Breast Cancer Screening in Semi-Rural Malaysia: Utilisation and Barriers

Abstract

Breast cancer (BC) is the commonest cancer in Malaysia. Delayed diagnosis is a significant cause of BC mortality in the country. Early diagnosis and screening are vital strategies in mortality reduction. This study assessed the level of utilisation and barriers for breast self-examination (BSE), clinical breast examination (CBE) and mammogram in a semi-rural population in Malaysia and compared these across the different ethnic groups. This cross-sectional study was conducted among women aged 40 years and above, embedded within a health and demographic surveillance site (HDSS) in Segamat, Malaysia. Trained data collectors collected data on screening and barriers during home visits. Study participants (n = 250) were aged 59.4 ± 10.9 years and represented Malaysia’s three major ethnic groups. Practice of regular BSE, CBE uptake (ever) and mammogram (ever) was 23.2%, 36% and 22.4%, respectively. Regular BSE practice was highest in the Malay ethnic group and least among the Chinese. Regular CBE was very low in all ethnic groups (<5%). Mammogram uptake was highest among Chinese (34.4%), followed by Indians (30.4%) and Malays (16.6%). After adjusting for other socio-demographic variables, Malay ethnicity was positively associated with regular BSE (adjusted OR = 5.26, 95% CI 2.05, 13.50) and negatively associated with having had a mammogram (adjusted OR = 0.3, 95% CI 0.15, 0.57). Lower education was negatively associated (adjusted OR = 0.36, 95% CI 0.17, 0.74) with mammogram attendance (ever). Emotional and financial barriers were the most reported types of barriers, specifically, fear of diagnosis (74.8%), cost of diagnosis (69.6%) and fear of losing a breast (66.4%). Malay women more commonly reported most barriers compared to other ethnic groups. Screening uptake was low among semi-rural women in Malaysia. Implementing culturally appropriate interventions that consider ethnic differences is crucial to empowering women to engage in BC screening initiatives in these communities.

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

“…Furthermore, women's financial concerns also opposed the reduction in subsidised mammogram available each month. This is in line with previous research suggesting 70% of women see cost as a barrier to screening [14]. These issues highlight the conflicting reality between women's personal barriers that are exacerbated by the shortcomings in the healthcare system that have been highlighted in this study [31].…”

“…nurses and radiographers). This was similar to quantitative findings reported previously where 50% women from Segamat reported that male doctors pose a barrier to BC screening attendance [14]. Since BC screening has to be conducted by female radiographers in Malaysia, this likely leads to underuse of mammogram facilities.…”

“…lack of awareness, low perceived risk, embarrassment, fear of a cancer diagnosis, competing responsibilities and lack of family support [21]. Fear of a cancer diagnosis was also the most commonly reported barrier to screening in Malaysian women previously (75%) [14]. This suggests that women in Malaysia, regardless of location, face similar barriers to access female cancer screening.…”

“…An in-depth understanding of the unique challenges that women as well as health care providers from rural areas face in providing BC screening is necessary to address the disparities in BC screening uptake in Malaysia. Previous studies that investigated barriers to BC screening uptake have mainly been of quantitative nature [11][12][13][14] and some qualitative studies have explored perceived barriers to screening in breast cancer patients [15]. It has been suggested that stigma associated with BC, fear of diagnosis, lack of knowledge, financial concerns and cultural concerns are common barriers to screening [6,16].…”

Improving breast and colorectal cancer screening uptake in Malaysia

“…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).…”