Breast Cancer Awareness among Female School Teachers in Saudi Arabia: A Population Based Survey

Knowledge, Attitudes, and Practices Toward Breast Cancer and Breast Cancer Screening Among Arab Females in the Middle East: A Literature Review

BACKGROUND

Breast cancer is one of the most diagnosed cancers in Arab countries. Lack of knowledge and awareness regarding breast cancer screening has increased the breast cancer-related morbidity and mortality.

PURPOSE

This literature review aimed to assess published research papers with a focus on the levels of knowledge, attitude, practice, and barriers of women in Arab countries of the Middle East toward breast cancer and its screening.

METHOD

SCOPUS, MEDLINE, and Google Scholar were searched using specific terms for relevant, quantitative, original studies published between 2017 and 2022. All English articles that matched the inclusion criteria were included in this review. Fourteen studies focusing on knowledge, attitudes, and barriers regarding breast cancer were included. Two independent reviewers performed screening and extraction.

RESULTS

Among the reviewed studies, a range from 19.6% in Oman to 67% in Saudi Arabia had poor knowledge of breast cancer. Past personal or family history was a well-recognized risk factor (n = 5), and being worried about the results was the most common barrier to screening. Although most women were aware of screening methods, the majority did not practice screening. Social media and the internet were the most used sources of information used by women to obtain knowledge regarding breast cancer and its screening (n = 6).

CONCLUSION

Most of the Arab female population had low levels of knowledge, attitudes, and practices regarding breast cancer and its screening. Programs designed to raise awareness are necessary, and more policy changes must take place on the national level in Arab, Middle Eastern countries to address the low knowledge, the negative attitudes, and the limited access to breast cancer screening.

Breast Cancer Awareness Among Women in Saudi Arabia: A Systematic Review

Purpose

Breast cancer (BC) is the most prevalent cancer worldwide, and second most common cause of cancer-related deaths among women worldwide. Early detection of BC significantly improves prognosis; thus, awareness is an important aspect of BC morbidity and survival as well as the economic burden. This systematic review aimed to explore awareness of BC among women in Saudi Arabia.

Patients and Methods

A systematic search was performed using Medline, Scopus, the Directory of Open Access Journals (DOAJ), and Google Scholar for all cross-sectional studies conducted in Saudi Arabia, published after the year 2000 and in English. The quality assessment of the included studies was performed using the AXIS tool.

Results

The total number of included articles after full-text assessment was 13 articles that were conducted between 2005 and 2022. The sample size of all the articles was 7,562 women. All the studies categorized BC awareness into low, moderate, and high groups. The level of low awareness among women reached 66.3% (n=2808), 13.5% (n=570) had moderate awareness levels, and 20.2% (n=858) had high awareness levels. Furthermore, 59.4% (n=1446) of the participants did not perform breast self-examination (BSE) regularly.

Conclusion

The level of awareness and knowledge regarding BC and BSE was significantly low among women in Saudi Arabia, as all included studies except one have indicated. We highly recommend and urge the implementation of effective special programs and campaigns to raise awareness regarding BC and integrating BSE into school health programs dedicated to women living in Saudi Arabia.

Breast Cancer Awareness and Screening Among Menopaused Females in Al-Qassim Region

BACKGROUND

Breast cancer (BC) is one of the most prevalent types of cancer among women worldwide including those in Saudi Arabia. The risk of developing BC can be lowered by reducing risk factors through early screening and by women having full knowledge of this condition. The aim of this study is thus to evaluate knowledge of the importance of early screening and detection of BC among post-menopausal women in Saudi Arabia's Qassim region and to compare it with pre-menopausal women.

METHODOLOGY

A cross-sectional study was conducted among post-menopausal women in the Qassim region. Data were collected by using a pre-tested, pre-coded, validated self-administered online questionnaire. Data were analyzed using SPSS (Social Package of Statistical Science) Statistics version 23.0.

RESULTS

Data were collected from 1386 women who agreed to participate in this study, of which 484 women reported that their menstruation had stopped (34.9%). In general, it was found that 73.7% of the participants had adequate knowledge with a significant difference between pre-menopausal and post-menopausal women. Concerning knowledge of BC (p = 0.042), pre-menopausal women had a higher level of knowledge (75.5% had adequate knowledge compared with 70.5% of post-menopausal women). Considering the source of knowledge of the participants regarding BC, websites or social media is considered the main source for 71.8% of the participants, followed by family and friends (52.2%). Concerning the knowledge about the risk factors of BC, 26.4% of the participants reported that they did not know them, and 11.8% of the participants did not know any of the symptoms of BC.

