WORLD BREAST CANCER AWARENESS CAMPAIGN 2020
SWG Coordinators Laura Lalucat, SCORA Director 2019-2020 Olayinka Fakorede, PC for Healthy Lifestyles and Non-communicable diseases 2019-2020 Salman Khan, PC for Healthy Lifestyles and Non-communicable diseases 2020-2021 Michelle Nhat Ly T Reyes (AMSA - Philippines)
SWG Members Mohamed Hoosen Suleman (SAMSA - South African) Camila Vera Escudero (IFMSA-Peru) Arwa Elbaghdady (IFMSA-Egypt) Warisha Fathima (MSAI India) Fatima Elbasri (MedSIN-Sudan) Maya Hamdanieh (LeMSIC-Lebanon) Praise Harbor (NiMSA-Nigeria) Kiara Jimenez Montes (IFMSA-Peru)
TO Reviewers Laura Lalucat, SCORA Director 2019-2020 Fatima Rodriguez SCORA Director 2020-2021
Layout Designer Maya Hamdanieh (LeMSIC-Lebanon)
Introduction Page 4 Definition and Objectives Page 6 What is Breast Cancer? Page 8 Statistics and Epidemiology in Men and Women Breast Cancer - Page 8 Risk Factors of Breast Cancer Myths Page 9 Myths vs Facts Page 11 Screening and Prevention Page 12 Genes involved in Breast Cancer Treatment Page 15 Breast Cancer in the time of COVID-19 Page 18 Psychosocial Impact of Breast Cancer Page 20 IFMSA Activities related to Breast Cancer Awareness - Page 22
Introduction
Dear IFMSA Members, It is my pleasure to invite you to read this beautifully put together manual for breast cancer awareness. As a newly appointed Program Coordinator, I planned to set up an International campaign for the #PINKMONTH and i am glad to finally see my idea come to life. Calling for the Small Working Group in just 4 days and getting almost 200 applications made me realize how important it is to discuss this topic more. Most Applicants started by saying someone they know who died from breast cancer as a motivation to join the SWG, one thing that is sure is that our passion is contagious. Our Passion to change our World, to make it a happier and healthier place for us and loved ones is contagious. A very effective way to put this passion to action is through our activities, by acting locally while thinking globally. The activities of 1.3 million medical students all around the globe can definitely make a difference. Let’s raise more awareness, let’s educate people, let’s advocate for changes to be made concerning situations we are not comfortable with. But remember, you cannot give what you do not have, so there in this booklet, you will find the basic information about breast cancer awareness and how to go about your activities. Remember to always affiliate your activities with IFMSA by enrolling and reporting them. I hope you get more innovative ideas for breast cancer campaigns in your NMOs as you read this booklet.
Olayinka Fakorede Program Coordinator for Healthy lifestyles and Non Communicable Diseases 2019/2020 term
Dear reader and passionate advocate, It is with great excitement that I want to encourage you to go through the following pages. Members from across the globe gathered to build up this comprehensive manual that can serve as the backbone of any initiative related to Breast Cancer awareness. All in all, IFMSA is the perfect place to find someone that can have your back and support you through your change-maker adventures and tools as this one, serve this same purpose. When it comes to advocacy and activism related to Breast Cancer, sometimes we do not know even where to get started and might feel lost on the way but I assure you, once you go through this manual, you’ll be fully equipped and ready to develop your own ideas and move into action. Enjoy! Laura Lalucat SCORA Director 2019/2020
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Introduction
Dear IFMSA readers, This October we celebrate the Breast Cancer Awareness Month, marked in countries across the world. As we all know, Breast Cancer is the most common cancer in women worldwide, and is one of the most common cause of cancer death among women in most countries. According to the World Health Organization, incidence of breast cancer in low- and middle-income countries has been rising steadily due to increased life expectancy, changing reproductive patterns (such as later age at first childbirth and less breast-feeding), and the adoption of western lifestyles. One of the approaches to prevent breast cancer is early diagnosis, which remains the cornerstone of breast cancer control. In such cases, treatment may improve quality of life and delay disease progression, while supportive and palliative care should be readily available to relieve suffering for patients and their families. The aim of our SWG is to increase attention and support for the awareness, early detection and treatment as well as palliative care of this disease including the psychosocial aspect, and skills needed to implement activities related to breast cancer. Another goal of the breast cancer awareness month is to raise funds for research into its cause, prevention, diagnosis, treatment, and cure. With this manual, we hope to equip the readers with knowledge and skills that are needed to organize activities related to breast cancer awareness. In addition, the SWG also planned poster and video campaigns through social media platforms throughout the entire month of October and will launch an activity called Pink October with words related to breast cancer to encourage creative medical students to support breast cancer survivors in their own way. IFMSA member engagement is imperative in these kinds of campaigns and we hope to instill IFMSA’s “Think globally, Act locally” to all members across the different regions, and to increase enrollment of breast cancer awareness-related activities in the IFMSA Programs through this manual.
