Perceived Barriers and Awareness of Mammography Screening Among Saudi Women Attending Primary Health Centers

The Impact of an Educational Project on Cancer-Related Knowledge and Awareness Among High School Students

Cancer is the second leading cause of death globally, making it a significant global health issue. Approximately half of cancer cases are linked solely to behavioral habits. Lifestyle changes made at a young age are easier to adopt and have lasting effects on future health, making early awareness about cancer essential. The "OncoAcademy: The Key to Health" project, aimed at high school Polish students, has been created to promote a positive health attitude and increase awareness among young people about cancer and methods of its prevention. From September 2023 to November 2024, we conducted educational sessions for 3000 high school students and assessed their cancer prevention knowledge before and after the project. Results revealed that students' level of knowledge before classes was moderate (M = 51.76%; SD = 13.63%). On average, students correctly answered 13 of 26 questions. After classes, the level of knowledge was assessed as moderately good (M = 62.47%; SD = 14.48%). On average, students correctly answered 16 out of 26 questions. The analysis revealed a statistically significant difference between the general level of knowledge-after classes, students achieved significantly better scores. This study highlighted changes in students' awareness and knowledge about cancer brought about by implementing a cancer education project. Generally, high school students in Poland have basic knowledge about cancer and its risk factors. Most adolescents are aware of the significant impact of lifestyle on cancer risk. Early education on cancer prevention, mainly aimed at lifestyle changes, is crucial. Enhancing adolescents' understanding of risk factors can play a significant role in lowering future cancer rates.

Accuracy of imaging of BI-RADS 4 subcategorizations in breast lesion diagnosis: Radiologic-pathologic correlation

OBJECTIVES

To correlate breast imaging-reporting and data system (BI-RADS) category 4 lesions with histopathology results to assess the accuracy of subcategorization.

METHODS

A retrospective study was carried out from September 2021 to June 2022. A total of 247 breast lesions were reviewed categorized as BI-RADS 4 using ultrasound (US) and digital mammography. Feature analysis of the lesions were obtained using BI-RADS terminology and assigned to subcategories (4A, 4B, and 4C). Pathological analysis was carried out on tissue obtained through US-guided core biopsy. A p-value of <0.05 was considered significant.

RESULTS

Of the 247 lesions, 135 were categorized as subcategory 4A, 68 as 4B, and 44 as 4C. Overall, 41 (16.6%) had malignant lesions, while 206 (83.4%) had benign lesions. The mean age of the patients with benign versus malignant lesions was (43.18±14.02 vs. 51.24±14.15 years; p<0.001). Mean size of benign versus malignant lesions was (1.93±1.65 vs. 3.82±3.89 cm; p<0.001). Findings were compared with histopathology, and the positive predictive value fell within the reference range for subcategories 4C (>70%). High reliability was observed between the 2 readers, with a weighted Cohen's Kappa value of 0.79 (0.73-0.85). Significant disagreements in the assignment of features on radiological lesion characterization were observed between the 2 readers regarding lesion density, shape, echo pattern, vascularity, and borders.

CONCLUSION

The results of this study contribute to the existing body of knowledge, emphasizing the need for standardized guidelines for the characterization of BI-RADS 4 subcategories and improved diagnostic accuracy in the management of breast lesions.

Insights into the Refusal of Free Screening Mammograms: Exploring Contributing Factors

Background

Despite the availability of free screening mammograms (SMG) through the Breast Cancer Early Detection (BCED) Program in the Qassim region of Saudi Arabia, a notable gap exists between program implementation and the actual uptake of SMG. This study aims to assess the refusal rate, identify barriers to participation, and shed light on the factors influencing women's decisions regarding SMG.

Methods

A cross-sectional study was conducted among consecutive women aged 40-69 participating anonymously in the BCED program in September 2023. The participants were administered a validated Arabic language survey encompassing breast cancer screening backgrounds and knowledge, reasons for refusal, and factors influencing SMG reconsideration. Logistic regression was employed to identify factors linked with SMG refusal using SPSS version 28.

