Breast cancer awareness of rural women in Malaysia: is it the same as in the cities?

Breast cancer screening awareness, practice, and perceived barriers: A community-based cross-sectional study among women in south-eastern Bangladesh

Background and Aims

Breast cancer is a leading cause of mortality in Bangladesh. An early-stage screening is the best way to reduce both the morbidity and mortality burden of breast cancer. The study evaluated awareness, practice, and perceived barriers toward breast cancer screening in Bangladesh.

Methods

A community-based cross-sectional study was conducted from October 2021 to December 2022 in Chattogram, Bangladesh, where 869 women (18 years or above) were randomly selected in this study.

Results

Among 869 participants, 47.3% of women were recruited from urban areas and 52.7% participated from rural areas. Only 32.68% of respondents (urban vs. rural: 44.28% vs. 22.27%) were aware of breast self-examination (BSE) and 52.47% of respondents (urban vs. rural: 63.75% vs. 42.36%) had ever heard Clinical Breast Examination (CBE), respectively. Among the respondents, 27.73% (urban vs. rural: 40.15% vs. 16.59%) performed their BSE, and only 14.61% of respondents (urban vs. rural: 21.90% vs. 8.08%) had ever visited for CBE. Women residing in rural areas were approximately three times (AOR: 0.36 [95% CI: 0.25-0.52], AOR: 0.37 [95% CI: 0.23-0.58]) less likely to perform BSE and CBE, respectively, than urban dwellers. We found that higher-educated women tend to do more BSE and CBE than women with low levels of education. Perceptions of having "no symptoms" and being "risk-free" are leading barriers to breast screening among women.

Conclusion

Poor awareness and practice were observed in screening among the urban and rural women in Bangladesh. Urban area dwellers had comparatively better understanding and practice than rural dwellers. We think extending health education and health promotion activities toward breast cancer screening is essential in this region.

The "Know Your Lemons" Tools: A strategy to improve breast cancer warning signs recognition in Malaysia

BACKGROUND

Breast cancer (BC) is the most common cancer in Malaysia, with many diagnosed at late stages. The "Know Your Lemons" (KYL) visual educational tools were developed by KYL Foundation. This study aimed to evaluate participants' confidence levels and perceived knowledge in identifying BC symptoms before and after exposure to KYL tools.

MATERIALS AND METHODS

A cross-sectional study was carried out among 788 participants in three KYL health campaigns from 2017 to 2020. Perceived knowledge (a 5-item Likert scale was used, zero means "very poor" and 4 means "excellent knowledge") and confidence in identifying BC symptoms were studied. A Wilcoxon Matched-Paired Signed-Rank Test was performed to assess the perceived knowledge.

RESULTS

There was a significant improvement in the perceived knowledge Mean (±SD) score (2.84 ± 1.02) versus (4.31 ± 0.66) before and after the campaign (P < 0.01). About 95.6% agreed that the language used in KYL materials was clear and understandable, 89.8% agreed it is acceptable in Malaysian culture, and 80% felt more confident in identifying BC symptoms. Therefore, 90.8% had the intention of breast self-examination and 90.8% would consult a doctor if symptomatic. The majority (92.7%) agreed that the KYL tools clarified the BC tests needed.

CONCLUSION

The KYL tools enhanced perceived BC symptom recognition knowledge and confidence levels.

Multi-level determinants of breast cancer screening among Malay-Muslim women in Singapore: a sequential mixed-methods study

Objective

Ethnic disparity persists despite equal access to health care in Singapore, with Malay-Muslim women having the lowest mammogram uptake rate and highest breast cancer mortality rate. We sought to understand barriers to and facilitators for mammogram uptake in this community.

Methods

We used a sequential mixed-methods design to first explore reasons for screening and not screening for breast cancer, then determine factors associated with screening and regular screening in a survey. We used maximum variation sampling for semi-structured in-depth interviews to select screeners and non-screeners of diverse ages and educational levels. Twenty-three Malay-Muslim women aged 40–69 years old were interviewed. Themes were categorized using thematic analysis. For the survey, we applied the Health Belief Model, Social Ecological Model, as well as themes from the interviews and findings from previous studies on factors influencing screening in Muslim women to guide questionnaire design. We surveyed 271 Malay-Muslim women aged 50–69 years old in a nationally representative sample. Multivariable logistic regression was used to determine factors associated with ever gone for mammogram and regular mammogram uptake.