On behalf of the World Breast Cancer Awareness Manual SWG, Michelle Nhat Ly T. Reyes, World Breast Cancer Awareness SWG Coordinator
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Description This manual has been developed as part of the Healthy Lifestyles and NCDs and SCORA’s initiative to raise awareness on breast cancer and support the World Breast Cancer Awareness Campaign. This offers a comprehensive knowledge on what is breast cancer, prevention, risk factors, and treatment. We also included how to address breast cancer in this time of COVID-19 and the psychosocial impact of breast cancer. Readers may also be equipped with skills needed to organize different breast cancer-related activities that will be impactful in their NMOs.
Objectives 1. To raise the knowledge level of the target groups regarding the different medical aspects of including but not limited to current statistics, risk factors, negative impact, methods of prevention and also public health perspective of breast cancer. 2. To encourage medical students to implement activities on breast cancer awareness and develop initiatives to support breast cancer patients and survivors 3. To increase NMO enrollments into the healthy lifestyles and NCDs program through sharing of resources and discussions with experienced activity coordinators.
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SWG members
Mohamed Hoosen Suleman
Camila Vera Escudero
Arwa Elbaghdady
Warisha Fathima
SAMSA- South African Medical Students' Association
IFMSA-Peru
IFMSA-Egypt
MSAI India
Fatima Elbasri
Maya Hamdanieh
Praise Harbor
Kiara Jimenez
MedSIN-Sudan
LeMSIC-Lebanon
NiMSA-Nigeria
IFMSA-Peru
SWG coordinators
Olayinka Fakorede PC for Healthy Lifestyle and Non-communicable diseases 2019-2020
Laura Lalucat, SCORA Director 2019-2020
Salman Khan PC for Healthy Lifestyles and Non-communicable diseases 2020-2021
Michelle Nhat Ly Reyes AMSA-Philippines
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What is breast cancer? It is a pathology characterized by a malignant tumor that has developed from the abnormal growth of breast cells . Usually this type of cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts , the passages that drain milk from the lobules to the nipple.
Statistics and Epidemiology
2nd
most common cancer
5th
leading cause of cancer death
Most common cancer among women both in the developed and less developed world, impacting
2.1 million each year
Male breast cancer is a rare malignancy that accounts for
< 1% of all cancers in men
<1% of all breast cancers
It is estimated that the incidence of breast cancer will go up 26,1% by 2030
and 46,5% by 2040
It accounts for approximately
15% of all cancer deaths among women
The incidence is rising and in some patient groups reaching
15% over the course of their lives
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Risk factors in Breast Cancer
Controllable risk factors
Non controllable risk factors
Body Weight
Age
Being overweight is associated with an increased risk of breast cancer especially for women after menopause.
Diet Eating a lot of processed meat is associated with a higher risk of breast cancer. A low-fat rich diet rich in fruits and vegetables is generally recommended.
Exercise
Physical exercise everyday reduces the risk of breast cancer.
Alcohol Consumption Alcohol limits the ability to control blood levels of the hormone estrogen, which in turn can increase risk.
With growing age, the chances of developing breast cancer is more.
Sex Women have breasts which are constantly growing mainly due to the activity of the female hormones estrogen and progesterone puts them at a much greater risk of breast cancer. However, men can also develop breast cancer.
Family History
Having first-degree relatives (mother, daughter, sister) who has a history of breast cancer increases the chances of developing cancer. 75% of those with breast cancer have no family history of the disease though.
Breast density
Having dense breasts make a woman at a higher risk of having breast cancer and also harder to see tumours during mammograms.
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Protective Factors
Avoiding smoking
Eating a healthy diet
Maintaining a healthy weight
Monthly self-breast exams
Regular excercise
Limiting alcohol consumption
Breastfeeding
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MYTH vs FACT Only women with a family history of breast cancer are at risk.
Men cannot get breast cancer.
