DOI QR코드

DOI QR Code

Application of Health Behavior Theories to Breast Cancer Screening among Asian Women

  • Ahmadian, Maryam (Department of Social and Development Sciences, Faculty of Human Ecology, Universiti Putra Malaysia) ;
  • Samah, Asnarulkhadi Abu (Department of Social and Development Sciences, Faculty of Human Ecology, Universiti Putra Malaysia)
  • Published : 2013.07.30

Abstract

Background: Although breast cancer is a major public health worry among Asian women, adherence to screening for the disease remains an obstacle to its prevention. A variety of psycho-social and cultural factors predispose women to delay or avoidance of screening for breast cancer symptoms at the early stages when cure is most likely to be successful. Yet few interventions implemented to date to address this condition in this region have drawn on health behavior theory. Materials and Methods: This paper reviews the existing literature on several cognitive theories and models associated with breast cancer screening, with an emphasis on the work that has been done in relation to Asian women. To conduct this review, a number of electronic databases were searched with context-appropriate inclusion criteria. Results: Little empirical work was found that specifically addressed the applicability of health theories in promoting adherence to the current breast cancer prevention programs Among Asian women. However, a few studies were found that addressed individual cognitive factors that are likely to encourage women's motivation to protect themselves against breast cancer in this region of the world. The findings suggest that multi-level, socio-cultural interventions that focus on cognitive factors have much promise with this issue. Conclusions: Interventions are needed that effectively and efficiently target the personal motivation of at-risk Asian women to seek out and engage in breast cancer prevention. Concerning implications, personal motivation to seek out and engage in individual preventive actions for breast cancer prevention among Asian women is a timely, high priority target with practical implications for community development and health promotion. Further studies using qualitative, anthropologic approaches shaped for implementation in multi-ethnic Asian settings are needed to inform and guide these interventions.

