|Year : 2022 | Volume
| Issue : 1 | Page : 11-18
Knowledge of breast cancer and self-diagnostic skills amongst women in the United Arab Emirates
Aysha Nasser Al Hosani1, Nahla Eissa Al Mazrouei1, Shalini Behl2, Aisha Meskiri3
1 Health Sciences Division, Abu Dhabi Women's College, Abu Dhabi, United Arab Emirates
2 Manipal Academy of Higher Education, Dubai, United Arab Emirates
3 Department of Health Sciences, Higher College of Technology, Abu Dhabi, United Arab Emirates
|Date of Submission||22-Nov-2020|
|Date of Decision||18-May-2021|
|Date of Acceptance||08-Jul-2021|
|Date of Web Publication||25-Mar-2022|
Department of Health Sciences, Higher College of Technology, Abu Dhabi
United Arab Emirates
Source of Support: None, Conflict of Interest: None
Background: Globally, breast cancer remains one of the world's greatest public health problems and a leading cause of death. Breast malignancies are considered as the major sites for tumors diagnosed in the United Arab Emirates (UAE) and they pose a significant concern for the general public's well-being. Aim: To conduct a descriptive cross-sectional study to determine the knowledge of breast cancer and self-diagnostic skills amongst women in the UAE. Methodology: The study was conducted for 1 month, based on an online survey designed via Microsoft Forms. It composed of 20 closed multiple-choice questions, which helped to assess the participant's knowledge of breast cancer and self-diagnostic skills. A total of 584 female participants were included in the study, out of which 498 (85.3%) were Emirati while 86 (14.7%) were non-Emirati females. Results: Despite the government's effort in enhancing breast cancer awareness programs across the UAE, only 6% of the females had excellent knowledge about breast cancer, 35% good, 46% average and 13% demonstrated poor knowledge. While only 4% had excellent breast self-examination skills, 17% had good skills, 61% had average skills and 18% had poor skills. A more concerning point was the least concern that females had towards non-lump breast cancer symptoms. Results from the current study showed that UAE female residents have an average knowledge of breast cancer and poor breast cancer self-diagnostic skills. Conclusion: The UAE government must emphasize the importance of breast screening practices, which may positively enhance breast-screening responses and practices amongst women in the UAE.
Keywords: Awareness, breast cancer, self-diagnosis, United Arab Emirates female population
|How to cite this article:|
Al Hosani AN, Al Mazrouei NE, Behl S, Meskiri A. Knowledge of breast cancer and self-diagnostic skills amongst women in the United Arab Emirates. Hamdan Med J 2022;15:11-8
|How to cite this URL:|
Al Hosani AN, Al Mazrouei NE, Behl S, Meskiri A. Knowledge of breast cancer and self-diagnostic skills amongst women in the United Arab Emirates. Hamdan Med J [serial online] 2022 [cited 2022 May 28];15:11-8. Available from: http://www.hamdanjournal.org/text.asp?2022/15/1/11/340825
| Introduction|| |
Breast cancer is the most well-known form of cancer amongst females around the world. In 2011, it was reported that the total incidences of breast cancer death increased from 250,000 to 425,000. There are a few modifiable factors that women can practice in order to reduce cancer development such as regular exercise, maintenance of a healthy body mass index, decreased alcohol consumption in addition to early breast cancer diagnosis. Family history of breast malignancy is a significant risk factor of breast cancer, as epidemiological investigations have reported that breast cancer is roughly twice as regular amongst first-degree relatives of breast cancer patients. The Gulf Center for Cancer Registration has reported that for every 100,000 females, there are 53.4 instances of breast malignant growth in Bahrain, 17.5 cases in Saudi Arabia, 22.8 incidences in the United Arab Emirates (UAE) and 46.6 incidences in Kuwait. An investigation conducted at Al Ain Hospital in the UAE to determine the common types of malignancies revealed that approximately 37% of the patients were Emirati and Omani natives, 35.5% originated from Asia and the male-to-female proportion was 3:2. It further concluded that breast cancer was the most common form of cancer in females (31.6%). King Fahad Hospital in Medina Saudi Arabia reported that a total of 2237 cancer patients, of which 75.4% were Saudis and 24.6% belonged to other nationalities; one