Thesis (MTech (Radiography))--Cape Peninsula University of Technology, 2011. / The focus of this study is on the presentation patterns of invasive cancer of the cervix (CaCx) in Zimbabwe. The study was undertaken at a large referral cancer treatment centre in Harare the capital city of Zimbabwe. The main study question addressed was: Are there any changes in the presentation patterns of invasive CaCx in Zimbabwe? This was subdivided into three sub questions: 1) What are the presentation patterns of invasive CaCx among the Zimbabwean women presenting to the major referral centre in terms of histology, stage of the disease, ages of patients, Human immunodeficiency virus (HIV) status and socioeconomic status? 2) What is the trend in the presentation patterns of invasive CaCx in terms of the study variables during the period of study? 3) Are there any correlations that exist among the study variables? This study was conducted because of the sharp contrast that exists in invasive CaCx presentation patterns and incidence between the developed and developing countries. The incidence is now very low in developed countries while it is continuing to rise in developing countries resulting in death among women at a time when they are supposed to be more effective in their families and the nation at large. A retrospective documentary study of patients' files using an observation check list was done from 1998 to 2010. A systematic sample of four years was selected with 1998 as the base year (1998, 2002, 2006 and 2010). To strengthen the sample all the available patients' files for the selected years were considered. On average the majority of the patients (91.75%) presented with squamous cell carcinoma (SCC), 5.5% presented with adenocarcinoma and 2.75% with other types of histology. It was found that (89%) of women presented with late stage disease (stage liB and above). The ages of patients at presentation were between 40 to 60 years. Very few patients had recorded HIV status in 1998 and 2002 but a significant increase in proportion of patients with known HIV status was noted in 2006 (48%) and 2010 (73%). The average percentage for HIV positive patients for 2006 and 2010 was 57% and the average percentage for HIV negative patients was 43%. The majority (58.25%) of the patients were of low socioeconomic status. No significant change in trend was noted for variables except for HIV status where there was a downward trend in the percentage of HIV positive patients and an upward trend in the percentage of HIV negative patients. When correlation analysis was done among the variables no significant association was noted among the variables except that a low degree of association was recorded for the ages of patients and HIV status. The association indicated that young invasive CaCx patients are associated with HIV infection at presentation. The recommendations are that the government should mobilize resources towards prevention and control of invasive cancer of the cervix and awareness campaigns on early presentation should increase. Furthermore the cancer registry should expand its services to cover all health institutions nationwide. It is also recommended that further studies should be done on the presentation patterns of invasive CaCx and of HIV status. Longitudinal studies are recommended in order to monitor changes in presentation patterns.

Breast cancer is fast becoming the leading cause of mortality in women worldwide. As of this year, there are more than 3.1 million women with a history of breast cancer in the U.S., and about 41,760 women are expected to die from this disease. Neoadjuvant chemotherapy (NAC) has become a well-established therapy in the treatment of patients with locally advanced or primarily inoperable breast cancer. It consists of 3-9 months of drug treatment to shrink the tumor size before surgical removal of any remaining mass. A pathological complete response (pCR) is defined as complete disappearance of the tumor before surgery and correlates with 5-year overall survival of the treated patient. However, only 15-40% of subjects who undergo NAC will achieve a pCR, while the remaining patients do not benefit from a therapy that has considerable side effects. In this Ph.D. thesis, I explore the potential of diffuse optical tomography (DOT) for breast cancer imaging and NAC monitoring. The overall objective is two-fold. First, I seek to identify breast cancer patients who will not respond to NAC shortly after the initiation of a 5-9 months therapy regimen. Identifying these patients early will allow a switch to a more promising therapy and avoiding months of ineffective therapy with a drug regimen that has considerable side effects. Second, I use the optical data simultaneously obtained from the contralateral, non-tumor bearing breast to better understand the factors that modulate breast density and the source of its contrast in DOT. This work analyzed DOT data from 105 patients with stage II-III breast cancer under NAC regimen. Data processing and image analysis protocols were developed to more effectively evaluate static tissue contrast and dynamic functional imaging of the breast. Notably, we observed that there are differences in the time evolution of DOT features between pCR and non-pCR tumors under NAC, and DOT features can contribute to the successful prediction of pCR status from pretreatment imaging. Lastly, our analysis demonstrated a positive correlation between DOT feature and mammographic density classification, which could lead to research on the potential use of DOT as a predictor of breast cancer as well as an assessment tool to longitudinally evaluate the efficacy of chemoprevention strategies. These findings represent important steps towards the translation of DOT into current clinical workflow to contribute to better-personalized breast cancer therapies and breast cancer risk management.

MCur / Department of Advanced Nursing Science / Cervical cancer remains one of the major public health problems globally, despite the fact that it is preventable and curable if identified at an early stage. Currently, cervical cancer is the leading cause of death among women in Sub-Saharan Africa where the knowledge about the disease is scarce among the affected population. Methods A quantitative cross-sectional survey was conducted in Thulamela Municipality of Limpopo Province. The purpose of the study was to assess the knowledge of cervical cancer prevention among women in four villages in Thulamela Municipality. The population of the study was composed of all women aged above 30 in the villages Malamulele, Mhinga, Muledane and Phiphidi. A sample of one thousand five hundred and forty-six (1546) was drawn using random sampling. Quantitative data were collected using a twenty-six-item questionnaire. The data were coded and then processed using the Statistical Package for Social Sciences to produce frequency tables and descriptive statistics such as chi-square and correlation. Results A number of findings were made in this study. The majority of the women in this study had little or no knowledge about cervical cancer, human papilloma virus and vaccines. The majority of the women had little or no knowledge on cervical cancer risk factors and how the disease is spread. These findings were confirmed by chi-squared values at p<0.05 and showed significant association between variables: that young women were likely to be aware of cervical cancer compared to elderly women, educated women were more likely to be knowledgeable about cervical cancer than those with low education attainment, elderly women were more likely to be not worried about cervical cancer compared to young women. Correlation, Pearson rho scores at p<0.05 showed significant correlations knowledge of cervical cancer and age (negative), knowledge and education (positive). The findings signified the need for cervical cancer prevention education in Vhembe District, and the need for primary health care nurses to promote access to such services through robust health education. vi Recommendations The study made a number of practical recommendations likely to educate women about cervical cancer, human papilloma virus and its prevention. These include: The possibility of large hospitals having their own small broadcasting stations that will frequently disseminate information throughout the local municipalities, road shows and use of informal sector like politicians and traditional healers in disseminating information.

