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  • Rural Digital Europe
  • Publications
  • Journal of Global Oncology

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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Carolyn, Bain; Tara Hayes, Constant; Ines, Contreras; Ana Maria Burga, Vega; +2 Authors

    Purpose Late-stage breast cancer detection should be something of the past; however, it is still all too common in low-resource areas, including Peru, where 57% of women diagnosed with cancer are diagnosed at stage III or IV disease. Early detection of breast cancer is feasible in low-resource semirural and rural areas where mammography is rarely accessible. Methods PATH collaborated with Peruvian health institutions at local, regional, and national levels to design and implement a model of care for the early detection of breast cancer in Peru. The model includes training health promoters for community outreach, professional midwives in clinical breast exam, doctors to perform fine-needle aspiration biopsy sampling with ultrasound to triage, and patient navigators to ensure patients follow through with treatment. Results In a northern region of Peru, 400 individuals, including health promoters, midwives, doctors, and volunteers, received early-detection training in two phases. In Peru, local health professionals continue to refine and improve methods and materials using locally available resources, and the Peruvian health information system now includes specific breast cancer detection categories. Despite challenges and limited resources, the model is effective, and partnership with government health administrations improves health systems and benefits the population. Conclusion Given the absence of screening mammography, the public health challenge is to bring breast cancer early detection and diagnostic services closer to women’s homes and to ensure appropriate follow-up and care. The model is eminently transferable with appropriate adaptation and should now be tested in other settings within and outside of Peru.

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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
    Data sources: Crossref
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    DOAJ
    Article . 2018
    Data sources: DOAJ
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      image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/ Europe PubMed Centra...arrow_drop_down
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
      Data sources: Crossref
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      DOAJ
      Article . 2018
      Data sources: DOAJ
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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: T.G. Flynn; C.M. Dunaway Altamirano; H.S. Reyes García; R.J. Barahona Campos; +10 Authors

    Background: Occupational exposure to agrochemicals, some of which are known or suspected carcinogens, is a major health hazard for subsistence agricultural workers and their families. These impacts are more prevalent in low-and-middle income countries (LMICs) due to weak regulations, lack of awareness of the risks of contamination, general lack of personal protective equipment (PPE), and low literacy about proper agrochemical application techniques. Fluorescent tracer dyes have been described as a means of visualizing and quantifying dermal exposure to agricultural chemicals, and dye techniques adapted for LMICs have been developed previously. These tracer dyes have also been used in educational demonstrations about pesticide safety. However, studies evaluating the efficacy of these educational dye interventions in reducing exposure have been lacking. Aim: To evaluate whether observing one's own chemical contamination after applying agrochemicals changed the amount of occupational dermal exposure during a subsequent chemical application. Methods: We used a multimodal community intervention in a rural village in Honduras that incorporated chemical safety education and use of a fluorescent tracer dye during pesticide application and compared dermal exposure between the intervention group (previous dye experience and safety education) and the control group (safety education only). Results: Mean total visual score (TVS) of the tracer dye, which accounts for both extent and intensity of contamination, was lower among those who had previously experienced the dye intervention (mean TVS=41.3) than among participants who were dye-naïve (mean TVS=78.4), with a difference between means of -37.10 (95% CI [-66.26, -7.95], P = 0.02). Conclusion: That workers who had experienced the dye demonstration once before were significantly less contaminated on average when compared with the dye-naïve group indicates that a multimodal community intervention that utilizes fluorescent dye visualization may be effective in reducing dermal exposure to carcinogenic agrochemicals among subsistence farmers in LMICs.

    image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/ Journal of Global On...arrow_drop_down
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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
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    Authors: A. Lasebikan; A. Nnamani; N. Iloanusi; I. Okoye; +3 Authors

    Background and context: Nigeria, being the most populous African country has the highest cancer burden. Most of the population reside in rural areas where there are no functional health centers. Life in these communities is marked by profound ignorance, superstition and stigma, concerning cancers. There is no cancer control plan in place in the country. Aim: BWS aims at increasing awareness of the need for prevention and early detection of cancers. Strategy/Tactics: Three-pronged approach of education, screening and vaccination, with navigation where required. Monthly education and cancer screening in rural communities. Provision of a navigation system of medical follow-up for patients with a positive screening result; establishing treatment and support care for patients and recruiting and training volunteers and local advocates for cancer awareness campaigns. Program/Policy process: Monthly education/enlightenment activities in various rural communities in southeast Nigeria. Dissemination of information on screening activities is done via church and other community groups; town criers, WhatsApp, radio and banners at strategic locations. Outcomes: A total of 1990 participants (1388 females and 602 males) were screened from January 2016 to December 2017. 1342 women had CBE, 96 were referred for mammography. 105 out 1041 females who had VIA with colposcopy were positive and 26 of them had cryotherapy. 426 girls and young women (9-26 years) received HPV vaccination. 12 out of 204 men who had PSA tests were positive and referred to urologists. Since the launch of project Rid Nigeria of Late Cancer Detection in 2016, BWS has acquired a physical infrastructure for daily screening and continued her monthly rural screening services. What was learned: Women need to take permission from their husbands to even get screened, therefore involvement of traditional rulers, local government chairmen, opinion molders, leaders of faith-based organizations, and local cancer advocates from the community, is helping to increase awareness and reduce stigmatization. Taking the screening to the community is helping combat “late presentation syndrome”. However, financing rural awareness and screening is quite a challenge without financial support.

