Breast cancer: attitude, knowledge and practice of breast self examination of 157 saudi women.

INTRODUCTION: Breast cancer is the commonest cancer in Saudi females. Breast self examination (BSE) is a practical screening method for early detection of breast cancer.
OBJECTIVES: The aim of the study is to find out knowledge and practice of BSE among Saudi women and their attitude towards breast cancer.
METHODS: 157 Saudi women were randomly selected and interviewed in the general clinics of King Abdulaziz University Hospital, Jeddah, and a questionnaire was used to collect data.
RESULTS: The age range of the women was from 15 to 69 years with mean age of 32.5 years and median of 30 years. 80 (51%) out of 157 women were illiterate. 19 (12%) women were found to conduct BSE, 8 (5%) regularly and 11 (7%) irregularly. 145 (92%) showed willingness to seek medical advice if they discover lumps in their breasts. The motives of these women were, a desire to reach a diagnosis at an early stage in the hope of cure in 120 (76%) and fear of cancer in 25 (16%). 11 (7%) women were unwilling to seek medical advice and the motives of these women were fear of cancer in 5 (3%) and shyness in 6 (4%). CONCLUSIONS #ENTITYSTARTX00026; RECOMMENDATIONS: The proper technique of BSE should be taught to all Saudi women using all means of education either through books and magazines for literate women or through video films and self explanatory charts for illiterate women. A national campaign aimed at raising women's awareness about breast cancer and BSE is recommended.

INTRODUCTION

Breast cancer is the commonest female cancer in the western communities. Sebai1 and Koreich2 have shown that breast cancer is also the commonest cancer in Saudi females. Breast self-examination (BSE) is a practical screening method for the early detection of breast cancer but its efficacy is limited by the extent to which women can be taught to perform a frequent and proficient examination.34 It is disheartening to see in the clinics, women with breast cancer at an incurable stage with fungating tumors or primary tumors often more than 5 cm in diameter. Surely these tumors were detectable for a long period of time before presentation. In the Cardiff breast clinic, a survey demonstrated that about two-thirds of women with lumps in their breast had intentionally delayed reporting their symptoms to the family doctor5. This delay varied from a few months to several years. In the vast majority of cases it was not ignorance that caused the delay, but more likely the fear of having the diagnosis of cancer confirmed, and a wish to delay or deny the inevitable.

This is a study of 157 Saudi women's knowledge and practice of BSE and attitude towards breast cancer.

SUBJECTS AND METHODS

The study was conducted in the general clinics of the Outpatient Department, general clinics, of King Abdulaziz University Hospital; a screening and referral facility for the speciality clinics. The study group was selected randomly from Saudi women among the patients who attended the clinics for various complaints. A questionnaire was developed to obtain demographic information and socioeconomic status of the women. Also it contained questions about BSE, whether each woman examines her breasts regularly, (i.e. at least once a month), how and when to conduct BSE, how the method was learned and the action the individual would take if confronted with the situation of having a lump in her breast and her motive. A well recognized BSE chart was shown to each selected woman for comparison with the method she was using (Winthrop Practitioner Service Breast Self-examination Chart). The questionnaire was administered to illiterate women by any of the four general practitioners attending the clinic. These practitioners were trained for this task by the co-author (AMI) who is in charge of the general clinics. The recorded information was entered into a personal computer and subsequently analyzed.

RESULTS

The study included 157 women with mean age of 32.5 years, median of 30 years and an age range from 15 to 69 (Table 1). 121(77%) women were married, 22 (14%) unmarried, 11 (7%) widow and 3 (2%) divorced. The educational status of these women is shown in (Table 2).

TABLE 1

Age Distribution of Women in BSE Study

TABLE 2

Educational Status of Women in BSE Study

BSE: KNOWLEDGE AND PRACTICE

19 (12%) out of 157 women were found to examine their breasts, 8 (5%) regularly and 11 (7%) irregularly. 3 (2%) of the women used the method shown on BSE chart and 16 (10%) used improper methods. Two of the women who examined their breasts regularly did so before, 2 during and 4 after the menstrual period. Only 3 (2%) women learned the BSE method from a book.

ATTITUDES

145 (92%) women chose to see a doctor if they discover lumps in their breasts. The motives behind these women's action were, the desire to reach early diagnosis in 120 (76%) women, fear of cancer in 30 (19%) and shyness in 6 (4%). 7 (4.5%) women considered the matter not important. 4 (2.5%) women chose to consult an elder female friend or relative and 1 had no idea what to do.

DISCUSSION

Breast self-examination (BSE) had been reported as useful means for early detection of breast cancer6–8. In the United States of America 70-90 percent of breast cancers are discovered by women themselves3. It is alarming to find only 19 (12%) out of 157 women in our study knew about BSE and only 3 (2%) of them knew the proper technique. Most of the women in our study were in the third and fourth decades of life. This is the age at which they are at risk9. Almost half of them (80) were illiterate. This fact should be carefully taken into consideration in planning any educational programme for women in Saudi Arabia. Television programs, video films and self explanatory charts will be needed for this group of women. BSE frequency is one of the factors which determine the effectiveness of BSE310. Unfortunately less than half (8/19) of the women who conducted BSE were regular and half of these women knew the appropriate time to conduct BSE, after the menstrual period. There is a great lack of women's education about this disease. The health education providers in the various sectors must participate in the education of Saudi females about this visible and palpable part of their body and how and when to perform BSE for the early detection of any lump and to report to the doctor as early as possible, as this action will lead to treatment of the disease with favourable results and prognosis.

It is encouraging that the majority of the women in the study group (145) were willing to seek medical advice if they find lumps in their breasts. Fear of cancer was a shared motive between 30 (19%) women; 25 (16%) were willing and 5 (3%) were unwilling to seek medical advice. Fear is a natural phenomenon but it should not be left to dominate and affect negatively the action of women when they find lumps in their breasts. We believe that pressure must be placed on women to seek medical advice as soon as they detect lumps in their breasts. Equal pressure must be put on general practitioners to conduct examination of breasts in every annual general examination, especially for women in the fourth and fifth decades of life.

In conclusion, the knowledge and practice of BSE is extremely poor among Saudi women. This implies their unawareness of the facts about the commonest female cancer. We strongly recommend that all means of education for women such as women's magazines and television programs should be directed towards the education of women about breast cancer and BSE. A national campaign aimed at raising women's awareness about breast cancer accompanied by referral breast clinics at the secondary health care centers all over the Kingdom is recommended. It is also recommended that biology books for female students in the secondary and intermediate schools should include information about breast structure and the importance of conducting. BSE regularly after each menstrual period.