Keywords

Breast cancer screening;health behavior theories;Asian women

References

  1. Abbaszadeh A, Haghdoost A, Taebi M, Kohan S (2007). The relationship between women's health beliefs and their participation in screening mammography. Asian Pac J Cancer Prev, 8, 471-5.
  2. Abdullah A, Leung T (2000). Factors associated with the use of breast and cervical cancer screening services among Chinese women in Hong Kong. Public Health J, 115, 212-7.
  3. Ahmadian M, Redzuan M, Emby Z, Samah AA (2010a). Women's community participation levels in community-based health programs regarding breast cancer prevention in Metropolitan Tehran, Iran. Asian Soc Sci, 6, 12-21.
  4. Ahmadian M, Samah AA, Emby Z, Redzuan M (2010b). Instrument development for understanding factors influencing mammography compliance among Iranian women in metropolitan Tehran, Iran. Asian Soc Sci, 6, 88.
  5. Ahmadian M (2011). Factors Influencing Women's Participation in Breast Cancer Prevention Program in Tehran, Iran. Doctoral research, Universiti Putra Malaysia.
  6. Ahmadian M, Samah AA, Emby Z, Redzuan M (2011). Barriers to Mammography among Women Attending Gynecologic Outpatient Clinics in Tehran, Iran. Scientific Res Essays, 6, 5803-11.
  7. Ahmadian M, Samah AA (2012a). A model for community participation in breast cancer prevention in Iran. Asian Pac J Cancer Prev, 13, 2419-23. https://doi.org/10.7314/APJCP.2012.13.5.2419
  8. Ahmadian M, Samah A A (2012b). A literature review of factors influencing breast cancer screening in Asian countries. Life Sci J, 9, 689-98.
  9. Ahmadian M, Samah AA, Redzuan M, Emby Z (2012a). Participation in breast cancer prevention: Assessing women's knowledge and their participation in mammography in Tehran, Iran. Sci Res Essays, 7, 915-22.
  10. Ahmadian M, Samah AA, Redzuan M, Emby Z (2012b). The influence of Psycho-social Factors on Participation Levels in Community-based Breast Cancer Prevention Programs in Tehran, Iran, Global J Health Sci, 4, 42-56.
  11. Ahmadian M, Samah AA, Redzuan M, Emby Z (2012c). Predictors of Mammography Screening among Iranian Women Attending Outpatient Clinics in Tehran, Iran. Asian Pac J Cancer Prev, 13, 969-74 https://doi.org/10.7314/APJCP.2012.13.3.969
  12. Ajzen I (2005). Attitudes, Personality, and Behavior. Berkshire, UK: Open Univ. 178 pp 2nd.
  13. Ajzen I, Fishbein M (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice Hall.
  14. Ajzen I, Brown TC, Carvajal F (2004). Explaining the discrepancy between intentions and actions: The case of hypothetical bias in contingent valuation. Personality Social Psychology Bulletin, 30, 1108. https://doi.org/10.1177/0146167204264079
  15. Allen JD, Sorensen G, Stoddard AM, Coldits G, Peterson K (1998). Intention to have a mammogram in the future among women who have underused mammography in the past. Health Educ Behav, 25, 474-88. https://doi.org/10.1177/109019819802500406
  16. Bandura A (1986). Social Foundation of Thought and Action: A Social Cognitive Theory.
  17. Bandura A, Adams NE (1977). Analysis of self-efficacy theory of behavioral change. Cog Therapy Res, 1, 287-310. https://doi.org/10.1007/BF01663995
  18. Becker JMH (1974). The health belief model and sick role behavior. Health Educ Monographs, 2, 409-19.
  19. Bener A, Honein G, Carter A, Da'ar Z (2002). The determinants of breast cancer screening behavior: a focus group study of women in the United Arab Emirates. Oncol Nurs Forum, 29, 91-8. https://doi.org/10.1188/02.ONF.E91-E98
  20. Bosompra K (2001). Determinants of condom use intentions of university students in Ghana: an application of the theory of reasoned action. Soc Sci Med, 52, 1057-69. https://doi.org/10.1016/S0277-9536(00)00213-6
  21. Brailey LJ (1986). Effects of health teaching in the workplace on women's knowledge, beliefs, and practices regarding breast self-examination. Res Nurs Health, 9, 223-31. https://doi.org/10.1002/nur.4770090307
  22. Brawley LR, Culos-Reed SN (2000). Studying adherence to therapeutic regimens: Overview, theories, recommendations. Control Clin Trials, 21, 156-63. https://doi.org/10.1016/S0197-2456(00)00073-8
  23. Bray F, McCarron P, Parkin DM (2004). The changing global patterns of female breast cancer incidence and mortality. Childhood, 4, 5.
  24. Champion V (1993). Instrument refinement for breast cancer screening behaviors. Nurs Res, 42, 139-43.
  25. Champion VL (1992). Compliance with guidelines for mammography screening. Cancer Detect Prev, 16, 253-8.
  26. Champion V, Menon U (1997). Reliability and validity of breast cancer screening scales in African American women. Nurs Res, 46, 331-7. https://doi.org/10.1097/00006199-199711000-00006