Results

Through in-depth-interviews, we found perceived benefits of saving lives and breasts from early detection, reminders from doctors and husbands, symptoms, perceived test from God, and personal responsibility to care for one’s health facilitated screening. Barriers were perceived low susceptibility, inconvenience, cost, negative psychological effects, misinformation on mammogram triggering cancer cells, religious beliefs, perceived negative outcomes from mammography and distrust of doctor. From the survey, we found cues from health care professionals and needing symptoms before deciding to go for mammogram to be significantly associated with ever gone for mammogram and regular mammogram. Factors associated with ever gone for mammogram only included age, perceived benefits of saving lives from early detection, perceived importance of mammogram, Punishing Allah Reappraisal, and modesty. Factors associated with regular mammogram only included household income, perceived structural barriers to screening and perceived susceptibility to breast cancer.

Conclusions

Mammogram uptake is affected by multiple levels of influence. Interventions to promote screening should be designed with multiple stakeholders including doctors, religious leaders and women who had attended screening.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01972-y.

Women's health beliefs and uptake of breast cancer screening in Malaysia

OBJECTIVES

This study investigated women's health beliefs, the use of breast cancer (BC) screening services, and the factors that potentially influence uptake of screening.

METHODS

Face-to-face interviews were conducted with a randomly selected community sample of 992 women (>40 years old) in Selangor State, Malaysia.

RESULTS

Approximately 35% of women received a clinical breast examination (CBE) and 27% had a mammogram within the last 1 to 2 years. The regression analyses indicated that Chinese ethnicity has higher perceived susceptibility to BC compared to Malay ethnicity (mean 7.74, SD: 2.75; 95% CI 0.09, 1.03) whilst a lower perceived susceptibility was observed in women aged ≥70 years (mean 6.67, SD: 3.01; 95% CI -1.66, -0.24) compared to women aged 40-49 years. Indian Malaysian women (mean 16.87, SD: 2.59; 95% CI 0.12, 1.01) and women who had received a CBE (mean 16.10, SD:2.35; 95% CI 0.18, 0.89) were more likely to have higher perceived benefits scoring. Indian ethnicity, secondary education and tertiary education, top 20% income group, past history of CBE and mammogram uptake were significantly associated with lower barriers scoring.

CONCLUSIONS

There is a need to target BC screening uptake improvement programmes towards communities in which women experience disadvantages related to income, education, employment, and, in particular, to tailor programmes to take into consideration differences between ethnic groups regarding their beliefs about cancer screening.

Women's awareness of breast cancer symptoms: a national cross-sectional study from Palestine

Background

Early diagnosis is crucial to reduce the morbidity and mortality associated with breast cancer (BC). Awareness of BC symptoms plays a key role in this. This study aimed to evaluate the Palestinian women’s awareness of BC symptoms and determine factors associated with good awareness.

Methods

This was a national cross-sectional study conducted from July 2019 to March 2020 in Palestine. Convenience sampling was used to recruit adult women from hospitals, primary healthcare centers, and public spaces located in 11 governorates. A translated-into-Arabic version of the validated BC awareness measure was utilized for data collection. The awareness level was categorized based on the number of symptoms recognized into: poor (0 to 4), fair (5 to 9), and good (10 to 13).

Results

Of 6269 approached, 5434 participants completed the questionnaire (response rate = 86.7%). A total of 5257 questionnaires were included in the analysis: 2551 from the Gaza Strip and 2706 from the West Bank and Jerusalem (WBJ). Participants living in the WBJ were more likely to be older, have higher monthly income, and suffer from more chronic diseases than participants living in the Gaza Strip.

The most frequently identified BC symptom was ‘lump or thickening in the breast’ (n = 4887, 92.9%) followed by ‘lump or thickening under the armpit’ (n = 4394, 83.6%). The least frequently identified symptoms were ‘pulling in of the nipple’ (n = 2665, 50.7%) and ‘change in the position of the nipple’ (n = 2710, 51.6%).

A total of 2191 participants (41.7%) demonstrated good awareness of BC symptoms. Participants from the Gaza Strip were more likely than participants from the WBJ to have good awareness (47.0.0% vs. 36.7%). On the multivariable analysis, being ≥ 40 years, completing a post-secondary education, knowing someone with cancer, and visiting hospitals and primary healthcare centers were all associated with an increase in the likelihood of having good awareness. However, living in the WBJ was associated with a decrease in the likelihood of having good awareness.

