to the control group .  All patients completed a baseline telephone survey and risk assessment ( via telephone for controls , via tablet computer in clinic waiting room prior to visit for intervention ) . All women were categorized as high or average risk based on the Referral Screening Tool , the Gail model or the Breast Cancer Surveillance Consortium model . Intervention patients and their physicians received an individualized risk report to discuss during the visit . All women completed a follow-up telephone survey 1 - 2 weeks after risk assessment . Post-test comparisons estimated differences at follow-up in breast cancer knowledge , risk perception and concern . RESULTS 580 intervention and 655 control women completed follow-up interviews . Mean age was 56 years ( SD = 9 ) . At follow-up , 73 % of controls and 71 % of intervention women correctly perceived their breast cancer risk and 22 % of controls and 24 % of intervention women were very concerned about breast cancer . Intervention patients had greater knowledge ( ≥75 % correct answers ) of breast cancer risk factors at follow-up ( 24 % vs. 16 % ; p = 0.002 ) . In multivariable analysis , there were no differences in correct risk perception or concern , but intervention patients had greater knowledge ( [ OR ] = 1.62 ; 95 % [ CI ] = 1.19 - 2.23 ) . CONCLUSIONS A simple , practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern . TRIAL REGISTRATION Clinical Trials.gov identifier NCT01830933 Background The purpose of this study was to explore women 's views of the design of a large pragmatic cost-effectiveness r and omised controlled trial of the policy of offering a health professional-delivered intervention to promote early presentation with breast symptoms in older women and thereby improve survival , with a view to informing protocol development . The trial will recruit over 100,000 healthy women aged 67 + , and outcome data will be collected on those who develop breast cancer . The scale of the trial and the need for long-term follow-up presented a number of design challenges in relation to obtaining consent , ascertaining and contacting participants who developed breast cancer , and collecting outcome data . Methods Qualitative study involving 69 women participating in 7 focus groups and 17 in-depth interviews . 15 women had a previous diagnosis of breast cancer and 54 did not . Results The women held strong views and had a good underst and ing of the rationale of the design of clinical trials . The women recognised that in a very large trial with long-term follow-up it was necessary to incorporate design features to make the trial feasible and efficient . Most strikingly , they supported the idea of opt-out consent and identifying women with breast cancer using routine data sets . Conclusions This model of user involvement engaged women well with the design challenges of the trial and led to improvements to the protocol . The study strengthens the case for user involvement , in particular through focus groups and in-depth interviews , in the design of trials BACKGROUND We evaluated a r and omized controlled treatment , utilizing Community Health Workers ( CHW ) to deliver breast and cervical cancer education intervention to African American , Latina , and Arab women in Detroit and Dearborn , Michigan . The main objectives of the study are to : ( 1 ) examine fidelity and consistency of treatment delivery and ( 2 ) assess qualitative elements of the intervention . METHODS We surveyed 305 women who received the intervention and 16 CHWs Survey included questions regarding the treatment integrity , treatment received , and training provided . Surveys included both quantitative and questions . RESULTS The intervention group ( n = 305 ) was made up of 48 % Black , 11 % Latina , and 41 % Arab women . Almost all ( ≥ 90 % ) women agreed that they received the treatment in the way that it was intended . Sixteen CHWs responded affirmatively as well . CONCLUSIONS Both participants and CHWs indicated that the program was mutually rewarding , indicating that there was " cross fertilization and cross benefit " of working with each other . These benefits served to endorse and confirm that CHWs are a very important mechanism in increasing health literacy in the community and referring underserved individuals to health providers . Second , with strong treatment fidelity the Kin Keeper(SM ) program and has the potential to be replicated for a number of diseases in a variety of venues especially for those facing health disparities Background : There is virtually no evidence for the effectiveness of interventions to promote early presentation in breast cancer . We aim ed to test the efficacy of an intervention to equip older women with the knowledge , skills , confidence and motivation to detect symptoms and seek help promptly , with the aim of promoting early presentation with breast cancer symptoms . Methods : We r and omised 867 women aged 67–70 years attending for their final routine appointment on the UK NHS Breast Screening Programme to receive : a scripted 10-min interaction with a radiographer plus a booklet , a booklet alone or usual care . The primary outcome was whether or not a woman was breast cancer aware based on knowledge of breast cancer symptoms and age-related risk , and reported breast checking . Results : At 1 month , the intervention increased the proportion who were breast cancer aware compared with usual care ( interaction arm : 32.8 % vs 4.1 % ; odds ratio ( OR ) : 24.0 , 95 % confidence interval ( CI ) : 7.7–73.7 ; booklet arm : 12.7 % vs 4.1 % ; OR : 4.4 , 95 % CI : 1.6–12.0 ) . At 1 year , the effects of the interaction plus booklet , and the booklet , on breast cancer awareness were largely sustained , although the interaction plus booklet remained much more effective . Conclusions : An intervention to equip older women with the knowledge , skills , confidence and motivation to detect breast cancer symptoms and seek help promptly increases breast cancer awareness at 1 year . Future research will evaluate whether the intervention promotes early presentation and reduces breast cancer mortality Background . Women over 70 with breast cancer have poorer one-year survival and present at a more advanced stage than younger women . Promoting early symptomatic presentation in older women may reduce stage cost effectively and is unlikely to lead to overdiagnosis . After examining efficacy in a r and omised controlled trial , we piloted a brief health professional-delivered intervention to equip women to present promptly with breast symptoms , as an integral part of the final invited mammogram at age ~70 , in the English National Health Service Breast Screening Programme . Methods . We trained  mammographers  , who then offered the intervention to older women in four breast screening services . We examined breast cancer awareness at baseline and one month in women receiving the intervention , and also in a service where the intervention was not offered . Results . We trained 27 mammographers to deliver the intervention confidently to a high st and ard . Breast cancer awareness increased 7-fold at one month in women receiving the intervention compared with 2-fold in the comparison service ( odds ratio 15.2 , 95 % confidence interval 10.0 to 23.2 ) . Conclusions . The PEP Intervention can be implemented in routine clinical practice with a potency similar to that achieved in a r and omised controlled trial . It has the potential to reduce delay in diagnosis for breast cancer in older women BACKGROUND Breast cancer is one of the most common types of cancer prevalent among women worldwide . Preventive behaviors such as early diagnosis through screening tests play an important role in prevention and control of the disease . This study aim ed to determine the effects of educational intervention using a health belief model on breast cancer preventive behaviors . METHODS This interventional study was conducted on 130 female employees of Zahedan University of Medical Sciences who were r and omly divided into  intervention and control groups .  A question naire , made and vali date d by the research er , was completed before and one month after training by the study subjects . Data were analysed using regression analysis , independent sample T-test , chi-square and Pearson 's correlation coefficient using the SPSS software 18 . RESULTS There were significant changes in the training group , following educational intervention in the awareness construct and in some constructs of the model including perceived susceptibility , perceived benefits , and perceived barriers , as well as in practice compared to the control group ( P < 0.05 ) . Nevertheless , perceived barriers remained as the only predictor in the model , such that for every unit increase in this variable , the behavior score increased by 18 % . CONCLUSION The use of educational intervention based on Health Belief Model had positive effect on knowledge of breast cancer preventive behaviors among participants BACKGROUND Although breast and cervical cancer deaths have declined due to early screening , detection , and more effective treatment , racial and ethnic disparities persist . This paper describes the study design and baseline characteristics of a r and omized controlled trial ( RCT ) evaluating the effectiveness of the Kin Keeper(SM ) Cancer Prevention Intervention , a family-focused educational intervention for underserved women applied in a community-based setting to promote health literacy and screening adherence to address cancer disparities . METHODS Female public health community health workers ( CHWs ) were trained to administer the intervention . They recruited female clients from their public health program caseload and asked each to assemble two to four adult female family members for the breast and cervical cancer home-based education sessions the CHWs would deliver in English , Spanish or Arabic . We r and omized the clients into the kin keeper group ( treatment ) or the participant client group ( control ) . RESULTS Complete data were obtained on 514 Black , Latina , and Arab women . Close to half were unemployed and had yearly family income below $ 20,000 . Thirty-four percent had no medical insurance , and 21 % had diabetes . Almost 40 % had no mammography in the last year  . Treatment and control groups were similar on most sociodemographics but showed differences in breast and cervical screening history . CONCLUSIONS This innovative study demonstrates the implementation of an RCT using community-based participatory research , while delivering cancer prevention education across woman 's life span with women not connected to the health care system Objectives : Women who delay presenting with breast cancer have a reduced chance of survival .  