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Barriers and opportunities for early detection of breast cancer in Gaza women

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... The age group revealed that nurses of early ages ,cultural ,socio economic &some health habits play an important role in the development of attitudes toward the subject of early detection of the diseases .A study conducted in Addis Ababa found that median age of nurses was 40 years ,another study by (10). revealed that(38.9%) of the sample aged between (20)(21)(22)(23)(24)(25)years which match the present study (11,10). In Nigeria a study was carried out on (347)participants , most of them were either secondary or tertiary graduation (12) . ...
... Sample of this study reported encouragement from their family that agree with family of Gaza families encouragement to get a mammogram (53% versus 32%) as well as encouragement from friends (64% versus 39%) (19) . Also majority of the sample had the desire to conduct the procedure and accept the results .The examination and other procedure were very essential in detecting any abnormalities ,preventing the complication ,providing greater chance to cure (20) . . Screening by the technical methods like ultrasound and mammography were favorable ,the study highlighted that breast cancer can be cured throughout the early detection ,while half of the sample found it costly ;as many predisposing factors regarding the disease that is agree with other study Nigeria,Turkey Pakistan. ...
... Screening by the technical methods like ultrasound and mammography were favorable ,the study highlighted that breast cancer can be cured throughout the early detection ,while half of the sample found it costly ;as many predisposing factors regarding the disease that is agree with other study Nigeria,Turkey Pakistan. South Korea (20,21,7,22,23) . In the present study almost majority believed the disease is a god will, Agree with UAE women because all of sample was Muslim (24) . ...
... The sample size of the quantitative studies ranged from 97 (Watkins et al., 2002) to 52,011 (Frie et al., 2013) participants. The age of the study participants was from 12 years and older as nine quantitative studies did not have an upper age limit (Perng et al., 2013;Rasu et al., 2011;Al-Naggar and Bobryshev, 2012;Avci and Kurt, 2008;Çam and Gümüs, 2009;Gang et al., 2013;Gürsoy et al., 2011;Secginli and Nahcivan, 2006;Shaheen et al., 2011). ...
... Two quantitative studies were conducted in Palestine (Azaiza et al., 2010;Shaheen et al., 2011), however, the list provided by the World Bank does not include Palestine as an independent sovereign country. One of these studies (Azaiza et al., 2010) stated knowledge, socio-demographic, cultural, religious, and structural factors as barriers of BCa screening uptake while the other Palestinian study (Shaheen et al., 2011) reported structural barriers as an important factors that influence women's decision of not undergoing for BCa screening. ...
... Two quantitative studies were conducted in Palestine (Azaiza et al., 2010;Shaheen et al., 2011), however, the list provided by the World Bank does not include Palestine as an independent sovereign country. One of these studies (Azaiza et al., 2010) stated knowledge, socio-demographic, cultural, religious, and structural factors as barriers of BCa screening uptake while the other Palestinian study (Shaheen et al., 2011) reported structural barriers as an important factors that influence women's decision of not undergoing for BCa screening. ...
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Background Cervical cancer (CCa) and breast cancer (BCa) are the two leading cancers in women worldwide. Early detection and education to promote early diagnosis and screening of CCa and BCa greatly increases the chances for successful treatment and survival. Screening uptake for CCa and BCa in low and middle - income countries (LMICs) is low, and is consequently failing to prevent these diseases. We conducted a systematic review to identify the key barriers to CCa and BCa screening in women in LMICs. Methods We performed a systematic literature search using Ovid MEDLINE, EMBASE, PsycINFO, SCOPUS, CINHAL Plus, and Google scholar to retrieve all English language studies from inception to 2015. This review was done in accordance with the PRISMA-P guidelines. Results 53 eligible studies, 31 CCa screening studies and 22 BCa screening studies, provided information on 81,210 participants. We found fewer studies in low-income and lower - middle - income countries than in upper - middle - income countries. Lack of knowledge about CCa and BCa, and understanding of the role of screening were the key barriers to CCa and BCa screening in LMICs. Factors that are opportunities for knowledge acquisition, such as level of education, urban living, employment outside the home, facilitated CCa and BCa screening uptake in women in LMICs. Conclusions Improvements to CCa and BCa screening uptake in LMICs must be accompanied by educational interventions which aim to improve knowledge and understanding of CCa and BCa and screening to asymptomatic women. It is imperative for governments and health policy makers in LMICs to implement screening programmes, including educational interventions, to ensure the prevention and early detection of women with CCa and BCa. These programmes and policies will be an integral part of a comprehensive population-based CCa and BCa control framework in LMICs.
... All four researchers separately read and coded the transcripts. The emerging coding framework was then developed in accordance to the input of the research team (Seale 1999). Afterwards, they applied this framework to the remaining transcripts although modifications were continually suggested and made during subsequent meetings. ...
... Many of them avoided using the term 'cancer' . These attitudes have been reported in many studies of Muslim and Eastern populations (Epel et al. 2004;Remennick 2006;Shaheen et al. 2011). It is known that fear of having BC can prevent people from adopting preventive practices (Remennick 2006). ...
... Attitudes of women in this study would reflect on wider public attitudes about a major public health issue. Although young women are at less risk of BC at present (Epel et al. 2004), capturing their attitudes and needs can inform the development of health education strategies and information resources (Shaheen et al. 2011). Understanding the problem in the Jordanian context is important because it has implications for the country itself and, indeed, sheds light on how this issue may be perceived in the wider Arab world. ...
Article
The goal of this study was to understand young Jordanian women's attitudes towards breast cancer screening practices in order to improve young women's uptake of screening and early detection. The incidence of breast cancer is increasing annually among younger Jordanian women; however, little is known about their attitudes towards breast cancer and associated screening practices. Young women's attitudes towards breast cancer must be taken into account when designing screening strategies and interventions specifically for this age group. Screening strategies must also acknowledge young women's cultural context; however, little is known about how culture shapes their understandings and practices. A qualitative interpretive approach was utilized to interview 45 young educated women about their breast cancer views and screening practices. Data were analysed thematically. Four overlapping themes emerged: (i) young women should not think about it, (ii) absence of a role model, (iii) cultural shame of breast cancer, and (iv) cancer means death and disability. The study found high levels of apprehension and ambiguity related to breast cancer. This was associated with the perceived impact of a cancer diagnosis on a young woman's social status and family role. Family support was perceived to be a necessary prerequisite for seeking treatment or screening. Understanding young women's perception about screening and early detection of breast cancer is essential for policy makers and healthcare providers to design culturally appropriate and age-appropriate health promotion campaigns and services.
... 13 Only two reports emphasized that population MS requires concomitant efficient and effective treatment to have any important effects on population mortality from breast cancer. 13,21 One other recommended a good surveillance system and early detection through screening for high-risk groups (eg, for women who had already received breast cancer treatment), so that cancers could be detected when they are small and potentially more curable (Al-Agha L: "To provide additional mammography machines to cover all five districts in the Gaza Strip and enable national mammography screening." 22 "We believe that a widespread and aggressive screening effort including increasing awareness among Palestinian Arab women and their health care providers will improve these presently dismal outcomes of breast cancer diagnosis and therapy." ...
... 15 15,17,18,20,23 In all theses, it was not clear whether authors were employed. Three reports were from authors working at higher education institutions, 13,19,21 and one report was published by a governmental research organization in support of an international body. 22 We could not establish a possible relationship between author affiliation and the quality of evidence cited on MS, nor could we detect any significant improvement in the quality of evidence cited on MS in relation to the year of publication. ...
... Seven reports mentioned the potential pain during the mammographic procedure (Jaddallah A: Evaluation of mammogram services in the Gaza Strip Governorates [master's thesis]. Al-Quds University, Palestine, 2014).[13][14][15]17,20,21 The other five did not mention any possible harmful effects and referred only to the claimed positive effects. ...
Article
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PURPOSE To critically review the evidence and opinions expressed about mammographic screening (MS) in research reports on breast cancer in the occupied Palestinian territory (oPt) and to assess whether benefits and harms in MS are presented in a balanced way. METHODS Searches of PubMed, Cochrane, MEDLINE, EMBASE, CINAHL, and gray literature identified 14 eligible research reports relating to the oPt. We reviewed these documents and then used a thematic analysis to describe and analyze the evidence and the opinions about MS expressed in them. RESULTS All 14 research reports mentioned that MS would improve survival rates in the oPt. Only three gave information on major harmful effects, and only two emphasized that MS must be accompanied by effective treatment to have any beneficial effects on population mortality. There was no consistency in the recommended frequency of MS. CONCLUSION Most information presented by Palestinian health researchers was selective and failed to address the important established harms of MS. Thus, calls to support MS in the oPt are not based on a measured discussion of the risks and benefits for women or grounded in the systemic readiness of health care necessary for its effectiveness. As long as diagnostic and treatment facilities remain deficient, screening cannot lead to reduced mortality from breast cancer.