Conclusion

Less than half of women included in this study showed good awareness of BC symptoms. More targeted educational interventions are needed to promote Palestinian women’s awareness of BC symptoms to facilitate early diagnosis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13224-7.

Breast Cancer Screening in Semi-Rural Malaysia: Utilisation and Barriers

Breast cancer (BC) is the commonest cancer in Malaysia. Delayed diagnosis is a significant cause of BC mortality in the country. Early diagnosis and screening are vital strategies in mortality reduction. This study assessed the level of utilisation and barriers for breast self-examination (BSE), clinical breast examination (CBE) and mammogram in a semi-rural population in Malaysia and compared these across the different ethnic groups. This cross-sectional study was conducted among women aged 40 years and above, embedded within a health and demographic surveillance site (HDSS) in Segamat, Malaysia. Trained data collectors collected data on screening and barriers during home visits. Study participants (n = 250) were aged 59.4 ± 10.9 years and represented Malaysia's three major ethnic groups. Practice of regular BSE, CBE uptake (ever) and mammogram (ever) was 23.2%, 36% and 22.4%, respectively. Regular BSE practice was highest in the Malay ethnic group and least among the Chinese. Regular CBE was very low in all ethnic groups (<5%). Mammogram uptake was highest among Chinese (34.4%), followed by Indians (30.4%) and Malays (16.6%). After adjusting for other socio-demographic variables, Malay ethnicity was positively associated with regular BSE (adjusted OR = 5.26, 95% CI 2.05, 13.50) and negatively associated with having had a mammogram (adjusted OR = 0.3, 95% CI 0.15, 0.57). Lower education was negatively associated (adjusted OR = 0.36, 95% CI 0.17, 0.74) with mammogram attendance (ever). Emotional and financial barriers were the most reported types of barriers, specifically, fear of diagnosis (74.8%), cost of diagnosis (69.6%) and fear of losing a breast (66.4%). Malay women more commonly reported most barriers compared to other ethnic groups. Screening uptake was low among semi-rural women in Malaysia. Implementing culturally appropriate interventions that consider ethnic differences is crucial to empowering women to engage in BC screening initiatives in these communities.

Construction and Validation of Breast Cancer Awareness Scale in Iranian Women

Introduction: Application of a single valid and reliable questionnaire in future studies in the area of Iranian women’s awareness of breast cancer provides the health policymakers with a comprehensive view over the issue. In designing the current questionnaires in Iran, the prior researchers neither explained about the design procedure, nor calculated the validity and reliability of the questionnaire completely. In this regard, researchers decided to design a standard questionnaire to examine women’s awareness about the symptoms and risk factors of the breast cancer.

Methods: This methodological study was conducted on 250 women in Yazd. Data were collected by a researcher-made questionnaire. The reliability was determined using the Cronbach’s alpha and test-retest method. Factor analysis was used to determine the construct validity in SPSS version 21.

Results: The face validity of the questionnaire was evaluated by the target population. The results of the impact score indicated that all questions had a score equal or greater than 1.5. The qualitative content validity of the questionnaire was evaluated by the expert panel. Content validity ratio (CVR) and content validity index (CVI) obtained close to one for questionnaire. Construct validity was confirmed by performing factor analysis and dimensions of the questionnaire were determined. Cronbach’s alpha coefficient for all dimensions was higher than 0.8. Also, intraclass correlation coefficient (ICC) for all dimensions was close to one and was between 0.84-0.95.

Conclusion: Validity and reliability of designed questionnaire in this study for Iranian women are acceptable and suitable.

Factors Associated with Breast Cancer Awareness in Thai Women

Background:

Breast cancer is the most common cancer in women worldwide. In south-east Asia, both the incidence and mortality rates of breast cancer are on the rise, and the latter is likely due to the limited access to large-scale community screening program in these resource-limited countries. Breast cancer awareness is an important tool which may, through increasing breast self-examination and the seeking of clinical examination, reduce breast cancer mortality. Investigating factors associated with breast cancer awareness of women is likely to help identify those at risk, and provide insights into developing effective health promotion interventions.

Objective:

To investigate factors associated with breast cancer awareness in Thai women.

Methods:

A cross-sectional sample of Thai women aged 20-64 years was collected during August to October, 2015 from two provinces of southern Thailand (Surat Thani and Songkla). A questionnaire including the Breast Cancer Awareness Scale along with demographic characteristics was administered and Proportional Odds Logistic regression was then used to investigate factors associated with breast cancer awareness.