    image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/ Journal of Global On...arrow_drop_down
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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/ Journal of Global On...arrow_drop_down
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
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    Authors: S. Mbunya; C. Asirwa; D. Felker;

    Background: The AMPATH Consortium has served to greatly expand healthcare in western Kenya. Gaps and limitations in care still exist, especially in oncology care in rural areas. Telemedicine provides a lower cost, practical method to maximize physician resources and limit cost and stress to families with socioeconomic limitations in rural Kenya. The following paper seeks to discuss the importance of developing a telemedicine model in western Kenya and the many advantages telemedicine can bring, as well as discuss the telemedicine model being developed by AMPATH Oncology. Aim: Integrate paper-based medical records into the AMPATH AIDS EMR; Identify sustainable telemedicine tools to integrate into the EMR; Establish networking in rural clinics; Budget in IT personnel at each clinic to assist in patient setup with central site; use solar as primary power source for devices to aid in power issues. Only 45% of Kenyans have access to power; Use cellular networks for communication; Maximize time allocated for physicians to see patients; Decrease travel time to clinics as only 32% of Kenyans live in urban environments. Methods: Cost analysis of remote clinic locations and associated costs; Clinic budget estimate for networking and telemedicine support position; Cost summary and savings Results: Estimated costs for the operations budget for the 17 rural outreach clinics include the costs of hardware, solar networking setup, and internet at a total $3400/wk. This will decrease after the first year to $1700 for maintenance costs of equipment. Personnel consists of 1 local person to support the system and will be a weekly cost of $1870. Lost time for physicians due to road travel totals ∼100 hours weekly. Estimated salaries for an oncologist at $30/h leads to a cost of $3007/wk in lost productivity. It should be noted that lodging and per diem expenses are not included in the estimated expenses that total $6114/wk. By doing telemedicine at the rural clinics in an ideal 48 workable week situation. The savings of $528,000 is a clear evidence that this is financially feasible solely based on travel savings over 5 years. For this reason, the actual savings is ∼$264,000 and still makes a strong argument for this being the right move. Conclusion: Telemedicine is a viable and necessary resource for developing oncologic care in rural Kenya. We believe that telemedicine represents a natural evolution in healthcare in Kenya to support its rural population. Telemedicine helps maximize the limited physician resources and allows them to reach a larger audience without tying up their time in lengthy commutes. Last, telemedicine should assist patients to overcome the barriers of cost and time that limit their treatment. Future challenges and gains will be made with the evolution of the newly formed national health insurance system. Gaining support and reimbursement from telemedicine visits will be crucial to ensuring the success of telemedicine.

    image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/ Journal of Global On...arrow_drop_down
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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/ Journal of Global On...arrow_drop_down
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
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    Authors: L. Abu Tahoun; Y. Khatib; H. Farfora; S. Ghoul; +7 Authors

    Background: Breast cancer is the most common malignancy among adults in Jordan accounting for 39.4% of all newly diagnosed cancers. Jordan is a lower-middle–income country that lacks national screening program. King Hussein Cancer Foundation/Center (KHCF/KHCC) and Jordan Breast Cancer Program had put significant efforts over past years to increase awareness about breast cancer and improve mammography services. They have introduced two mobile mammography units aiming at reaching women in their local communities, in underserved and underprivileged regions. Aim: Describe the experience of making mammography accessible and free of charge to women in rural and remote areas with limited access to mammography services. Methods: Local health educators were trained to recruit women aged 40 years and above to get free screening mammogram in mobile mammography unit. Data collected from five rural areas in Jordan from 2012 until 2017. Total number is 13570 women. Recall was performed at the fixed mammography unit at KHCC and was free of charge until the diagnosis of cancer affirmed or deferred. Results: The highest percentage of women 55.2% (N: 7733) aged 41-50 years. Women aged less than 40 years were recruited due to their breast-related symptoms. It was ethically difficult to refrain imaging symptomatic women in van in remote areas. However, in areas closer to KHCC symptomatic women with no medical insurance were directly referred to KHCC with voucher for free mammogram and workup. Total number of women referred for screening was 13058 (96.2%) and those referred as diagnostic was 512 (3.8%); their mean age was 48.8 and 45 years respectively. Overall recall rate was 29.3% (N: 3822) among screening cases. Cancer detection rate was 0.85% (N: 112) among screened women and 6.8% (N: 35) among diagnostic cases. Number of women who failed to adhere to follow-up procedures was N=1191 (8.8%). It was noticed that family history of cancer correlated with better adherence to complete follow-up procedures. Conclusion: Mobile mammography unit enabled access to screening mammography in rural areas and also encouraged symptomatic women to seek medical advice early. Ensuring financial coverage may have been an additional motivational factor. Follow-up studies may be conducted to compare tumor size differences between screening and diagnostic cases, prognosis and quality of life.