I am too young to get breast cancer.
Breast cancer always causes a lump you can feel.
Wearing a bra can cause breast cancer.
Using underarm antiperspirant can cause breast cancer.
Annual mammograms guarantee that breast cancer will be found early.
All women are at risk, but family history increases the risk.
1 in 922 men have alifetime risk of breast cancer.
Many women who are under 40 are diagnosed with breast cancer.
Breast cancer might not cause a lump, especially at early developing stage.
There is no evidence that bras cause breast cancer.
There is no evidence of a connection between underarm antiperspirant and breast cancer, but the safety of antiperspirants is still being studied. Although mammography is the best early-detection tool we have, it doesnâ&#x20AC;&#x2122;t always find breast cancer at an early stage.
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Screening of Breast cancer Since early detection and prompt treatment provide the best possible way to protect an individual against cancer, screening is the most effective method for early detection and literally means search for an unrecognised malignancy by rapid tests. Screening of breast cancer as it has a favourable effect on the mortality from breast cancer. The basic techniques for early detection of breast cancer are the following:
Breast self examination (BSE) Palpation by physician or clinical breast examination Mammography
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Steps of Breast Self Examination (BSE)
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Prevention of Breast Cancer
1
Regular exercise
2
Low intake of lipids
3 4 5
Breastfeeding
Reduced alcohol consumption
Breast Self Examination
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Genes According to The Centers for Disease Control and Prevention: The genes most commonly affected in hereditary breast and ovarian cancer are the breast cancer 1(BRCA1) and breast cancer 2 (BRCA2) genes. Normally, the BRCA1 and BRCA2 genes protect you from getting certain cancers. Some mutations in the BRCA1 and BRCA2 genes prevent them from working properly, so that if you inherit one of these mutations, you are more likely to get breast cancer. However, not everyone who inherits a BRCA1 or BRCA2 mutation will get breast or ovarian cancer!
According to American Academy of Family Physicians:
Other less common gene mutations that cause breast cancer are: ATM, TP53, CHEK2, PTEN,CDH1, STK11,PALB2
Approximately 10 to 15 percent of all breast cancers are thought to be familial and about one third of these cases are due to an inherited mutation in a BRCA1 or BRCA2 breast cancerâ&#x20AC;&#x201C; susceptibility gene. In women with breast cancer before age 45 and a family history of breast cancer, the incidence of BRCA1 mutation jumps to 7.2 percent. On average, a woman with a BRCA1 or BRCA2 gene mutation has up to a 7 in 10 chance of getting breast cancer by age 80.
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TREATMENT The treatment options depend on the STAGE of your disease and these factors: 1. The size of the tumor in relation to the size of your breast. 2. The results of specific pathology tests (hormone receptors, HER2 receptors, grade of the cells, proliferation rate of the cells). 3. Whether you have gone through menopause 4. General health age 5. Family history 6. Other risk factors associated with a predisposition for developing breast or ovarian cancer. Most treatment plans include a combination: Some are local, targeting just the area around the tumor. Others are systemic, targeting your whole body with cancer fighting agents. Follow up for regular checkup is needed after treatment. There are five treatment options 1. Surgery:lumpectomy ,mastectomy(partial or radical),Breastconserving surgery 2. Radiation therapy :Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated with the radiation. Breast cancer radiation therapy may be used to destroy any remaining mutated cells that remain in the breast or armpit area after surgery. 3. Hormone therapy: as Tamoxifen If the cancer cells have hormonal receptors, the doctor may recommend hormone therapy drugs, such as blockers or inhibitors. 4. Chemotherapy: neoadjuvant or adjuvantChemotherapy is a treatment method that uses a combination of drugs to either destroy cancer cells or slow down the growth of cancer cells. 5. Targteted therapies: One type of targeted therapy currently being studied is monoclonal antibodies. These laboratorymanufactured proteins bind with certain cancers. As Herceptin (also known as Trastuzumab) and Lapatinib.Another targeted therapy, Bevacizumab, prevents tumors from making new blood vessels that could feed the tumor, essentially cutting off the cancer cells from all nutrients. 16
Breast Cancer and COVID-19 How does COVID-19 impact breast cancer patients?
Some breast cancer treatments can weaken the immune system and possibly cause lung problems people who have weakened immune systems , lung problems or breast cancer metastasized to the lung have a much higher risk of complications If they develop COVID-19.
