{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T11:24:22Z","timestamp":1764588262325,"version":"3.40.5"},"reference-count":27,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"7","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Global Oncology"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec><jats:title>PURPOSE<\/jats:title><jats:p> Nearly half of Kenyan women with breast cancer present with advanced disease\u2014owing partially to limited patient education and screening limitations in low- and middle-income countries. With increasing access to nurse-led cervical cancer screening (CCS) in government clinics in Kenya, we investigated provider-perceived barriers and facilitators to integrating clinical breast examinations (CBEs) with ongoing CCS programs in Kisumu County, Kenya. <\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p> CCS providers within the Ministry of Health Clinics in Kisumu County, Kenya, were recruited to participate in a two-phase, sequential, mixed methods study. Knowledge of CBE guidelines was assessed with a questionnaire. Providers with significant CCS and CBE experience then completed a one-on-one interview discussing barriers and facilitators to integration. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p> Sixty-nine providers from 20 randomly selected facilities participated in the survey. Providers all agreed that breast cancer screening was very important. Although 93% said that they routinely offered CBEs, only 22% of these providers screened at least eight of their last 10 patients. Forty-four percent identified four or more of five signs and symptoms of breast cancer, and 33% identified four to five risk factors. Although providers showed enthusiasm for integration of CBEs into their practices, barriers were identified and grouped into four themes: (1) fragmentation of services, (2) staffing shortage and inadequate on-the-job training, (3) limited space and referral system challenges, and (4) limited patient awareness on need for cancer screening. <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p> Addressing providers' concerns by providing routine on-the-job clinical training, improving staffing shortages, strengthening the diagnostic and treatment referral pathway, and increasing patient education are some of the first steps in facilitating integration of CBEs with CCS services in primary care clinics in Kenya. <\/jats:p><\/jats:sec>","DOI":"10.1200\/go.21.00272","type":"journal-article","created":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T20:59:33Z","timestamp":1640206773000},"page":"1722-1729","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":7,"title":["Barriers and Facilitators to Integrating Clinical Breast Examinations With Cervical Cancer Screening Programs in Outpatient Clinics in Western Kenya"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0285-5518","authenticated-orcid":false,"given":"Prisca C.","family":"Diala","sequence":"first","affiliation":[{"name":"University of California, San Francisco, School of Medicine, San Francisco, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2319-6232","authenticated-orcid":false,"given":"Magdalene","family":"Randa","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services (FACES), Kisumu, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0028-9900","authenticated-orcid":false,"given":"Jackline","family":"Odhiambo","sequence":"additional","affiliation":[{"name":"School of Public Health and Community Development, Maseno University, Kisumu, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4969-6777","authenticated-orcid":false,"given":"Gregory","family":"Ganda","sequence":"additional","affiliation":[{"name":"Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig R.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3655-4721","authenticated-orcid":false,"given":"Chemtai","family":"Mungo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"233","reference":[{"key":"b1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"b2","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S197115"},{"volume-title":"Global Cancer Observatory","key":"b3"},{"key":"b4","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.36.15_suppl.e12546"},{"volume-title":"WHO Position Paper on Mammography Screening","year":"2014","author":"World Health Organization 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