Results:

In total, 660 Thai women participated in this study. Factors most often associated with the various breast cancer awareness domains were age and rurality. While rural women had poorer knowledge of breast cancer signs and symptoms, they also had lower levels of perceived barriers and considerably better breast cancer awareness behaviors.

Conclusion:

Despite lower knowledge of breast cancer risk factors and no evidence of better knowledge of signs and symptoms, we found rural Thai women had considerably better breast cancer awareness behavior. This may be due to these women’s lower levels of perceived barriers to breast cancer screening services. Indeed this suggests, at least in Thai women, that interventions aimed at lowering perceived barriers rather than enhancing disease knowledge may be more successful in engaging women with breast cancer screening services and increasing breast self-examination.

Awareness Level about Breast Cancer Risk Factors, Barriers, Attitude and Breast Cancer Screening among Indonesian Women

Background: Globally, breast cancer is the second most common cancer in women and is a leading cause of mortality in Indonesia. Raising awareness of breast cancer is particularly important to help at risk women seek medical treatment for this disease. This study aimed to comprehensively investigate the Indonesian women’s level of knowledge about breast cancer risk factors, barriers, attitude and breast cancer screening. Methods: This population-based cross-sectional study administered the breast cancer awareness Indonesian scale (BCAS-I) to 856 Indonesian women. Samples were selected in rural and urban combinations from three provinces by stratified random sampling. The ordinal logistic model was used to investigate the clustering effect of the participant’s characteristics in this study. Results: Of the women, 62% lived in rural areas and 38% lived in urban areas. Living in an urban area was significantly associated with a lower knowledge of the risk factors. However, living in an urban area was significantly associated with better attitudes and healthier behaviours related to breast cancer awareness. Women with higher education levels had 70% worse attitudes toward breast cancer awareness. Women living South of Sumatera, women living in Yogyakarta, and unmarried women were 5.03, 3.84, and 1.56 times as likely to have higher perceived barriers, respectively. Conclusion: Urban women had a poorer level of knowledge of breast cancer risk factors compared to women living in more rural areas. The result of this study may reflect inadequate breast cancer awareness campaigns or a lack of breast cancer awareness campaigns. These findings suggest that additional education programs aiming to increase awareness and educate the public are needed.

Transcultural adaptation and validation of the Persian version of the breast cancer awareness measure (BCAM) questionnaire

BACKGROUND/OBJECTIVE

Enhancing awareness level about breast cancer is a pivotal strategy for reducing breast cancer burden. There is no fully validated Persian instrument for evaluating breast cancer awareness. This study aimed at investigating the validity and reliability of the Persian version of the Breast Cancer Awareness Measure (BCAM) questionnaire.

METHODS

This methodological cross-sectional study was conducted among 1078 Persian language women (including 965 general women and 113 medical/clinical experts), which selected from different parts of Isfahan city using multistage cluster random sampling method. Translation of BCAM questionnaire was performed using forward-backward method. Internal consistency was evaluated through Cronbach's α and test-retest reliability using unweighted kappa statistic and intraclass correlation (ICC) coefficient. Construct validity was investigated using both exploratory and confirmatory factor analyses as well as Latent class analysis (LCA), and discriminant validity using ROC curve. Convergent validity was assessed using phi and eta correlation coefficients. Ceiling and floor effects, SE of measurement (SEM), and smallest detectable change (SDC) were also determined.

RESULTS

Persian version of BCAM showed excellent test-retest reliability (ICC = 0.841) and internal consistency (Cronbach's alpha = 0.882). Most of the computed kappa coefficients were in the range moderate to very good (0.47-0.81). Medical/clinical experts had higher levels of breast cancer awareness than general women, indicating good discriminant validity (Area under the curve [AUC]) of 0.822 (95% CI: 0.781, 0.864). Construct validity evaluation by exploratory factor analysis (EFA) led to extraction of two factors from 11 items ("breast shape changes" and "breast pain and lump"), and the confirmatory factor analysis (CFA) confirmed the adequacy of extracted construct from EFA. Latent class analysis for evaluating of construct validity led to extracting three classes from participants (high [12.83%], moderate [60.97%], and low [26.2%]) in terms of awareness levels about early warning signs of breast cancer. All item-scale correlation coefficients exceeded the set value of 0.40, indicating satisfactory convergent validity. No ceiling and floor effects were detected. SEM and SDC were found to be 0.85 and 2.36, respectively.

