Association of Knowledge and Cultural Perceptions of Malaysian Women with Delay in Diagnosis and Treatment of Breast Cancer: a Systematic Review

Abstract

Background: Breast cancer is the most common cancer and the leading cause of cancer mortality among women of all ethnic and age groups in Malaysia. Delay in seeking help for breast cancer symptoms is preventable and by identifying possible factors for delayed diagnosis, patient prognosis and survival rates could be improved. Objectives: This narrative review aimed to understand and evaluate the level of in-depth breast cancer knowledge in terms of clinical breast examination and breast self-examination, and other important aspects such as side-effects and risk factors in Malaysian females. Since Malaysia is multicultural, this review assessed social perceptions, cultural beliefs and help-seeking behaviour in respect to breast cancer among different ethnic groups, since these may impinge on efforts to 'avoid' the disease. Materials and Methods: A comprehensive literature search of seven databases was performed from December 2015 to January 2015. Screening of relevant published journals was also undertaken to identify available information related to the knowledge, perception and help-seeking behaviour of Malaysian women in relation to breast cancer. Results: A total of 42 articles were appraised and included in this review. Generally, women in Malaysia had good awareness of breast cancer and its screening tools, particularly breast self-examination, but only superficial in-depth knowledge about the disease. Women in rural areas had lower levels of knowledge than those in urban areas. It was also shown that books, magazines, brochures and television were among the most common sources of breast cancer information. Delay in presentation was attributed mainly to a negative social perception of the disease, poverty, cultural and religion practices, and a strong influence of complementary and alternative medicine, rather than a lack of knowledge. Conclusions: This review highlighted the need for an intensive and in-depth breast cancer education campaigns using media and community health programmes, even with the existing good awareness of breast cancer. This is essential in order to avoid misconceptions and to frame the correct mind-set about breast cancer among women in Malaysia. Socio-cultural differences and religious practices should be taken into account by health care professionals when advising on breast cancer. Women need to be aware of the risk factors and symptoms of breast cancer so that early diagnosis can take place and the chances of survival improved.

Factors influencing delayed presentation of breast cancer at a tertiary care hospital in Pakistan

“…Cancer is less often suspected among young patients as compared to older patients. Mammography is significantly less sensitive in detecting lesions in younger women than older women (68% vs 91%) . Fibroadenosis and fibrocystic disease are very common in young women .…”

“…Mammography is significantly less sensitive in detecting lesions in younger women than older women (68% vs 91%) . Fibroadenosis and fibrocystic disease are very common in young women . There are serious problems in access to health services, the strength of the first level of care for the early detection of symptomatic patients, the regulation of establishments where breast imaging tests are performed, and the faulty or absent delineation of referral pathways to cancer care …”

Awareness about breast cancer among women attending obstetrics and gynaecology department in a tertiary care hospital of Jharkhand, India

“…The study also showed that awareness was higher in participants of urban area than that of rural area as found in a study in Malaysia also. 25 …”

Breast cancer awareness: survey of participants at annual walk in Kigali

“…In a systematic review of 42 studies by Khan and colleagues (2015) in Malaysia, limited knowledge of breast cancer caused misconceptions and delays in accessing healthcare. [16] Ten women in our study (15%) said they would visit the traditional healer first, which would delay seeking care at a health facility. In Kenya, oncologists visited traditional healers to advise that women with breast problems should be referred to physicians immediately to improve their chance of survival.…”