... According to the Portland Trust (2010) (Shaheen et al., 2011). There is a considerable amount of research that reports the positive relationship between plastic products and cancer prevalence (Brandt-Rauf et al., 2012). ...
... As a consequence of prolonged estrogenic consumption, breast cancer is reported to be induced by this behaviour (ibid.). In addition, this could explain that why cancer accounted for the highest prevalence cancer in Gaza women in 2010 (Shaheen et al., 2011). ...
... To establish this programme, the local government could initiate this scheme as a preliminary project for the highest incidence rate cancer in Gaza women (i.e. breast cancer) (Shaheen et al., 2011 carried out by Roth et al. (2011) found that breast cancer detection by means of selfreported method was 43%, while mammography combined with clinical breast examination were 56%. This means breast cancer self-examination remains important for early diagnosis of cancer. ...
Research
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School of Modern Languages and Cultures University of Glasgow, UK
... Contrary to what is reported in Jordan (19,20) , the respondents in our study did not believe that breast cancer could bring disgrace to the family leading to divorce nor that the disease is usually fatal. Although those who were free of the disease thought that mammography is a painful procedure, yet both groups did not consider it an embarrassing procedure against religious beliefs that could cause cancer and preferred to have the diagnostic examinations inside the country. ...
... In conclusion, the aforementioned findings supported other studies in the region which emphasized that misconceptions manifested in social and cultural attitudes could affect breast cancer preventive behaviors (1, [18][19][20][21][22][23] . ...
Article
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Breast Cancer is the most common malignancy among the Iraqi population ; the majority of cas es are still diagnosed at advanced stages with poor prospects of cure. E arly detection through promoting public awareness is one of the promising tools in its control
... Contrary to what was reported in Jordan (19,20) the respondents in our study did not believe that breast cancer could bring disgrace to the family leading to divorce nor that the disease is usually fatal. Although those who were free of the disease thought that mammography is a painful procedure, yet both groups did not consider it an embarrassing procedure against religious beliefs that could cause cancer and preferred to have the diagnostic examinations inside the country. ...
... In conclusion, the aforementioned findings supported other studies in the region which emphasized that misconceptions manifested in social and cultural attitudes could affect breast cancer preventive behaviors (1,(18)(19)(20)(21)(22)(23). Identifying barriers to breast cancer screening in the local community could aid in removing those obstacles by designing successful national cancer control strategies. ...
Article
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Background: Breast Cancer is the most common malignancy among the Iraqi population; the majority of cases are still diagnosed at advanced stages with poor prospects of cure. Early detection through promoting public awareness is one of the promising tools in its control. Objectives: To evaluate the baseline needs for breast cancer awareness in Iraq through exploring level of knowledge, beliefs and behavior towards the disease and highlighting barriers to screening among a sample of Iraqi women complaining of breast cancer. Methodology: Two-hundred samples were enrolled in this study; gathered from the National Cancer Research Center of Baghdad University and the Oncology Teaching Hospital of the Medical City throughout the year 2015. The study population comprised two groups: the first included 100 female patients who were receiving treatment for breast cancer (Group A), while another 100 randomly selected apparently healthy women served as Control (Group B). Those were asked to complete a structured questionnaire which was designed to explore the level of knowledge, beliefs, behavior towards breast cancer and the barriers to early diagnosis. The studied variables included the socio demographic and clinical data, women needs and beliefs regarding breast health and cancer care, and the barriers to screening. Results: Ninety percent of patients with breast cancer in Group I recorded a minimum score of Good; they answered confidently that the disease is common among women, can be curable when detected at early stages and is not contagious. They also displayed a significantly higher attitude regarding performing BSE, receiving routine CBE check up and having the courage to be informed about the diagnosis of cancer. Although both groups believed that early detection of cancer should be promoted culturally, Group I displayed a stronger reaction to place this approach as a priority in the community. Overall, both groups did not believe that the disease is usually fatal, could bring disgrace to the family leading to divorce, and did not consider mammography as an embarrassing procedure against religious beliefs. Nevertheless, the majority refused to be examined by a male doctor and to undergo screening mammography if they have no complaints. Conclusion: Feasible strategies should be more promptly adopted to overcome barriers to early detection of breast cancer among the Iraqi patients; focusing on promoting public health education and ensuring the availability of accessible well equipped diagnostic facilities.
... Contrary to what was reported in Jordan (19,20) the respondents in our study did not believe that breast cancer could bring disgrace to the family leading to divorce nor that the disease is usually fatal. Although those who were free of the disease thought that mammography is a painful procedure, yet both groups did not consider it an embarrassing procedure against religious beliefs that could cause cancer and preferred to have the diagnostic examinations inside the country. ...
... In conclusion, the aforementioned findings supported other studies in the region which emphasized that misconceptions manifested in social and cultural attitudes could affect breast cancer preventive behaviors (1,(18)(19)(20)(21)(22)(23). Identifying barriers to breast cancer screening in the local community could aid in removing those obstacles by designing successful national cancer control strategies. ...
Research
Full-text available
Background: Breast Cancer is the most common malignancy among the Iraqi population; the majority of cases are still diagnosed at advanced stages with poor prospects of cure. Early detection through promoting public awareness is one of the promising tools in its control. Objectives: To evaluate the baseline needs for breast cancer awareness in Iraq through exploring level of knowledge, beliefs and behavior towards the disease and highlighting barriers to screening among a sample of Iraqi women complaining of breast cancer (PDF) Baseline Needs Assessment for Breast Cancer Awareness among Patients in Iraq. Available from: https://www.researchgate.net/publication/313243590_Baseline_Needs_Assessment_for_Breast_Cancer_Awareness_among_Patients_in_Iraq [accessed Dec 06 2018].
... The baseline rate of willingness to undergo CRC screening was not established. Based on extrapolation from breast cancer studies in Palestinian women in Gaza, we predicted that this rate would be around 25%. 23 We wanted to detect this rate with a 5% margin of error. Based on the above, the sample size was calculated to be 970. ...
Article
Cultural, religious, and financial barriers may hinder uptake of CRC screening in Arab communities. We aim to understand attitudes and barriers that contribute to the low rate of CRC screening among Palestinians in the West Bank. This was a national, cross-sectional study of Palestinian adults over 50 years of age. A self-administered questionnaire was developed and validated. Data was randomly collected in all major districts of the West Bank. The primary outcome was the willingness to undergo CRC screening. Multivariable logistic regression models were used to assess the strength of association between the primary outcome and its predictors while controlling for possible confounders. Of 1601 people approached for interview, 1352 agreed to participate (response rate 84%). Rate of CRC screening was very low (14%, n=193). Willingness to undergo CRC screening was 79% for Fecal Occult Blood Testing and 67% for colonoscopy. Most people, 81% (1098), were willing to undergo CRC screening if recommended by a physician. Only 14% (n=194) said they were informed about CRC screening by a physician. Urban residents were more likely to be screened for CRC compared to non-urban residents (OR 0.73 [0.56-0.93], p=0.011). Multivariable analysis showed that education below secondary school, lack of familiarity with CRC screening, distrust of Western medicine, religious objection, and finding the test to be embarrassing were all associated with decreased odds of accepting CRC screening. Understanding cultural and religious barriers to CRC screening among Arabs can help understand barriers to CRC screening in Arab populations in the Middle East and in Western countries.
... However, breast self-examination didn't reduce mortality from breast cancer in China (Thomas et al., 2002). For women who live in countries/territories with limited resources and/or have strong cultural barriers to getting screened for breast cancer, such as reliance on alternative medicine, public education is necessary to reduce the morbidity and mortality from breast cancer (Seow et al., 1997;Anderson et al., 2011;Erwin et al., 2011;Huang et al., 2011;Shaheen et al., 2011;Wee and Koh, 2011). ...
Article
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Although the incidence of breast cancer in Asia remains lower than in North America, Western Europe, and Oceania, rates have been increasing rapidly during the past few decades, and Asian countries now account for 40% of breast cancer cases diagnosed worldwide. Breast cancer mortality has also increased among Asian women, in contrast to decreased mortality in Northern America, Western Europe, and Oceania. These increased rates are associated with higher prevalence of breast cancer risk factors (e.g., reduced parity, delayed childbirth, increased obesity) that have accompanied economic development throughout the region. However, Asian regions (western, south-central, south-eastern, and eastern) and countries differ in the types and magnitude of changes in breast cancer risk factors, and cannot be viewed as a single homogeneous group. The objective of this paper was to contrast the heterogeneous epidemiology of breast cancer by Asian regions and countries, and to suggest potential avenues for future research.