COVID-19 and breast cancer healthcare
The associated change with COVID-19 pandemic including social distancing, lock down has affected the screening, diagnosis, follow-up and treatment of breast cancer because hospitals and healthcare facilities take these regulations because people can be infected with COVID-19.
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How to support breast cancer patients in COVID-19 time?
1
2
Healthcare units should schedule appointments with the breast cancer patients and follow the preventive precautions to ensure that the pandemic won't affect the efficiency of the treatment.
3
Keeping a healthy lifestyle to strengthen the immune system through having a well balanced diet supervised by a nutritionist and regular exercising are needed to win the double battle with breast cancer and COVID-19.
To increase awareness of breast cancer patients about COVID-19 and how it impacts their health.
4
To support breast cancer patients mentally and emotionally and educate them how to cope with the stress associated with their disease and COVID-19.
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To empower medical students with the needed knowledge and skills through online sessions to advocate for breast cancer and organize related activities.
To participate in the mental support of breast cancer patients by educating them about how to cope with the double burden of COVID-19 and breast cancer.
Role of medical students in COVID-19 time To organize online campaigns to educate the community about breast cancer, screening and how to deal with breast cancer during COVID-19.
Start a research to measure how COVID-19 impacts breast cancer patients and healthcare. What are you waiting for? put your research question and addd something new to humanity!
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Anxiety, Depression, and Breast Cancer What is Anxiety? Anxiety is more than just feeling stressed or worried. It can be a serious condition that makes it hard for a person to cope with daily life. Living with breast cancer is one of the many things that may trigger anxiety.
What is Depression? Depression is more than just a low mood--it's a serious condition that has an impact on both physical and emotional well-being. Depression affects how you feel about yourself. If a person with breast cancer has depression, they may lose interest in work, hobbies and doing things that they normally enjoy.A person may be depressed if she or he has felt sad, down or miserable most of the time for more than 2 weeks.
Anxiety and depression are common in women with Breast Cancer. Unfortunately, they are often overlooked, and often the psychosocial impact of women with Breast Cancer is undertreated.
One study found that up to 50 percent of women with early breast cancer may experience anxiety and/or depression in the year after being diagnosed.
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Psychosocial Support for Breast Cancer What are the support needed for anxiety and depression in Breast Cancer? Talking and emotional support from close family and friends can help reduce the stress of coping with breast cancer. However, if things become more difficult, especially during this time of COVID-19, professional help may be needed. The treatment for anxiety and depression in someone with breast cancer involves a coordinated approach managed by their primary health professional that monitors and treats the symptoms of anxiety, depression, and breast cancer.
How Family and Friends Can Help
Learn about the symptoms of anxiety and depression, and recognize warning signs.
Family and friends can encourage the person with breast cancer to go to the doctor if their anxiety or depression gets worse.
Support them by helping them follow their treatment and mental health plans. Gently remind them to take their cancer, anxiety and depression medications regularly.
Encourage the person with breast cancer to do things they would normally enjoy
Information on Breast Cancer Awareness and Research-related Organizations or Foundations can be found here
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ACTIVITIES RELATED TO BREAST CANCER An activity is a "unique set of planned interventions designed and implemented to achieve certain specific objectives, within a given budget and a specified period of time." Normally, an activity starts with a planning phase, progressing to a monitoring phase when the activity has been implemented. An activity ends with an evaluation aiming to provide learning points and recommendations that can be used to plan a new activity and set a new vision and goals.
Source: From Idea to Impact To learn more about Activities, please refer to this IFMSA Manual.
TYPES OF ACTIVITIES There are several ways in which activities on breast cancer can be organized. The choice of the type of activity to be organized is influenced mainly by the target population. Hence, each activity must be suitable to the target groups. Firstly, it is important to decide if the activity is going to be face-to-face or online. With the onset on COVID-19 and the lockdown that accompanied it, many activities have been taken in online settings, not only to respect the social isolation but also to accommodate more people who would like to be part of the activities but cannot be present at the venue. There are, however, several pros and cons to holding activities online. Hence, the activity coordinator must seek out ways to maximize the benefits and reduce to a bare minimum the cons.
An activity is created to solve a specific problem or to improve an actual situation.
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ACTIVITIES RELATED TO BREAST CANCER WHAT TYPE OF ACTIVITIES CAN WE ORGANIZE? I. EDUCATION ACTIVITIES Education on health issues for specific societal groups. The purpose of this activity is to give the participants a wide and deep knowledge of the topic. Education activities are most commonly used to promote health among the population. They can be face to face or online in the form of webinars and training.