of the most common forms of cancer was breast cancer, which represented 8.5% of the patients. In another study report, there were 14.9 million incidences of cancer cases worldwide and the highest incidences were breast cancer amongst women. Another statistical study reported that breast cancer percentages reached 37.3% in 2004 and 38.6% in 2005. Additionally, it is expected that the number of new breast cancer cases will increase from 10 million in 2002 to 15 million by 2025. Breast malignancies are considered one of the main sites for tumours diagnosed in the UAE. According to the Cancer Registry Report, 2012, more than 130 new cases of breast cancer are diagnosed annually in the UAE. It is a significant worry for the general public's well-being in the UAE. It is a commonly diagnosed cancer across the world, and if detected early, the prognosis of the patient is improved., A study conducted in Al Ain city, UAE, found that 48.6% of the participants rehearsed breast self-assessment, 49.4% had experienced clinical breast assessment and 44.9% had mammography. These results indicated that breast cancer knowledge amongst females in the UAE is limited, which has a negative impact on screening rehearses amongst UAE females. Early detection of cancer in addition to its treatment improves the prognosis of the patient. In the Arab community, women prefer not to participate in breast cancer screening programmes due to cultural and religious factors, which subsequently results in delayed tumour detection. Another study also reported that the limitation in breast screening amongst women in the UAE could be due to cultural, psychological, religious and personal factors. The World Health Organization has promoted control programmes and has been actively involved in educating and screening young women for the appearance of breast cancer. Screening programmes have been considered effective methods for reducing the morbidity and mortality of breast cancer as well as enhancing the survival rate. Breast self-examination (BSE) is a mechanistic self-assessment of the breasts to recognize a variation from the norm aiming at early detection to reduce mortality. To be able to conduct self-assessment for breast cancer, one must know the normal structure of breast and be familiar with how the breasts normally feel. He/She should be able to recognize any changes that might be noticed and know how to act if a change is observed. Additionally, women over the age of 50 must go for regular screening.
Increasing breast cancer education and awareness amongst women will enhance the early detection of breast cancer. This can be accomplished by various methods such as educational programmes on television, newspaper and radio. The highest benefits of educational programmes can be achieved through well-designed culturally sensitive programmes. The National Breast Cancer Foundation reported that 70% of breast diseases were detected by ladies performing standard BSE. Investigators have studied many diagnostic methods in order to detect early stages of breast cancer, such as mammography, ultrasonography, magnetic resonance imaging (MRI), positron emission tomography and biopsy. Mammography is important for mass screening, ultrasonography is helpful to evaluate lumps found in mammography and MRI is recommended for young women who are at high risk of developing breast cancer. Physicians recommend computed tomography scans for patients in order to determine and detect distant metastasis [Figure 1]. In 1995, the UAE Ministry of Health established programmes that provided screening, including BSE, clinical breast examination and mammography. These screening programmes are provided in the Emirates and are available free of charge to local females over the age of 40. Despite this, local female participation in these programmes is low. The aim of breast cancer programmes is to maintain the quality of life and extend lifespan.
|Figure 1: A pie chart illustrating the United Arab Emirates women's knowledge score of breast cancer|
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Moreover, the correspondence between doctors and patients plays a significant part in improving clinical results and patients' mental capabilities of dealing with the negative impacts of breast cancer.,
The present survey-based study was designed with an aim to assess the knowledge of breast cancer and self-diagnostic skills amongst women in the UAE.
