Knowledge, beliefs, and practices on breast cancer, clinical breast examination, mammography screening and associated factors among rural Malay women in Kedah, Malaysia

In Malaysia, breast cancer is the commonest cancer in all ethnic groups and all age groups in females from the age of 15 years. The incidence of breast cancer in Malaysia had increased within a year from 30.8 per 100,000 populations in 2002 to 46.2 per 100,000 populations in 2003. Furthermore, there was no improvement regarding the presentation of stage and size of tumours. The delay in presentation of breast cancer among women in Malaysia can be connected with the social and cultural perception towards the disease. The recommended screening methods for breast cancer detection are mammography (MMG), clinical breast examination (CBE), and breast-self examination (BSE). However, MMG is recognized as the best method for early detection available today. Early detection is the secondary prevention to reduce the chance from cancer mortality and morbidity. It also could increase the chances for successfully treatment and cost-effective interventions. The purpose of this study was to assess the proportion of CBE and MMG screening practices the knowledge and beliefs on breast cancer and its screening as well as the factors associated with the screening practices. Thus, the result from this study can be used to create awareness, improved knowledge and change the perception of breast cancer and screening among rural population. A cross- sectional study was conducted among Malay rural women in Kedah. Four hundred and eighteen women were invited to participate in the study. Only 320 women aged 21 to 70 years agreed giving a response rate of 76.6%. The respondents were selected by simple random sampling. Face- to- face interview was conducted using a structured questionnaire. The questionnaire consisted of five core sections, namely socio demographic data, sources of information on breast cancer, practices on CBE and MMG, knowledge, and beliefs. Data analysis was performed using SPSS version 16. All the p- values were two-sided with a statistical significance level set at p <0.05. The respondents’ age in this study ranged between 21 and 70 years old mean age of the respondents was 44.89 + SD 12.89 years. Furthermore, 79.5% of the respondents were married and majority of them (71.9%) were not working. More than half of respondents had completed at least secondary school (51.9%). Majority (80.3%) of the respondents had monthly household income of less than RM 1,000 with median income of RM 675.00 + IQR 500.00. Sixteen (5%) respondents reported had family history of breast cancer. This study found only 154 (48.1%) of the respondents ever performed CBE screening while, there were six (2.8%) of respondents aged 40 years and older ever performed MMG screening. No pain, lack of knowledge, and embarrassment were most common barriers reported by respondents for not performed CBE and MMG screening. Age (p <0.001), marital status (p= 0.001), and education level (p= 0.001), were revealed to be significantly associated with practice on CBE screening. In addition, there were a significant difference between practices on CBE and score of knowledge (p <0.001). Similarly, for beliefs on breast cancer and screening, health motivation (p= 0.030), benefits of CBE (p= 0.021) and barriers of CBE (p< 0.001) score had significantly difference with CBE screening practices. Married women (OR= 2.242; 95% CI: 1.180- 4.259), and women with higher scores on knowledge of risk factors (OR= 1.160; 95% CI: 1.091- 1.235) were more likely to practice CBE. In contrast, women who had higher score on barriers towards CBE were less likely to practice the CBE (OR= 0.868; 95% CI: 0.814- 0.925). This study showed lower CBE and MMG screening practices among rural Malay women in Kedah. A few barriers were addressed which contributed to the reluctance from practicing the breast cancer screening. Sociodemographic factors, knowledge, and beliefs were found significantly associated with the practice of CBE screening among Malay rural women in Kedah. This study was identified the knowledge gaps, cultural beliefs, or behavioural patterns that may facilitate understanding and action, as well as pose problems or create barriers for breast cancer screening practices. Therefore, the result from this study can be used to identify needs, problems, and barriers that could be a reason in screening program delivery. The solutions for improving quality and accessibility of the screening services in Malaysia also could be addressed.

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