Who can be targeted? We can either focus on other medical and health care students to teach them about the topic in an academic or non-academic environment (as peer education), or we can design an activity to the population in general. It is utterly important to define the target population to properly plan the activity, as the level of knowledge on the topic is not going to be the same. If we want to educate other health care students they will probably be familiar with the topic that we want to talk about, whereas in an activity oriented to the population we will have to explain the most basic concepts before going further in our explanations.
Let's see an example from...
Breast Cancer Project
MedSIN-Sudan!
Etege App
A.C.: Nusiba Alebed Musa
A.C.: Bethel Samson Bayu
What? To decrease the burden of breast cancer. How? By educating medical students and women, and empowering them.
What? To decrease the rate of death from breast cancer and complication. How? By demonstrating basic self breast examination in our mobile application.
EMSA Ethiopia!
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ACTIVITIES RELATED TO BREAST CANCER WHAT TYPE OF ACTIVITIES CAN WE ORGANIZE? II. CAPACITY BUILDING ACTIVITIES These activities are held in the form of training and workshops. They aim at teaching and developing knowledge, skills and techniques on the topic being discussed. They may either be formal or informal. While training can have any form, workshops are more formal and also include exchange of information between participants.
Who can be targeted? The participants can range from just medical students to the general population. As with education activities, it is important to define the target population and streamline the information to suit the audience. Also, because of the nature of the activity (formal activities), participants are likely to become bored and worn out. Hence, it will be important to include energizers and other activities that might help revitalize the participants.
Let's see an example from...
IFMSA-Egypt
Mr & Mrs Breastestis A.C.: Ahmed Said What? To contribute to the increase of early detected cases. How? By educating the members by national trainers with differents dynamics.
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ACTIVITIES RELATED TO BREAST CANCER WHAT TYPE OF ACTIVITIES CAN WE ORGANIZE? III. CAMPAIGNING ACTIVITIES These activities are held as a combination of education and advocacy. They aim to create awareness in society about a certain topic (education part) and try to funnel this awareness into pressure on the decision makers to adapt policies accordingly (advocacy part).
Who can be targeted? The participants can range from just medical students to the general population. Itâ&#x20AC;&#x2122;s important for this kind of activity to organize properly all the steps that we are making with our target population in order to achieve our goals. Itâ&#x20AC;&#x2122;s not just about educating people but going further to an advocacy level and making changes in their realities.
Let's see an example from...
BMSS-Bangladesh!
Think Pink A.C.: Myesha Maliha Binte Mamun What? To educate people about breast cancer. How? By doing seminars & trainings on self breast examinations in many districts.
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ACTIVITIES RELATED TO BREAST CANCER HOW TO ORGANIZE A BREAST CANCER ACTIVITY In the very beginning of an activity-making-process, it is essential to allow a broad range of ideas to be discussed. This is the time where creativity should be encouraged. It is essential for the whole activity period and outcome that as many people/members of the team are involved in the planning phase. This is to ensure the best possible engagement to the activity as well as obtaining as many inputs and ideas as possible. It is important that plans are set on how monitoring and evaluation of the activity would be carried out before the start of the activity.In order for the team to build this activity, some useful tools are required. We will briefly describe the tools:
I. PROBLEM TREE Problem tree analysis is a key step to plan an activity. A problem tree is a graphic representation of a problemâ&#x20AC;&#x2122;s anatomy: the branches are the consequences the trunk corresponds to the main problem the up roots represent causes
After this problem analysis, you will have an overall view of the problem and you will be able to accurately create your objectives to tackle each one of its causes. Before creating the tree you need to list all the problems related to the topic, in this case, breast cancer. It will be required of you to research about breast cancer and gather as much information as possible. With all these information, you will be able to brainstorm all the problems related to the topic. Consider these problems in terms of cause and effects. Example, let us consider this problem "increasing incidence of breast cancer in women in low and middle income countries". One of the causes of this would be low awareness of breast cancer in communities. The effect of this would be late diagnosis and poor prognosis. (See problem tree for more examples) Now you have an overall view of the problem!