| Methodology|| |
In the present study, a descriptive cross-sectional study was conducted for 1 month (October to November 2019). The study was based on an online survey [Appendix], which was approved by the Survey Review Committee (SRC) at Higher Colleges of Technology (HCT) in October 2019. After a thorough review of the survey, the committee members noted that there were no ethical issues for the conduct of this survey. The study included a total of 584 females residing in the UAE. All participants were asked to complete a 10–15-min questionnaire designed via Microsoft Forms consisting of 20 multiple-choice questions. The questionnaire aimed to identify a clear understanding of breast cancer knowledge and self-diagnostic skills amongst females in the UAE [Figure 2]. Some of the questions within the survey had an additional option which allowed the participant to add further details if needed or choose more than one answer. The questionnaire was divided into three different parts. The first part aimed at gathering demographic data such as marital status, age group, occupational status, nationality, level of education, and field of education [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]. The second part of the survey was based on gathering information about the participant's background knowledge about breast cancer, common symptoms, identifying diagnostic procedures and other factors associated with breast cancer. The third part of the survey aimed at gathering information about the participant's breast cancer self-diagnostic skills such as knowledge of self-examination and screening, family history, diagnosis, cancer metastasis and awareness of various breast cancer screening services offered in the UAE. Before the survey was conducted, every participant was informed of the benefits and aims of the study and informed consent for the participation was obtained. Additionally, the confidentiality of information and anonymity of the participants was guaranteed. Before the survey was released publicly, a pilot test run of the questionnaire was conducted to ensure that the survey would yield accurate reliable results. Once the survey period was over, the data were exported into a Microsoft Excel sheet. Descriptive statistical analysis was performed for quantitative variables, frequency and percentages. Within Sections 2 and 3, each question was given a score. Participants' knowledge and self-diagnostic skill scores were distributed as follows: Participant's knowledge and self-diagnostic skills scores were categorized as strongly disagree, disagree, neutral, agree and strongly agree. The collected data from the questionnaire were analysed by statistical software 'Statistical Package for the Social Sciences (SPSS Statistics, Version 25, developed by IBM for multivariate analysis)' to evaluate breast cancer knowledge and self-diagnostic skills in the UAE.
|Figure 2: Pie chart illustrating the United Arab Emirates women self-diagnostic skill score of breast|
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|Table 4: Participant's response of breast cancer self-diagnostic skills (n=584)|
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|Table 5: The link between variables and breast cancer self-diagnostic skill score|
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The association between the sociodemographic characteristics (categorical variables) of women and their knowledge and self-diagnostic skills was also assessed through ANOVA, Chi-square test, Fisher's test and t-test.
| Results|| |
The survey was conducted for 1 month, after receiving the approval in October 2019 by the SRC at the HCT. Data were analysed and organized into three sections: demographic, breast cancer knowledge and breast cancer skills.
A total of 584 UAE female residents participated in this study. Out of the 584 participants, 498 (85.3%) were Emirati and 86 (14.7%) were non-Emirati females. Over half of the participants were under the age of 25 (56.8%), most of them were single (60.1%) and only 27.5% were married. Approximately 53.9% of the participants in the survey were students, 23.1% were employed and 11% were unemployed. The highest percentage of participants held a high school certificate and a diploma/bachelor certificate, 37.7% and 42.6%, respectively, and only 2.6% held a doctorate. More than half of the participants were from a non-health science background (62.5%) and only 29.1% of the participants had a health science background.
Breast cancer knowledge
Most (84.3%) of the participants agreed that they had background knowledge about breast cancer. Although 58.7% still thought that they need to know more about breast cancer. 41.1% of the participants were not aware of when breast cancer self-examination should be practiced. 34.1% agreed that all menstruating women should practice BSE; 10.1% and 11.1% agreed that women over 20 and over 30 should practice BSE, respectively. 3.4% thought that BSE should only be practiced by women who had breast cancer in their families. The majority of the participants (43.2%) thought that breast lump was the most common symptom of breast cancer, followed by breast swelling (13.9%) and nipple (13.2%). However, 19.0% of the participants did not know what the symptoms of breast cancer were. Most of the participants (39.0%) thought that age was the main risk factor for breast cancer, followed by family history/genetics (16.1%), obesity (15.1%) and smoking (15.1%). When questioned how breast cancer is treated, just over half (52.4%) responded that they knew and 44.7% did not know how it was treated. 65.2% of the participants knew that the UAE offered free breast cancer screening for women aged 40 and above, while 31.8% did not know.
Women's breast cancer knowledge scoring results were as follows: 13% had poor knowledge, 46% had average knowledge, 35% had good knowledge and only 6% had excellent knowledge. In this study, the significant variables related to knowledge were educational status (P = 0.001, P < 0.05) and family genetic disease (P = 0.016, P < 0.05). The rest of the variables showed no knowledge-associated significance.
