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      Patterns, knowledge, and barriers of mammography use among women in Saudi Arabia

      research-article
      , FRCPC, , BDS, PhD, , BDS, SD, , PhD
      Saudi Medical Journal
      Saudi Medical Journal

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          Abstract

          Objectives:

          To assess mammography utilization and knowledge, and to determine barriers associated with mammography utilization among Saudi women.

          Methods:

          We conducted a cross-sectional survey in 5 main geographic regions of Saudi Arabia from February 2015 to May 2015. The sample comprised women aged ≥40 years. Associations between socio-demographic factors and mammography use were tested using chi-square test. Predictors of mammography use were assessed by logistic regression.

          Results:

          A total of 3,245 women were surveyed, with 40% reporting ever having a mammogram. As indicated by the univariable analyses, older age (≥60 years), being single or divorced, having <2 children, not completing high school, and having a family history (hx) of breast cancer were significantly associated with never having a mammogram. Participants of older age (odds ratio [OR] 51-60 versus 41-50 = 0.6, 95% CI: 0.5-0.7 and OR >60 versus 41-50 = 0.5, 95% CI: 0.3-0.8), and divorced (OR divorced versus married = 0.6, 95% CI: 0.5-0.8] were less likely to have had a mammogram, while participants with no family hx of breast cancer (OR no family hx versus family hx = 1.5, 95% CI: 1.3-1.8)were more likely to have had a mammogram.

          Conclusion:

          Mammography utilization and knowledge are low in Saudi Arabia. Increasing the awareness of breast cancer screening through educational programs could help women overcome existing barriers and misconceptions.

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          Most cited references31

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          Epidemiology and prognosis of breast cancer in young women.

          Breast cancer is the most common malignancy in women with 6.6% of cases diagnosed in young women below the age of 40. Despite variances in risk factors, Age Standardized Incidence Rates of breast cancer in young women vary little between different countries. Review of modifiable risk factors shows that long-term use of oral contraceptives, low body mass index (BMI) and high animal fat diet consumption are associated with increased risk of premenopausal breast cancer. Decreased physical activity and obesity increase risks of breast cancer in postmenopausal women, but data on premenopausal women rather shows that high BMI is associated with decreased risk of breast cancer. Non-modifiable risk factors such as family history and genetic mutations do account for increased risks of breast cancer in premenopausal women. Breast cancer in young women is associated with adverse pathological factors, including high grade tumors, hormone receptor negativity, and HER2 overexpression. This has a significant negative impact on the rate of local recurrence and overall survival. Moreover, younger women often tend to present with breast cancer at a later stage than their older counterparts, which further explains worse outcome. Despite these factors, age per se is still being advocated as an independent role player in the prognosis. This entails more aggressive treatment modalities and the need for closer monitoring and follow-up.
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            Using the health belief model to predict breast self examination among Saudi women

            Background In the Kingdom of Saudi Arabia, breast cancer (BC) usually presents at advanced stages and more frequently in young pre-menopausal women in comparison to western countries. There is controversy surrounding the efficacy of breast self examination (BSE) for early detection of BC in countries where other methods are available. This study aims to explore the perception towards breast cancer and towards BSE among Saudi women, using the Health Belief Model (HBM). Methods A convenient sample of adult Saudi female employees, working at King Abdulaziz Medical City, Riyadh, Saudi Arabia (n = 225), and their non-working adult female family members (n = 208), were subjected to the Arabic version of revised Champion’s Health Belief Model Scale (CHBMS) and the Arabic version of Breast Cancer Awareness Measure (CAM), to assess their knowledge and attitude on BC respectively. Percentage mean score (PMS) for each HBM domain was calculated. Significant predictors of BSE practice were identified using logistic regression analysis and significance was considered at p < 0.05. Results The majority of women heard about BSE (91.2 %), only 41.6 % reported ever practicing BSE and 21 % performed it regularly. Reported reasons for not doing BSE were: not knowing how to examine their breast (54.9 %), or untrusting themselves able to do it (24.5 %). Women were less knowledgeable about BC in general, its risk factors, warning signs, nature and screening measures (PMS:54.2 %, 44.5 %, 61.4 %, 53.2 %, 57.6 % respectively). They reported low scores of; perceived susceptibility, seriousness, confidence and barriers (PMS: 44.8 %, 55.6 %, 56.5 % & 41.7 % respectively), and high scores of perceived benefits and motivation (PMS: 73 % & 73.2 % respectively) to perform BSE. Significant predictors of  BSE performance were: levels of perceived barriers (p = 0.046) and perceived confidence (p = 0.001) to BSE, overall knowledge on BC (p < 0.001), work status (p = 0.032) and family history of BC (p = 0.011). Conclusions Saudi women had poor knowledge on BC, reported negative attitude towards BSE and their practice was poor. Working women and those with family history of BC, higher perceived confidence and lower perceived barriers on HBM, and those with high level of knowledge on BC were more likely to perform BSE. Breast awareness as an alternative to BSE needs further investigations. HBM was shown as a valid tool to predict BSE practice among Saudi women.
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              Family history of cancer and its association with breast cancer risk perception and repeat mammography.

              We examined the strength of association between family history of breast cancer and family history of other cancers with breast cancer risk perception and repeat mammography. The sample included 6706 women, aged 46 to 74 years, with no breast cancer history. Multinomial logistic regression assessed the association between family history of cancer and breast cancer risk perception. Structural equation modeling estimated the relationship between family history of cancer and repeat mammography. Breast cancer risk perception was strongly associated with family history of breast cancer in the mother or mother and sister (odds ratio [OR] = 32.15; P < .001); family history of breast cancer in the sister, daughter, or male first-degree relative (OR = 6.6-8.4; P < .001); and maternal history of other cancers (OR = 1.38-2.73; P < .001). For repeat mammography, women with maternal history of breast cancer had a mean increase of 0.50 more mammograms in the past 6 years compared with women without maternal history of breast cancer (P < .001). Breast cancer risk perception was associated with the type of cancer found in first-degree relatives and with the person's relationship to the family member with cancer. Family history of breast cancer affected repeat mammography behavior.
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                Author and article information

                Journal
                Saudi Med J
                Saudi Med J
                Saudi Medical Journal
                Saudi Medical Journal (Saudi Arabia )
                0379-5284
                August 2017
                : 38
                : 9
                : 913-921
                Affiliations
                [1] From the Department of Radiology (Al-Wassia, Hagi), Faculty of Medicine, and from the Department of Dental Public Health (Farsi, Merdad), Faculty of Dentistry, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
                Author notes
                Address correspondence and reprint request to: Dr. Rolina K. Al-Wassia, Department of Radiology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. E-mail: ralwassia@ 123456kau.edu.sa ORICD: 0000-0003-4466-9024
                Article
                SaudiMedJ-38-913
                10.15537/smj.2017.9.20842
                5654025
                28889149
                efea38ad-2348-474b-b024-da715c934e32
                Copyright: © Saudi Medical Journal

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 April 2017
                : 28 June 2017
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