CONCLUSION

In this study, the knowledge of post-menopausal women was found to be adequate; however, it is significantly lower than that of the pre-menopausal women. Educational level is a significant factor that affects the level of knowledge regarding BC risk factors and different modalities for diagnosis and approaches for management, and this indicates the importance of increasing interest in education in our society.

G. S, Osman H, Khandaker MU. Awareness level, knowledge and attitude towards breast cancer among staff and students of Hail University, Saudi Arabia

INTRODUCTION

Awareness of screening procedures and illness warning signals is critical for expanding and implementing screening programs in society, which would improve the odds of early identification of breast cancer.

OBJECTIVES

This study aimed to evaluate the knowledge, awareness, attitudes, and practices related to breast cancer risk factors, signs, symptoms and methods of screening among female faculty and students at Hail University in the Kingdom of Saudi Arabia.

METHODS

A cross-sectional study was conducted from January 2021 through February 2021 in the Hail region of Saudi Arabia. A closed-ended questionnaire, which consisted of 37 questions, was distributed online (using a Google Forms link) in both English and Arabic languages. Data was collected from 425 female subjects who participated in the study.

RESULTS

The study showed an overall knowledge level of 46.36% regarding breast cancer. Participants had average knowledge about risk factors, signs, and symptoms, whereas their awareness and practice of breast self-examination and screening methods were weak.

CONCLUSION

The current study concluded that public awareness of breast cancer remains relatively low, and Saudi Arabia still needs several public awareness initiatives using mass media, such as television, the Internet, and radio, as well as social media. Special awareness programs should also be held in places where a large number of women can easily be reached, such as colleges, universities, and hospitals.

Awareness of Palestinian Women About Breast Cancer Risk Factors: A National Cross-Sectional Study

PURPOSE

This study aimed to assess awareness of Palestinian women about breast cancer (BC) age-related and lifetime risks and its risk factors and to identify factors associated with good awareness.

MATERIALS AND METHODS

Adult women were recruited from government hospitals, primary health care centers, and public spaces in 11 governorates in Palestine. Recognition of 14 BC risk factors was assessed using a translated-into-Arabic version of the validated BC awareness measure. The level of BC risk factor awareness was determined on the basis of the number of risk factors recognized: poor (0-4), fair (5-9), and good (10-14).

RESULTS

Of 6,269 potential participants approached, 5,434 agreed and completed the questionnaire (response rate = 86.7%). A total of 5,257 questionnaires were included: 2,706 from the West Bank and Jerusalem and 2,551 from the Gaza Strip. Only 173 participants (3.3%) recognized the age-related risk of BC. More than one quarter (n = 1,465; 27.9%) recognized the lifetime risk of BC. The most recognized modifiable risk factor was not breastfeeding (n = 4,937; 93.9%), whereas the least recognized was having children later on in life or not at all (n = 1,755; 33.4%). The most recognized nonmodifiable risk factor was radiation exposure (n = 4,579; 87.1%), whereas the least recognized was starting the periods at an early age (n = 1,030; 19.6%). In total, 2,024 participants (38.4%) demonstrated good BC risk factor awareness. Participants from the Gaza Strip had a higher likelihood than participants from the West Bank and Jerusalem to have good awareness (42.0% v 35.2%). Age ≥ 40 years, postsecondary education, and visiting hospitals and primary health care centers were all associated with an increase in the likelihood of having good BC risk factor awareness.

CONCLUSION

The awareness of BC risk factors was suboptimal. These findings highlight the need for implementing health education programs combined with consistent use of ad hoc opportunities to raise awareness by health care providers.

