Breast Cancer Screening in Malaysia: A Policy Review

Htay, Mila Nu Nu; Donnelly, Michael; Schliemann, Désirée; Loh, Siew Yim; Dahlui, Maznah; Somasundaram, Saunthari; Tamin, Nor Saleha Binti Ibrahim; Su, Tin Tin

doi:10.31557/apjcp.2021.22.6.1685

Cited by 17 publications

(24 citation statements)

References 14 publications

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“…Despite these recommendations and efforts to educate women about BC and BC screening, mammography screening in Malaysia has been a particular challenge in rural communities and remains low despite efforts to implement mobile screening camps [4,5], i.e. it has been reported to range from 6.8% to 8.3% in rural areas and from 8.3% and 15% in urban and suburban areas [6].…”

Section: Introductionmentioning

confidence: 99%

Challenges and opportunities for breast cancer early detection among rural dwelling women in Segamat District, Malaysia: A qualitative study

et al. 2022

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Introduction Breast cancer patients in low- and middle-income countries often present at an advanced stage. This qualitative study elicited views regarding the challenges and opportunities for breast cancer screening and early detection among women in a low-income semi-rural community in Segamat district, Malaysia. Methods Individual semi-structured interviews with 22 people (health professionals, cancer survivors, community volunteers and member from a non-governmental organization) and four focus group discussions (n = 22 participants) with women from a local community were conducted. All participants were purposively sampled and female residents registered with the South East Asia Community Observatory aged ≥40 years were eligible to participate in the focus group discussions. Data were transcribed verbatim and analyzed using thematic analysis. Results The thematic analysis illuminated barriers, challenges and opportunities across six domains: (i) personal experiences and barriers to help-seeking as well as financial and travel access barriers; (ii) primary care challenges (related to delivering clinical breast examination and teaching breast-self-examination); (iii) secondary care challenges (related to mammogram services); (iv) disconnection between secondary and primary care breast cancer screening pathways; and (v) opportunities to improve breast cancer early detection relating to community civil service society activities (i.e. awareness raising, support groups, addressing stigma/embarrassment and encouraging husbands to support women) and vi) links between public healthcare personnel and community (i.e. improving breast self-examination education, clinical breast examination provision and subsidised mammograms). Conclusion The results point to a variety of reasons for low uptake and, therefore, to the complex nature of improving breast cancer screening and early detection. There is a need to adopt a systems approach to address this complexity and to take account of the socio-cultural context of communities in order, in turn, to strengthen cancer control policy and practices in Malaysia.

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Section: Introductionmentioning

confidence: 99%

Challenges and opportunities for breast cancer early detection among rural dwelling women in Segamat District, Malaysia: A qualitative study

et al. 2022

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“…Similar to Singapore, most studies in this region focused on the general multi-ethnic population. Much of the studies also focused on access to screening facilities and reviewing screening guidelines [ 23 – 25 ] since population-based screening program has yet to be established in these countries [ 26 ]. Data on breast cancer screening behavior is thus limited, and among them, most factors elucidated were on intrapersonal level factors such as lack of awareness and knowledge [ 27 – 30 ], and negative perception towards mammography and its outcome [ 28 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Objective Ethnic disparity persists despite equal access to health care in Singapore, with Malay-Muslim women having the lowest mammogram uptake rate and highest breast cancer mortality rate. We sought to understand barriers to and facilitators for mammogram uptake in this community. Methods We used a sequential mixed-methods design to first explore reasons for screening and not screening for breast cancer, then determine factors associated with screening and regular screening in a survey. We used maximum variation sampling for semi-structured in-depth interviews to select screeners and non-screeners of diverse ages and educational levels. Twenty-three Malay-Muslim women aged 40–69 years old were interviewed. Themes were categorized using thematic analysis. For the survey, we applied the Health Belief Model, Social Ecological Model, as well as themes from the interviews and findings from previous studies on factors influencing screening in Muslim women to guide questionnaire design. We surveyed 271 Malay-Muslim women aged 50–69 years old in a nationally representative sample. Multivariable logistic regression was used to determine factors associated with ever gone for mammogram and regular mammogram uptake. Results Through in-depth-interviews, we found perceived benefits of saving lives and breasts from early detection, reminders from doctors and husbands, symptoms, perceived test from God, and personal responsibility to care for one’s health facilitated screening. Barriers were perceived low susceptibility, inconvenience, cost, negative psychological effects, misinformation on mammogram triggering cancer cells, religious beliefs, perceived negative outcomes from mammography and distrust of doctor. From the survey, we found cues from health care professionals and needing symptoms before deciding to go for mammogram to be significantly associated with ever gone for mammogram and regular mammogram. Factors associated with ever gone for mammogram only included age, perceived benefits of saving lives from early detection, perceived importance of mammogram, Punishing Allah Reappraisal, and modesty. Factors associated with regular mammogram only included household income, perceived structural barriers to screening and perceived susceptibility to breast cancer. Conclusions Mammogram uptake is affected by multiple levels of influence. Interventions to promote screening should be designed with multiple stakeholders including doctors, religious leaders and women who had attended screening.

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Section: Cancer Screening Programme Provision and Uptakementioning

confidence: 99%

“…There would appear to be merit in considering the involvement of additional providers of screening such as private general practitioners and other MoH or government service initiatives (e.g. NPFDB) and healthcare professionals such as primary care clinic‐based nurses (Htay et al, 2021). CBE is an important measure of early detection in low‐resource settings (Tran et al, 2020; World Health Organization, 2014), and it is important to find ways to support primary care physicians to offer CBE to women aged 35 years and above when they visit their local clinic for any reason.…”

Section: Improvement Of Opportunistic Screeningmentioning

confidence: 99%

“…In other words, a significant proportion of older women at risk of BC appear to have been missed. Moreover, screening uptake varied according to availability of screening facilities, and implementation is challenging in terms of difficulties related to accessing services, especially in rural areas (Htay et al, 2021;Mohan et al, 2021). CRC screening guidelines in Malaysia recommend that primary care clinicians conduct opportunistic screening using an immunochemical faecal occult blood test (iFOBT) in patients who are aged 50-74 years, have no family history of CRC and present asymptomatically (Ministry of Health, 2017).…”

Section: Cancer Screening Programme Provision and Uptakementioning

confidence: 99%

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