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ACTIVITIES RELATED TO BREAST CANCER II. OBJECTIVES TREE After you have created your problem tree, you will have to transform each problem you identified on your list into positive desirable conditions. These will make up your objectives tree.Let's give an example: Increase awareness of breast cancer â&#x2020;&#x2019; Promotion of self-breast examination and breast cancer screening â&#x2020;&#x2019; Early detection and better prognosis. (See objectives tree)
Create your objectives to tackle each part: The causes become the means The main problem become the main objective The consequences become the ends For more information on activity management, see "From Idea to impact manual on activity and project management"
PROBLEM TREE EXAMPLE Lack of information or poor knowledge of breast cancer
Low number of students based activities about breast cancer.
OBJECTIVE TREE EXAMPLE
Low awareness among the community.
To increase education about breast cancer
To increase number of activities on breast cancer
To increase awareness of breast cancer in local communities.
CAUSES Increase of risk factors associated with lifestyles.
Unavailability of screening tools.
Late detection and late presentation at hospitals for treatment
To promote healthier lifestyles.
MEANS
To promote methods for diagnosing earlystage breast cancer
MAIN OBJECTIVE
Incidence of Breast Cancer in women is increasing in lowand middle-income countries
MAIN PROBLEM
To reduce the incidence of Breast Cancer in women in low- and middle-income countries
Foment early diagnosis and better prognosis
Late diagnosis and poor prognosis Increase of stigma towards breast cancer.
EFFECTS Deterioration of mental health status of breast cancer patients.
To promote increased availability of screening tools.
Increase in economic problems due to treatment expenses.
Increased rate of mortality due to diagnosis of breast cancer in the late stages.
ENDS
Decrease of stigma towards breast cancer.
Decrease of deterioration of mental health status of breast cancer patients.
Decrease in economic problems due to treatment expenses.
Decreased rate of mortality due to diagnosis of breast cancer in the late stages.
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IFMSA Programs and Activity Enrollment IFMSA Programs are an important part of the IFMSA structure that addresses problems from a specific topic. Programs act as a link between local or national activities (conducted by NMOs) and international IFMSA activities. Every program has a program coordinator who is in charge of it. Enrolling activities to IFMSA Programs has some direct benefits, which are: 1. The support of the Program Coordinator that includes: continuous development and designing of the activity, monitoring and evaluating, contact with IFMSA officials or NMOs working on the same topic. 2. International recognition: IFMSA certificate, inclusion in activities database,impact coalesced in IFMSA Programs annual report. 3. Opportunities: application for the Activities Fair or Rex Crossley Awardsduring General Assemblies, as well as scholarships. Every member of IFMSA can enroll their activity in a program (it is notrequired to hold a position within IFMSA or your NMO in order to do this).Activities that can be enrolled include projects, campaigns, celebrations,workshops, fundraising events, exchanges and other kinds of events
To learn more about IFMSA Programs, please refer to this toolkit
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References:
https://www.cancer.org/cancer/breast-cancer/risk-and-prevention/breast-cancer-risk-factorsyou-cannot-change.html https://www.aafp.org/afp/1999/0101/p99.html#afp19990101p99-b3 https://www.cdc.gov/genomics/disease/breast_ovarian_cancer/genes_hboc.htm https://www.nationalbreastcancer.org/breast-cancer-treatment/World Health Organization https://www.who.int/cancer/breast_cancer_awareness/en/American Cancer Society. Breast Cancer Facts & Figures 2019-2020. Atlanta: American Cancer Society, Inc. 2019. Burgess C., Cornelius V., Love S., Graham J., Richards M., Ramirez A. ‘Depression and anxiety in women with early breast cancer: five year observational cohort study.’ BMJ. 330(7493):702, 2005 Mar 26. Park’s Textbook Of Preventive & Social Medicine, 24th Edition https://www.hopkinsmedicine.org/health/conditions-and-diseases/breast cancer/breastcancer-awareness-infographic https://www.breastcancer.org/symptoms/understand_bc/myths-facts https://www.cancer.org/cancer/breast-cancer/risk-and-prevention/breast-cancer-risk-factorsyou-cannot change.html https://www.aafp.org/afp/1999/0101/p99.html#afp19990101p99-b3 https://www.breastcancer.org/research-news/exercise-improves-survival-and-reduces-risk https://www.cancernetwork.com/view/breast-cancer-management-during-the-covid-19pandemic https://www.breastcancer.org/about_us/press_room /news/coronavirus https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5502868/#!po=0.632911https://academic.oup.c om/jnci/advance-article-abstract/doi/10.1093/jnci/djaa046/5814214?redirectedFrom=fulltext https://www.nationalbreastcancer.org/breast-cancer-treatment/
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