Female breast cancer patients are often confused, frustrated, and devastated by changes occurring in their bodies and the treatment process. Many women express frustration and concern with the inability to know what the next phases of their life will bring. Previous research also states that many women struggle to communicate with others about treatment as well as side effects. This research examined how woman are use metaphors to describe their experience with breast cancer, specifically throughout the treatment period related to body image struggles. I qualitatively conducted interviews with women who were either currently in treatment or just finishing. My interview questions related to their uncertainties, as well as the changes occurring to their bodies. After conducting the interviews I transcribed the conversations and coded for specific metaphors. The results were consistent with previous research, in that that the interviewees used at least four major metaphors to describe what they are going through. The four most prominent metaphors were (1) journey, (2) game, (3) struggle/fight, (4) grasping. The findings could benefit patients, nurses, physicians as well as family and friends to reduce stress and help with coping. The findings may also help female patients struggling with identity issues due to lumpectomies or mastectomies. Understanding how patients comprehend the disease can ultimately help others to understand and hopefully reduce some of the concerns of all those involved in such situations.

MPH / Department of Public Health

Treatment outcomes of young patients with invasive breast cancer treated radically at Groote Schuur Hospital from 2013 to 2017: A single centre study Background: Breast cancer is the leading cause of cancer- related deaths globally, and the commonest cancer in women under 40 years. There is currently a lack of data relating to treatment outcomes of young women with breast cancer particularly in low-and middle-income countries. Aim: This study aims to evaluate the treatment outcomes of young patients (under 40 years) treated radically for invasive breast cancer in a low-and middle-income setting. Settings: Groote Schuur Hospital, Cape Town, South Africa Methods: A retrospective review of 101 women under 40 years, with invasive breast cancer treated radically, between 2013 and 2017 was conducted. Patient characteristics, tumour characteristics, disease stage, treatment, and follow-up were recorded. Primary objectives included evaluating overall and disease free survival, and analysing recurrence patterns and clinicopathological features. Results: The five-year overall and disease free survival for the entire cohort was 77% and 51%, respectively. Five-year overall survival by molecular subtype showed that Luminal A had the best survival, while triple negative breast cancer had the worst overall survival. Conclusion: Young women with breast cancer have poor survival outcomes despite early presentation. There is limited data regarding breast cancer treatment outcomes in patients under forty years.

This qualitative study explored and described the experience of African women diagnosed with both HIV/AIDS and cervical cancer in order to gain an understanding of the experience of both illnesses as lived by these women. Phenomenological research methods were employed using in-depth semi-structured interviews. Communication as a strategy facilitating diagnosis, disclosure, acceptance and support for women with HIV/AIDS and cervical cancer emerged as the main theme, followed by the experience of physical symptoms and emotional experiences. The study shows the importance of communication in the management and support of these women attending public health institutions and in the community. For communication to occur the relationship between healthcare professionals and women diagnosed with HIV/AIDS and cervical cancer is very important. Treatment approaches in radiation therapy need to be developed for women diagnosed with HIV/AIDS and cervical. More research is needed in this area (HIV/AIDS and cervical cancer). / Health Studies / M.A. (Public Health)

This qualitative study explored and described the experience of African women diagnosed with both HIV/AIDS and cervical cancer in order to gain an understanding of the experience of both illnesses as lived by these women. Phenomenological research methods were employed using in-depth semi-structured interviews. Communication as a strategy facilitating diagnosis, disclosure, acceptance and support for women with HIV/AIDS and cervical cancer emerged as the main theme, followed by the experience of physical symptoms and emotional experiences. The study shows the importance of communication in the management and support of these women attending public health institutions and in the community. For communication to occur the relationship between healthcare professionals and women diagnosed with HIV/AIDS and cervical cancer is very important. Treatment approaches in radiation therapy need to be developed for women diagnosed with HIV/AIDS and cervical. More research is needed in this area (HIV/AIDS and cervical cancer). / Health Studies / M.A. (Public Health)

Text in English / The purpose of the study was to explore perceptions, knowledge and attitudes of women undergoing cervical cancer screening in Omaheke, Namibia. A qualitative exploratory study was conducted. Data were collected from a purposive sample of eight participants using a self-developed interview guide. Data were analysed using Tesch’s descriptive method of open coding. Three themes were identified namely; cervical cancer as a disease, perception of cervical cancer and service delivery at the facility. The findings also revealed some suggestions for the facility that could improve screening uptake. The study proposes a community education programme on cervical cancer and related topics to be covered during health education sessions. In addition the study recommends the Omaheke directorate to look into operational issues in order to facilitate access to cervical cancer screening. / Health Studies / M.P.H.

MPH / Department of Public Health / See the attached abstract below