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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      Journal of Global Oncology
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    Authors: L. De Jonge;

    Amount raised: $50,000 (180,000 AED). Background and context: Ana, an Arabic word which means 'I' in English, is a childhood cancer initiative under Friends of Cancer Patients. Ana seeks to raise awareness about the 7 common warning signs of childhood cancer and highlight the importance of early detection, in the United Arab Emirates. In 2018, the Ana initiative launched a 3-year undertaking aimed at using S.T.E.A.M. education to roll out an annual school championship titled “Ana-vation”, a play on words between “Ana” and “innovation”. Ana-vation strategically launched in February during national innovation month, at the Sharjah Center for Astronomy and Space Sciences Planetarium. During the launch, media was invited to observe and 15 participating schools from around the country were briefed on the 4-month championship, electronic components, timeline and expected deliverables. The Ana initiative partnered with a start-up of young engineers to form the Ana-vation team. Students were preselected by their science teachers, to represent their school. Aim: Ana-vation aims to inspire young students to become future researchers, doctors, scientist and engineers, through using innovation and S.T.E.A.M education. The program also offers a bridge to aware parents and teachers, by sending home pamphlets. Strategy/Tactics: Ana-vation is a 4-month campaign (February to May) that rolls out with 15 schools across the Emirates. The program involves the science teacher at each school, who selects 10 students to participate in teams of two (5 teams per school, totaling 75 teams). They have to use the electronic components in the Ana-vation robotic kits and recyclable materials found around their homes, to create a robot to answer in the challenge: “Create an innovative solution to raise awareness about childhood cancer signs and symptoms”. Throughout the 4 months, Ana-vation will conduct workshops at each of the 15 schools to mentor and engage with the students and teach them to code, using basic programing language. Program process: Championship launch - February Training and evaluation roadshows - March Debugging workshops - April Championship and awarding ceremony - May Costs and returns: To cover the cost of the kits + launch event + 15 road show school visits + workshop + award ceremony = $50,000 (180,000 AED) total or $3300 (12,000 AED) per school. FOCP approached corporates to adopt and sponsor a school at $3300. What was learned: Ana-vation was well received by participating schools and sponsoring corporates. It received high media coverage on TV interviews and print media. Offered corporates CSR opportunities, publically associate with a good cause and offered employees volunteer opportunities, plus chance to mentor and engage with young students. FOCP partnered with Manipal University film students and faculty to produce a short documentary on Ana-vation, to be submitted to the Sharjah Children Film Festival in September, to further highlight awareness.

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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
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    Authors: Belinda C. Goodwin; Sonja March; Michael J. Ireland; Fiona Crawford-Williams; +3 Authors

    Background: Utilization of health services is thought to vary between urban and nonurban residents. In Australia, colorectal cancer (CRC) patients in peri-urban and rural areas tend to be diagnosed at a more advanced stage than their urban counterparts and have poorer 5 year survival rates. Aim: In this study, we investigate the effect that attitudes toward health and health related help-seeking have on compliance with population CRC screening programs and whether this varied among varied locations. We also examined the rate of recipients complying with overall program guidelines as opposed to the commonly reported participation rates in mail-out screening programs. Methods: A cross-section of recipients (n=371) who reported receiving a mail-out fecal occult blood test (FOBT) as part of the National Bowel Cancer Screening Program (NBCSP) in Australia were surveyed in 2017 regarding compliance. Attitudinal constructs including fatalism, stoicism and consideration of future consequences known to impact health-related help seeking were also measured. Logistic regression models were tested to assess the attitudinal predictors of program compliance in urban, peri-urban and rural groups. Results: Program participation (% returning kits) was relatively even across geographical locations, however, compliance with overall screening guidelines (returning kit or engaging in suitable alternative) was significantly lower in peri-urban, compared with urban, areas. Higher levels of stoicism and lower levels of consideration for future consequences were associated with lower NBCSP compliance in rural and peri-urban, but not urban areas. Fatalism was not associated with NBCSP compliance. Conclusion: Attempts to increase compliance with mail-out CRC screening program guidelines need to consider the use of appropriately tailored interventions that reflect the different ways in which socio-cultural and psychological factors impact cancer screening practices in geographically diverse communities. Interventions to enhance compliance in nonurban areas should promote the consideration of one's future, and discourage stoic attitudes to health.

