A Survey on Singaporean Women’s Knowledge, Perception and Practices of Mammogram Screening

Abstract

Introduction: Singapore is the first Asian country to establish a nationwide breast screening programme, but our breast cancer screening uptake lags behind the Western countries. This survey focused on the subject of screening mammography, to assess the reasons for non-attendance and explore ways to improve our screening uptake. Materials and Methods: Females ≥21 years old were approached at primary healthcare clinics to participate in this survey, which questioned their knowledge, perception and expectations of breast screening. Results: There were 1011 respondents. Of the 740 respondents ≥40 years old, 332 respondents (45.5%) went for regular mammogram screening. Women who had lower household incomes [<$2000 (OR 0.49; 95% CI, 0.28 to 0.85); $2000 to $3999 (OR 0.59; 95% CI, 0.36 to 0.97)], did not know anyone with breast cancer (OR 0.62; 95% CI, 0.42 to 0.92), did not perform breast self-examination (OR 0.42; 95% CI, 0.28 to 0.62), had lower knowledge scores (OR 0.34; 95% CI 0.22 to 0.51), did not attend other health screening (OR 0.14; 95% CI, 0.05 to 0.41), and perceived mammography as embarrassing (OR 0.55; 95% CI, 0.31 to 0.96), were less likely to attend mammographic screening. Many did not know that screening is for the asymptomatic (51.2%), or the age to start screening (46.3%). Most respondents preferred to have their mammograms in the polyclinics (62.2%) and their screening reminders to be through short messaging service (SMS) (46.0%). Conclusion: Our results show the current influences on Singapore women’s screening practices, and also revealed that their understanding of mammogram screening is limited despite a high level of breast cancer awareness. Key words: Breast screening, Breast cancer, Asian women

Multi-level determinants of breast cancer screening among Malay-Muslim women in Singapore: a sequential mixed-methods study

“…To our knowledge this is the first study locally, to assess and compare factors associated with both ever gone for mammography, and regular mammography uptake. Most studies viewed mammography uptake as a single behavior and therefore assessed either uptake [ 12 – 14 ] or the intention to screen [ 42 ]. Of note, we found first and regular mammography uptake were only similar on two accounts in that, receiving cues from healthcare professionals facilitated both uptakes, and perception of needing symptoms prior to mammogram hindered both uptakes.…”

Barriers to breast cancer screening in Singapore: A literature review

“…Fear was the most common subtheme elicited. Perceived fear of the screening components (fear of procedural pain and fear of radiation from mammograms), 18,19 and perceived fear of screening outcomes (fear of cancer diagnosis leading to high out-of-pocket cost of treatment, fear of poor quality of life, fear of treatment side effects, fear of lifetime medication and fear of social stigma) are the most widely reported barriers to breast cancer screening among women in Singapore. 8,18,20…”

“…Such challenges included having "no time" due to personal or professional responsibilities and "inconvenience" in having to personally attend the screening that may or may not be nearby. 18,[20][21][22]…”

“…This was apparent in low-income families and among women who did not have any personal experience with breast cancer. 18…”

“…The involvement of male staff, previous negative personal experiences and negative experiences by others were specifically mentioned as barriers to screening. 18,22 These experiences could have contributed to distrust felt towards HCPs and screening methods. 22,25 Perceived susceptibility to breast cancer "I'm healthy" was commonly cited as a reason for avoiding breast cancer screening among women who have and have not undergone for a mammogram before.…”