Breast cancer self-diagnostic skills
When participants were asked about their knowledge of breast cancer diagnostic procedures, approximately 50% of them were familiar with mammography, followed by ultrasound (8.6%) and BSE (6.2%). A total of 22.1% of the participants had never heard of any breast diagnostic procedures. Over half of the participants (66.1%) confirmed that they did not have a family history of cancer, while 22.9% did. 11.8% of the females who had a family history of breast cancer would consider undergoing genetic testing for breast cancer, 3.9% would not consider undergoing genetic testing and 2.1% preferred not to answer this question. When the participants were asked whether they had ever been diagnosed with breast cancer, 87.5% responded no, 5.3% had been diagnosed with breast cancer and 7.2% preferred not to answer. 60.8% of the participants had heard of BSE, while 30.1% had never heard of it. When participants were asked whether they had ever performed BSE, shockingly 60.6% had never performed it. Only 20.7% of the participants performed BSE rarely, 5.5% performed once every 2 months, 9.6% performed once a month and 3.6% performed it once per week. Unfortunately, approximately 70% of the participants had never been for breast cancer screening.
Women's breast cancer self-diagnostic skill scoring results were as follows: 18% had poor skills, 61% had average skills, 17% had good skills and only 4% had excellent skills. All of the variables related to self-diagnostic skills showed no significance.
| Discussion|| |
Since there are no confirmed methods to prevent breast cancer at later stages, it is highly important to identify its early symptoms. Studies have reported that in Arab countries, the average breast cancer presentation appears a decade earlier than those within Western countries. Therefore, breast cancer knowledge and awareness in Arab countries is of high importance. The current study evaluated a total of 584 UAE female residents over a period of 1 month.
The study obtained more responses from UAE female citizens, under the age of 25, most of which were single; this could mainly be due to the fact that the survey was mainly distributed amongst students of the HCT. In the current study, females had breast cancer knowledge scores between average and good, indicating that the participants had a sufficient amount of knowledge. The good level of knowledge amongst the participants may be attributed to their level of education as most of the participants were holders of diploma/bachelor certificates. Our results were similar to studies by Elobaid et al., who also reported that educated women in Al Ain, UAE, had a higher level of breast cancer knowledge. About half of the participants had average breast cancer knowledge, but they wanted additional information on breast cancer; these groups of people require more breast cancer awareness programmes; For instances, such events may be organized by different hospitals or universities. Similar studies on Qatari women indicated adequate breast cancer knowledge. While it is reported that women from Saudi Arabia had insufficient awareness levels, another study concluded that age plays a role in breast cancer. Women are not aware that age is a predominant risk of breast tumour formation. Our findings opposed this and indicated that the majority of the participants agreed that age contributed to breast cancer development, Elderly people seemed to be more susceptible to develop breast cancer.
Half of the participants in this study thought that the first noticeable symptom of breast cancer was breast lump; these results are consistent with those of Singh, which indicated that women with breast cancer first noticed a breast lump and then went for further examination. Women in the United Kingdom showed a poor understanding of the early warning signs of breast tumours. These results are similar to our study, as the majority of the participants were only familiar with a breast lump and were unaware of other non-lump symptoms. Literature indicates that mammography is the first screening procedure taken in order to assess breast lumps. Our findings indicated that the most well-known breast cancer diagnosing procedure amongst participants was mammography. In our studies, 41.1% of the participants did not know when to start practicing BSE. The figures pose a great concern to public health. Campaigns raising such concerns may be helpful in spreading awareness about BSE. The significant variables related to the knowledge of UAE women were educational status and family genetic disease. These variable clearly indicated that women with either higher educational level or with past experience had greater knowledge about breast cancer than other participants. In the current study, more than half (65.2%) of the participants knew that the UAE offers a free screening programme for breast cancer detection; despite this, 69.5% of the UAE female residents had never been for breast screening programmes. Our results are consistent with those of previous studies which indicated that female participation in breast screening programmes was quite low.