CONCLUSIONS

The Persian version of BCAM is a reliable and valid instrument for monitoring levels of breast cancer awareness in general women population, also it can be used for evaluating the impacts of interventions attempting to raise breast cancer awareness.

Patterns and Determinants of Attitudes towards Genetic Risk of Cancer: Case Study in a Malaysian Public University

Genetic risk to cancer is a knowledge largely confined to experts and the more educated sectors of the developed western countries. The perception of genetic susceptibility to cancer among the masses is fragmented, particularly in developing countries. As cancer diseases affect developing countries as much as developed nations, it is imperative to study perception and reception of genetic risk to cancer in Southeast Asia. Here, we report on a novel case study to gauge the awareness and attitudes towards genetic determination of cancer among the undergraduates of a Malaysian public university. A total of 272 university undergraduate students completed an online questionnaire. On causes of cancer, the respondents believed that cancer is caused by lifestyle and environmental factors, but those with science background were more likely to associate it with genetic factors. The results on awareness of genetic profiling of cancer risk showed that there are significant differences between those with science and nonscience background but there are no significant differences for gender and socioeconomic background. As for attitudes towards cancer risk, female respondents, those from middle socioeconomic status and science background, are more likely to believe in genetic determinism of cancer. The findings have implications on target population segmentation in strategic health communication on cancer.

Availability and accessibility of subsidized mammogram screening program in peninsular Malaysia: A preliminary study using travel impedance approach

Access to healthcare is essential in the pursuit of universal health coverage. Components of access are availability, accessibility (spatial and non-spatial), affordability and acceptability. Measuring spatial accessibility is common approach to evaluating access to health care. This study aimed to determine the availability and spatial accessibility of subsidised mammogram screening in Peninsular Malaysia. Availability was determined from the number and distribution of facilities. Spatial accessibility was determined using the travel impedance approach to represent the revealed access as opposed to potential access measured by other spatial measurement methods. The driving distance of return trips from the respondent's residence to the facilities was determined using a mapping application. The travel expenditure was estimated by multiplying the total travel distance by a standardised travel allowance rate, plus parking fees. Respondents in this study were 344 breast cancer patients who received treatment at 4 referral hospitals between 2015 and 2016. In terms of availability, there were at least 6 major entities which provided subsidised mammogram programs. Facilities with mammogram involved with these programs were located more densely in the central and west coast region of the Peninsula. The ratio of mammogram facility to the target population of women aged 40-74 years ranged between 1: 10,000 and 1:80,000. In terms of accessibility, of the 3.6% of the respondents had undergone mammogram screening, their mean travel distance was 53.4 km (SD = 34.5, range 8-112 km) and the mean travel expenditure was RM 38.97 (SD = 24.00, range RM7.60-78.40). Among those who did not go for mammogram screening, the estimated travel distance and expenditure had a skewed distribution with median travel distance of 22.0 km (IQR 12.0, 42.0, range 2.0-340.0) and the median travel cost of RM 17.40 (IQR 10.40, 30.00, range 3.40-240.00). Higher travel impedance was noted among those who lived in sub-urban and rural areas. In summary, availability of mammogram facilities was good in the central and west coast of the peninsula. The overall provider-to-population ratio was lower than recommended. Based on the travel impedance approach used, accessibility to subsidised mammogram screening among the respondents was good in urban areas but deprived in other areas. This study was a preliminary study with limitations. Nonetheless, the evidence suggests that actions have to be taken to improve the accessibility to opportunistic mammogram screening in Malaysia in pursuit of universal health coverage.

Assessing Breast Cancer Awareness in Thai Women: Validation of the Breast Cancer Awareness Scale (B-CAS)

Background:

Raising breast cancer awareness is a well-established first line strategy to reduce breast cancer mortality. A properly validated instrument is needed to gain a better understanding of breast cancer awareness.

Objective:

The objective of this study was to develop and validate an instrument to assess breast cancer awareness in Thai women.

Methods:

In this study, we develop and evaluate the validity of the Breast Cancer Awareness Scale (B-CAS). Construct validity was evaluated by using exploratory factor analysis and confirmatory factor analysis, and criterion validity was investigated using ROC curves to examine the associations between B-CAS subscales and breast self-examination. Internal consistency and test-retest reliability were also investigated. This validation process employed two independent samples of Thai women aged 20-64 years collected from communities in southern Thailand.

