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Why is breast cancer detection late in Ghana?

Studying more about the detection and treatment of breast disease in Ghanaian women

Although breast cancer is on the rise in Africa, few well-designed molecular epidemiologic studies have been conducted. Such studies are vital for disease surveillance and public health preparedness.

Westat provided expertise to investigators at the National Cancer Institute (NCI) to design a breast cancer case-control study called the Ghana Breast Health Study, which took place in the 2 largest metropolitan areas in Ghana: Accra and Kumasi. 

Between 2013 and 2016, the study enrolled 2,200+ potential breast cancer cases and 2,160+ population controls. Eligible participants were asked to

  • Complete an extensive risk factor questionnaire
  • Have anthropometry measurements taken
  • Provide specimens, including saliva, blood, stool, and biopsy or surgical tissue (cases only)

Westat also served as the central coordinating center for the study.

Westat conducted a thorough literature review and identified potential novel risk factors (e.g. skin lighteners) for breast cancer among Ghanaian women.

We reached out to the Ghanaian community in the Washington, DC, area and conducted cognitive interviews to determine how best to design and administer potentially sensitive questions.

We developed an award-winning study logo and brochure for recruiting population controls and for providing credibility to the study when presented to potential participants. The graphics and messages in the study recruitment brochure used imagery and language familiar to the study populations.

We worked with NCI to develop all the procedures for data and biospecimen collections.

We conducted a week-long training, in-country, to ensure all interviewers and laboratory staff adhered to standardized implementation of procedures.

We created a data entry system that could be used offline while simultaneously detecting if the internet was available and automatically transmitting data to Westat to review and provide feedback.

Two publications were created on the following topics:

  • Design considerations for conducting a breast cancer population-based study in Africa
  • Skin lighteners and hair relaxers as risk factors for breast cancer

The brochure

  • Gained the attention of other researchers in Africa for its positive impact on recruitment and retention
  • Received the 2014 National Association of Government Communicators (NAGC) Blue Pencil and Gold Screen Award of Excellence, particularly for the design theme and imagery, cultural acceptability, and easy-to-understand content

Response rates to interviews were 99% in cases and 92% in controls. Over 90% provided a saliva sample, over 80% provided a blood sample, and over 45% provided a stool sample.

The work helped create an extensive data and biospecimen resource for numerous future analyses and methodologic molecular studies. 

Westat continues to support NCI with data and biospecimen management for the study for the production of additional analyses and publications.

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