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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 2  |  Page : 89-100

Screening mammography and breast self-examination: Attitudes and practices of women in the Eastern Province of Saudi Arabia


1 Consultant Radiologist, Head of Breast Imaging Unit, Chairperson of Breast Cancer Early Diagnostic Committee, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
2 Anesthesia & Intensive Care, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
3 6th Year Medical Student, Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
4 Department of Internal Medicine, Royal Commission Hospital, AL Jubail, Saudi Arabia

Date of Web Publication1-Oct-2018

Correspondence Address:
Dr. Radwa Bakr
P.O. Box 1982, Dammam 31441
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_4_18

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  Abstract 


Background: The Eastern Province has the highest incidence of breast cancer in Saudi Arabia. The absence of an organized national education and screening program, combined with sociocultural factors, contributes to the presentation of advanced stages. Aim: This study was undertaken to assess the attitudes and practices of women in the Eastern Province toward screening mammography (SM) and breast self-examination (BSE). Subjects and Methods: A cross-sectional study was carried out using a structured questionnaire. Statistical Analysis: We used the Statistical Package for the Social Sciences. Double data entry procedures were used to assure quality and to detect errors in data entry. Frequency distributions were used to describe the data. Association between variables was evaluated by the Chi-square test, and a P≤ 0.05 was considered indicative of statistical significance. Results: A total of 611 females responded to the questionnaire. 12.4% reported having undergone mammography, 48.1% reported that they intended to do it in the future, while 12.7% reported having no intention to perform it. 43% reported performing BSE regularly. Sources of information about breast cancer and breast cancer screening included educational campaigns (27.8%) and media (27.8%). 75.2% of the respondents reported that their physician had no role in educating them about breast cancer screening. There was a significant relationship between the educational level of respondents and the practice of both BSE (P = 0.0001) and SM (P = 0.0000), as well as a significant association between the practice of mammography and having a relative diagnosed with cancer (P = 0.001). Conclusion: The results of our study revealed a low prevalence of breast cancer screening behaviors, 43% reported performing BSE, and only 12.4% had previously undergone SM. We strongly recommend that efforts must be carried out to increase the awareness of women.

Keywords: Awareness, breast cancer, breast self-examination, mammogram, radiology


How to cite this article:
AL-Mulhim F, Bakr R, Almedallah D, Alkaltham N, Alotaibi A, Alnoaim S. Screening mammography and breast self-examination: Attitudes and practices of women in the Eastern Province of Saudi Arabia. Saudi J Health Sci 2018;7:89-100

How to cite this URL:
AL-Mulhim F, Bakr R, Almedallah D, Alkaltham N, Alotaibi A, Alnoaim S. Screening mammography and breast self-examination: Attitudes and practices of women in the Eastern Province of Saudi Arabia. Saudi J Health Sci [serial online] 2018 [cited 2018 Oct 21];7:89-100. Available from: http://www.saudijhealthsci.org/text.asp?2018/7/2/89/242502




  Introduction Top


Breast cancer is leading cancer in women in Saudi Arabia and worldwide.[1] In the last few decades, a steady rise has been noted in the incidence of breast cancer in Saudi Arabia.[2] This is especially true about the Eastern Province which has the highest incidence of breast cancer in the Kingdom.[1] The malignancy affects women's health from several facets including socioeconomic and emotional aspects, in addition to their ability to fulfill their role in the community. These implications are especially evident in Saudi Arabia due to conservative nature of the society in which certain dynamics such as fatalism, shyness, and cultural beliefs affect the adaptability and quality of life of breast cancer patients.[3],[4],[5],[6] One of the factors that contribute to the late diagnosis of breast cancer among Saudi women is lack of knowledge leading to their belief in the misconceptions associated with the disease. Multiple studies have demonstrated this lack of basic knowledge and awareness and its association with the diagnosis of the disease in late stages. Recent research conducted in Riyadh reported that, although over 90% of women knew about breast self-examination (BSE), the majority (79%) did not perform it regularly.[7] Another study conducted in Abha found that the practice of BSE was around 29.7%, while screening mammography (SM) was 6.2%.[8] These findings should raise concerns especially since SM has been shown to play an important role as a screening modality for asymptomatic patients for early detection of breast cancer due to its high sensitivity and specificity.[9] Recent studies showed a reduction in mortality due to breast malignancy in patients aged 50–69 years who underwent regular mammography.[10] In the absence of an organized national education and screening program in the region, combined with social and cultural factors, most of the breast cancer cases present at an advanced stage compared to developed countries.[10] However, several breast cancer awareness campaigns have been conducted over the past 8 years in the Eastern Province, making it crucial to evaluate the level of awareness in our population. The aim of this study is to assess the attitudes and practices of women in the Eastern Province of Saudi Arabia toward SM and BSE as steps for early detection of breast cancer.