Results:

In total, 660 Thai women (mean age 41 years) participated in this study. Confirmatory factor analysis demonstrated the construct validity of B-CAS (CFI =0.91; NNFI=0.90; GFI=0.95; AGFI= 0.95; RMSEA=0.044, 95%CI 0.041 to 0.047; P< 0.05). Several of the B-CAS subscales demonstrated strong utility in discriminating between women who do and do not regularly conduct breast self-examination. B-CAS also demonstrated strong internal consistency (Cronbach’s α=0.86) and test-retest reliability. The final version of B-CAS contains 35 items across five domains: knowledge of risk factors, knowledge of signs and symptoms, attitude to breast cancer prevention, barriers of breast screening, and health behaviour related to breast cancer awareness.

Conclusion:

The breast cancer awareness scale (B-CAS) was shown to have good psychometric properties in Thai women, and is likely to prove useful in studying the epidemiology of breast cancer awareness in Thai women, and evaluating breast cancer prevention programs for raising awareness.

Breast and cervical cancer-screening uptake among females in Ardabil, northwest Iran: a community-based study

PURPOSE

Breast and cervical cancers are the most commonly diagnosed type of cancer and cause of cancer-related deaths in Iranian females. In contrast to previous studies, this study was carried out with a large sample size for assessment of breast self-examination (BSE)-, clinical breast examination (CBE)-, mammography-, and Pap smear-uptake rates and determination of associations among these screening behaviors with sociodemographic and cognitive variables in Azeri females.

MATERIALS AND METHODS

This was a cross-sectional, community-based study that was carried out among 1,134 females 20-60 years old during March-June 2016. Data-collection variables included sociodemographic questions, screening behaviors for breast and cervical cancer, self-efficacy, beliefs, and barriers to breast and cervical cancer screening. Collected data were analyzed by SPSS version 13 using χ2, Mann-Whitney U, and logistic regression tests.

RESULTS

Among the 1,134 participants, 53.9%, 9.8%, and 28.1% had done BSE, CBE, and Pap smear tests, respectively, and among the 625 females aged >40 years, 187 (29.9%) had done the mammography test. Moreover, 416 (36.7%), 103 (16.5%), and 64 (5.6%) females had done BSE, mammography, and CBE regularly, respectively. Beliefs, barriers, income, health insurance, number of children, and age were all important factors for BSE and regular BSE and mammography. Females who had high belief scores were more likely to undertake mammography (odds ratio [OR]: 1.2, 95% confidence interval [CI]: 1.03-1.5), regular mammography (OR: 4.2, 95% CI: 1.9-9.3), regular CBE (OR: 1.25, 95% CI: 1.2-1.3), and Pap smears (OR: 1.2, 95% CI: 1.1-1.4). Also, females who had high self-efficacy scores were more likely to perform regular BSE (OR: 1.8, 95% CI: 1.4-2.5) and mammography (OR: 2.5, 95% CI: 1.4-4.6) than females with lower self-efficacy scores.

CONCLUSION

The frequency of breast and cervical cancer screening was low in our study. The findings of this study indicated that beliefs, self-efficacy, and barriers were important predictive factors of cancer-screening behavior among the females studied.

Development of a Breast Cancer Awareness Scale for Thai Women: Moving towards a Validated Measure

BACKGROUND

Breast cancer is a major health problem among women around the world. Recent developments in screening and treatment have greatly improved the prognosis of patients with breast cancer in developed countries. However, in developing countries breast cancer mortality remains high.Breast cancer awareness is a first and important step in reducing breast cancer mortality. The development of a validated instrument to measure breast cancer awareness is crucial for the understanding and implementation of suitable health education programs to facilitate early deletion and minimize mortality.

OBJECTIVE

The objective of this study was to develop an instrument for the assessment of breast cancer awareness in Thai women.

MATERIALS AND METHODS

This methodological study was conducted in two stages: (1) literature searches and semi-structured interviews were conducted to generate items of the breast cancer awareness scale (B-CAS) which were subsequently examined for content and face validity, and (2) an exploration of the factor structure of the resulting instrument and an examination of its reliability. Data were collected using a self-administered questionnaire in Thai women aged 20-64 in August, 2015.