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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
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    Authors: J. Li;

    Background: The cancers of the lung, liver, stomach, esophagus, colorectum and nasopharynx account for more than 70% of the causes of cancer death, making them the major cancer burdens in China. The early detection and treatment of cancers including lung, liver, stomach, esophagus, colorectum and nasopharynx was supported by the central government special financial transfer payment in the rural areas in 2006-2017. Aim: To improve the efficiency of early diagnosis and early treatment to reduce cancer mortality and incidence in the population in China. Methods: Cancer screening methods developed by Group of Expert Committee of Cancer Foundation of China were used, including digestive tract endoscopy for stomach and esophageal and colorectal cancer, LDCT for lung cancer, AFP and abdominal ultrasound for liver cancer, EB virus antibody detection and nasal endoscopy for nasopharyngeal carcinoma. Results: Among the cancers of lung, liver, stomach, esophagus, colorectum and nasopharynx, the screening high risk population were 55,363; 126,443; 103,3036; 1,425,642; 252,911; and 79,726 respectively; and the screening detection rates of precancerous lesions and cancer were 0.62%, 0.66%, 0.87%, 1.62%, 5.29% and 0.49% respectively; and the early diagnosis rates were 47.80%, 60.86%, 71.24%, 73.38%, 91.85% and 64.43% respectively; and the treatment rates were 83.28%, 90.33%, 87.94%, 82.91%, 94.04% and 95.88% respectively. Conclusion: The programs for early detection and early treatment of colorectal cancer and esophageal cancer demonstrated a promising benefit, which should be generalized to broad population implementation.

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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
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    Authors: Racquel E, Kohler; Satish, Gopal; Clara N, Lee; Bryan J, Weiner; +2 Authors

    Purpose Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge. Methods We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software. Results Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE); few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both) was the most important attribute of an intervention, followed by the encounter setting and travel time. Conclusion Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women’s preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position.

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    Journal of Global Oncology
    Article . 2017 . Peer-reviewed
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    DOAJ
    Article . 2017
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      Journal of Global Oncology
      Article . 2017 . Peer-reviewed
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      Article . 2017
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    Authors: Alvaro Rivera-Andrade; Maria F Kroker-Lobos; Mariana Lazo; Neal D. Freedman; +6 Authors

    Abstract 13 Background: The proportion of liver cancer (LC) that is linked to metabolic risk factors has been increasing in many countries. Guatemala has the highest reported incidence of LC in the Americas, 1 but the prevalence of metabolic risk factors is not clear. We undertook this work to examine the prevalence of metabolic risk factors for LC in Guatemala by sex and residence. Methods: We conducted a cross-sectional study of 461 adults older than 40 years who resided in rural and urban areas. Risk factors were defined by using physical exam and laboratory data, including anthropometry, blood pressure, fasting plasma glucose, serum liver enzymes, and lipids. Fatty liver disease (FLD) was defined as a fatty liver index score of > 60 and liver fibrosis (LF) as defined by a FIB-4 score of > 2.67. 2 , 3 Results: Among participants, 66% resided in rural areas and 57% were women. Mean ages of men and women were 58.0 ± 11.3 and 53.4 ± 9.8 years, respectively. Compared with men, women had higher prevalence of obesity (15% v 41%; P ≤ .001), metabolic syndrome (46% v 74%; P < .001), and FLD (67% v 52%; P < .001), but not LF (6% v 4%; P = .238). Compared with men and women from rural areas, those from urban areas had higher prevalence of diabetes (10% v 27%; P = .002; and 14% v 32%; P < .001) FLD (42% v 67%; P < .001; and 59% v 79%; P < .001), and metabolic syndrome (37% v 58%; P = .005; and 69% v 81%; P = .032), respectively. There was no difference in prevalence of LF by area among either men (6% v 6%; P = .86) or women (3% v 4%; P = .75). Conclusion: This study highlights a high prevalence of metabolic risk factors for LC in Guatemala, especially among women in urban areas. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Alvaro Rivera-Andrade No relationship to disclose Maria Fernanda Kroker-Lobos No relationship to disclose Mariana Lazo No relationship to disclose Neal Freedman No relationship to disclose John Groopman No relationship to disclose Eliseo Guallar No relationship to disclose Carlos Mendoza-Montano No relationship to disclose Katherine McGlynn No relationship to disclose Josh Smith Research Funding: Abbott Nutrition Manuel Ramirez-Zea No relationship to disclose