... Literature about Muslim women showed that seeking clinical breast examination (CBE) and/or mammogram posed a serious threat to their cultural identity and was viewed as insufficient for trespassing cultural boundaries [6,[8][9][10][11]. Male relatives in many Arab and Islamic countries see themselves as protectors of female relatives [12]. ...
Article
The purpose of this study is to understand the attitudes of young Jordanian men towards breast cancer screening practices. A qualitative descriptive design informed by Clendenin and Connelly was used. Thirty-seven in-depth semi-structured individual audiotaped interviews were conducted. The analysis of the men's attitudes toward breast cancer captures the perception that breast cancer is an illness that occurs mainly later in life. This was associated with the perception of negative impact of cancer diagnosis on a young woman's social status and family role. Men believed that breast cancer preventive practices must be performed in a similar context of women's religious and cultural background. Younger generations are in need for health education related to breast cancer and its screening. It is important to provide support and guidance for young men to be more involved in providing early detection of breast cancer.
... Our findings refute previous reports that gender inequity, modesty, wanting only to see a female doctor and cultural and religious beliefs are significant barriers to Bangladeshi women undergoing any form of breast assessment [3,[28][29][30]. Small studies in Bangladesh and in Palestine have reported similar findings to ours [31,32]. Women who had no education were less likely to undergo BCa assessment which is in agreement with another small study of working women in Dhaka where highly educated women are more likely to practice BSE compared with less educated women [31]. ...
Article
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Objectives: To investigate the awareness of breast cancer (BCa) and BCa screening amongst women at midlife in Bangladesh. Methods: A nationally representative cross-sectional survey of women aged 30-59 years was conducted in 7 districts of the 7 divisions in Bangladesh, using a multistage cluster sampling technique. The factors associated with the awareness of BCa and breast assessment of asymptomatic women were investigated separately, using multivariable logistic regression. Results: Of the 1590 participants, mean age 42.3 (±8.0) years, 81.9% had ever heard of BCa and 64.2% of any methods of BCa screening, respectively. Awareness of BCa was associated with being aged 40-49 years (adjusted OR 2.04, 95% CI 1.46-2.84), aged 49-59 years (1.96, 1.32-2.91), being overweight (1.46, 1.07-2.01) and obesity (1.62, 1.01-2.62), while inversely associated with rural dwelling (0.37, 0.22-0.61), primary education (0.44, 0.27-0.70), having no education (0.23, 0.14-0.36) and parity (0.62, 0.44-0.87). Of the 750 women who were aware of clinical breast examination (CBE) or mammography, reasons provided for not undergoing screening included that they had no symptoms (92%) and that they did not know screening was needed (40%). 8% of women reported CBE. Women with no education were less likely to have undergone CBE (0.38, 0.141.04; p=0.059). Conclusion: Lack of understanding of the assessment of asymptomatic women is the key obstacle to BCa screening uptake in Bangladesh. Health education programs, especially BCa awareness programs, have the potential to increase BCa awareness and down-staging of the disease.
... The structured questionnaire used to collect data was available in Arabic language. Knowledge survey points regarding the disease, risk factors and methods for detection of breast cancer were well validated in several studies [14,15]. A face-toface interview technique was performed according to a form translated into simple Arabic language to ensure its comprehensibility. ...
Article
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Abstract Introduction: Breast cancer in women is the commonest type of cancer worldwide. However, in Libya, ordinary systematic screening for breast cancer is neglected. Aim: The present study was aimed to evaluate the women’s knowledge towards breast cancer and its risk factors. Methods: A cross-sectional survey, using self-administered questionnaire and face-to-face interviews was conducted at different places in Tripoli city along a period of nine months, from April-December 2013. Results: The mean age (SD) of the participating women was 485 years and out of 284 contributors 84.5% were married. One hundred and eighty women (63.4%) stated that long-term use of contraceptive pills (> 5 years) increases the incidence rate of breast cancer. Besides, more than half of participants (157 women) specified that breast cancer is treated by surgery, chemotherapy and radiotherapy. However, although 50.7% of women reported that mammography and ultrasound are used for early detection, more than 60% of women believed that mammogram can cause cancer. In addition, our data demonstrate that increased knowledge was associated with women who know how to do self-examination and living in urban area. Conclusion: Our findings demonstrate that Libyan women have acceptable level of knowledge regarding breast cancer. However, improvement of the health systems and awareness regarding breast cancer is needed.
... of Gaza showed that women are willing to work up a breast complaint including diagnostic mammography, however there is significant less willingness to go for screening mammograms (26,28,29). ...
Chapter
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While several strategies were adopted by the EMR countries in recent times to improve cancer early detection, a considerable inequity exists between and within the countries in implementation. Moreover, most countries face multiple challenges that hinder the effective performance of cancer early detection programmes. Recent data show that almost half of the EMR countries reported having organized population-based screening programmes for breast cancer. In addition, approximately one-third and one-fifth of the countries reported having population-based organized cervical and colorectal cancer screening. Nevertheless, none of the screening programmes in the EMR have met the criteria to be considered as population-based programmes (defined as programmes systematically inviting the eligible populations) and the majority of them lack most of the components of organized screening programmes. For instance, high-resourced countries provided opportunistic cancer screening for breast and colorectal cancers. However, the uptake of screening is relatively low in each country despite the existing cancer awareness campaigns. To advance cancer screening, EMR countries need to identify priority cancers for screening, the set of interventions that can be included in the health insurance or universal health coverage package and to ensure sustainable financing, and increase the accessibility of cancer screening interventions. More importantly, all countries need to invest in developing Early detection of common cancers is one of the vital cancer control programmes and includes two different complementary approaches: cancer screening and early diagnosis. While the cancer burden varies across the 22 countries in the Eastern Mediterranean Region (EMR), some similarities have been observed in the most commonly diagnosed cancers. The five most common cancers among men in the region are lung, prostate, liver, colorectum, and bladder. In Women the most common cancers are breast, colorectum, liver, thyroid, and ovarian. Late-stage diagnosis and limited access to cancer screening programmes are significant factors negatively affecting cancer survival in the EMR. Many of these common cancers can be prevented and detected early if evidence-based, cost-effective public health interventions are implemented. Data obtained from various oncology centres show that the proportion of breast cancer patients diagnosed at an advanced stage (stage III or IV) ranged from 46% in Pakistan to 78% in the Sudan. A recent meta-analysis of nearly 80 studies from 12 countries in EMR reported a 5-year average survival rate of 71% for breast cancer, with a range varying widely from less than 30% to almost 90% across the studies. KAZEM ZENDEHDEL PARTHA BASU ROLA SHAHEEN SLIM SLAMA DEBORAH MUKHERJI SAMAR AL HOMOUD ALI AL ZAHRANI IBTIHAL FAHIL OPHIRA GINSBURG
... Studies, including some using mixed methods [9][10][11][12][13], have reported barriers and facilitators to the participation of women in screening mammography programs [14][15][16]. However, to our knowledge, there have been no comparable studies among Mexican women. ...
Article
Objective: To evaluate facilitators and barriers influencing mammography screening participation among women. Design: Mixed methods study. Setting: Three hospital catchment areas in Hidalgo, Mexico. Participants: Four hundred and fifty-five women aged 40-69 years. Intervention: Three hundred and eighty women completed a survey about knowledge, beliefs and perceptions about breast cancer screening, and 75 women participated in semi-structured, in-person interviews. Survey data were analyzed using logistic regression; semi-structured interviews were transcribed and analyzed using elements of the grounded theory method. Main outcome measure: Women were categorized as never having had mammography or having had at least one mammogram in the past. Results: From survey data, having had a Pap in the past year was associated with ever having had breast screening (odds ratio = 2.15; 95% confidence interval 1.30-3.54). Compared with never-screened women, ever-screened women had better knowledge of Mexican recommendations for the frequency of mammography screening (49.5% vs 31.7% P < 0.001). A higher percentage of never-screened women perceived that a mammography was a painful procedure (44.5% vs 33.8%; P < 0.001) and feared receiving bad news (38.4% vs 22.2%; P < 0.001) compared with ever-screened women. Women who participated in semi-structured, in-person interviews expressed a lack of knowledge about Mexican standard mammographic screening recommendations for age for starting mammography and its recommended frequency. Women insured under the 'Opportunities' health insurance program said that they are referred to receive Pap tests and mammography. Conclusions: Local strategies to reduce mammogram-related pain and fear of bad news should work in tandem with national programs to increase access to screening.
... Social and cultural factors impact on the stage at which women with symptoms present to the health services. Fear, embarrassment and fatalism about breast cancer are major cultural barriers in Gaza, which influence women's decision to seek diagnosis [15][16][17][18]. In a survey by Badawi (2016) in a governmental hospital in the oPt, 54% of women with breast cancer reported delaying their visit to their doctor for more than 3 months after the onset of symptoms [15]. ...