Results

Of the 2446 eligible women in the study, 576 (23.6%) declined to undergo SMG. The median age of participants was 49 years, primarily married (91.5%) and residing in central cities (60.3%). Previous mammogram history was reported by 21.4%, with only 12.9% performing regular SMGs every 1-2 years. Married women had a 31% lower refusal likelihood to SMG compared to widowed/divorced women (Adjusted Odds Ratio [aOR] = 0.69, p = 0.02). Women residing in peripheral areas showed approximately 1.45 times higher odds of refusal compared to those in central cities (aOR = 1.45, p < 0.001), and women without prior history of SMG had 2.13 times higher odds of refusal (aOR = 2.14, p < 0.001).

Conclusion

The refusal rate for SMG in the Qassim region aligns closely with rates observed in developed countries. Despite this progress, significant barriers to SMG uptake persist, and tailored interventions targeting specific demographic groups and addressing these barriers are essential to improving screening participation, promoting a culture of proactive screening behavior, and ensuring equitable access to screening services for all eligible women.

Barriers to Breast Cancer Screening in Saudi Arabia: A Systematic Review and Meta-Analysis

Breast cancer is a significant public health concern globally, and early detection through screening programs can improve treatment outcomes and reduce mortality rates. However, the uptake of breast cancer screening among women in Saudi Arabia is hindered by various barriers. This systematic review and meta-analysis aimed to elucidate the barriers to breast cancer screening among women in Saudi Arabia, providing insights into the multifaceted challenges hindering screening uptake and informing tailored interventions and policy recommendations. A comprehensive literature search was conducted across electronic databases and grey literature sources to identify relevant studies on barriers to breast cancer screening in Saudi Arabia. Studies conducted between 2017 and 2023, employing diverse settings and methodologies, were included in the analysis. Data on the prevalence of barriers, family history of breast cancer, and self-reported breast examination practices were extracted and synthesized. A total of 14 studies met the inclusion criteria, encompassing diverse populations and methodologies. The included studies predominantly employed cross-sectional survey designs and targeted various populations across different regions of Saudi Arabia. The barriers to breast cancer screening were investigated, revealing concerns such as fear of discovering cancer, embarrassment due to breast-related tests, fear of pain related to clinical examination, and lack of awareness. Additionally, a substantial proportion of participants reported a family history of breast cancer, indicating a significant risk factor for the disease. Self-reported breast examination practices varied among participants, with disparities in screening behaviors observed. Our review identified fear of diagnosis, embarrassment, and lack of awareness as key barriers to breast cancer screening in Saudi Arabia. Targeted interventions, including education and improved access, are essential to address these challenges and enhance early detection efforts, reducing the burden of breast cancer.

Knowledge and Attitudes Regarding Breast Cancer Screening and Mammograms Among Women Aged 40 Years and Older in the United Arab Emirates

OBJECTIVES

To assess the knowledge and attitude regarding breast cancer screening and mammograms among 40 years and older females in the United Arab Emirates.

METHODS

 A cross-sectional questionnaire-based study was conducted on women faculty, staff, and female patients attending our hospital. The inclusion criteria were women ≥ 40 years old who agreed to participate. The exclusion criteria were women < 40 and those ≥ 40 years who refused to participate. A signed informed consent was taken. A p-value of < 0.5 was considered significant.

RESULTS

 Among the 460 women enrolled, 420 completed the survey (response rate 91%). The mean age was 48.4 ± 8.2 years. A total of 63.4% of the participants were < 50 years of age. A total of 53.3% were never screened before. About 98% believed that screening is beneficial in early detection. Social media (52.2%) and health professionals (46%) played a vital role in creating awareness. The majority of women were aware of self-breast examinations (73.3%), followed by mammography (68.6%). About 84% and 68.3%, of the participants had incorrect knowledge of the timing and frequency of mammograms, respectively. Only 16.3% of the participants were recommended by their physician, while the rest (83.7%) performed screening based on their awareness. No significant association was found between nutritional status (p=0.252), age at first pregnancy (p=0.409), or having children (p= 0.377) with mammogram uptake. There was a significant association between the perceived benefit of screening and mammogram uptake (p=0.033). There was a positive association between radiation therapy to the chest area and mammogram uptake (p<0.024). A statistically significant association was found between the correct timing of mammograms with family history of cancer (p = 0.037) and previous exposure to radiation therapy to the chest (p = 0.002).