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    Journal of Global Oncology
    Article . 2017 . Peer-reviewed
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      Journal of Global Oncology
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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Carolyn, Bain; Tara Hayes, Constant; Ines, Contreras; Ana Maria Burga, Vega; +2 Authors

    Purpose Late-stage breast cancer detection should be something of the past; however, it is still all too common in low-resource areas, including Peru, where 57% of women diagnosed with cancer are diagnosed at stage III or IV disease. Early detection of breast cancer is feasible in low-resource semirural and rural areas where mammography is rarely accessible. Methods PATH collaborated with Peruvian health institutions at local, regional, and national levels to design and implement a model of care for the early detection of breast cancer in Peru. The model includes training health promoters for community outreach, professional midwives in clinical breast exam, doctors to perform fine-needle aspiration biopsy sampling with ultrasound to triage, and patient navigators to ensure patients follow through with treatment. Results In a northern region of Peru, 400 individuals, including health promoters, midwives, doctors, and volunteers, received early-detection training in two phases. In Peru, local health professionals continue to refine and improve methods and materials using locally available resources, and the Peruvian health information system now includes specific breast cancer detection categories. Despite challenges and limited resources, the model is effective, and partnership with government health administrations improves health systems and benefits the population. Conclusion Given the absence of screening mammography, the public health challenge is to bring breast cancer early detection and diagnostic services closer to women’s homes and to ensure appropriate follow-up and care. The model is eminently transferable with appropriate adaptation and should now be tested in other settings within and outside of Peru.

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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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    DOAJ
    Article . 2018
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
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    Authors: T.G. Flynn; C.M. Dunaway Altamirano; H.S. Reyes García; R.J. Barahona Campos; +10 Authors

    Background: Occupational exposure to agrochemicals, some of which are known or suspected carcinogens, is a major health hazard for subsistence agricultural workers and their families. These impacts are more prevalent in low-and-middle income countries (LMICs) due to weak regulations, lack of awareness of the risks of contamination, general lack of personal protective equipment (PPE), and low literacy about proper agrochemical application techniques. Fluorescent tracer dyes have been described as a means of visualizing and quantifying dermal exposure to agricultural chemicals, and dye techniques adapted for LMICs have been developed previously. These tracer dyes have also been used in educational demonstrations about pesticide safety. However, studies evaluating the efficacy of these educational dye interventions in reducing exposure have been lacking. Aim: To evaluate whether observing one's own chemical contamination after applying agrochemicals changed the amount of occupational dermal exposure during a subsequent chemical application. Methods: We used a multimodal community intervention in a rural village in Honduras that incorporated chemical safety education and use of a fluorescent tracer dye during pesticide application and compared dermal exposure between the intervention group (previous dye experience and safety education) and the control group (safety education only). Results: Mean total visual score (TVS) of the tracer dye, which accounts for both extent and intensity of contamination, was lower among those who had previously experienced the dye intervention (mean TVS=41.3) than among participants who were dye-naïve (mean TVS=78.4), with a difference between means of -37.10 (95% CI [-66.26, -7.95], P = 0.02). Conclusion: That workers who had experienced the dye demonstration once before were significantly less contaminated on average when compared with the dye-naïve group indicates that a multimodal community intervention that utilizes fluorescent dye visualization may be effective in reducing dermal exposure to carcinogenic agrochemicals among subsistence farmers in LMICs.

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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
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    Authors: A. Lasebikan; A. Nnamani; N. Iloanusi; I. Okoye; +3 Authors

    Background and context: Nigeria, being the most populous African country has the highest cancer burden. Most of the population reside in rural areas where there are no functional health centers. Life in these communities is marked by profound ignorance, superstition and stigma, concerning cancers. There is no cancer control plan in place in the country. Aim: BWS aims at increasing awareness of the need for prevention and early detection of cancers. Strategy/Tactics: Three-pronged approach of education, screening and vaccination, with navigation where required. Monthly education and cancer screening in rural communities. Provision of a navigation system of medical follow-up for patients with a positive screening result; establishing treatment and support care for patients and recruiting and training volunteers and local advocates for cancer awareness campaigns. Program/Policy process: Monthly education/enlightenment activities in various rural communities in southeast Nigeria. Dissemination of information on screening activities is done via church and other community groups; town criers, WhatsApp, radio and banners at strategic locations. Outcomes: A total of 1990 participants (1388 females and 602 males) were screened from January 2016 to December 2017. 1342 women had CBE, 96 were referred for mammography. 105 out 1041 females who had VIA with colposcopy were positive and 26 of them had cryotherapy. 426 girls and young women (9-26 years) received HPV vaccination. 12 out of 204 men who had PSA tests were positive and referred to urologists. Since the launch of project Rid Nigeria of Late Cancer Detection in 2016, BWS has acquired a physical infrastructure for daily screening and continued her monthly rural screening services. What was learned: Women need to take permission from their husbands to even get screened, therefore involvement of traditional rulers, local government chairmen, opinion molders, leaders of faith-based organizations, and local cancer advocates from the community, is helping to increase awareness and reduce stigmatization. Taking the screening to the community is helping combat “late presentation syndrome”. However, financing rural awareness and screening is quite a challenge without financial support.