Article
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Gaza has experienced 12 years of isolation which has crippled the health system infrastructure, reduced the quality of living conditions, damaged the health of the population and reduced health service capacity and capability. This paper presents a context-setting review of what is already known about breast cancer in Gaza to identify which interventions are applicable to help prevent women there from dying unnecessarily from breast cancer. A search of the published and unpublished literature was conducted to identify potentially relevant studies on breast cancer which were either done in Gaza or elsewhere in the occupied Palestinian territory. This paper highlights the pervasive lack of basic modalities of cancer care (surgery, radiotherapy, systemic therapies and pathology/imaging) in Gaza. Poor access to breast cancer services in Gaza leaves women with only one alternative-to seek treatment outside of Gaza. However, women are sometimes forced to wait months before receiving permits to leave Gaza for treatment. Furthermore, a lack of complete and reliable data remains a major challenge for improving breast cancer services in Gaza. There is a need to develop and evaluate interventions to promote infrastructure for pathology and drug delivery, medical training and cancer registration and monitoring.
... Israel is almost 85% (19,20). The difference may be attributed to poor breast cancer awareness, lack of screening programs for breast cancer, and limited access to and poor utilization of health care (21). These challenges to early detection can be addressed by awareness campaigns and a national screening program. ...
Preprint
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PURPOSE: The Palestinian Ministry of Health (MoH) routinely refers Palestinian patients with cancer to the King Hussein Cancer Center (KHCC), the largest cancer center in the Middle East. Our aim was to describe the characteristics of these patients. PATIENTS AND METHODS: We performed a retrospective chart review of all Palestinian patients with cancer who were treated at the KHCC during 2018 and 2019. We retrieved data from the Cancer Registry and described the demographic and clinical characteristics of the cohort. RESULTS: Out of 521 Palestinian patients, we excluded 41 patients who were misdiagnosed and included the remaining 480. Most patients were adults (n = 426, 88.8%). The most common cancer sites in men (n = 200) were the hematolymphoid system (n = 47, 23.5%), followed by the digestive system (n = 35, 17.5%), and lung and pleura (n = 23, 11.5%). In women (n = 226), the most common cancer sites were the breast (n = 104, 46.0%), followed by the digestive system (n = 34, 15.0%), and hematolymphoid system (n = 23, 10.2%). Children and adolescents accounted for 11.3% (n = 54) of the total cases. The hematolymphoid system was the most common cancer site (n = 27, 50%), followed by the brain (n = 8, 14.8%). More than a third of all patients presented with distant metastasis. CONCLUSION: The most common cancer sites in our cohort are generally similar to data from the Palestinian territories. Many patients presented with advanced-stage disease, which signals the need for awareness campaigns and screening programs. Cancer is misdiagnosed in many patients with benign tumors, which is a consequence of a shortage in specialists and limited diagnostic equipment.
... The structured questionnaire used to collect data was available in Arabic language. Knowledge survey points regarding the disease, risk factors and methods for detection of breast cancer were well validated in several studies [14,15]. A face-toface interview technique was performed according to a form translated into simple Arabic language to ensure its comprehensibility. ...
... For example, Palestinian women living in the West Bank faced hardships passing military checkpoints. As a result, they considered the journey to a hospital for screening worthless and postponed seeking diagnosis until the late stages of the disease [22,23]. ...
Article
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Breast cancer, the most common cancer among women in the Middle East and North Africa (MENA) region, is associated with social and psychological implications deriving from women's socio-cultural contexts. Examining 74 articles published between 2007 and 2019, this literature/narrative review explores the psychosocial aspects of female breast cancer in the MENA region. It highlights socio-cultural barriers to seeking help and socio-political factors influencing women's experience with the disease. In 17 of 22 Arab countries, common findings emerge which derive from shared cultural values. Findings indicate that women lack knowledge of breast cancer screening (BCS) and breast cancer self-examination (BSE) benefits/techniques due to a lack of physicians' recommendations, fear, embarrassment, cultural beliefs, and a lack of formal and informal support systems. Women in rural areas or with low socioeconomic status further lack access to health services. Women with breast cancer, report low self-esteem due to gender dynamics and a tendency towards fatalism. Collaboration between mass media, health and education systems, and leading social-religious figures, plays a major role in overcoming psychological and cultural barriers, including beliefs surrounding pain, fear, embarrassment, and modesty, particularly for women of lower socioeconomic status and women living in crises and conflict zones.
... The baseline rate of willingness to undergo CRC screening was not established. Based on extrapolation from breast cancer studies in Palestinian women in Gaza, we predicted that this rate would be around 25%. 23 We wanted to detect this rate with a 5% margin of error. Based on the above, the sample size was calculated to be 970. ...
... 16 Likewise, a survey of 155 Palestinian women in 2009 found that only 33% of those living in Gaza indicated breast cancer was not contagious compared to 84% of women living in nine other countries. 17 In an earlier study of 200 women with gynecological cancers in Iran in the year 2000 found that 67% indicated "no" to the question of whether cancer is contagious, leaving one-third who either believed it was contagious or were not sure. 18 Finally, in a study of 543 adults age 15 or older in Yemen in 2013, 20% said "yes" when asked if oral cancer was contagious, 40% did not know, and only 38% said "no." 19 For the past 8 years, the senior author (RA, a radiation oncologist) and her colleagues in radiation oncology at King Abdulaziz University have observed that a cancer diagnosis often changes the relationship between patients and their spouses. ...
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... Certain ethnic and cultural groups may be at higher risk of such beliefs about the spread of cancer or cancer treatments, due to their educational level or certain cultural beliefs and traditions (Lannin et al. 2002;Barton-Burke and Gustason 2007). Research has shown that questions about the transmissibility of cancer may be particularly common in the Middle East (Eftekhar and Yarandi 2004;Shaheen et al. 2011;Mellon et al. 2013;Al-Maweri et al. 2014), where one of those cultural factors that influences belief and behavior is religiosity. ...
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We examined relationships between religiosity and Saudi cancer patients’ beliefs about the spread of cancer, chemotherapy, and radiation therapy through close physical contact. Surveyed were 64 patients seen in university oncology clinics. Assessed were beliefs about the spread of cancer and its treatments, along with religious, demographic, social, psychological, and cancer-related characteristics. Greater religiosity was related to older age, non-Saudi nationality, less anxiety, earlier cancer stage, and greater time since initial diagnosis. Non-significant trends suggested that religious practices were associated with less, but intrinsic religious beliefs with more concern about contagiousness, although the findings were limited by low statistical power.
... The majorities of women is interested in lowering their risk of breast cancer and have no religious or significant cultural barriers to mammography. Thus educational projects to promote clinical and mammographic screening for breast cancer are an appropriate starting point in helping to increase early detection of breast cancer 18 17 .Other studies of attitudes toward breast cancer screening among women in the Middle East suggest that some of the barriers to screening mammography may be mitigated by their age. A recent study in 2009 on Qatari women showed that breast cancer screening is utilized more frequently by the younger Qatari women with higher educational levels 19 .This would also allow for comprehensive understanding of the health attitudes and provide more filtered and specific interventions to improve early detection of breast cancer. ...
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The main aim of the study was to assess the factors influencing mammography participation in Iraqi women
... Only women who get to know about the program and the location of screening from a health care professional usually can take partmany women remain unaware of the available screening program. 16,17 To our knowledge, this is the first study conducted in the Gaza Strip to assess BC knowledge among women in Gaza, the attitude of these women toward BC, the awareness of BC agerelated and lifetime risks and availability of a BC screening program, and to uncover the barriers to seeking medical help. ...
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Purpose: Timely detection of breast cancer (BC) is important to reduce its related deaths. Hence, high awareness of its symptoms and risk factors is required. This study aimed to assess the awareness level of BC among females in Gaza. Materials and methods: A cross-sectional study was performed during September and October 2017 in Gaza, Palestine. Stratified sampling was used to recruit patients from four hospitals and seven high schools. The validated Breast Cancer Awareness Measure (BCAM) was used to assess confidence and behavior in relation to breast changes, awareness of BC symptoms and risk factors, barriers to seek medical help, and knowledge of BC screening. Women (age ≥ 18 years) visiting or admitted to any of the four hospitals, and female adolescents (age 15 to 17 years) in any of the seven schools, were recruited for face-to-face interviews to complete the BCAM. Results: Of 3,055 women approached, 2,774 participants completed the BCAM questionnaire (response rate, 90.8%); 1,588 (57.2%) were adults, and 1,186 (42.8%) were adolescents. Of these, 1,781 (64.2%) rarely (or never) checked their breasts, and 909 (32.8%) were not confident to notice changes. In total, 1,675 (60.4%) were aware of the availability of BC screening programs. The overall mean ± standard deviation score for awareness of BC symptoms was 5.9 ± 2.9 of 11, and that of risk factors 7.5 ± 3.1 of 16. Feeling scared was the most reported barrier to seeking advice reported among women (n = 802; 50.2%), whereas feeling embarrassed was the most reported in adolescents (n = 745; 62.8%). Conclusion: Awareness of BC symptoms, risk factors, and screening programs is suboptimal in Gaza. Educational interventions are necessary to increase public awareness of BC and to train local female breast surgeons to address barriers to early detection.
