Breast Cancer Knowledge among Bahraini Women Attending Primary Health Care Centers
Reported, December 15, 2011
To evaluate breast cancer knowledge among Bahraini women aged 20 years and more attending primary health care centers.
A multistage sample was selected with a cluster sampling technique for the selection of one health center from each region; five health centers were selected. The sample was stratified according to the percentage of females residing in each region. A semi-structured questionnaire was used for interviewing the study participants.
Result: Seventeen (5.6%) women knew more than half of the correct answers, and the mean Percent Knowledge Index was 32.1% ± 12.7%. Newspapers, television, radio, were identified as the main source of knowledge of breast cancer. Highly educated
women were more knowledgeable about breast cancer (p=0.002), diagnostic modalities (p=0.008), and risk factors (p<0.0001). Women with positive family history of breast cancer knew more about treatment modalities than those without a history (p=0.017).
Moreover, no significant differences were found between the general knowledge and its subtypes among women with positive or negative personal history of breast complaints.
Conclusion: Breast cancer knowledge was deficient among Bahraini women. Efforts to improve womens education should be encouraged. Breast cancer should be included as a subject in the high school curricula, with emphasis on modifiable risk factors. The
maximum use of media should be encouraged in breast cancer campaigns.
Breast cancer is a global public health problem. It is the commonest cancer among women in the world; 1.4 million new cases are seen yearly, a prevalence of 4.4 million and 458,367 deaths annually. In 2008, the worlds age standardized incidence rate (ASIR) was 39
per 10 and the worlds age standardized mortality rate (ASMR) was 12.5 per 10 for breast cancer indicating a high survival rate for this type of cancer
1.In the Gulf Cooperation Council (GCC) countries, breast cancer is the commonest cancer
among females and the highest incidence is in Bahrain
2.The gulf center for cancer registration reported 1,206 female breast cancer cases during 2003 among the GCC female
nationals, accounting to 24.7% of cancers among females and 12.5% in both sexes. The ASIR
figures in GCC countries were as follow: Bahrain 56.3 per 10,, Kuwait 49.0 per 10,Qatar 46.4 per 10, Oman 26.8 per 10,UAE 24.3 per 10
, and Saudi Arabia 15.6 per 10
Breast cancer has been the leading cause of cancer among female nationals in Bahrain since the start of cancer registration in 1998. It has shown a marked increase with time, attributed partly to the implementation of mammography screening program in 2005. The ASIR has increased from 46.8 per 10 in 1998-2002 to 56.3 per 10 in 2003-2007
3. Data indicate that ASIR (49.8 per 10) in Bahrain is higher than less developed countries and higher than most
countries in the WHO Eastern Mediterranean Region
Breast cancer studies in Bahrain have shown that Bahraini women present usually late at diagnosis 5-6. Fakhro et al found that 93% of the patients are seen for the first time when they attend a physician at the Salmaniya Medical Complex (SMC); the patients had a disease
progression beyond clinical stage I, of which 21.4% were in clinical stage III and 11.1% in clinical stage IV, half of them having auxiliary lymph node involvement and a lump size of 2-5 cm on presentation.
A recent study revealed that half of the women diagnosed with breast cancer at the SMC were stage II, an average tumor size at presentation of 5.5 cm and that over half were between 41 to 60 years old
The study by Al-Saad et al confirmed that women in Bahrain appear to develop breast cancer at an early age, 70% were younger than 56 years old at presentation.
Although there are several private clinics and hospitals in the country, cancer management is centralized at Salmaniya Medical Complex, which receives referrals from all over the country
The aim of the study is to evaluate the knowledge of breast cancer among Bahraini women attending the primary healthcare centers (PHC).
RESULT OF THE STUDY
The mean age of the 300 women included in the study was 36.8 ± 9.1 years, a range of 21-61 years. Two hundred sixty-nine (90%) women were married, divorced or widowed. Hundred and sixty-six (55.3%) had a middle level of education (secondary education or diploma) and 99 (33%) were employed, of whom 58 (58.6%) had professional occupations. The differences between means of age across the educational level was highly significant (p<0.0005), whereby older women had lower educational levels (primary and less) than the younger women,
Two hundred eighty-six (95.3%) responded positively for the question have you ever heard
or read any information about breast cancer?. The sources of information were as follows:
television and radio, 187 (65.4%), followed by newspapers and journals, 149 (52.1%) and health care providers, 85 (29.7%). Although 18 (6.3%) of the women gave a positive history of breast complaints, none was due to breast cancer. However, 52 (17.3%) women reported a positive family history of breast cancer, of which 10 (19.2%) were among mothers or sisters. Identified risk factors were as follows: smoking 206 (68.7%), short periods of breast-feeding 178 (59.3%), advanced age 104 (34.7%), age at delivery of first child 69 (23.0%), early menarche 26 (8.7 %), and late menopause 19 (6.3%). None of the woman had attained the maximum 26 possible BCKS. The mean BCKS was 8.3 ± 3.3 with a median of 8 and a range from 0 to 18. The mean PKI was 32.1 ± 12.7%, with a minimum score of 0% and a maximum of 69.2%. Furthermore, only 17 (5.6%) women knew more than half of the correct answers.
CONCLUSION
This study shows that the overall breast cancer knowledge was deficient among Bahraini women, which could partly explain the late presentation of breast cancer patients to the health care providers as reported in the earlier studies. The finding that the highly educated women were more knowledgeable about breast cancer implies that efforts to improve womens education should be encouraged. Breast cancer should be included as a subject in the high school curricula, with emphasis on modifiable risk factors. Moreover, the maximum use of media as a vital source of knowledge of breast cancer should be encouraged in breast cancer campaigns.
Credits:
Majida Fikree, MD, MSc* Randah R Hamadeh, BSc, MSc, D Phil (Oxon)
More information :
http://www.bahrainmedicalbulletin.com/september_2011/
breast_cancer.pdf