  Subjects and Methods Top


A cross-sectional study was carried out among a community-based sample of Saudi Arabian women in the period between October 2015 and October 2016. All adult females aged 18 years and above who were able to communicate in the Arabic language were included in our study. Informed consent was obtained from all the study participants before filling the questionnaire.

Instrument

The data collection tool consisted of a validated and reliable, self-administered structured questionnaire [Questionnaires 1 and 2]. An expert panel verified the content validity of the questionnaire, and internal consistency was assessed using item-total subscale correlation. The original questionnaire was developed in Arabic and then translated to English by bilingual members of the research team. The questionnaire consisted of three sections:

Background information on respondents

This section included information about the respondents' age, nationality, gender, education level, marital status, employment status, and menstrual and reproductive history.

Respondents' attitudes and practices toward screening mammography

This section was divided into two parts; the first part covered respondents' attitudes toward mammography and consisted of eight open-ended questions and the second part covered respondents' intention to undergo mammography

Respondents' attitudes and practices toward breast self-examination

This section was divided into two parts; the first part covered respondents' attitudes toward BSE and consisted of six questions and the second part covered respondents' practices of BSE.

Statistical analysis

For analysis of data, we used the Statistical Package for the Social Sciences version 20.0 (IBM Corporation, Armonk, NY, USA). Frequency distributions were used to describe the data. Association between variables was evaluated using Chi-square test, and a P ≤ 0.05 was considered statistically significant.


  Results Top


Six hundred and eleven females responded to the study questionnaire. The general characteristics of the respondents are shown in [Table 1]. Regarding respondents' attitudes toward mammography, only 12.4% had previously undergone mammography; of these, 50.9% performed it based on physician's recommendations and 42.1% were self-motivated. 61.1% of participants underwent mammography for due to fear of getting cancer, 21.8% preformed BSE because somebody they knew had cancer, and 2.1% because they themselves had cancer. For those who did not undergo mammography, 51.3% did not undergo the procedure because they did not have any complaint, 7.8% for fear of discovering cancer, and 20.6% thought they were too young to need it. Most respondents reported that their sources of information about breast cancer and breast cancer screening were educational campaigns and the media (27.8% and 23.7%, respectively). 75.2% of the respondents reported that their physician had no role in educating them about the importance of mammography[Table 2]. Respondents' intention to undergo mammography is demonstrated in [Figure 1].
Table 1: Sociodemographic characteristics (n=611)

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Table 2: Attitudes towards mammography (n=611)

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Figure 1: Respondents' intention to undergo mammography

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Our results showed that 43% of the respondents perform BSE. Of these, 2.7% performed it daily, 9.7% performed it weekly, 58.3% performed it monthly, and 29.3% performed it yearly [Table 3]. The steps that the respondents followed during BSE are detailed in [Figure 2].
Table 3: Attitudes toward breast self-examination (n=611)

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Figure 2: Knowledge of breast self-examination practices

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No statistically significant differences were found between different age groups regarding the practice of SM or BSE. In addition, there was no relationship between marital status and these practices. However, there was a significant association between the educational level and the practice of both BSE (P = 0.0001) and SM (P = 0.0000). Our results also demonstrated a significant relationship between the practice of mammography and having a relative diagnosed with cancer (P = 0.001) [Table 4].
Table 4: Practice of breast self-examination and screening mammography according to sociodemographic characteristics (n=611)

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  Discussion Top


Cancer screening involves testing to detect the disease in its early stages before the appearance of signs or symptoms. This involves the application of a population-wide early detection screening test for apparently healthy people to detect unrecognized malignancies. The aim of national screening is to decrease the incidence of cancer and to reduce deaths from cancer by the detection of preclinical disease.