The low number of participants can be attributed to cultural and religious aspects. Healthcare providers such as doctors and nurses have a major role in educating women as studies have shown that breast cancer knowledge improvement increases screening uptakes., All of the variables related to the participant's self-diagnostic skills showed no skill-associated significance. BSE must be performed in the early years of menstruation to avoid delayed detection of breast cancer. A large number of participants (34.1%) in this study agreed that menstruating women should practice BSE. The determination of awareness and self-diagnostic skills amongst females within the community is an important factor in controlling breast cancer. In this study, although 60.8% of the participants had heard of BSE, the majority of them (60.6%) had never performed it.
The results of our study are similar to studies conducted by Bener et al., that showed only 12.7% of the females practiced BSE, 13.8% attended clinical breast examinations and 10.3% had mammography. Nowadays, genetic testing has proven to be a powerful tool in identifying gene mutations that may increase the risk of breast cancer development. Data from our study showed that 22.9% of the females had a family history of cancer; out of which only 11.8% would consider undergoing genetic testing for breast cancer. In contrast, it was reported that 84% of the Italian women agreed that they would undergo genetic testing. In another instance, 72% of the young Canadian females diagnosed with breast cancer reported their interest in breast cancer genetic testing.
| Conclusion|| |
Despite breast cancer being the leading cancer amongst women in the UAE, the current study results show that UAE female residents have an average knowledge of breast cancer and poor breast cancer self-diagnostic skills. A special breast cancer self-diagnostic educational awareness campaign to be integrated into the existing programmes across the UAE is recommended.
Additionally, promoting programs that target in spreading awareness of breast cancer must be encouraged. Such programs must emphasize the need of regular breast screening to minimize the mortality and morbidity rate among women.Although, the prevalence of breast cancer in elderly women is common, it is not uncommon to develop breast cancer in an early age. Therefore, such campaigns and screening programs must target women of all ages. It is suspected that culture might have an effect on screening acceptance in the UAE, therefore targeting religious leaders to educate, spread breast cancer awareness, and emphasize the importance of breast screening practices, which nevertheless may positively enhance breast-screening responses and practices amongst women in the UAE. Last but not the least, allied healthcare professionals and female doctors and nurses need to play an important role in encouraging and educating female patients on breast cancer signs and symptoms.
The study was approved by the institutional Ethics Committee of Higher College of Technology. (Approval No. HML_4936).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Elobaid Y, Aw TC, Lim JN, Hamid S, Grivna M. Breast cancer presentation delays among Arab and national women in the UAE: A qualitative study. SSM Popul Health 2016;2:155-63.
Forouzanfar MH, Foreman KJ, Delossantos AM, Lozano R, Lopez AD, Murray CJ, et al.
Breast and cervical cancer in 187 countries between 1980 and 2010: A systematic analysis. Lancet 2011;378:1461-84.
Akram M. Awareness and current knowledge of breast cancer. Biol Res 2017;50:1-23.
Antoniou A, Easton D. Models of genetic susceptibility to breast cancer. Nature 2006;25:5898-905.
Rahman S, Zayed H. Breast cancer in the GCC countries: A focus on BRCA1/2 and non-BRCA1/2 genes. Sciencedirect 2018;668:73-6.
El-Helal T. Pattern of cancer in the United Arab Emirates referred to Al-Ain Hospital. ASM 1997;17:506-9.
Al Saigh AA, Allam MM, Khan KA, Al Hawsawi ZM. Pattern of cancer in Madina Al-Munawara region. Ann Saudi Med 1995;15:1-5.
McCready T. Breast self-examination and breast awareness: A literature review. Womens Health 2004;14:570-8.
Al-Sharbatti S. Breast self-examination practice and breast cancer risk perception among female university students in Ajman, UAE. Gulf Med J 2012;1:72-9.
Anderson B. Breast cancer issues in developing countries: An overview of the breast health global initiative. World J Surg 2008;32:2578-85.
DeSantis C. International variation in female breast cancer incidence and mortality rates. Cancer Epidemiol Biomarkers Prev 2015;24:1495-506.
Albeshan, S. Transforming breast cancer diagnosis in Ras Al Khaimah. Policy Pap 2008;25:1-10.
Tabar L, Tot T, Dean P. The art of Science of Early Detection with Mammography
. Thieme International; Stuttgart, Germany: Breast Cancer 2005.