  27. Choi JS, Park JY, Han CH (2001). The behavioral and educational factors affecting the breast self-examination and breast cancer screening. J Korean Soc Health Educ Prom, 18, 61-78.
  28. Choudhry UK, Srivastava R, Fitch MI (1998). Breast cancer detection practices of South Asia women: knowledge beliefs and beliefs. Oncol Nurs Forum J, 25, 1693-701.
  29. Chua M, Franzcr M, Mok T (2005). Knowledge, perceptions and attitudes of Hong Kong Chinese women on screening mammography and early breast cancer management. Breast J ,11, 52-6. https://doi.org/10.1111/j.1075-122X.2005.21480.x
  30. Crane LA, Kaplan CP, Bastani R (1996). Determinants of adherence among health department patients referred for a mammogram. Women and Health, 24, 43-6. https://doi.org/10.1300/J013v24n02_03
  31. Edgar L, Shamian J, Patterson D (1984). Factors affecting the nurse as a teacher and practice of breast self-examination. Int J Nurs Studies, 21, 255-65. https://doi.org/10.1016/0020-7489(84)90018-X
  32. Eun-Ok Lee (2001). Health promotion for the chronic patients. Seoul National University College of Nursing. http://www.oita-nhs.ac.jp/journal/PDF/2_2/2_2_2.pdf
  33. Fishbein M, Ajzen A (1975). Belief Attitude Intention and Behavior. New York, USA: Wiley.
  34. Fung SY (1998). Factors associated with breast self-examination behavior among Chinese women in Hong Kong. Patient Educ Counsel, 33, 233-43. https://doi.org/10.1016/S0738-3991(98)00023-8
  35. Garbers S, Jessop DJ, Foti H, Uribelarrea M, Chiasson MA (2003). Barriers to breast cancer screening for low-income Mexican and Dominican women in New York City. J Urban Health, 80, 81-91.
  36. Gillmore MR, Morrison DM, Lowery C, Becker SA (1994). Beliefs about condoms and their association with intentions to use condoms among youths in detention. J Adoles Health, 15, 228-37. https://doi.org/10.1016/1054-139X(94)90508-8
  37. Ferlay J, Bray F, Pisani P, et al (2000). Globocan: cancer incidence, mortality and prevalence worldwide, version 1.0. IARC Cancer Base No. 5. Lyon: IARC, 2001.
  38. Gollwitzer PM (1993). Goal achievement: the role of intentions. Eur Rev Soc Psych, 4, 141. https://doi.org/10.1080/14792779343000059
  39. Gotay C, Wilson ME (1998). Social support and breast cancer screening in African American hispanic and native American women. Cancer Pract, 6, 31-7. https://doi.org/10.1046/j.1523-5394.1998.1998006031.x
  40. Gotzsche PC and Nielsen M: (2006). Screening for breast cancer with mammography. Cochrane Database System Review Art No.: CD001877.
  41. Green LW, Kreuter MW (2005). Health Program Planning: An Educational and Ecological Approach. New York: McGraw-Hill. 458 pp. 4th ed.
  42. Han Y, Williams RD, Harrison RA (2000). Breast cancer screening knowledge, attitudes, and practices among Korean American women. Oncol Nurs Forum, 27, 1585-9.
  43. Harirchi I, Karbakhsh M, Kashefi A, Momtahen AJ. (2004). Breast cancer in Iran: results of multi-center study. Asian Pacific J Cancer Prev, 5, 24-27.
  44. Heaney CA, Israel BA (1997). Social networks and social support. In health behavior and health education: theory, research, and practice, ed. K Glanz, FM Lewis, BK Rimer, 9, 179-205.
  45. Hiatt RA (1996). Pathways to early cancer detection in the multiethnic population of San Francisco Bay area. Health Educ Quart, 23, 10-27.
  46. Hisham AN, Yip CH (2003). Spectrum of breast cancer in Malaysian women: an overview. World J Surg, 27, 921-3. https://doi.org/10.1007/s00268-003-6976-x
  47. Hisham AN, Yip CH (2004). Overview of breast cancer in Malaysian women: a problem with late diagnosis. Asian J Surg, 27, 130-3. https://doi.org/10.1016/S1015-9584(09)60326-2
  48. Hochbaum GM (1958). Public participation in medical screening programs: a socio-psychological study. PHS Publication No. 572. Washington, DC: US Government Printing Office.
  49. Hoskins CN, Baker S, Sherman D, Bohlander J, Bookbinder M (1996). Social support and patterns of adjustment to breast cancer. Sch Inq Nurs Pract, 10, 99-123.
  50. House JS, Umberson D, Landis KR (1998). Structures and processes of social support. Annu Rev Sociol. 14, 293-318
  51. Im EO, Park YS, Lee EO (2004). Korean women's attitudes toward breast cancer screening tests. Int J Nurs Studies, 41, 583-9. https://doi.org/10.1016/j.ijnurstu.2004.01.004
  52. Janz NK, Becker MH (1984). The health belief model: a decade later. Health Educ Quarterly, 2, 1-47.
  53. Jarvandi S, Montazeri A, Harirchi I, Kazemnejad A (2002). Beliefs and behaviors of Iranian teachers toward early detection of breast cancer and breast self-examination. Public Health, 116, 245-9. https://doi.org/10.1038/sj.ph.1900854