The American Cancer Society and the US Preventive Services Task Force (USPTF) have established guidelines for the early detection of breast cancer. The guidelines suggest that mammography, with or without clinical breast examination, should be carried out every 1–2 years as an efficient means for the detection of breast cancer in its early stages.[11],[12]

In Saudi Arabia, national recommendations for early detection of breast cancer are in line with the international guidelines; clinical practice guidelines on the use of screening strategies for breast cancer developed by the Ministry of Health of Saudi Arabia suggest screening with mammography for women aged 40–49 years every 1–2 years and for women aged 50–69 years every 2 years and no SM for women aged 70–74 years. The guidelines suggest that BSE and clinical breast examination should not be used as a single screening method for breast cancer in women of all ages.[13]

The Eastern Province of Saudi Arabia has experienced a rise in the number of cases diagnosed with breast cancer. With an age-standardized rate of 41 per 100,000 of the female population,[1] the Province has the highest number of newly diagnosed cases of breast cancer compared to other regions of the country. In Saudi Arabia, most cases of breast cancer present late; consequently, there is an urgent need for prevention and early diagnosis of this disease. Considering these factors, the Saudi Cancer Foundation and King Fahd University Hospital, among other nongovernmental organizations, provide free breast cancer screening programs.[14]

Our study showed that of our sample of women in the Eastern Province of Saudi Arabia, only 12.4% had previously undergone mammography. These rates are even lower than those recorded in other Arabic and Islamic countries characterized by the conservative nature of their culture.[4],[15],[16],[17] These low compliance rates may contribute to the late diagnosis and increased mortality from breast cancer among Saudi Arabian women.

In our study, 50.9% of the women who underwent mammography performed it based on their physician's recommendation. Our findings match the results of other studies that demonstrated that lack of physician recommendation accounted for approximately 30% of the recorded reasons for not undergoing SM.[18] Similarly, Soskolne et al. reported that women were more inclined to go through the procedure if they received advice to do so from a healthcare professional,[15] highlighting the fact that although preventive health actions are carried out by individuals, they are commonly facilitated by the quality of the interaction between patients and their physicians.

This study showed that 61.1% of the respondents underwent SM for fear of getting cancer and 21.8% did the screening because somebody they knew had cancer. This indicates that they performed the procedure with the intention of early detection and screening. Only 2.1% expressed that their reason for performing the mammography was that they had felt a breast lump. In contrast to these findings, Othman et al. found that almost half the women in their study performed mammography after already noticing a breast lump.[4] The fact that our respondents exhibited a proactive attitude toward screening instead of waiting until a lump was detected may be due to the effect of awareness campaigns in the Eastern Province such as “Pink Eastern” which may have contributed to these favorable results. Arab women generally exhibit a peculiar view toward health; they believe that good health is equivalent to the absence of visible symptoms[19] and habitually seek medical help only for the management of apparent disease, instead of undertaking preventive health measures. Health professionals should keep in mind these perceptions and aim for the delivery of health advice and services that are sensitive to these cultural singularities.[20]

For those in this study who reported never having undergone mammography, the majority claimed that they did not undergo the screening because they did not have any complaint or that they thought they were too young to need it. Earlier studies have reported that the most frequently cited reasons for the reluctance of women to undergo mammography were too busy or fear of a diagnosis of breast cancer.[21] Several studies have investigated the causes for the late presentation of breast cancer and have attributed it to the sociocultural perception of this disease. Fear that a diagnosis of breast cancer will entail mastectomy has been reported as one of the main reasons, for which some women delay therapy or seek alternative therapy.[22] Consequently, valuable time is lost on ineffective treatment which results in the patient presenting later with more advanced stages of cancer. The presence of a strong supportive social network, including family, friends, colleagues, and employers, is likely to promote a positive attitude toward preventive health care; this concept should be promoted by well-planned health education campaigns.

