title: Experiences and perceptions regarding clinical breast exam screening by trained laywomen in Malawi.
abstract: Despite the increasing burden, breast cancer control in sub-Saharan Africa is insufficient. Late diagnosis and lack of early detection and screening services contribute to high mortality. Clinical breast exam (CBE) screening can be valuable in low-income countries, including use of community health workers and non-health professionals to conduct exams. We assessed experiences of women who underwent CBE screening by trained laywomen in Lilongwe, Malawi, as part of a pilot program.
  
  
  
  The pilot study invited women attending urban health clinics to a breast cancer educational talk followed by CBE screening by trained laywomen. We purposively sampled participants from the pilot study and interviewed them about the screening experience and future cancer education programs and services.
  
  
  
  Overall participants had positive experiences and were willing to undergo CBE screening by trained laywomen. Participants were motivated by the educational talk, shared newly acquired cancer knowledge with their social networks, and encouraged others to seek screening. Screened women suggested strategies for future interventions including combining breast and cervical cancer screening, using female providers, partnering with community leaders to increase uptake, and expanding services into the community.
  
  
  
  Asymptomatic Malawian women accepted CBE screening by trained laywomen and considered breast cancer an important health issue. Women appreciated combined education and screening services and proposed further linkage of breast and cervical cancer screening. Based on our results, training laywomen to educate the public on breast cancer and conduct CBE is a feasible breast cancer control strategy in sub-Saharan Africa.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02115, USA. racquel_kohler@dfci.harvard.edu.
authors.forename: Racquel E
authors.identifier: 0000-0002-1017-3832
authors.initials: RE
authors.lastname: Kohler
authors.affiliation: Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27514, USA.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Miller
authors.affiliation: Department of Surgery, University of Utah, 30 North 1900 East, 3B 110 School of Medicine, Salt Lake City, UT, 84132, USA.
authors.forename: Lily
authors.initials: L
authors.lastname: Gutnik
authors.affiliation: Department of Surgery, University of North Carolina at Chapel Hill, 7041 Burnett-Womack, Chapel Hill, NC, 27599-7195, USA.|Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Clara N
authors.initials: CN
authors.lastname: Lee
authors.affiliation: Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27514, USA.|Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Satish
authors.initials: S
authors.lastname: Gopal
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006266:Health Education; D006801:Humans; D008295:Malawi; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D010865:Pilot Projects; D011203:Poverty
keywords: Breast cancer screening; Health education; Lay health worker; Qualitative interviews; Sub-Saharan Africa