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Background Several factors might contribute to the delay to get cancer care including poor cancer awareness and having barriers to seeking help. This study described these barriers in Gaza and their association with recalling and recognizing cancer symptoms and risk factors. Methods A cross-sectional study was conducted in Gaza. Adult visitors (≥18 years) to the largest three governmental hospitals and adolescent students (15–17 years) from ten high schools were recruited. A translated-into-Arabic version of the validated Cancer Awareness Measure (CAM) was used to collect data in face-to-face interviews. It described demographic data, barriers to seek cancer care as well as recall and recognition of cancer symptoms and risk factors. Responses were compared between adults and adolescents as well as males and females. Results Of 3033 participants approached, 2886 completed the CAM (response rate= 95.2%). Among them, 1429 (49.5%) were adult (702 females; 49.1%) and 1457 (50.5%) were adolescent (781 females; 53.6%). The mean age± standard deviation (SD) of adult and adolescent participants was 33.7±11.7 years and 16.3±0.8 years, respectively. Emotional barriers were the most common barriers with ‘feeling scared’ as the most reported barrier ( n =1512, 52.4%). Females and adolescents were more likely to report ‘feeling scared’ as a barrier than males and adults, respectively. Higher recall scores for cancer symptoms were associated with lower likelihood to report ‘embarrassment’, ‘worry about wasting doctor’s time’ and ‘difficulty arranging transport’. This was also seen for recalling risk factors, where ‘embarrassment’ and all practical barriers showed significant inverse associations with higher scores. In addition, greater recognition scores of cancer risk factors were inversely associated with reporting ‘embarrassment’ and ‘feeling scared’. Conclusions The most commonly perceived barriers to seeking cancer care were ‘feeling scared’ and ‘feeling worried about what the doctor might find’, followed by practical and service barriers. Females and adolescents were more likely to report ‘fear’ as a barrier to seek medical advice. Having a higher recall of cancer symptoms and risk factors was inversely associated with reporting most barriers. To improve patient outcome, early presentation can be facilitated by targeting barriers specific to population groups.
Chapter
This chapter explores funding for the prevention and control of breast and cervical cancer in low and middle income countries (LMIC), including: existing patterns of financing for cancer within the context of global health financing trends; the challenges to resource mobilization for cancer control; and recommendations for diversifying and strengthening resource mobilization to ensure more robust, effective, and efficient cancer control efforts. Domestic financing for health in LMICs—government and out-of-pocket payments—is the primary source of global health financing. Multilateral and bilateral funding provides the second main source of global health financing. International and domestic private funding—both corporate and not-for-profit sources—accounts for a less significant proportion of global health financing, yet plays an important role in driving policy and systems changes. Cancer control has been severely underfunded in LMICs: cancer control financing is marked by severe inequities between countries, and cancer has received extremely limited support from development donors and major global philanthropic organizations. As a result, cancer prevention and control resources have been very limited and, where existent, more strongly beholden to domestic sources than other major global health challenges. In order to redress the grave disparities in cancer control financing and strengthen resource mobilization for cancer control, there is a need to fortify global and national cancer control policies, develop innovative domestic models for health financing cancer and other chronic diseases, more strongly leverage existing global and national health financing mechanisms to foster synergistic women’s health and health systems strengthening initiatives, and cultivate greater engagement of corporate, nonprofit, and individual donors in global and domestic spheres. These multiple and complementary efforts will help ensure that resources are more equitable and adequate to the cancer burden, that resources are mobilized more effectively and efficiently, that resources are utilized in a manner better aligned with local stakeholder priorities, that resources limit redundancies and duplication of efforts, and that resources promote sustainability to ensure longer term progress on cancer control and global health.
Conference Paper
Breast cancer is a major health problem and continues to be the primary cause of death among women all over the world. Screening mammography is recognized the most effective method for its early detection. since reading mammograms is an error-prone and time-consume task, a number of computer-aided detection and diagnosis (CAD) systems have been developed to aid the radiologists in the complex work of discriminating types of breast lesions. in almost all of the CAD systems, segmentation of lesions is a very crucial step. Image enhancement which is as a pre-process can largely improve performance of segmentation algorithms. However, the effectiveness of improvements has not been quantized evaluated and compared in previous studies. in this study, we conducted a set of experiments to evaluated two methods, namely 2D segmentation method based on dynamic programming (DPA) and DPA with image enhancement method. the detailed description of our image dataset, experimental procedures and results are presented. the study demonstrates that due to the using of image enhancement, DPA has an obvious improvement in segmenting suspicious regions of interest (ROIs) in mammogrphic lesions.
Article
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Objectives: The main aim of the study was to assess the factors influencing mammography participation in Iraqi women Methodology: A descriptive design was carried out on 100 women volunteer. The data were collected from women referred to the Outpatient Clinic of the Oncology Teaching Hospital and the Iraqi National Cancer Research Center of Baghdad University during the period from June to September 2016. The questionnaire was composed of two section: 1-demographics and clinical data2-The Factors influencing mammography which include four categories; 1) women's attitudes toward breast health, 2) knowledge and misconceptions about breast cancer, 3) cultural, religious and societal values, and 4) resources and accessibility of medical services. Results: About 53% of the study population was within age group (40-49) years, (81%) were married, (28%) were College graduates (52%) were housewife while the majority (97%) were income moderate. Approximately of the sample (74%) was had family history, (21%) had breast cancer and (50%) for women not done a mammogram The results of the presented work demonstrated that, over (29%) of sample were willing to undergo a diagnostic mammogram for a breast complaint and (87%) believed survival was increased with early detection. However, (77%) of samples were willing to undergo screening mammography. Religion and culture were not barriers to mammography for over (86%) only (47%) reported being worried about divorce if diagnosed with breast cancer. Limited resources and lack of access to medical facilities were identified as barriers in lack of resources to treat breast cancer if diagnosed (29%), concern about personal safety during traveling to medical centers (48%), and difficulty in reaching the medical centers (35%). Misconceptions about breast cancer were reported more frequently by sample, including beliefs that breast cancer can be contagious. Conclusions: Our results illustrated that, Iraq women complain many barrier of mammography screening which include attitude, knowledge and misconceptions about breast cancer, some cultural, religious and societal values, and resources and accessibility of medical services. Recommendation: The study urges promoting public health educational programs to elevate the level of awareness regarding the necessity to support women barrier at screening of breast cancer in Iraq.
Article
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The Middle East region is experiencing an alarming acceleration in the incidence of several cancers, aggravated by adverse lifestyles often secondary to rapid westernization, with complex intersections and interactions between culture, religion and native traditions, leading to cancer being typically diagnosed at more advanced stages of disease, and often with more aggressive tumor biologies than seen in other regions. The challenge therefore is to analyze the medical and non-medical etiologies contributing to this grim situation and to devise interventions that are both effective remedies and are also respectful and mindful of region’s unique identities and traditions. As a medical researcher specializing in advanced oncology, especially but not restricted to breast cancer, I have had occasion to consult with patients and colleagues across the globe, including considerable outreach in the Middle East. Here I share my thoughts and experiences with Middle East oncology, and offer my contribution towards addressing the unique oncology fabric of the Middle East, and in the process analyze some of the most relevant research findings distilled from an in-progress review, concluding with some practical suggestions for tailored interventions and for opportunities for cross-cultural cooperation in the service of moving forward positively against the unparalleled challenges of Middle East oncology.
Article
The aim of this study was to assess the attitudes of women and general practitioners (GPs) living in Karachi, Pakistan, regarding breast cancer, mammographic screening, and local barriers to breast health care. This study was performed using questionnaires designed specifically for women and for GPs in Karachi. Geographically dispersed collaborators identified GPs from neighborhoods across Karachi; snowball sampling located additional GPs and women in neighboring areas. Trained local community health workers conducted one-on-one surveys and used specially equipped (openXdata) mobile phones to enter and upload participant responses in real time. The survey included 200 women (median age, 35 years; range, 24-63 years), and 100 GPs (49% men, 51% women). Women's knowledge of breast cancer incidence, diagnosis, and treatment was proportionate to educational level, while willingness to address breast health issues and interest in early detection were high regardless of education level. Very few women had ever undergone clinical breast examinations (16%) or mammography (9%). Among GPs (median time practicing, 12 years; range, 1-40 years), most understood major risk factors and importance of early detection. However, 20% did not believe breast cancer occurs in Pakistan, and 30% believed that it is a fatal disease. Female GPs were more likely to perform clinical breast examinations (98%) than male GPs (24%). This study has identified specific areas to target for educational and early detection programs. Women need more awareness and access to routine examinations and mammography; GPs need more education regarding the incidence and management of breast cancer. Male GPs would benefit from having trained female assistants to perform clinical breast examinations.