Several authors reported that embarrassment and cost were some of the reasons cited by women for not undergoing SM.[21],[22] However, these reasons were not encountered in our study due to the availability of female medical staff in screening campaigns and the fact that the services are offered for free. Saudi Arabia does not have a shortage of health care providers or settings; a nationwide breast cancer screening center has been established in Riyadh in 2007. Mammography is currently available in all regions of the Kingdom. In fact, data from earlier studies showed that the Eastern Province exhibited the highest rates of screening mammograms in Saudi Arabia. However, despite their availability, SM programs in Saudi Arabia are still opportunistic. It has been demonstrated that organized cancer-screening programs help in the reduction of cancer mortality, are more cost-effective in the long term, and have less harmful effects compared to opportunistic programs.[23]

When asked about the source of information that had the greatest impact on them, 27.8% answered that it was the educational campaigns and 23.7% said that it was the media. These findings highlight the role of the media and educational campaigns as important sources of information about breast cancer and screening programs. It is reasonable to believe that media-based health education interventions can successfully promote and encourage participation in screening tests for breast cancer.[24]

Our study also examined women's attitudes and practices regarding BSE. BSE is a cost-free, easy, and simple procedure. Despite not having been proven to induce a decrease in mortality, it remains effective in promoting self-responsibility about health and disease prevention, as well as enhancing awareness about breast cancer.[25]

Although the USPTF suggested that BSE showed no benefit, evidence from other sources suggests that BSE can help in breast cancer detection in high-risk women.[26] Furthermore, recent studies have revealed that breast cancer is often detected by the women themselves.[25] In western countries, many health education authorities and guideline-making institutions have shifted their efforts toward breast awareness, which involves a watchful attitude of women toward any changes detected in their breasts.[27]

In our study, 43% of the respondents reported performing BSE. Of these 2.7% reported performing it daily, 9.7% weekly, 58.3% monthly, and 29.3% once a year. Comparable results have been reported by Othman et al., who found that approximately half of the women performed regular BSE. Our data about the steps that our respondents take in performing BSE and the frequency with which they perform it lead us to believe that more education programs are needed to better educate women about BSE.

Despite the controversy in the literature around BSE, the American Cancer Society still encourages women to be mindful of the way their breasts feel and look to be able to detect any changes rapidly and report them promptly to their health care provider.[23] Women should be trained on how to carry out BSE and the timing and frequency with which it should be performed.


  Conclusion Top


The results of our study reveal a low prevalence of breast cancer screening behaviors among females in the Eastern Province of Saudi Arabia as well as insufficient efforts by health care professionals to educate women in the region. Emphasis should be made on raising awareness towards breast cancer among women to overcome the constantly increasing burden of the disease. It is strongly recommended that well-designed health education campaigns be carried out to increase awareness of women about breast cancer as well as to inform them about the methods and frequency of breast self-examination and the value of regular screening mammography.

Acknowledgments

We would like to thank Deema Al-Abdulhadi and Faisal Katbi for their contributions to the data collection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Questionnaire 1: Top


Questionnaire about men awareness of breast cancer



First: Personal Data:

  1. Age:……….
  2. Education: 1-Diploma ( ) 2-Intermediate ( ) 3-College Graduate ( ) 4-Post Graduate ( )
  3. Marital status: 1-Single ( ) 2-Married ( ) 3-Widowed ( ) 4-Divorced ( )
  4. Occupation:………………………….