RESULTS

A total of 219 women (response rate 97.4 %) participated in this validation study. The B-CAS contains five domains with 53 items on breast cancer awareness: 1) knowledge of risk factors, 2) knowledge of signs and symptoms, 3) attitude to breast cancer prevention, 4) barriers of breast screening, and 5) health behavior related to breast cancer awareness. Items with a content validity index <0.80 were excluded, and factor structure for the remaining items reflected the hypothesized five factor model. The scales based on all retained items was shown to have strongly internal consistency reliability (Cronbach's α=0.86).

CONCLUSIONS

The B-CAS provides good psychometric properties to assess breast cancer awareness in women. It can be used to examine breast cancer awareness in Thai women and it could lead to the development and evaluation of suitable educational interventions for raising breast cancer awareness. Future research should focus on further validating the B-CAS including an assessment of construct and criterion-based validity.

Association of Knowledge and Cultural Perceptions of Malaysian Women with Delay in Diagnosis and Treatment of Breast Cancer: a Systematic Review

BACKGROUND

Breast cancer is the most common cancer and the leading cause of cancer mortality among women of all ethnic and age groups in Malaysia. Delay in seeking help for breast cancer symptoms is preventable and by identifying possible factors for delayed diagnosis, patient prognosis and survival rates could be improved.

OBJECTIVES

This narrative review aimed to understand and evaluate the level of in-depth breast cancer knowledge in terms of clinical breast examination and breast self-examination, and other important aspects such as side-effects and risk factors in Malaysian females. Since Malaysia is multicultural, this review assessed social perceptions, cultural beliefs and help-seeking behaviour in respect to breast cancer among different ethnic groups, since these may impinge on efforts to 'avoid' the disease.

MATERIALS AND METHODS

A comprehensive literature search of seven databases was performed from December 2015 to January 2015. Screening of relevant published journals was also undertaken to identify available information related to the knowledge, perception and help-seeking behaviour of Malaysian women in relation to breast cancer.

RESULTS

A total of 42 articles were appraised and included in this review. Generally, women in Malaysia had good awareness of breast cancer and its screening tools, particularly breast self-examination, but only superficial in-depth knowledge about the disease. Women in rural areas had lower levels of knowledge than those in urban areas. It was also shown that books, magazines, brochures and television were among the most common sources of breast cancer information. Delay in presentation was attributed mainly to a negative social perception of the disease, poverty, cultural and religion practices, and a strong influence of complementary and alternative medicine, rather than a lack of knowledge.

CONCLUSIONS

This review highlighted the need for an intensive and in-depth breast cancer education campaigns using media and community health programmes, even with the existing good awareness of breast cancer. This is essential in order to avoid misconceptions and to frame the correct mind-set about breast cancer among women in Malaysia. Socio-cultural differences and religious practices should be taken into account by health care professionals when advising on breast cancer. Women need to be aware of the risk factors and symptoms of breast cancer so that early diagnosis can take place and the chances of survival improved.

The spectrum of genetic mutations in breast cancer

Breast cancer is the most common malignancy in women around the world. About one in 12 women in the West develop breast cancer at some point in life. It is estimated that 5%-10% of all breast cancer cases in women are linked to hereditary susceptibility due to mutations in autosomal dominant genes. The two key players associated with high breast cancer risk are mutations in BRCA 1 and BRCA 2. Another highly important mutation can occur in TP53 resulting in a triple negative breast cancer. However, the great majority of breast cancer cases are not related to a mutated gene of high penetrance, but to genes of low penetrance such as CHEK2, CDH1, NBS1, RAD50, BRIP1 and PALB2, which are frequently mutated in the general population. In this review, we discuss the entire spectrum of mutations which are associated with breast cancer.

Yazd Breast Cancer Project Profile; A Community Based Trial for the Evaluation of Self-Examination and Physical Examination of the Breast Cancer Disease

There is some evidence to suggest that a benefit might be derived from a program that incorporated both annual physical examination of the breast (BPx) and the teaching of breast self-examination (BSE). Current investigation presents the profile of a multicenter community based intervention for evaluating the effect of BSE+BPx on the reduction of morbidity and mortality due to breast cancer amongst women residing in urban areas of Yazd (Iran) from 2008 to 2018. There were three distinctive phases in this trial with 10 years duration: pilot phase with the duration of 1 year, active intervention phase with 4 rounds of annual screening of BPx+BSE and follow up phase with 5 years duration. Tools of enquiry included a pre-tested questionnaire, repeated annual physical examination of the breast and more importantly mammography, sonography, and fine needle aspiration (FNA). Data were analyzed using descriptive statistics such as frequencies, percent, mean (SD), tests of chi-square and student t-test with 95% confidence level. Comparison of socio-demographic and socio-economic factors such as age, age at marriage, family size, number of live births, occupation, education level, total family income and marital status showed that no significant difference was seen between the groups (P>0.05). A response rate of 84.5% was seen by participants of the experiment group visiting the health centers for the first BPx. Our results showed that except for the education and marital status, the difference in other main demographic and socio-economic factors between the groups were not significant, and the response rate of individuals in the experiment group was at an acceptable level.