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Background. Incorporating breast cancer screening into day-to-day clinical care leads to early diagnosis and decreases mortality. Patients' participation in screening depends on their knowledge and attitudes, other barriers, and physician behavior. Methods. A cross-sectional questionnaire survey was conducted to evaluate knowledge, attitudes, barriers, and practices related to breast cancer screening among Arabic women. A convenience sample was selected from 1,750 women aged 40-65 years who, for any reason, attended primary health care (PHC) clinics in Al-Ain, United Arab Emirates (UAE). Results. Of the 1,750 invited women, 1,445 agreed to participate; 78 were excluded from analysis because of histories of breast cancer. Breast self-examination (BSE) was practiced by 12.7% of the study population, clinical breast examination (CBE) by 13.8%, and mammography by 10.3%. Knowledge about breast cancer screening was low in the study population. Women were infrequently instructed about or offered screening for breast cancer by health professionals. Being employed was an independent predictor for participation in the three screening examinations. Conclusions. Health workers infrequently offered screening examinations and women lacked adequate knowledge about breast cancer screening. Acquired information about barriers to screening may help in the design of effective screening programs for Arabic women.
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To assess the breast cancer knowledge level of Saudi female school students. A detailed questionnaire on cancer breast was designed with all the needed information. Using a map of the Jeddah area of Saudi Arabia, schools were identified in each area and permission was sought from the Ministry of Education to distribute the questionnaire to the students. A team of volunteers was instructed on how to distribute and collect the questionnaires. The collected questionnaires were then statistically analyzed. This Pilot study of 500 students was performed in King Abdul-Aziz University Hospital using high schools from the city of Jeddah between April and June 2009. The results were used to build up a base for designing a community educational program. Analysis of the data from 337 questionnaires from high school and college students showed that the level of knowledge of young females on breast cancer is limited. However, it also indicated that the students are very enthusiastic to learn about cancer breast, and its prevention. The limited knowledge level of breast cancer in the younger generation might be an obstacle to screening programs and early diagnosis. Awareness programs should be developed including lectures, seminars workshops, and on hands training.
Article
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In the State of Qatar, breast cancer has become the most common form of cancer among women. The aim of this study was to explore knowledge, attitude and practice about breast cancer and to identify potential barriers to screening procedures among women. This multistage sampling cross sectional survey in primary health care centers and the outpatient department of the Women's Hospital in the State of Qatar targeted a representative sample of 1,200 Qatari women aged between 30 to 55 years of age during the period from December 2008 to April 2009. A total 1,002 subjects (83.5%) consented to participation. Face to face interviews were conducted with a designed questionnaire covering knowledge about breast cancer, attitudes and practices of breast cancer screening. Socio-demographic variables were included. The majority of Qatari women demonstrated an adequate knowledge about breast cancer, with a significant relation to education status. Almost three quarters were aware that breast cancer is the most common cancer in women. A good proportion knew that nipple retraction (81.2%) and discharge of blood (74.6%) are warning signs. Of the studied Qatari women, 24.9% identified breast self examination, 23.3% clinical breast examination (CBE) and 22.5% mammography as methods for detection of breast cancer. The frequently reported barriers among the Qatari women were asking any doctor/nurse how to perform breast self examination (57.3%), embarrassment about CBE (53.3%) and fear of mammography results (54.9%). Univariate and multivariate logistic regression analysis showed that family history, level of education, living in an urban area and having medical check-ups when healthy were significant predictors for CBE and mammography. The study findings revealed that although Qatari women had adequate general knowledge about breast cancer, the screening rates for BSE, CBE and mammography were low, these being performed most frequently by young Qatari women with a higher level of education.
Article
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The Arab world, stretching from Lebanon and Syria in the north, through to Morocco in the west, Yemen in the south and Iraq in the east, is the home of more than 300 million people. Cancer is already a major problem and the lifestyle changes underlying the markedly increasing rates for diabetes mean that the burden of neoplasia will only become heavier over time, especially with increasing obesity and aging of what are now still youthful populations. The age-distributions of the affected patients in fact might also indicate cohort effects in many cases. There are a number of active registries in the region and population-based data are now available for a considerable number of countries. A body of Arab scientists is also contributing to epidemiological research into the causes of cancer and how to develop effective control programs. The present review covers the relevant PubMed literature and cancer incidence data from various sources, highlighting similarities and variation in the different cancer types, with attempts to explain disparities with reference to possible environmental factors. In males, the most prevalent cancers vary, with lung, urinary bladder or liver in first place, while for females throughout the region breast cancer is the greatest problem. In both sexes, non-Hodgkins lymphomas and leukemias are relatively frequent, along with thyroid cancer in certain female populations. Adenocarcinomas of the breast, prostate and colorectum appear to be increasing. Coordination of activities within the Arab world could bring major benefits to cancer control in the eastern Mediterranean region.
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Breast cancer is the leading cause of cancer deaths in Malaysian women, and the use of breast self-examination (BSE), clinical breast examination (CBE) and mammography remain low in Malaysia. Therefore, there is a need to develop a valid and reliable tool to measure the beliefs that influence breast cancer screening practices. The Champion's Health Belief Model Scale (CHBMS) is a valid and reliable tool to measure beliefs about breast cancer and screening methods in the Western culture. The purpose of this study was to translate the use of CHBMS into the Malaysian context and validate the scale among Malaysian women. A random sample of 425 women teachers was taken from 24 secondary schools in Selangor state, Malaysia. The CHBMS was translated into the Malay language, validated by an expert's panel, back translated, and pretested. Analyses included descriptive statistics of all the study variables, reliability estimates, and construct validity using factor analysis. The mean age of the respondents was 37.2 (standard deviation 7.1) years. Factor analysis yielded ten factors for BSE with eigenvalue greater than 1 (four factors more than the original): confidence 1 (ability to differentiate normal and abnormal changes in the breasts), barriers to BSE, susceptibility for breast cancer, benefits of BSE, health motivation 1 (general health), seriousness 1 (fear of breast cancer), confidence 2 (ability to detect size of lumps), seriousness 2 (fear of long-term effects of breast cancer), health motivation 2 (preventive health practice), and confidence 3 (ability to perform BSE correctly). For CBE and mammography scales, seven factors each were identified. Factors for CBE scale include susceptibility, health motivation 1, benefits of CBE, seriousness 1, barriers of CBE, seriousness 2 and health motivation 2. For mammography the scale includes benefits of mammography, susceptibility, health motivation 1, seriousness 1, barriers to mammography seriousness 2 and health motivation 2. Cronbach's alpha reliability coefficients ranged from 0.774 to 0.939 for the subscales. The translated version of the CHBMS was found to be a valid and reliable tool for use with Malaysian women. It can be used easily to evaluate the health beliefs about breast cancer, BSE, CBE and mammography and for planning interventions. For greater applicability, it is recommended that this tool be tested among ethnically diverse populations.
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To update its cancer statistics, the newly established Middle East Cancer Society examined the cancer frequency patterns in Egypt and the Gaza Strip. The results revealed differing overall patterns. For men the highest frequencies were found for lymphoma, bladder cancer and cancers of the oral cavity and pharynx in Egypt, and for lung cancer, leukaemia and lymphoma in Gaza. For women, breast cancer had the highest frequency in both areas, followed by cancers of the oral cavity and pharynx in Egypt, and leukaemia and lymphoma in Gaza. The distribution of cancer occurrence by organ system also varied. In the light of the different ethnicities, lifestyles, socioeconomic levels and carcinogenic exposure among the countries of the Middle East, this kind of comparison can provide the background for more sophisticated approaches for discerning risk factors in cancer. We believe that further cooperation among participating countries will overcome the present limitations in data collection, registration and access.
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Incorporating breast cancer screening into day-to-day clinical care leads to early diagnosis and decreases mortality. Patients' participation in screening depends on their knowledge and attitudes, other barriers, and physician behavior. A cross-sectional questionnaire survey was conducted to evaluate knowledge, attitudes, barriers, and practices related to breast cancer screening among Arabic women. A convenience sample was selected from 1,750 women aged 40-65 years who, for any reason, attended primary health care (PHC) clinics in Al-Ain, United Arab Emirates (UAE). Of the 1,750 invited women, 1,445 agreed to participate; 78 were excluded from analysis because of histories of breast cancer. Breast self-examination (BSE) was practiced by 12.7% of the study population, clinical breast examination (CBE) by 13.8%, and mammography by 10.3%. Knowledge about breast cancer screening was low in the study population. Women were infrequently instructed about or offered screening for breast cancer by health professionals. Being employed was an independent predictor for participation in the three screening examinations. Health workers infrequently offered screening examinations and women lacked adequate knowledge about breast cancer screening. Acquired information about barriers to screening may help in the design of effective screening programs for Arabic women.