Donnelly T, Hwang J. Breast cancer screening interventions for Arabic women: A literature review. J Immigr Minor Health 2005;17:925-39.
Ohaeri B, Aderigbigbe M. Knowledge and use of breast self-examination and mammogram among women of reproductive age in Oyo State Secretariat, Ibadan, Oyo State, Nigeria. Eur J Midwifery 2019;3:1-7.
Anderson B. Early detection of breast cancer in countries with limited resources. Breast J 2003;9:S51-9.
Austoker J. Breast self-examination. Br Med J 2003;326:1-2.
Julietta P. Giving the knowledge. Deepdyve 1995;9:1-20.
Wang L. Early diagnosis of breast cancer. Sensors 2017;17:1572.
Sadler GR, Dhanjal SK, Shah NB, Shah RB, Ko C, Anghel M, et al.
Asian Indian women: Knowledge, attitudes and behaviors toward breast cancer early detection. Public Health Nurs 2001;18:357-63.
Haad TJ. Community Profile Summary of Findings; 2008. Available from: http://www.haad.ae
. [Last assessed on 2019 Nov 15].
Sharifa Ezat WP, Fuad I, Hayati Y, Zafar A, Wanda Kiyah GA. Observational study on patient's satisfactions and quality of life (QoL) among cancer patients receiving treatment with palliative care intent in a tertiary hospital in Malaysia. Asian Pac J Cancer Prev 2014;15:695-701.
Oshima S. A qualitative study of Japanese patients' perspectives on post- treatment care for gynecological cancer. Asian Pac J Cancer Prev 2011;12:2255-61.
Omotara B, Yahya S, Amodu M, Bimba J. Awareness, attitude and practice of rural women regarding breast cancer in Northeast Nigeria. J Community Med Health Educ 2012;2:2-4.
Najjar H, Easson A. Age at diagnosis of breast cancer in Arab nations. NCBI 2010;8:448-52.
Bener A, El Ayoubi R, Moore A, Basha B, Joseph S, Chouchane L. Do we need to maximize the breast cancer screening awareness? Experience with an endogamous society with high fertility. NCBI 2005;10:599-604.
Radi M. Breast cancer awareness among Saudi females in Jeddah. Asian Pac J Cancer Prev 2013;14:4307-12.
Singh D. Breast cancer epidemiology, prevention, and screening. Int J Cancer 2014;136:1-32.
Grunfeld A, Ramirez J, Hunter S, Richards A. Women's knowledge and beliefs regarding breast cancer. Br J Cancer 2002;86:1373-8.
Brunswick N, Wardle J, Jarvis J. Public awareness of warning signs for cancer in Britain. Cancer Causes Control 2001;12:33-7.
Milosevic M, Jankovic D, Milenkovic A, Stojanov D. Early diagnosis and detection of breast cancer. Technol Health Care 2018;26:729-59.
Fletcher W, Black W, Harris R, Rimer K, Shapiro J. Report of the international workshop on screening for breast cancer. Natl Cancer Inst 1993;85:1644-56.
Davis C, Arnold C, Berkel J, Nandy I, Jackson H, Glass J. Knowledge and attitude on screening mammography among low-literate, low- income women. Cancer 1996;78:1912-20.
Holowaty P, Miller B, Baines J, Risch H. Canadian National Breast Screening Study: First screen results as predictors of future breast cancer risk. PubMed 1993;2:11-9.
Ibrahim A, Odusanya O. Knowledge of risk factors, beliefs and practices of female healthcare professionals towards breast cancer in a tertiary institution in Lagos, Nigeria. BMC Cancer 2009;9:76.
Valencia M, Samuel E, Viscusi K, Riall S, Neumayer A, Aziz H. The role of genetic testing in patients with breast cancer: A review. NCBI 2017;152:589-94.
Bruno M, Tommasi S, Stea B, Quaranta M, Schittulli F, Mastropasqua A, et al.
Awareness of breast cancer genetics and interest in predictive genetic testing: A survey of a southern Italian population. Ann Oncol 2004;15 Suppl 1:I48-54.
Tambor S, Rimer K, Strigo S. Genetic testing for breast cancer susceptibility: Awareness and interest among women in the general population. Am J Med Genet 1997;68:43-9.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]