  54. Juon H S, Kim M, Shankar S (2004). Predictors of adherence to screening mammography among Korean American women. Prevent Med, 39, 474-81. https://doi.org/10.1016/j.ypmed.2004.05.006
  55. Katapodi MC, Facione NC, Miaskowski C (2002). The influence of social support on breast cancer screening in a multicultural community sample. Oncol Nurs Forum, 29, 845-52. https://doi.org/10.1188/02.ONF.845-852
  56. Kim R (2002). Use of a theoretical framework to understand factors that influence participation in mammography screening among Korean women. Doctoral research, University of Texas.
  57. Lechner L, de Vries H, Offermans N (1997). Participation in a breast cancer screening program: Influence of past behavior and determinants on future screening participation. Prevent Med, 26, 473-82. https://doi.org/10.1006/pmed.1997.0161
  58. Lee CY, Kim HS, Ham O (2000). Knowledge, practice, and risk of breast cancer among rural women in Korea. Nurs Health Sci, 2, 225-30. https://doi.org/10.1046/j.1442-2018.2000.00063.x
  59. Leventhal H, Cameron L (1987 ). Behavioural theories and the problem of compliance. Patient Educ Couns, 10, 117-38. https://doi.org/10.1016/0738-3991(87)90093-0
  60. Lugton J (1997). The nature of social support as experienced by women treated for breast cancer. J Advanced Nurs, 25, 1184. https://doi.org/10.1046/j.1365-2648.1997.19970251184.x
  61. McCance KL, Mooney KH, Field R (1996). The influence of others in motivating women to obtain breast cancer screening. Cancer Pract, 4, 141-6.
  62. McPhee SJ (1997). Barriers to breast and cervical cancer screening among Vietnamese-American women. Am J Prev Med, 13, 205-13.
  63. Meleis A, Hatter-Pollard M (1995). Arab Middle Eastern American women. Stereotyped, invisible, but powerful. In D. L. Adams (Ed.), Health Issues for Women of Color: A cultural diversity perspective 133-63. Sage Publications.
  64. Miller AM, Champion VL (1997). Attitudes about breast cancer and mammography: Racial income and educational differences. Women and Health, 26, 41-63. https://doi.org/10.1300/J013v26n01_04
  65. Montano DE, Thompson B, Taylor VM, Mahloch J (1997). Understanding mammography intention and utilization among women in an inner city public hospital clinic. Prevent Med, 26, 817-24. https://doi.org/10.1006/pmed.1997.0215
  66. Montazeri A, Haji-Mahmoodi M, Jarvandi S (2003).Breast self-examination: do religious beliefs matter? A descriptive study. J Public Health Med, 25, 154-5. https://doi.org/10.1093/pubmed/fdg031
  67. Munro S, Lewin S, Swart T, Volmink J (2007). A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS? BMC Public Health, 7, 104. https://doi.org/10.1186/1471-2458-7-104
  68. Nissan A, Spira M, Hamburger T (2004). Clinical profile of breast cancer in Arab and Jewish women in the Jerusalem area. Am J Surg, 188, 62-7. https://doi.org/10.1016/j.amjsurg.2003.11.039
  69. O'Malley AS, Earp JA, Harris RP (1997). Race and mammography use in two North Carolina counties. Am J Public Health, 87, 782-6. https://doi.org/10.2105/AJPH.87.5.782
  70. Parsa P, Kandiah M, Abdul Rahman H, Zulkefli N (2006). Barriers for breast cancer screening among Asian women: A mini literature review. Asian Pac J Cancer Prev, 7, 509.
  71. Pasick RJ, Burke NJ (2008). A critical review of theory in breast cancer screening promotion across cultures. Annu Rev Public Health, 29, 351-68. https://doi.org/10.1146/annurev.publhealth.29.020907.143420
  72. Pender NJ (1987) Interview: James Michael McGinnis, MD, MPP. Family Community Health, 10, 59-65. https://doi.org/10.1097/00003727-198708000-00010
  73. Persson K, Svensson P, Ek A (1997). Breast self-examination: An analysis of self-reported practice. J Advanced Nurs, 25, 886-92. https://doi.org/10.1046/j.1365-2648.1997.1997025886.x
  74. Petro-Nustus W, Mikhail BI (2002). Factors associated with breast self-examination among Jordanian women. Public Health Nurs, 19, 263-71. https://doi.org/10.1046/j.1525-1446.2002.19406.x
  75. Poss JE (2001). Developing a new model for cross-cultural research: Synthesizing the Health Belief Model and the Theory of Reasoned Action. Advances Nurs Sci, 23, 1-15.
  76. Prochaska JO (1991). Assessing how people change. Cancer, 67, 805-7. https://doi.org/10.1002/1097-0142(19910201)67:3+<805::AID-CNCR2820671409>3.0.CO;2-4
  77. Prochaska JO, Redding CA, Harlow LL, Rossi JS,Velcier WF (1994). The transtheoretical model of change and HIV prevention: a review. Health Educ, 21, 471-86. https://doi.org/10.1177/109019819402100410