Older women , who are at greater risk of developing breast cancer , are more likely to delay presenting with the disease . The aim of this developmental work was to design a psycho-educational intervention to promote early help-seeking by older women with breast cancer symptoms . We also aim ed to demonstrate the feasibility of implementing the intervention with women attending for their final invited mammogram in the National Health Service ( NHS ) Breast Screening Programme . Methods : The intervention was design ed to address the factors associated with delayed presentation by women with breast cancer . These risk factors were placed in a theoretical framework to underst and patient delay . The intervention incorporated behavioural change techniques that , according to previous research , have been demonstrated to be effective . Results : The intervention was developed in two formats to be delivered by diagnostic radiographers : a booklet alone and a brief interview plus the booklet . The intervention was acceptable to both older women and healthcare professionals in the NHS Breast Screening Programme . Discussion : The intervention will be tested ultimately in a multicentre r and omized controlled trial to determine whether it can reduce the proportion of  older women who delay their presentation  and thereby save lives Background : Breast Cancer ( BC ) is the most frequently occurring cancer among Egyptian women . This study aim ed to determine the effectiveness of a health education program on raising the knowledge related to BC , its risk factors , and some related preventive practice s among women living in an urban slum area in Alex and ria . Patients and Methods : A pre-/post-test interventional study was conducted during 2009–2010 on a r and om sample of women aged 30–65 years ( n = 486 ) living in a slum area in Alex and ria , Egypt . 20 health education sessions were carried out to educate the women on BC risk factors and some preventive practice s. Previously trained nurses educated the sample d women on breast self-examination ( BSE ) . The women ’s knowledge and opinion about BC and their practice of BSE were evaluated before and 3 months after the intervention . Results : The findings indicated a significant increase in the mean knowledge score regarding BC and the mean opinion score regarding some BC risk factors . A significant increase in the practice of BSE was observed post intervention . Conclusion : This study confirms the effectiveness of intervention programs in improving the knowledge about BC risk factors and practice of BSE even in a group of women with a low literacy rate living in a slum area Objectives Older women are more likely to delay presentation with breast cancer , which contributes to poorer survival . We evaluated a written intervention that was design ed to provide women with the knowledge , motivation , confidence and skills to present promptly with breast cancer symptoms . Methods We assessed acceptability and underst and ing of the intervention by interviewing 43 women . We used their responses to refine the intervention . We tested the effect of the intervention on breast cancer awareness , confidence and intentions to check breasts and perceived barriers to help-seeking using a self-report question naire administered to 61 women prior to and one month after receiving the intervention . Quantitative data were analysed using the McNemar test . Results Women were not made anxious by the intervention and understood its messages . At one month , a greater proportion of women knew that breast cancer risk increases with age , identified ≥5 non-lump symptoms and reported breast checking at least monthly in comparison to before the intervention was implemented . Discussion The intervention does not induce anxiety , is underst and able , and appears to increase breast cancer awareness . The results provide justification for a more rigorous trial to test efficacy OBJECTIVE To test the early effects of a novel one-to-one health professional-delivered intervention design ed to increase awareness and thereby promote early presentation of breast cancer among older women . METHODS Women attending their final routine appointment in the English NHS Breast Screening Programme received a booklet or a booklet supplemented by a brief interview , in addition to usual care . This was a within-group before- and -after evaluation of the two versions of the intervention . The primary outcome was change in the knowledge of breast cancer symptoms from baseline to 1 month postintervention . Secondary outcomes were knowledge of risk of developing breast cancer , confidence to detect a breast change , and likelihood of disclosure to someone close . Levels of cancer worry and any adverse effects caused by the intervention were also monitored . RESULTS One hundred seventy-six women received the booklet and 116 received the booklet-plus-interview .  