Awareness, Knowledge, Perceptions, and Attitudes towards Familial and Inherited Cancer

Background and Objectives: In 2020, the World Health Organization (WHO) reported 9.9 million deaths from cancer, with a mortality rate of 10.65%. Early detection of cancer can decrease mortality and increase the chance of cure. In Saudi Arabia, multiple studies were performed for awareness and attitudes toward cancer, but few studies evaluated the awareness of familial and inherited cancers. Materials and Methods: This is a cross-sectional observational survey of the awareness, knowledge, and attitudes of Saudi women toward familial and inherited cancers. The estimated sample size was 385. Questionnaires were distributed through social media platforms from 1 January 2021 to 22 January 2021. Results: Of the 385 participants, the majority have a bachelor’s degree. More than half (68.9%) know that family history is related to cancer, and approximately 57.2% are aware of genetic testing. The most common indication of genetic testing is premarital testing (18.5%). An inverse relationship is noted between the awareness of familial and inherited cancers and age (p = 0.003, CI = 0.723−0.938). However, awareness of inherited and familial cancer is positively associated with awareness of the association of genetic mutation to cancer (p = 0.013, CI = 1.080−1.921) and knowledge about genetic testing (p > 0.000, CI = 2.487−8.426). Conclusions: Our results reveal that Saudi women, especially older adults, have suboptimal knowledge about inherited and familial cancers, and poor attitudes toward genetic screening. We recommend increasing public awareness regarding risk factors and screening for inherited and familial cancers.

Comparison of Classification Success Rates of Different Machine Learning Algorithms in the Diagnosis of Breast Cancer

OBJECTIVE

To identify which Machine Learning (ML) algorithms are the most successful in predicting and diagnosing breast cancer according to accuracy rates.

METHODS

The "College of Wisconsin Breast Cancer Dataset", which consists of 569 data and 30 features, was classified using Support Vector Machine (SVM), Naive Bayes (NB), Random Forest (RF), Decision Tree (DT), K-Nearest Neighbor (KNN), Logistic Regression (LR), Multilayer Perceptron (MLP), Linear Discriminant Analysis (LDA), XgBoost (XGB), Ada-Boost (ABC) and Gradient Boosting (GBC) ML algorithms. Before the classification process, the dataset was preprocessed. Sensitivity, accuracy, and definiteness metrics were used to measure the success of the methods.

RESULT

Compared to other ML algorithms used in the study, the GBC ML algorithm was found to be the most successful method in the classification of tumors with an accuracy of 99.12%. The XGB ML algorithm was found to be the lowest method with an accuracy rate of 88.10%. In addition, it was determined that the general accuracy rates of the 11 ML algorithms used in the study varied between 88-95%.

CONCLUSION

When the results obtained from the ML classifiers used in the study are evaluated, the efficiency of the GBC algorithm in the classification of tumors is obvious. It can be said that the success rates obtained from 11 different ML algorithms used in the study are valuable in terms of being used to predict different cancer types.

A national survey to assess breast cancer awareness among the female university students of Pakistan

The incidence of breast cancer is increasing in Pakistan as well as globally. Awareness of women about breast cancer plays a cornerstone role in its early detection, better management, and prevention. Keeping this in mind, a cross-sectional study was carried out to assess the awareness of female university students about breast cancer’s risk factors, signs and symptoms, and breast cancer examination. The data was collected from female university students studying in Pakistan. A total of 774 participants completed the survey and recorded their responses on an online pre-tested self-administered questionnaire. Only 29.8% of the participants have identified breast cancer history in their first-degree relatives as a risk factor. Moreover, 14.1% of the participant considered that the use of oral contraceptives for more than 5 years can increase the risk of developing breast cancer. In addition, inward pulled nipple, wounds around the nipple, and abrupt changes in the breast size were considered as the sign and symptoms of breast cancer by 25.2%, 25.7%, and 31.7% of the participants, respectively. Moreover, only 20.9% of the participants identified the correct year for starting breast cancer examination and 44.4% of the respondents marked that mammography should be initiated after 40 years. Overall, the university female students of Pakistan were poorly aware of breast cancer’s risk factors, signs and symptoms, and breast examination. This study has highlighted the need for initiation of aggressive strategies regarding breast cancer awareness in both the literate and illiterate female population of Pakistan.

Screening Practices, Knowledge and Adherence Among Health Care Professionals at a Tertiary Care Hospital

Introduction

Screening, a routine procedure done on individuals with or without disease, results in the early detection of disease. The aim of this study was to assess healthcare professionals’ (HCPs) level of knowledge related to and the adherence to screening.

Methods

A survey was conducted in HCPs, using a self-administered questionnaire. Knowledge was defined based on the correct or incorrect responses to the questions. Adherence to screening was considered if a test was done at least once in the past one year.