Article
BACKGROUND There is a lack of data on the access to mammography and its relation to the incidence of early breast cancer. In this study, the authors evaluated access by correlating geographically the number of U.S. Food and Drug Administration (FDA)-certified mammography facilities and the AJCC stage of breast cancer at diagnosis by county.METHODS Breast cancer incidence rates and stage at diagnosis were compared with the number of FDA-certified mammography facilities by county in the Surveillance, Epidemiology, and End Results reporting areas. The objective was to determine whether the number of certified facilities was associated with the percent of breast cancers diagnosed at the in situ stage. This was a multiple-group ecologic study, and counties were used as the units of analysis.RESULTSThere was a strong correlation between the number of mammography facilities and the population of a county, whereas there was no correlation between the number of mammography facilities and the land area of a county. A correlation existed between the percent of incident breast cancers that were diagnosed as in situ disease and the number of mammography facilities per 10,000 women among both whites and African Americans.CONCLUSIONS There was an association between the number of mammography facilities and population. In counties with ≥ 30,000 black and white females, 1) the percent of in situ breast cancers in black women and white women was correlated with the number of facilities per 10,000 women, indicating that population density is a factor in access for both racial groups; 2) except for 2 counties with ≥ 30,000 black women, the percent of incident in situ cases was similar in both black women and white women, indicating equal access in both groups; and 3) there was a correlation between the percent in situ incidence and number of facilities per 1000 square miles in white women, but not in black women. There was a direct correlation of statewide mammography rates with the number of facilities per 1000 square miles, indicating that the rate of screening depends on availability. Maximum rates of statewide screening were achieved when there were > 15 mammography facilities per 1000 square miles. Cancer 2005;103:1571–80. © 2005 American Cancer Society.
Article
This study aimed to assess outcomes of a culture-specific intervention devised to reduce barriers to breast cancer screening among Arab women in Israel. Women in intervention (n = 42) and control (n = 24) groups answered breast examination performance and Arab culture-specific barriers and health beliefs questionnaires at pre- and postintervention. Women in the study group received tailored telephone intervention between the 2 interviews. Although the study and control groups did not differ in rate of attending clinical examinations and mammography at pre-intervention, at post-intervention, almost 48% of the intervention group and 12.5% of the control group scheduled or attended a clinical examination, and 38.5% of women in the intervention group and 21.4% of the control group attended or scheduled a mammography. Of the cultural barriers, a significant group x time effect was found for the cultural barriers of exposure, social barriers, and self-uneasiness with body, with a higher decrease in the intervention group. Of the health beliefs, a group x time effect was found for perceived vulnerability and perceived barriers to clinical examination and mammography, which significantly decreased in the intervention group, but not in the control group. The preliminary results showed that the culture-based intervention was effective in reducing barriers and increasing the rate of breast cancer examinations.
Article
The current study was conducted to assess screening behaviors in relation to cultural and environmental barriers among Palestinian women in the West Bank. The participants were 397 women, ages 30 to 65 years, residing in the Palestinian Authority, and a stratified sample method was used (98.3% participation rate). The participants completed questionnaires on breast examination behaviors and knowledge, on perceived cancer fatalism and health beliefs, and on environmental barriers scales. Greater than 70% of the women had never undergone mammography or clinical breast examination (CBE), whereas 62% performed self breast examination (SBE). Women were more likely to undergo mammography if they were less religious (odds ratio [OR], 0.59; 95% confidence interval [95% CI], 0.47-0.81) and if they expressed lower personal barriers (OR, 0.59; 95% CI, 0.29-0.76) and lower fatalism (OR, 0.39; 95% CI, 0.28-0.63). A higher likelihood for CBE was related to being Christian (OR, 2.91; 95% CI, 1.49-5.73) and being less religious (OR, 0.32; 95% CI, 0.13-0.78), to perceived higher effectiveness of CBE (OR, 1.46; 95% CI, 1.20-1.79), and to perceived lower cancer fatalism (OR, 0.35; 95% CI, 0.28-0.60). Women were more likely to perform SBE if they were more educated, resided in cities, were Christian, were less religious, had a first-degree relative with breast cancer, perceived higher effectiveness and benefits of SBE, and perceived lower barriers and fatalism. Participants reported a combination of personal, cultural, and environmental barriers, which should be addressed by educational programs and followed by the allocation of resources for early detection and treatment of breast cancer.
Article
Physicians in Egypt and other Arab and developing countries still have to deal on a daily basis with large numbers of patients with advanced stages of breast cancer at presentation. Efforts at measuring the magnitude of the breast cancer issues, epidemiology, and awareness, are now moving further in the right direction. We are now starting to face the challenges of early detection of breast cancer as well as the implementation of proper modern management. Dorria S. Salem et al. publish in this issue of the Journal of Egyptian NCI an outline and initial results of a very ambitious Women Health Outreach Program (WHOP) designed to be completed in 5 phases 1. She and her co-authors state that those 5 phases include a prior training and demonstration phase that was completed in the Imaging Unit of Kasr El Aini Hospital in Cairo, as well as a one-year pilot phase completed between October 2007 and October 2008. Authors present us with results of screening of 20.098 women over the age of 45 years, between October 30, 2007 and February 9, 2009 in Cairo, Alexandria and Suez Governorates in Egypt. In addition to breast cancer, WHOP included screening for diabetes, hypertension and obesity. WHOP investigators are to be congratulated for this extraordinary ambitious project and all the efforts put into it. They were well prepared in regards to having a multi-disciplinary working team and they included in their project programs for training of clerks, data managers, radiographers, nurses, radiologists and other physicians who deal with diagnosis and management of breast cancer. They also included engineers and arranged for mobile units to reach women who could not otherwise reach them. WHOP investigators are to be commended also for performing a field plan demonstration project and testing it and for measuring citizens' response before finalizing their plans and starting the project1. They set a great example for other people working in the field. Breast cancer is the most common female malignancy in women in almost all Arab countries [2-5]. Randomized trials of mammographic screening of average-risk women above 50 years reduced breast cancer mortality by more than 36%. Analysis of the eight randomized trials, including the Canadian trials on women, ages 40-49 years old, showed a relative reduction of breast cancer deaths by 18% [6]. There is an obvious overlap as women with ages ranging from 40-49 years old reach the age of 50 and above, and enjoy the more clear benefits of mammographic screening beyond the age of 50 years. Many societies, including the American Cancer Society, recommend mammographic screening starting at age 40 years [7,8]. As it would be very difficult in this day and age to do more studies on breast cancer screening, and in view of the observations that almost 50% of cases are below the age of 50 years with a median age of 48-52 years at presentation, we recommend screening be done starting age 40, where resources are available and where setup for breast cancer care is appropriate [4,9]. Salem et al. report an initial very significant and alarming number of 10.215 women out of 20.098 women to be overweight and 2692 women to be obese [1]. Their observation that there is no significant correlation with breast cancer is only a one point in time observation and it cannot be used to confirm or refute any potential relationship between overweight, obesity and breast cancer. Future results, follow-up, and multivariate analysis will be awaited. Correlation of mammographic abnormalities with diabetes and hypertension in WHOP participants are very preliminary and will also need further multivariate analysis. WHOP investigators report that they invited women aged 45 years and up for screening. Eligibility criteria listed include only two points, women should have no personal history of breast cancer and no recent mammography [1], authors neither describe clinical history nor physical breast examination of selected and invited women. In future reports, authors will be asked about the assessement of those invited women, and what were the results and outcome if referred women were found to have abnormalities in their breasts. In another study from Cairo, Egypt, women were taught how to examine themselves, and authors reported that many were found to have clinical breast cancers for which they were effectively downstaged, and therefore treated for cancers that would have otherwise presented later as more advanced cases [10]. This issue brings me back to re-emphasize the importance of awareness, teaching women self-breast exam, and clinical breast examination once-a-year by a physician, particularly in countries with limited resources. Breast cancer awareness campaigns emphasize the benefits of early detection by promoting breaking of taboos, and teaching scientific facts that early breast cancer can be cured, and that cure can be achieved without the need of mastectomy. Advanced breast cancer is devastating to women and to their husbands and children, and therefore campaigns should be directed towards women as well as husbands who should be asked to encourage their wives to enroll in screening campaigns. Campaigns have begun to reduce the effects of taboos and people started to talk more freely about cancer, in fact, we and many centers in Arab countries have started to see more cases of early breast cancer and even a significant number of cases with microcalcifications [4]. Breast cancer screening in countries with limited resources have been recently reviewed [11,12]. As for the management of abnormal findings, Dorria S. Salem et al. [1] report