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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
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    Authors: S. Mbunya; C. Asirwa; D. Felker;

    Background: The AMPATH Consortium has served to greatly expand healthcare in western Kenya. Gaps and limitations in care still exist, especially in oncology care in rural areas. Telemedicine provides a lower cost, practical method to maximize physician resources and limit cost and stress to families with socioeconomic limitations in rural Kenya. The following paper seeks to discuss the importance of developing a telemedicine model in western Kenya and the many advantages telemedicine can bring, as well as discuss the telemedicine model being developed by AMPATH Oncology. Aim: Integrate paper-based medical records into the AMPATH AIDS EMR; Identify sustainable telemedicine tools to integrate into the EMR; Establish networking in rural clinics; Budget in IT personnel at each clinic to assist in patient setup with central site; use solar as primary power source for devices to aid in power issues. Only 45% of Kenyans have access to power; Use cellular networks for communication; Maximize time allocated for physicians to see patients; Decrease travel time to clinics as only 32% of Kenyans live in urban environments. Methods: Cost analysis of remote clinic locations and associated costs; Clinic budget estimate for networking and telemedicine support position; Cost summary and savings Results: Estimated costs for the operations budget for the 17 rural outreach clinics include the costs of hardware, solar networking setup, and internet at a total $3400/wk. This will decrease after the first year to $1700 for maintenance costs of equipment. Personnel consists of 1 local person to support the system and will be a weekly cost of $1870. Lost time for physicians due to road travel totals ∼100 hours weekly. Estimated salaries for an oncologist at $30/h leads to a cost of $3007/wk in lost productivity. It should be noted that lodging and per diem expenses are not included in the estimated expenses that total $6114/wk. By doing telemedicine at the rural clinics in an ideal 48 workable week situation. The savings of $528,000 is a clear evidence that this is financially feasible solely based on travel savings over 5 years. For this reason, the actual savings is ∼$264,000 and still makes a strong argument for this being the right move. Conclusion: Telemedicine is a viable and necessary resource for developing oncologic care in rural Kenya. We believe that telemedicine represents a natural evolution in healthcare in Kenya to support its rural population. Telemedicine helps maximize the limited physician resources and allows them to reach a larger audience without tying up their time in lengthy commutes. Last, telemedicine should assist patients to overcome the barriers of cost and time that limit their treatment. Future challenges and gains will be made with the evolution of the newly formed national health insurance system. Gaining support and reimbursement from telemedicine visits will be crucial to ensuring the success of telemedicine.

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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
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    Authors: L. Abu Tahoun; Y. Khatib; H. Farfora; S. Ghoul; +7 Authors

    Background: Breast cancer is the most common malignancy among adults in Jordan accounting for 39.4% of all newly diagnosed cancers. Jordan is a lower-middle–income country that lacks national screening program. King Hussein Cancer Foundation/Center (KHCF/KHCC) and Jordan Breast Cancer Program had put significant efforts over past years to increase awareness about breast cancer and improve mammography services. They have introduced two mobile mammography units aiming at reaching women in their local communities, in underserved and underprivileged regions. Aim: Describe the experience of making mammography accessible and free of charge to women in rural and remote areas with limited access to mammography services. Methods: Local health educators were trained to recruit women aged 40 years and above to get free screening mammogram in mobile mammography unit. Data collected from five rural areas in Jordan from 2012 until 2017. Total number is 13570 women. Recall was performed at the fixed mammography unit at KHCC and was free of charge until the diagnosis of cancer affirmed or deferred. Results: The highest percentage of women 55.2% (N: 7733) aged 41-50 years. Women aged less than 40 years were recruited due to their breast-related symptoms. It was ethically difficult to refrain imaging symptomatic women in van in remote areas. However, in areas closer to KHCC symptomatic women with no medical insurance were directly referred to KHCC with voucher for free mammogram and workup. Total number of women referred for screening was 13058 (96.2%) and those referred as diagnostic was 512 (3.8%); their mean age was 48.8 and 45 years respectively. Overall recall rate was 29.3% (N: 3822) among screening cases. Cancer detection rate was 0.85% (N: 112) among screened women and 6.8% (N: 35) among diagnostic cases. Number of women who failed to adhere to follow-up procedures was N=1191 (8.8%). It was noticed that family history of cancer correlated with better adherence to complete follow-up procedures. Conclusion: Mobile mammography unit enabled access to screening mammography in rural areas and also encouraged symptomatic women to seek medical advice early. Ensuring financial coverage may have been an additional motivational factor. Follow-up studies may be conducted to compare tumor size differences between screening and diagnostic cases, prognosis and quality of life.