CONCLUSION

There is a need to increase knowledge and awareness regarding breast cancer screening and mammograms among women in UAE. Specifically, breast self-examination should be encouraged and recommended.

Knowledge, attitude, and practice of breast self-examination is associated with general self-care and cultural factors: a study from Tamil Nadu, India

AIM

Breast cancer is the most prevalent type of cancer among women. One form of care related to early detection of breast cancer is breast self-examination (BSE). However, evidence on knowledge, attitude, and practice (KAP) of BSE and its determining factors are minuscule in an Indian context. Therefore, the present study primarily examined the prevalence of KAP of BSE. Further, its association with general self-care and cultural factors was determined.

METHODS

This cross-sectional study obtained data from 412 women (Mn age = 26.63) from two rural localities of Vellore district, Tamil Nadu, India. Self-reported questionnaires of KAP of BSE, self-care, and cultural factors were applied. Statistical analyses include independent sample t-test and binomial logistic regression.

RESULTS

The majority of the sample had inadequate knowledge (58%), unfavourable attitudes (73.8%), and poor practice (89.6%) of BSE. The general self-care among the sample was moderate. Self-care was found to be a significant predictor of knowledge (b = 0.07, p < .05) and attitude (b = 0.092, p < .05) toward BSE. Shyness was identified as a negative predictor of KAP. Discouraged breast health discussions predicted inadequate knowledge, and not being educated by family/friends had a negative impact on knowledge and practice. A preference for same-gender physicians led to an unfavourable attitude toward BSE.

CONCLUSION

The observed negative trends in KAP of BSE are concerning. The results imply that girls and women should be educated and encouraged to practice BSE and promote self-care behaviours. At the same time, efforts to reduce cultural barriers may be helpful to promote the KAP of BSE.

Knowledge, attitudes, and practices related to breast cancer screening among female Jordanian university employees: A cross-sectional study

INTRODUCTION

To improve participation in breast screening programs, the level of knowledge about BC, attitudes, and practices of women in different sections of society must be understood. This study aimed to measure the level of knowledge of BC risk factors, signs and symptoms and determine current mammography practices among female employees at Jordanian universities.

METHODS

A cross-sectional descriptive study was conducted on female employees at Jordanian government universities. Data was collected using a structured questionnaire that included: sociodemographic characteristics, knowledge of BC risk factors, knowledge of BC symptoms and knowledge, attitude and practice of mammography as an early detection method.

RESULTS

A total of 362 participants completed the questionnaire. Overall, 174 scored ≥50% correct answers regarding BC risk factors, while 231 scored ≥50% correct answers regarding BC signs and symptoms. Half of the participants (n = 184, 50.8%) understood mammography to be an early BC detection method. Among those participants, 95 (51.6%) were eligible for screening and 39 (21.2%) had had a previous mammogram. The main reason for not engaging in mammography was the absence of BC signs and symptoms (37.2%). Profession, educational level and family history of BC were associated with increased knowledge of BC risk factors, signs and symptoms (p = 0.01). Lecturers in medical faculties exhibited the highest level of knowledge about mammography compared to participants in other professions (p = 0.02).

CONCLUSION

Only 79 participants had good to excellent knowledge about BC. Participants' profession was the major indicator for awareness of BC and mammography as an early detection method.

IMPLICATIONS FOR PRACTICE

The findings of this study reinforce the importance of providing BC educational programs for university employees in Jordan to increase awareness of BC and mammography.

A Cross-Sectional Evaluation of Knowledge About Breast Cancer and Perceived Barriers to the Uptake of Mammogram Screening Among Northern Saudi Women: A Population-Based Study

Background

Mammogram screening (MS) is the gold-standard method for early detection of breast cancer (BC), and its use has been proven to minimize BC-related deaths and reduce treatment costs. However, recent epidemiological surveys have reported that rates of mammogram uptake by the Saudi female population are low. Here, we assessed the knowledge of BC and perceived barriers to MS uptake among pre-eligible northern Saudi women.