performing FNAB as first line management in suspicious cases and reserving core biopsies for inconclusive cases. I fully agree with the authors' efforts to ensure accurate diagnosis and the importance of having an experienced cytopathologist. However, FNA is useful and recommended when there is a palpable tumor or a highly suspicious tumor with irregular borders and infiltrative characteristics on mammography and ultrasound. Core biopsy is indicated when FNA is inconclusive as the authors state, and also if mammography shows micro-calcifications where FNA cannot distinguish between in-situ and infiltrative carcinoma. A core biopsy is important for better assessment of pathology and determination of receptors (estrogen, progesterone, and HER2 receptors) especially in patients with large tumors who require preoperative (neoadjuvant) therapy, particularly when targeted anti-HER2 therapy is indicated [13]. In the present report, WHOP investigators [1] report that 31 patients, out of 86 true positive cancers, underwent modified radical mastectomy while 21 had breast-conserving surgery. Eleven patients required only excisional biopsy and had benign tumors, 25 had surgery at private institutions and no data is available on them. Further WHOP reports will be awaited to report to us on the stages and follow-up information on all patients. Availability of experienced surgeons and radiation oncology are also important issues when referring patients for partial or total mastectomy. After screening of over 20000 women, authors report that abnormal mammographies with BiRADS 4 and 5 were found in 433 cases (reported as 2.1%). Additional work-up with ultrasound and FNA/biopsy showed 2 false negatives, 110 false positives, and confirmed 86 true positive cases (0.4% of total 20.098 women screened). In the US, the likelihood of a woman being called back for additional testing after first round of screening is an average of 11% (range 3-57%) [14]. In women for whom a biopsy is then indicated, the likelihood of finding an invasive and/or insitu cancer is 25-47% [15]. This is what we call positive predictive value (PPV) and it varies with expertise and patients own risk factors for breast cancer. What is of concern in this present WHOP article, although not unexpected, is that more than half of the recalled women did not show up or no feedback is available on them. This should generate yet another important experience on how to deal with missing information and how to assure follow-up of patients in Egypt and other Arab countries, as well as in all limited resource countries. WHOP investigators will be asked to report in the future on screening intervals and data collection. Screening started at age 45 years, and data were analyzed by 10-year age groups starting age 50, which makes comparisons somehow difficult. In view of the high incidence of women with breast cancer with young age at presentation, it would be more helpful if WHOP investigators revise the starting age for screening mammography and make it 40 years and analyze data according to 10-year age groups starting age 40 years. On the other hand, it is important to note that increasing the time interval of periodic mammography diminished the mortality reduction by allowing undetected growth of interval cancers. Increasing the screening interval of women in their forties from annual to every 2 years or to every 3 years would diminish mortality reduction rates from 36% to 18% and to 4%, respectively [16]. Once a screening strategy is adopted, women aged 40 years and up should be screened at yearly intervals because data from Egypt and other Arab countries indicate that 50% of breast cancers are seen in women below age 50 years, and because young women have more aggressive tumors [17,18] and may be missed by two-year intervals. Finally, WHOP investigators, staff, and their sponsors are to be commended for this excellent, well planned and executed project that sets a great example for devotion for science and public health. In addition to regional and national cancer registries, they provide many new innovative approaches to characterize, diagnose and treat breast cancer in Egypt and other Arab countries. (ABSTRACT TRUNCATED)
Article
Stage at diagnosis was examined for various malignancies identifiable through screening to determine whether rural-urban differences exist in Georgia. Data were obtained from a population-based cancer registry which registers all incident cancers among residents of metropolitan Atlanta and ten neighboring rural counties. Black and white patients with a first primary invasive malignancy newly diagnosed between 1978 and 1985 were included in this study. Residents of the rural area were twice as likely to have unstaged cancers (18.3%) as were urban residents (9.6%). Among patients with known stage at diagnosis, rural patients tended to have more advanced disease than urban patients. The relative excess of nonlocalized malignancies in rural Georgia was 21% for whites and 37% for blacks. The rural excess of nonlocalized prostate cancer among blacks was especially pronounced. Differences in access to or utilization of early detection methods may contribute to the rural-urban differential in the extent of disease at diagnosis.
Article
To translate to the Arabic language, adapt, and test Champion's revised Health Belief Model Scales to measure Jordanian women's beliefs about breast cancer and breast self-examination (BSE). In Jordan, the primary site of cancer in women is the breast. No published studies have been found which describe women's beliefs or practices about breast cancer and BSE in Jordan. Descriptive correlational, using a cross-sectional survey with a random sample of 519 female university students and employees in Jordan, 1999 to 2000. Champion's revised Health Belief Model Scales were translated to Arabic, validated by professional judges, back-translated to English, and pretested. Analyses included descriptive statistics of all the study variables, internal consistency, reliability estimates, construct validity using factor analysis, and predictive validity using multiple regression analyses. The dependent variables were the frequency of practice of BSE and the intention to practice BSE. Factor analysis yielded nine factors: confidence 1, confidence 2, benefits, susceptibility, barriers, seriousness 1, seriousness 2, motivation 1, and motivation 2. All items on each factor were from the same construct. Significant correlations were found between the two confidence factors, the two motivation factors, and the two seriousness factors. Alpha coefficients ranged from .65 to .89. All the health belief variables accounted for 21% of the variance in the frequency of practice of BSE, and 7% of the variance in the intended frequency of practice. The translated version of Champion's scales was found to be a valid and reliable tool for use with Jordanian women. It can be used in planning and testing interventions to improve BSE beliefs and practice.
Article
Breast cancer is commonly diagnosed at late stages in countries with limited resources. Efforts aimed at early detection can reduce the stage at diagnosis, potentially improving the odds of survival and cure, and enabling simpler and more cost-effective treatment. Early detection of breast cancer entails both early diagnosis in symptomatic women and screening in asymptomatic women. Key prerequisites for early detection are ensuring that women are supported in seeking care and that they have access to appropriate, affordable diagnostic tests and treatment. We therefore propose the following sequential action plan: 1) promote the empowerment of women to obtain health care, 2) develop infrastructure for the diagnosis and treatment of breast cancer, 3) begin early detection efforts through breast cancer education and awareness, and 4) when resources permit, expand early detection efforts to include mammographic screening. Public education and awareness can promote earlier diagnosis, and these goals can be achieved in simple and cost-effective ways, such as dissemination of messages through mass media. All women have the right to education about breast cancer, but it must be culturally appropriate and targeted and tailored to the specific population. When resources become available for screening, they should be invested in screening mammography, as it is the only modality that has thus far been shown to reduce breast cancer mortality. Clinical breast examination (CBE) and breast self-examination (BSE) are important components of routine breast care in countries with access to mammography and are important for general breast health education in all countries. However, the evidence does not support the use of CBE and BSE as lifesaving screening methods at this time, recognizing that data from countries with very limited resource are lacking. When widespread screening is not possible, screening can begin in an institution, city, or region, or by targeting screening to women at highest risk. A pilot program can be an ideal way to define the best approach to screening. To succeed, early detection efforts must include the health care providers with whom women have contact; these providers may be physicians, nurses, midwives, traditional healers, or others. There are tremendous differences among and within countries, and a program to promote early detection must be tailored to each country's unique situation.
Article
Breast cancer is the second leading cause of cancer deaths in Turkish women, and the use of breast self-examination (BSE) and mammography remains low in Turkey. Therefore, we need to identify the beliefs, influencing BSE and mammography, and a valid and reliable tool to measure constructs. The Champion's health belief model scale (CHBMS) is a valid and reliable tool to measure beliefs about breast cancer, BSE, and mammography in an English culture. The purpose of this study was to assess the psychometric characteristics of a Turkish version of the CHBMS related to breast cancer, BSE, and mammography. A convenience sample of 656 women was recruited from 3 health centers and 2 maternal and child health centers in Istanbul. The CHBMS was translated to Turkish, validated by professional judges, back translated, and tested. Factor analysis yielded 7 factors for BSE: confidence, seriousness, barriers-BSE, health motivation 1 and 2, susceptibility, and benefits-BSE. For mammography scale, 6 factors were identified: seriousness, benefits-mammography, barriers-mammography, health motivation 1 and 2, and susceptibility. All items on each factor were from the same construct. Cronbach alpha reliability coefficients ranged from.75 to.87 for the subscales. The Turkish version of the CHBMS showed adequate reliability and validity for use in Turkish women. It could easily be used to evaluate the health beliefs about breast cancer, BSE, and mammography. Further refinement is required to study Turkish women's health beliefs and breast cancer screening behaviors in various settings.