  5. Second: Health Status Data:

  6. Do you have Cancer?


    1. Yes ( )
    2. No ( )


  7. Have you had any surgery?


    1. Yes ( )
    2. No ( )


  8. In case of answering Yes, what was the surgery?…………………….


  9. Do you take medications?


    1. Yes ( )
    2. No ( )


    Mention the duration of that medication …………

  10. Have anyone of your family had tumors before?


    1. Yes ( )
    2. No ( )


  11. If Yes, which kind of tumor?


    1. Benign ( )
    2. Malignant ( )


  12. Mention its location:


    1. Breast ( )
    2. Ovary ( )
    3. Colon ( )
    4. Others:………


  13. How you are related?


    1. Your Mother ( )
    2. Your Father ( )
    3. Ant to your father side ( )
    4. Ant to our mother side ( )
    5. Other:………………


    Third: Breast Cancer Information:

  14. What is breast cancer?


    1. I do not know (DK)
    2. It is a cancerous tumor that metastasizes to surrounding tissues, lymphatics, and other sites of the body (META)
    3. It is the most tumor affecting women (TAW)
    4. Dimples appearing on the breast (DAB)


  15. Who are the risk group:


    1. I do not know (DK)
    2. Men ( )
    3. Women ( )
    4. There is no difference (No Diff.)


  16. What are the kinds of this tumor?


    1. I do not know (DK)
    2. Benign and malignant (BAM)
    3. Only benign (B)
    4. Only malignant (M)


  17. What are the breast tumor symptoms?


    1. I do not know (DK)
    2. Inflammations or ulcers (IOU)
    3. Secretions of the nipples (SON)
    4. Bloody secretions of the nipples (BS)
    5. Itchy breasts (IB)


  18. How to early detect the disease?


    1. I do not know (DK)
    2. Breast self-examination (SE)
    3. Medical-examination (ME)
    4. Mammogram (Mamo)
    5. Ultrasound (U)
    6. All of that (All)


  19. Is there a cure for breast cancer?


    1. Yes ( )
    2. No ( )


  20. If Yes, how to treat it?


    1. I do not know (DK)
    2. Chemotherapy (CT)
    3. Radiation (Rad)
    4. Surgical (Sur)
    5. All of that (All)


  21. How to protect yourself from breast cancer? (you may choose more than one)


    1. I do not know (DK)
    2. Lowering Fats in your diet (LF)
    3. Eating more food containing fibers (Fibers)
    4. Eating more fruits and vegetables (FAV)
    5. Avoiding radiation (ARad)
    6. Avoiding Hormone supplements after menopause (AH)
    7. Exercising three times a week for at least thirty minutes (E3T)
    8. Not to smoke (NTS)
    9. Avoid stress and psychological strain (ASAPS)
    10. Ideal weight (IW)
    11. Monthly breast self-examination (MSE)
    12. Continuously taking enough sleep (ES)
    13. Avoid obesity (AO)
    14. Performing mammogram yearly after menopause (PMY)


  22. What is the association between Aging and the risk of breast cancer?


    1. I do not know (DK)
    2. Increases it ( )
    3. Decreases it ( )
    4. Has no effect (NoE)


  23. What is the association between infertility and the risk of breast cancer?


    1. I do not know (DK)
    2. Increases it ( )
    3. Decreases it ( )
    4. Has no effect (NoE)


  24. What is the association between delaying the age at birth of the first child until after the thirtieth and the risk of breast cancer?