Participants and Methods

We administered a standard and validated Arabic questionnaire to 400 women aged 40-69 years. SPSS version 21.0 (IBM Corporation, Armonk, NY, USA) was used for data analysis. We applied logistic regression analysis to find the factors associated with participants' knowledge of BC and MS. Spearman correlation test was applied to find the correlation between knowledge and barrier scores.

Results

The study participants reported that smoking habits (61.3%) and unhealthy food habits (57.8%) were the most common risk factors for BC. Of the studied participants, 56.3% had low or medium degrees of knowledge about BC risk factors and MS. The degree of knowledge was significantly associated with education level (adjusted odds ratio [aOR], 2.35; 95% confidence interval [CI]. = 1.61-3.13; P = 0.008) and a family history of BC (aOR, 3.66; 95% CI, 1.94-5.49; P < 0.001). Fear of a BC diagnosis (50.8%) and concerns regarding test procedures were the most common barriers to MS uptake. We also found a negative correlation between participants' knowledge and perceived barriers to MS (rho = -0.389, P < 0.001).

Conclusion

We recommend that concerned authorities offer women multiple health education sessions covering BC risk factors and the necessity for pre-eligible women to undergo MS spaced at regular intervals at different facilities. Furthermore, a multicentric mixed-methods survey is warranted to find the qualitative aspects of barriers to MS.

Female Healthcare Workers' Knowledge, Attitude towards Breast Cancer, and Perceived Barriers towards Mammogram Screening: A Multicenter Study in North Saudi Arabia

Breast cancer is the most commonly diagnosed cancer among women in the Kingdom of Saudi Arabia and other Middle East countries. This analytical cross-sectional study assessed knowledge, attitude towards breast cancer, and barriers to mammogram screening among 414 randomly selected female healthcare workers from multiple healthcare facilities in northern Saudi Arabia. Of the studied population, 48.6% had low knowledge, and 16.1% had a low attitude towards breast cancer risk factors and symptoms. The common barriers to mammogram screening were fear to discover cancer (57.2%) and apprehension regarding radiation exposure (57%). Logistic regression analysis found that lack of awareness regarding mammogram was significantly associated with age (p = 0.030) and healthcare workers category (ref: physicians: p = 0.016). In addition, we found a significant negative correlation between knowledge and barrier scores (Spearman’s rho: −0.315, p < 0.001). It is recommended to develop target-oriented educational programs for the healthcare workers, which would empower them to educate the community regarding the risk factors and the importance of mammogram screening. Furthermore, a prospective study is warranted in other regions of the Kingdom of Saudi Arabia to understand the region-specific training needs for the healthcare workers.

Knowledge and barriers to early detection of breast cancer among female primary care patients in Serbia

OBJECTIVES

Breast cancer is the leading cause of cancer mortality among women in Serbia and accounts for 22.8% of total cancer mortality in 2018. This study assessed the knowledge and barriers to early detection of breast cancer in women.

METHODS

In March 2019, at the Primary Healthcare Centre Kikinda, Serbia, a 22-item questionnaire was distributed to a series of patients (N = 403, response rate 91.8%) to assess the odds ratio (OR) and 95% confidence interval (CI) between variables explaining knowledge of breast cancer symptoms and risk factors and barriers to screening, and four types of early detection of breast cancer.

RESULTS

The majority of patients (85.4%) know that a lump in a breast is a common symptom of breast cancer and that a family history of breast cancer is a risk factor (80.1%); 63.8% of respondents aged ≥ 30 years self-examined their breasts in the past month, 39.1% of patients aged ≥ 40 years had clinical, while 34.4% had ultrasound breast examination in the past year, and 51.1% of patients aged ≥ 50 years had mammography once in the past two years. Patients aged ≥ 40 years retired and those with a positive family history were 84% and 63% less likely not to undergo a clinical breast examination in the past year. Participants over 40 years of age who reported a lack of funds were 2.46 times more likely to miss a clinical breast examination than those who did not have that barrier. Among participants aged 50-69 years, the likelihood of not receiving the mammography increases by 2.82 with an increase in wealth status and it was 65% lower for those who lack information about the available treatment.

CONCLUSION

Women under the age of 50 rarely practice breast cancer screening. Study findings can be used to improve breast cancer screening at the primary level.