  78. Rajaram S, Rashidi A (1999). Asian-Islamic women and breast cancer screening: a socio-cultural analysis. Women and Health, 28, 45-58. https://doi.org/10.1300/J013v28n03_04
  79. Rakowski W, Dube CE, Marcus BH (1992). Assessing elements of women's decisions about mammography. Health Psychol J, 11, 111. https://doi.org/10.1037/0278-6133.11.2.111
  80. Rashidi A, Rajaram S (2000). Middle eastern Islamic women and breast self-examination. Cancer Nurs, 23, 64-71. https://doi.org/10.1097/00002820-200002000-00010
  81. Redding CA, Rossi JS, Rossi SR, Velicer WF, Prochaska JO (2000). Health behaviour models. Int Electr J Health Educ, 3, 180-93.
  82. Rosenstock IM (1960). What research in motivation suggests for public health. Am J Public Health, 50, 295-301. https://doi.org/10.2105/AJPH.50.3_Pt_1.295
  83. Rosenstock IM (1996). Why people use health services. Milbank Memorial Fund Quarterly, 44, 94-124.
  84. Rosenstock IM, Strecher VJ, Becker MH (1988). The social learning theory and the health belief model. Health Educ Quarterly, 15, 175-83. https://doi.org/10.1177/109019818801500203
  85. Rutter DR, Steadman L, Quine L (2006). An implementation intentions intervention to increase uptake of mammography. Annals Beh Med, 32, 127. https://doi.org/10.1207/s15324796abm3202_10
  86. Samah AA, Ahmadian M (2012). Socio-demographic correlates of participation in mammography; a survey among women aged between 35-69 in Tehran, Iran. Asian Pac J Cancer Prev, 13, 2717-20. https://doi.org/10.7314/APJCP.2012.13.6.2717
  87. Savage SA, Clarke VA (1996). Factors associated with screening mammography and breast self-examination intentions. Health Educ Res, 11, 409.
  88. Schwartz K, Fakhouri M, Bartoces M, Monsur J, Younis A (2008). Mammography screening among Arab American women in metropolitan Detroit. J Immigr Minor Health, 10, 541-9. https://doi.org/10.1007/s10903-008-9140-8
  89. Secginli S, Nahcivan NO (2006). Factors associated with breast cancer screening behaviors in a sample of Turkish women: A questionnaire survey. Int J Nurs Studies, 43, 161-71. https://doi.org/10.1016/j.ijnurstu.2005.02.004
  90. Selvan MS, Ross MW, Kapadia AS, Mathai R, Hira S (2001). Study of perceived norms, beliefs and intended sexual behavior among higher secondary school students in India. AIDS Care, 13, 779-88. https://doi.org/10.1080/09540120120076968
  91. Sheeran P (2002). Intention-behavior relations: a conceptual and empirical review. Eur Rev Soc Psychol, 12, 1. https://doi.org/10.1080/14792772143000003
  92. Shirazi M, Champeau D, Talebi A (2006). Predictors of breast cancer screening among immigrant Iranian women in California. J Women's Health, 15, 485-506. https://doi.org/10.1089/jwh.2006.15.485
  93. Slenker SE, Grant MC (1989). Attitudes, beliefs, and knowledge about mammography among women forty years of age. J Cancer Educ, 4, 61-5. https://doi.org/10.1080/08858198909527969
  94. Smith R, Maira C, Ute S (2006). Breast cancer in limited resource countries: early detection and access to care. Breast J, 12, 16-26. https://doi.org/10.1111/j.1075-122X.2006.00185.x
  95. Smith RA, Biddle SJ (1999). Attitudes and exercise adherence: test of the theories of reasoned action and planned behavior. J Sports Sci, 17, 269-81. https://doi.org/10.1080/026404199365993
  96. Straughan P, Seow A (2000). Attitude as barriers in breast screening: a prospective study among Singapore women. Soc Sci Med, 51, 1695-703. https://doi.org/10.1016/S0277-9536(00)00086-1
  97. Strecher VJ, Rosenstock IM (1997). The Health Belief Model. Health Belief and Health Education: Theory Research and Practice. San Francisco: Jossey-Bass.
  98. Thomas LR, Fox SA, Leake BG, Roetzheim RG (1996). The effects of health beliefs on screening mammography utilization among a diverse sample of older women. Women and Health, 24, 11-9.
  99. Thongsuksai P, Sripung H (2000). Delay in breast cancer care: a study in Thai women. Med Care, 38,108-14. https://doi.org/10.1097/00005650-200001000-00012
  100. Trost SG, Saunders R, Ward DS (2002). Determinants of physical activity in middle school children. Am J Health Behav, 26, 95-102. https://doi.org/10.5993/AJHB.26.2.2
  101. Umeh K, Rogan-Gibson J (2001). Bri J Health Psychol, 6, 361-72. https://doi.org/10.1348/135910701169269
  102. Usmani K, Khanum A, Afzal H, Ahmad N (1996). Breast cancer in Pakistani women. J Environ Pathol Toxicol Oncol, 15, 251-3.
  103. Wallace LS (2002). Osteoporosis prevention in college women: application of the expanded health belief model. Am J Health Behav, 26, 163-72. https://doi.org/10.5993/AJHB.26.3.1
  104. Yip CH, Ng EH (1996). Breast cancer- a comparative study between Malaysian and Singaporean women. Singapore Med J, 37, 264-7