At 1-month postintervention , the mean number of breast cancer symptoms identified ( out of 11 ) increased from 5.3 by 1 symptom ( P<.001 ) in the booklet group and by 1.9 ( P<.001 ) in the booklet-plus-interview group . Improvements were sustained at 6 months . Positive improvements were made in the knowledge of risk of developing breast cancer and the confidence to detect a breast change in both groups ; however , neither version of the intervention had an impact on encouraging women to disclose to someone close immediately on discovery of a breast symptom . No adverse effects were reported , and there was no significant increase in the level of cancer worry . DISCUSSION Both versions of the intervention are worthy of testing in r and omized trials to assess the impact on breast cancer awareness and ultimately on delayed presentation of breast cancer and mortality The value of screening by Clinical Examination of the Breast ( CBE ) as a means of reducing mortality from breast cancer ( BC ) is not established . The issue is relevant , as CBE may be a suitable option for countries in economic transition , where incidence rates are on the increase but limited re sources do not permit screening by mammography . Our aims were to assess whether mass screening by CBE carried out by trained para‐medical personnel is feasible in an urban population of a low‐income country , and its efficacy in reducing BC mortality . Our study was design ed as a r and omised controlled trial of the effect on BC mortality of 5 annual CBE carried out by trained nurses . The target population was women aged 35–64 years , resident in 12 municipalities of the National Capital Region of Manila , Philippines . The units of r and omization were the 202 health centres ( HC ) within the selected municipalities . During 1995 nurses and midwives were recruited and trained in performing CBE . The first round of screening took place in 1996–1997 . The intervention however showed a refractory attitude of the population with respect to clinical follow‐up and was discontinued after the completion of the first screening round . Cases of breast cancer occurring in the study population during 1996–1999 were identified by the 2 local population ‐based registries . In the single screening round 151,168 women were interviewed and offered CBE  , 92 % accepted ( 138,392 ) , 3,479 were detected positive for a lump and referred for diagnosis . Of these only 1220 women ( 35 % ) completed diagnostic follow‐up , whereas 42.4 % actively refused further investigation even with home visits , and 22.5 % were not traced . Of 53 cases that occurred among screen‐positive women in the 2 years after CBE only 34 were diagnosed through the intervention . Eighty cases occurred among screen‐negative women . The test sensitivity  for CBE repeated annually was 53.2 % . The actual sensitivity of the programme was 25.6 % and positive predictive value 1 % . Screen‐detected cases were non‐significantly less advanced than the others . Previous studies have shown that most breast cancer cases in the Philippines present at advanced stages and have an unfavourable outcome . Although CBE undertaken by health workers seems to offer a cost‐effective approach to reducing mortality , the sensitivity of the screening programme in the real context was low . Moreover , in this relatively well‐educated population , cultural and logistic barriers to seeking diagnosis and treatment persist and need to be addressed before any screening programme is introduced . © 2005 Wiley‐Liss , INTRODUCTION Although continuing education is necessary for practicing nurses , it is very difficult to organize traditional classes because of large numbers of nurses and working shifts . Considering the increasing development of mobile electronic learning , we carried out a study to compare effects of the traditional face to face method with mobile learning delivered as text messages by cell phone . MATERIAL S AND METHODS Sixty female nurses working in our hospital were r and omly divided into class and short message service ( SMS ) groups . Lessons concerning breast cancer screening were prepared as 54 messages and sent in 17 days for the SMS group , while the class group participated in a class held by a university lecturer of breast and cancer surgery . Pre- and post-tests were undertaken for both groups at the same time ; a retention test also was performed one month later . For statistical analysis , the paired T test and the independent sample T test were used with SPSS software version 16 ; p<0.05 was considered significant . RESULTS Mean age and mean work experience of participants in class and SMS groups was 35.8±7.2 , 9.8±6.7 , 35.4±7.3 , and 11.5±8.5 , respectively . There was a significant increase in mean score post-tests ( compared with pre-tests ) in both groups ( p<0.05 ) . Although a better improvement in scores of retention tests was demonstrated in the SMS group , the mean subtraction value of the post- and pretests as well as retention- and pre-tests showed no significant difference between the 2 groups ( p=0.3 and p = 0.2 , respectively ) . CONCLUSIONS Our study shows that teaching via SMS may probably replace traditional face to face teaching for continuing education in working nurses . Larger studies are suggested to confirm this BACKGROUND Most women are not getting regular mammograms , and there is confusion about several mammography-related issues , including the age at which women should begin screening . Numerous groups have called for informed decision making about mammography , but few programs have result ed . Our research is intended to fill this gap . METHODS We conducted a r and omized controlled trial , which ran from 1997 to 2000 . Women aged 40 to 44 and 50 to 54 , who were enrolled in Blue Cross Blue Shield of North Carolina , were r and omly assigned to one of three groups : usual care ( UC ) , tailored print ( TP ) material s , or TP plus tailored telephone counseling ( TP+TC ) . We assessed the impact of tailored interventions on knowledge about breast cancer and mammography , accuracy of breast cancer risk perceptions , and use of mammography at two time points after intervention-12 and 