Abstract
Breast cancer (BC) has the highest incidence and mortality rate of all cancers in Vietnamese women. Although nearly two thirds of the new BC cases were diagnosed at late stages (stage III/IV), the country does not have a national screening programme. While mammography is not feasible due to resource constraints and breast self-examination was proven to have limited effectiveness, research into clinical breast examination (CBE) is critical but lacking. This PhD thesis evaluates the feasibility, acceptability, and cost-effectiveness of a national screening programme based on CBE in Vietnam.The thesis consists of six component studies each of which employs various methods. Firstly, an overview of systematic reviews about the effectiveness of CBE was performed, followed by two cross-sectional studies that investigated the quality of life of BC patients and survivors and the costs of BC treatment. These first three component studies provided the necessary input data for the fourth study – a cost-effectiveness analysis. The fifth study utilised empirical data from a household survey of women to investigate the question of CBE screening acceptability. Lastly, key informant interviews and situational analysis were conducted to study the question of CBE screening feasibility.
The project showed that a national screening programme using CBE would be highly cost-effective in Vietnam given the downstaging impact of CBE in the context of a country with late diagnosis and increased treatment costs that are incurred at later stages of BC. Considering the current engagement level of women and the absence of socio-demographic disparities in CBE uptake, a national CBE screening programme appears promising. Implementation of screening services at district level is feasible and received wide support from women, clinicians, and health authorities.
These results will be used to inform policy makers and contribute to their decision-making process regarding the implementation of a CBE screening programme in Vietnam. Furthermore, the results may be of interest to other low- and middle-income countries where a national screening programme based on mammography is not a realistic option. The fact that mammography has been proven to be effective and widely used in high income countries may have led to a lack of research attention being given to CBE.
Thesis embargoed until 31 July 2024.
| Date of Award | Jul 2022 |
|---|---|
| Original language | English |
| Awarding Institution |
|
| Sponsors | Queen's University Belfast |
| Supervisor | Ciaran O'Neill (Supervisor), Michael Donnelly (Supervisor) & Hoang Van Minh (Supervisor) |
Keywords
- Breast cancer
- screening
- LMICs
- clinical breast examination
- health-related quality of life
- EQ-5D-5L
- financial toxicity
- cost of treatment
- out-of-pocket payment
- cost-effectiveness analysis
- knowledge-attitude-practice
- Vietnam
- implementation