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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
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    Authors: L. De Jonge;

    Amount raised: $50,000 (180,000 AED). Background and context: Ana, an Arabic word which means 'I' in English, is a childhood cancer initiative under Friends of Cancer Patients. Ana seeks to raise awareness about the 7 common warning signs of childhood cancer and highlight the importance of early detection, in the United Arab Emirates. In 2018, the Ana initiative launched a 3-year undertaking aimed at using S.T.E.A.M. education to roll out an annual school championship titled “Ana-vation”, a play on words between “Ana” and “innovation”. Ana-vation strategically launched in February during national innovation month, at the Sharjah Center for Astronomy and Space Sciences Planetarium. During the launch, media was invited to observe and 15 participating schools from around the country were briefed on the 4-month championship, electronic components, timeline and expected deliverables. The Ana initiative partnered with a start-up of young engineers to form the Ana-vation team. Students were preselected by their science teachers, to represent their school. Aim: Ana-vation aims to inspire young students to become future researchers, doctors, scientist and engineers, through using innovation and S.T.E.A.M education. The program also offers a bridge to aware parents and teachers, by sending home pamphlets. Strategy/Tactics: Ana-vation is a 4-month campaign (February to May) that rolls out with 15 schools across the Emirates. The program involves the science teacher at each school, who selects 10 students to participate in teams of two (5 teams per school, totaling 75 teams). They have to use the electronic components in the Ana-vation robotic kits and recyclable materials found around their homes, to create a robot to answer in the challenge: “Create an innovative solution to raise awareness about childhood cancer signs and symptoms”. Throughout the 4 months, Ana-vation will conduct workshops at each of the 15 schools to mentor and engage with the students and teach them to code, using basic programing language. Program process: Championship launch - February Training and evaluation roadshows - March Debugging workshops - April Championship and awarding ceremony - May Costs and returns: To cover the cost of the kits + launch event + 15 road show school visits + workshop + award ceremony = $50,000 (180,000 AED) total or $3300 (12,000 AED) per school. FOCP approached corporates to adopt and sponsor a school at $3300. What was learned: Ana-vation was well received by participating schools and sponsoring corporates. It received high media coverage on TV interviews and print media. Offered corporates CSR opportunities, publically associate with a good cause and offered employees volunteer opportunities, plus chance to mentor and engage with young students. FOCP partnered with Manipal University film students and faculty to produce a short documentary on Ana-vation, to be submitted to the Sharjah Children Film Festival in September, to further highlight awareness.

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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
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    Authors: Belinda C. Goodwin; Sonja March; Michael J. Ireland; Fiona Crawford-Williams; +3 Authors

    Background: Utilization of health services is thought to vary between urban and nonurban residents. In Australia, colorectal cancer (CRC) patients in peri-urban and rural areas tend to be diagnosed at a more advanced stage than their urban counterparts and have poorer 5 year survival rates. Aim: In this study, we investigate the effect that attitudes toward health and health related help-seeking have on compliance with population CRC screening programs and whether this varied among varied locations. We also examined the rate of recipients complying with overall program guidelines as opposed to the commonly reported participation rates in mail-out screening programs. Methods: A cross-section of recipients (n=371) who reported receiving a mail-out fecal occult blood test (FOBT) as part of the National Bowel Cancer Screening Program (NBCSP) in Australia were surveyed in 2017 regarding compliance. Attitudinal constructs including fatalism, stoicism and consideration of future consequences known to impact health-related help seeking were also measured. Logistic regression models were tested to assess the attitudinal predictors of program compliance in urban, peri-urban and rural groups. Results: Program participation (% returning kits) was relatively even across geographical locations, however, compliance with overall screening guidelines (returning kit or engaging in suitable alternative) was significantly lower in peri-urban, compared with urban, areas. Higher levels of stoicism and lower levels of consideration for future consequences were associated with lower NBCSP compliance in rural and peri-urban, but not urban areas. Fatalism was not associated with NBCSP compliance. Conclusion: Attempts to increase compliance with mail-out CRC screening program guidelines need to consider the use of appropriately tailored interventions that reflect the different ways in which socio-cultural and psychological factors impact cancer screening practices in geographically diverse communities. Interventions to enhance compliance in nonurban areas should promote the consideration of one's future, and discourage stoic attitudes to health.