    1. I do not know (DK)
    2. Increases it ( )
    3. Decreases it ( )
    4. Has no effect (NoE)


  25. What is the association between early menarche and late menopause with the risk of breast cancer?


    1. I do not know (DK)
    2. Increases it ( )
    3. Decreases it ( )
    4. Has no effect (NoE)


  26. What is the association between having a family history of breast cancer and the risk of having it?


    1. I do not know (DK)
    2. Increases it ( )
    3. Decreases it ( )
    4. Has no effect (NoE)


  27. What is the association between taking oral contraceptive pills and the risk of breast cancer?


    1. I do not know (DK)
    2. Increases it ( )
    3. Decreases it ( )
    4. Has no effect (NoE)


  28. What is the association between breastfeeding and the risk of breast cancer?


    1. I do not know (DK)
    2. Increases it ( )
    3. Decreases it ( )
    4. Has no effect (NoE)


  29. What is the association between previously having breast cancer and the risk of developing a new one?


    1. I do not know (DK)
    2. Increases it ( )
    3. Decreases it ( )
    4. Has no effect (NoE)


  30. When should a lady start to examine her breasts?


    1. I do not know (DK)
    2. Adulthood ( )
    3. After marriage ( )
    4. After having a baby (AHB)
    5. During breastfeeding ( )
    6. The period after having a baby (PAHB)


  31. Till which age a lady should examine her breasts?


    1. I do not know (DK)
    2. Adulthood ( )
    3. After menopause ( )
    4. All of her life (All)
    5. At necessary ( )


  32. What is the right time at which a lady should examine her breasts?


    1. I do not know (DK)
    2. Before menstrual period (BMP)
    3. During menstrual period (DMP)
    4. Directly after the menstrual period (DAMP)
    5. Two weeks after menstrual period (2WAMP)


  33. What is the importance of breasts self-examination?


    1. I do not know (DK)
    2. To be familiar with the normal breasts and detect any future changes (FWNB)
    3. To detect the disease at earlier stages (DAES)


  34. When a lady is at her menopause, when she should examine her breasts?


    1. I do not know (DK)
    2. Monthly ( )
    3. Every three months ( )
    4. Every 6 months ( )
    5. Yearly ( )


  35. When a lady should perform mammogram?


    1. I do not know (DK)
    2. Adulthood ( )
    3. After marriage ( )
    4. After having a baby (AHB)
    5. During breastfeeding ( )
    6. After fortieth ( )


  36. What is the best time for performing mammogram?


    1. I do not know (DK)
    2. weekly ( )
    3. Monthly ( )
    4. Yearly ( )


  37. Is breast cancer infectious?


    1. Yes ( )
    2. No ( )
    3. I do not know (DK)


  38. If your wife had breast cancer, what is your reaction?


    1. Fear ( )
    2. Unacceptance ( )
    3. Acceptance ( )
    4. Divorcing ( )
    5. Support ( )
    6. I do not know (DK)


  39. What is the source of your information?


    1. TV and radio ( )
    2. Friends ( )
    3. Magazines and newspapers ( )
    4. Saudi cancer society ( )
    5. Others:……………



  Questionnaire 2: Top


Questionnaire about the Breast Cancer Examination (Mammogram)

Age:

Nationality:

Occupation:

Social status: __Married __Unmarried

Number of children:

Age at first pregnancy:

Breastfeeding: ___Yes ___No

If yes, how many months_______

What age were you when you had your first menstrual cycle? _______

When did the last menstrual cycle come? ______

Did you use any contraceptives?
  1. Yes ( ) and
  2. No ( )


Weight:

Height:

BMI:

  1. Have you undergone the periodic mammogram examination before?

    Yes____ No____ Number of times?______
  2. How old were you when you undergone the mammogram for the first time?
  3. When was the last time when you undergone the mammogram?
  4. Who made the decision of you undergoing the mammogram?
  5. What was the motive behind undergoing the periodic examination of the mammogram?


    • Fear of getting cancer (FOC)
    • Somebody I know was diagnosed with cancer (SDWC)
    • I have/had cancer (CANCER)
    • Other:………………….


  6. What was the most significant motive behind not undergoing this examination?


  7. Please choose one answer from the following options:

    • I didn't suffer from any problem/complain in my breast (NP)
    • Fear of discovering that I have cancer (FEAR)
    • I'm not old (Not Old)
    • The cost of the examination (COST)
    • I'm very busy (BUSY)
    • Fear of X-ray (Xray)
    • I'm too old (OLD)
    • I'm not convinced (NC)
    • Other:…………………. (Other)


  8. What was the source of information that had the biggest impact on your decision on undergoing the periodic mammogram examination?