24 months . RESULTS At 12 and 24 months , women who received TP+TC had significantly greater knowledge and more accurate breast cancer risk perceptions . Compared to UC , they were 40 % more likely to have had mammograms ( odds ratio=0.9 - 2.1 ) . The effect was primarily for women in their 50s . TP had significant effects for knowledge and accuracy , but women who received TP were less likely to have had mammography . CONCLUSIONS Decision-making interventions , comprised of two tailored print interventions ( booklet and newsletter ) , delivered a year apart , with or without two tailored telephone calls , significantly increased knowledge and accuracy of perceived breast cancer risk at 12 and 24 months post-intervention . The effect on mammography use was significant in bivariate relationships but had a much more modest impact in multivariate analyses The purpose of this study was to examine factors related to  breast self-examination ( BSE ) among teachers in Selangor , Malaysia . A cross-sectional study was conducted among 425 female teachers in 20 r and omly selected secondary schools . A self-administered question naire based on the health belief model was r and omly selected secondary schools . A self-administered question naire based on the health belief model was used , including sociodemographic background and knowledge , beliefs and practice s about breast cancer and BSE . Only 19 % of the women performed BSE on a regular basis . Higher knowledge about breast cancer , greater confidence in performing BSE and regular visits to a physician were significant predictors for practising BSE . To promote BSE practice among Malaysian women , tailored health education and health promotion programmes should be developed based on a specific underst and ing of women 's health beliefs BACKGROUND Selective outcome and analysis reporting ( SOR and SAR ) occur when only a subset of outcomes measured and analyzed in a study is fully reported , and are an important source of potential bias . KEY METHOD OLOGICAL ISSUES We describe what is known about the prevalence and effects of SOR and SAR in both r and omized controlled trials ( RCTs ) and non-r and omized studies ( NRS ) , and the effects of SOR and SAR on summary effect estimates and conclusions in systematic review s of the effectiveness of healthcare interventions . GUIDANCE Review authors should always suspect SOR and SAR in review s that include NRS , assess primary studies for the risk of bias , and make reasonable attempts to retrieve study protocol s or other documentation developed before study recruitment began . There are clues that may suggest SOR or SAR in NRS , including differences between the methods and results sections of the publication , study funder , and differences between study protocol or registration information and the study report . CONCLUSION Existing evidence about reporting biases in primary studies comes almost exclusively from method ological review s of RCTs . The prevalence and impact of SOR and SAR in NRS are likely even greater than in RCTs but it is difficult to identify and confirm selective reporting in NRS . Copyright © 2012 John Wiley & Sons , OBJECTIVE To demonstrate proof of concept for a smart phone-empowered community health worker ( CHW ) model of care for breast health promotion , clinical breast examination ( CBE ) , and patient navigation in rural Bangladesh . METHODS This study was a r and omized controlled trial ; July 1 to October 31 , 2012 , 30 CHWs conducted door-to-door interviews of women aged 25 and older in Khulna Division . Only women who disclosed a breast symptom were offered CBE .  Arm A : smart phone with applications to guide interview , report data , show motivational video , and offer appointment for women with an abnormal CBE . Arm B : smart phone/applications identical to Arm A plus CHW had training in " patient navigation " to address potential barriers to seeking care . Arm C : control arm ( no smart phone ; same interview recorded on paper ) . Outcomes are presented as the " adherence " ( to advice regarding a clinic appointment ) for women with an abnormal CBE . This study was approved by Women 's College Hospital Research Ethics Board ( Toronto , Ontario , Canada ) and district government officials ( Khulna , Bangladesh ) . Funded by Gr and Challenges Canada . RESULTS In 4 months , 22,337 women were interviewed ; < 1 % declined participation , and 556 women had an abnormal CBE . Control group CHWs completed fewer interviews , had inferior data quality , and identified significantly fewer women with abnormal breast exams compared with CHWs in arms A and B. Arm B had the highest adherence . CONCLUSION CHWs guided by our smart phone applications were more efficient and effective in breast health promotion compared with the control group . CHW " navigators " were most effective in encouraging women with an abnormal breast examination to adhere to advice regarding clinic attendance
BACKGROUND Breast cancer continues to be the most commonly diagnosed cancer in women globally .
Early detection , diagnosis and treatment of breast cancer are key to better outcomes .
Since many women will discover a breast cancer symptom themselves , it is important that they are breast cancer aware i.e. have the knowledge , skills and confidence to detect breast changes and present promptly to a healthcare professional .
OBJECTIVES To assess the effectiveness of interventions for raising breast cancer awareness in women .