Awareness of risk factors for cancer among Omani adults--a community based study

BACKGROUND

Cancer is the leading cause of mortality around the world. However, the majority of cancers occur as a result of modifiable risk factors; hence public awareness of cancer risk factors is crucial to reduce the incidence. The objective of this study was to identify the level of public awareness of cancer risk factors among the adult Omani population.

MATERIALS AND METHODS

A community based survey using the Cancer Awareness Measure (CAM) questionnaire was conducted in three areas of Oman to measure public awareness of cancer risk factors. Omani adults aged 18 years and above were invited to participate in the study. SPPSS (ver.20) was used to analyse the data.

RESULTS

A total of 384 participated from 500 invited individuals (response rate =77%). The majority of respondents agreed that smoking cigarettes (320, 83.3%), passive smoking (279, 72.7%) and excessive drinking of alcohol (265, 69%) are risks factors for cancer. However, fewer respondents agreed that eating less fruit and vegetables (83, 21.6%), eating more red or processed meat (116, 30.2%), being overweight (BMI>25) (123, 32%), doing less physical exercise (119, 31%), being over 70 years old (72, 18.8%), having a close relative with cancer (134, 34.9%), infection with human papilloma virus (HPV) (117, 30.5%) and getting frequent sunburn during childhood (149, 38.8%) are risk factors for cancer. A significant association was found between participant responses and their educational level. The higher the educational level, the more likely that respondents identified cancer risk factors including smoking (p<0.0005), passive smoking (p= 0.007), excessive drinking of alcohol (p<0.0005), eating less fruit and vegetables (p= 0.001) and infection with HPV (p<0.0005).

CONCLUSIONS

The majority of respondents in this study in Oman were not aware of the common risk factors for cancer. It may be possible to reduce the incidence of cancers in Oman by developing strategies to educate the public about these risk factors.

Awareness of breast cancer warning signs and screening methods among female residents of Pokhara valley, Nepal

BACKGROUND

Breast cancer is the second most common cancer in the world and by far the most frequent cancer among women.

OBJECTIVE

The present study was undertaken to assess the awareness of breast cancer warning signs and screening methods among the women of Pokhara valley, Nepal.

MATERIALS AND METHODS

A cross-sectional questionnaire survey was carried out in a community setting with the female population. The questionnaire was administered in face-to-face interviews by trained research assistants.

RESULTS

Nepalese women demonstrated poor awareness of warning signs like a breast lump, lump under the armpit, bleeding or discharge from the nipple, pulling of the nipple, changes in the position of the nipple, nipple rash, redness of the breast skin, changes in the size of the breast or nipple, changes in the shape of the breast or nipple, pain in the breast or armpit, and dimpling of the breast skin. While 100% of nurses were aware about breast self- examination (BSE), mammography and warning signs of breast cancer. Levels of knowledge were significantly poorer in women with other occupations. Graduates were more aware about BSE, mammogram and warning signs of breast cancer compared to those with other educational levels.

CONCLUSIONS

The findings indicated that the level of awareness of breast cancer, including knowledge of warning signs and BSE, is sub-optimal among Nepalese women.

Clinical breast examination as the recommended breast cancer screening modality in a rural community in Malaysia; what are the factors that could enhance its uptake?

Breast cancer is the most common cause of deaths and the most frequently diagnosed cancer among women worldwide. This study aimed to determine the prevalence of breast cancer screening, specifically on clinical breast examination, and the predictors of its uptake among women in Malaysia. A cross-sectional study was carried out in five selected districts whereby women aged between 20 to 64 years old, from a total of 1000 households were interviewed. A total of 1192 women responded to the survey of which 53.3% reported had ever done clinical breast examination. Significant associations with clinical breast examination were noted for income and distance from the hospital. These factors should be considered in developing interventions aimed at promoting clinical breast examination. In particular, healthcare providers should be proactive in raising awareness about clinical breast examination among women in Malaysia.