Improving early detection and diagnosis of breast cancer among multi-ethnic rural communities in Malaysia - implementation of the CENP

乳腺癌（BC）是马来西亚最常见的癌症。农村地区的妇女患有晚期癌症，由于对症状的认识不足和对BC筛查的参与率低，生存率很低。该项目旨在利用我们以前在马来西亚成功研究的经验教训和实施科学的方法，制定和评估社区教育和导航方案，以改善农村妇女中BC的早期发现和诊断。该研究将在柔佛州塞加马特区进行，并与当地利益相关者协商，并得到东南亚社区观察站（SEACO）的支持，SEACO是一个既定的健康和人口监测网站。直接受益者将是马来西亚当地农村社区的妇女和家庭。我们的项目将通过提高公众对警告信号和症状的认识，更具体地说，通过引导妇女进行乳腺癌筛查，使农村社区受益。CENP将识别和消除情感障碍，消除错误信念，并促进寻求帮助的行为，从而加强癌症预防，并在适当的情况下，导致早期诊断和治疗。我们的项目通过改进预防和早期诊断，将减轻负担，包括许多妇女及其家庭所经历的个人、经济和心理负担，以及卫生保健系统的资源负担和马来西亚更广泛的社会经济后果。此外，我们的项目将与初级保健医生合作，以进一步提高他们对所服务社区的了解，在社区和初级保健服务中嵌入患者导航，并加快疑似病例的转诊。此外，该项目还将通过加强有关癌症的知识和教育材料以及相关技能，为农村社区、非政府组织、公共卫生研究人员和学术界开展能力建设。

Breast cancer (BC) is the commonest cancer in Malaysia. Women in rural areas present with advanced cancer and experience poor survival due to low awareness about symptoms and low participation in BC screening. This project aims to harness the lessons from our previous successful study in Malaysia and the methods of implementation science to develop and evaluate a community education and navigation programme (CENP) that will improve the early detection and diagnosis of BC among rural women. The study will be conducted in Segamat district, Johor State in consultation with local stakeholders and with the support of the South East Asia Community Observatory (SEACO), an established Health & Demographic Surveillance Site. The immediate beneficiaries will be women and families in local rural communities in Malaysia. Our project will benefit rural communities by increasing public awareness about warning signs and symptoms and, more specifically, by navigating women to breast cancer screening. The CENP will identify and counter emotional barriers, dispel misbeliefs and prompt help-seeking behaviour thereby enhancing cancer prevention and leading, where appropriate, to early diagnosis andtreatment. Our project via improved prevention and earlier diagnosis will reduce the burden including the personal, financial and psychosocial burden that is experienced by many women and their families as well as the resource burden to the health care system and the wider societal economic consequences for Malaysia. In addition, our project will collaborate with primary care physicians in order to improve their understanding further about the community in which they serve, embed patient navigation in community and primary care services and expedite referral of suspected cases. Furthermore, the project will capacity build' to the benefit of rural communities, NGOs, public health researchers and academics by enhancing knowledge and educational materials and related skills regarding cancer.