Cited by

  1. Stage at Diagnosis and Delay in Seeking Medical Care Among Women With Breast Cancer, Delhi, India vol.16, pp.12, 1970, https://doi.org/10.5812/ircmj.14490
  2. Factors Affecting Breast Cancer Screening Behavior in Japan - Assessment using the Health Belief Model and Conjoint Analysis vol.14, pp.10, 2013, https://doi.org/10.7314/APJCP.2013.14.10.6041
  3. Breast cancer-preventive behaviors: exploring Iranian women’s experiences vol.14, pp.1, 2014, https://doi.org/10.1186/1472-6874-14-41
  4. Total Delay for Treatment among Cancer Patients: a Theory-guided Survey in China vol.15, pp.10, 2014, https://doi.org/10.7314/APJCP.2014.15.10.4339
  5. An Outline of the Need for Psychology Knowledge in Health Professionals: Implications for Community Development and Breast Cancer Prevention vol.15, pp.12, 2014, https://doi.org/10.7314/APJCP.2014.15.12.5097
  6. Multivariate Analysis of Prognostic Factors in Male Breast Cancer in Serbia vol.15, pp.7, 2014, https://doi.org/10.7314/APJCP.2014.15.7.3233
  7. Development of a Family Nursing Model for Prevention of Cancer and Other Noncommunicable Diseases through an Appreciative Inquiry vol.15, pp.23, 2015, https://doi.org/10.7314/APJCP.2014.15.23.10367
  8. Psychosocial Predictors of Breast Self-Examination among Female Students in Malaysia: A Study to Assess the Roles of Body Image, Self-efficacy and Perceived Barriers vol.17, pp.3, 2016, https://doi.org/10.7314/APJCP.2016.17.3.1277
  9. Benzoquinone from Fusarium pigment inhibits the proliferation of estrogen receptor-positive MCF-7 cells through the NF-κB pathway via estrogen receptor signaling vol.39, pp.1, 2016, https://doi.org/10.3892/ijmm.2016.2811
  10. Beyond a Paycheck: The Influence of Workforce Participation on Women’s Cancer Screening in Turkey vol.75, pp.11-12, 2016, https://doi.org/10.1007/s11199-016-0611-4
  11. Applying the Health Belief Model and an Integrated Behavioral Model to Promote Breast Tissue Donation Among Asian Americans pp.1532-7027, 2017, https://doi.org/10.1080/10410236.2017.1315678
  12. The effect of knowledge on uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda vol.18, pp.1, 2018, https://doi.org/10.1186/s12889-018-5183-5
  13. The ‘Be Cancer Alert Campaign’: protocol to evaluate a mass media campaign to raise awareness about breast and colorectal cancer in Malaysia vol.18, pp.1, 2018, https://doi.org/10.1186/s12885-018-4769-8