Results

Of the 379 participants, 61% were nurses, 34% physicians, and 5% pharmacists. The majority 68.78% were female. The average age of pharmacists was 29.17±7.09, physicians 35.57±10.08, and nurses 35.46±8.63 years. The knowledge related to breast cancer screening ranged between 50% and 57% and of a Pap smear, 41–54%. 94% nurses and 90% pharmacists had recorded an incorrect response to the required age of colon cancer screening. The overall screening adherence to diabetes was 46%, hypertension 68%, liver profile 43%, lipid profile 50%, breast cancer 10.38%, Pap smear 26%, prostate cancer 33%, and colon cancer 2.37%. HCPs aged ≥45 years had good adherence to diabetes screening. Pharmacists (88%) had the highest level of adherence to hypertension screening. Female HCPs poorly adhered to breast 38% and cervical cancer 26% screening. Only a third 33% of males, aged > 50 years, were screened for prostate cancer. Among HCPs aged ≥50 years (n=32), only three were screened for colon cancer.

Conclusion

Despite the increased incidence of diabetes, breast and colon cancer in Saudi Arabia, HCPs displayed poor knowledge related to screening. The adherence to diabetes screening was good. However, HCPs in a high-risk group displayed poor adherence to screening, specifically for breast, cervical and colon cancer. The medical and cancer screening guidelines should be made available to all HCPs regardless of their specialty.

Effects of neoadjuvant therapies on genetic regulation of targeted pathways in ER+ primary ductal breast carcinoma: A meta-analysis of microarray datasets

Breast cancer arises as a result of multiple interactions between environmental and genetic factors. Conventionally, breast cancer is treated based on histopathological and clinical features. DNA technologies like the human genome microarray are now partially integrated into clinical practice and are used for developing new "personalized medicines" and "pharmacogenetics" for improving the efficiency and safety of cancer medications. We investigated the effects of four established therapies-for ER+ ductal breast cancer-on the differential gene expression. The therapies included single agent tamoxifen, two-agent docetaxel and capecitabine, or combined three-agents CAF (cyclophosphamide, doxorubicin, and fluorouracil) and CMF (cyclophosphamide, methotrexate, and fluorouracil). Genevestigator 8.1.0 was used to compare five datasets from patients with infiltrating ductal carcinoma, untreated or treated with selected drugs, to those from the healthy control. We identified 74 differentially expressed genes involved in three pathways, i.e., apoptosis (extrinsic and intrinsic), oxidative signaling, and PI3K/Akt signaling. The treatments affected the expression of apoptotic genes (TNFRSF10B [TRAIL], FAS, CASP3/6/7/8, PMAIP1 [NOXA], BNIP3L, BNIP3, BCL2A1, and BCL2), the oxidative stress-related genes (NOX4, XDH, MAOA, GSR, GPX3, and SOD3), and the PI3K/Akt pathway gene (ERBB2 [HER2]). Breast cancer treatments are complex with varying drug responses and efficacy among patients. This necessitates identifying novel biomarkers for predicting the drug response, using available data and new technologies. GSR, NOX4, CASP3, and ERBB2 are potential biomarkers for predicting the treatment response in primary ER+ ductal breast carcinoma.

Knowledge, Attitudes, and Practices Concerning Breast Cancer and Self Examination Among Females in UAE

Breast cancer (BC) is one of the most prevalent cancers and the leading cause of cancer related deaths among women worldwide with a steadily increasing global annual incidence. This study aims is to evaluate the knowledge, attitude, and practice of females in the UAE toward BC and Breast Self-Examination practice in the seven Emirates. This was a face-to-face questionnaire-based study using CAM (Breast Cancer Awareness Measure) conducted over 3 months (from March to June 2019) on a random sample of females across the UAE. Of the 400 females who filled the questionnaire, 112 (28%) did the CBE at least once, and 184 (46%) practice BSE. Only 33% of participants were aware of the incidence of the BC in the UAE and those females were more likely to practice BSE (P < 0.05). In contrast, the majority showed a high awareness level in identifying cancer as a curable (91.5%) and non-transmittable (87%) disease that can be diagnosed at its earlier stages (93%). Only 11% of the participants identified weight reduction as a way to prevent BC. Knowledge of breast cancer sign/symptoms were good, as 41-87% of respondents were able to identify at least a single sign/symptom. The lack of awareness of BC among females in the UAE is of concern as it leads to low practices of screening and early detection, which ultimately will result in increased morbidity, mortality, and treatment costs. Further initiatives should be taken to increase practice, knowledge and awareness on early detection and screening for BC in the UAE community.