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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      Journal of Global Oncology
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    Authors: J. Li;

    Background: The cancers of the lung, liver, stomach, esophagus, colorectum and nasopharynx account for more than 70% of the causes of cancer death, making them the major cancer burdens in China. The early detection and treatment of cancers including lung, liver, stomach, esophagus, colorectum and nasopharynx was supported by the central government special financial transfer payment in the rural areas in 2006-2017. Aim: To improve the efficiency of early diagnosis and early treatment to reduce cancer mortality and incidence in the population in China. Methods: Cancer screening methods developed by Group of Expert Committee of Cancer Foundation of China were used, including digestive tract endoscopy for stomach and esophageal and colorectal cancer, LDCT for lung cancer, AFP and abdominal ultrasound for liver cancer, EB virus antibody detection and nasal endoscopy for nasopharyngeal carcinoma. Results: Among the cancers of lung, liver, stomach, esophagus, colorectum and nasopharynx, the screening high risk population were 55,363; 126,443; 103,3036; 1,425,642; 252,911; and 79,726 respectively; and the screening detection rates of precancerous lesions and cancer were 0.62%, 0.66%, 0.87%, 1.62%, 5.29% and 0.49% respectively; and the early diagnosis rates were 47.80%, 60.86%, 71.24%, 73.38%, 91.85% and 64.43% respectively; and the treatment rates were 83.28%, 90.33%, 87.94%, 82.91%, 94.04% and 95.88% respectively. Conclusion: The programs for early detection and early treatment of colorectal cancer and esophageal cancer demonstrated a promising benefit, which should be generalized to broad population implementation.

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    Journal of Global Oncology
    Article . 2018 . Peer-reviewed
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      Journal of Global Oncology
      Article . 2018 . Peer-reviewed
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    Authors: Racquel E, Kohler; Satish, Gopal; Clara N, Lee; Bryan J, Weiner; +2 Authors

    Purpose Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge. Methods We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software. Results Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE); few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both) was the most important attribute of an intervention, followed by the encounter setting and travel time. Conclusion Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women’s preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position.

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    Journal of Global Oncology
    Article . 2017 . Peer-reviewed
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    DOAJ
    Article . 2017
    Data sources: DOAJ
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      Journal of Global Oncology
      Article . 2017 . Peer-reviewed
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      DOAJ
      Article . 2017
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    Authors: Alvaro Rivera-Andrade; Maria F Kroker-Lobos; Mariana Lazo; Neal D. Freedman; +6 Authors

    Abstract 13 Background: The proportion of liver cancer (LC) that is linked to metabolic risk factors has been increasing in many countries. Guatemala has the highest reported incidence of LC in the Americas, 1 but the prevalence of metabolic risk factors is not clear. We undertook this work to examine the prevalence of metabolic risk factors for LC in Guatemala by sex and residence. Methods: We conducted a cross-sectional study of 461 adults older than 40 years who resided in rural and urban areas. Risk factors were defined by using physical exam and laboratory data, including anthropometry, blood pressure, fasting plasma glucose, serum liver enzymes, and lipids. Fatty liver disease (FLD) was defined as a fatty liver index score of > 60 and liver fibrosis (LF) as defined by a FIB-4 score of > 2.67. 2 , 3 Results: Among participants, 66% resided in rural areas and 57% were women. Mean ages of men and women were 58.0 ± 11.3 and 53.4 ± 9.8 years, respectively. Compared with men, women had higher prevalence of obesity (15% v 41%; P ≤ .001), metabolic syndrome (46% v 74%; P < .001), and FLD (67% v 52%; P < .001), but not LF (6% v 4%; P = .238). Compared with men and women from rural areas, those from urban areas had higher prevalence of diabetes (10% v 27%; P = .002; and 14% v 32%; P < .001) FLD (42% v 67%; P < .001; and 59% v 79%; P < .001), and metabolic syndrome (37% v 58%; P = .005; and 69% v 81%; P = .032), respectively. There was no difference in prevalence of LF by area among either men (6% v 6%; P = .86) or women (3% v 4%; P = .75). Conclusion: This study highlights a high prevalence of metabolic risk factors for LC in Guatemala, especially among women in urban areas. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Alvaro Rivera-Andrade No relationship to disclose Maria Fernanda Kroker-Lobos No relationship to disclose Mariana Lazo No relationship to disclose Neal Freedman No relationship to disclose John Groopman No relationship to disclose Eliseo Guallar No relationship to disclose Carlos Mendoza-Montano No relationship to disclose Katherine McGlynn No relationship to disclose Josh Smith Research Funding: Abbott Nutrition Manuel Ramirez-Zea No relationship to disclose

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    Journal of Global Oncology
    Article . 2017 . Peer-reviewed
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      Journal of Global Oncology
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