  9. Please choose one answer from the following options:

    • Media
    • Physician
    • Personal belief
    • Husband
    • Relative
    • Educational campaigns: Eastern region pink Zahra Foundation (ZAHRA)


  10. Did your physician have any role in educating you about the importance of undergoing the mammogram examination? Yes No


  11. Chose one of the following choices that specifically determine your determination to undergo the test or not:


    • I have never done the test, and I don't intend to do so (NDNI)
    • I have never done the test, but I intend to do so when I reach a certain age ……. (NDIA)
    • I did one or more test in the past and I don't intend to do it again in the future (DTNI)
    • I don't know what to do to undergo the mammogram examination in the future (DK)
    • I will discuss this topic with my physician before making the choice (DWP)
    • I have done the test and I intend to do it again in the future when I reach a certain age ……. (DTIF)
    • I will undergo the mammogram examination every year or two years if possible (YEARLY)


  12. Do you have a relative that was diagnosed with breast cancer, please specify the relationship:


    • Grandmother
    • Mother
    • Aunt (mother's sister) (AM)
    • Aunt (father's sister) (AF)
    • Sister
    • Daughter


  13. What is your educational level?


    • Less than high school (LHS)
    • High school (HS)
    • University (UNI)
    • Graduate studies (GRAD)


  14. Self-examination of the breast:


    1. Do you perform self-examination of the breast?


      • Yes
      • No


    2. How many times do you self-examine yourself?


      • Daily
      • Weekly
      • Monthly
      • Yearly


    3. If the answer was no, then chose one of the following answers:


      • Time-consuming (TC)
      • Not knowledgeable about self-examination (NKSE)
      • Fear of finding any abnormalities (FEAR)
      • Others, please mention………. (Other)


    4. What is the method that you use to self-examine your breast?


      • Standing in front of the mirror (Standing)
      • Laying on a bed and using your palm (Laying)
      • Choosing your fingers (Fingers)






 
  References Top

1.
Cancer Incidence Report, Saudi Cancer Registry. Kingdom of Saudi Arabia: Saudi Health Council; 2013. Available from: http://www.chs.gov.sa/Ar/HealthCenters/NCC/CancerRegistry/CancerRegistryReports/2013.pdf. [Last accessed on 2018 Aug 04].  Back to cited text no. 1
    
2.
Saggu S, Rehman H, Abbas ZK, Ansari AA. Recent incidence and descriptive epidemiological survey of breast cancer in Saudi Arabia. Saudi Med J 2015;36:1176-80.  Back to cited text no. 2
    
3.
Brown R, Kerr K, Haoudi A, Darzi A. Tackling cancer burden in the Middle East: Qatar as an example. Lancet Oncol 2012;13:e501-8.  Back to cited text no. 3
    
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Othman A, Ahram M, Al-Tarawneh MR, Shahrouri M. Knowledge, attitudes and practices of breast cancer screening among women in Jordan. Health Care Women Int 2015;36:578-92.  Back to cited text no. 4
    
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Al-Saad S, Al-Shinnawi H, Mahmood Shamsi N. Risk factors of breast cancer in Bahrain. Bahrain Med Bull 2009;31:1-11.  Back to cited text no. 5
    
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Miller AB. Screening for breast cancer in the Eastern Mediterranean region. East Mediterr Health J 2010;16:1022-4.  Back to cited text no. 6
    
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Saeedi MY. Knowledge, attitude and practice of breast cancer screening among female general practitioners in Riyadh, Saudi Arabia. Cancer Res J 2014;2:108-18.  Back to cited text no. 7
    
8.
Mahfouz AA, Hassanein MH, Nahar S, Farheen A, Gaballah II, Mohamed A, et al. Breast cancer knowledge and related behaviors among women in Abha city, Southwestern Saudi Arabia. J Cancer Educ 2013;28:516-20.  Back to cited text no. 8
    
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Siu AL, U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive services task force recommendation statement. Ann Intern Med 2016;164:279-96.  Back to cited text no. 9
    
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