Impact of a mass media campaign on breast cancer symptoms awareness and screening uptake in Malaysia: findings from a quasi-experimental study

Abstract

ObjectiveTo evaluate the impact of a mass media campaign in terms of improving breast cancer (BC) symptoms awareness and screening uptake.DesignBefore—and after—study with comparator groups.SettingSelangor State, Malaysia.ParticipantsMalaysian women aged >40 years (n=676) from randomly selected households.InterventionA culturally adapted mass media campaign (TV, radio, print media and social media).Primary and secondary outcome measuresThe primary endpoint was BC symptoms awareness, which was assessed with the Breast Cancer Awareness Measure precampaign and postcampaign. Secondary outcomes included campaign reach, self-efficacy to notice BC symptoms and clinical outcomes. Clinical breast examination and mammogram screening data were collected from hospitals and clinics.ResultsMost participants recognised at least one of the campaign materials (65.2%). The odds of seeing the campaign were lowest for Chinese women (adjusted OR 0.25, 95% CI 0.15 to 0.40) compared with Malays and for women aged >70 years (adjusted OR 0.47, 95% CI 0.23 to 0.94) compared with younger women. Participants who recognised the campaign were significantly more likely to have improved awareness postcampaign compared with non-recognisers particularly for key symptoms such as ‘a lump or thickening in your breast’ (88.9% vs 62.1%) and ‘discharge or bleeding from nipple’ (79.7% vs 55.3%). Improvement in symptoms awareness scores was not associated with sociodemographic variables.ConclusionsImplementation in Malaysia of an evidence-based mass media campaign from the UK that was culturally adapted appeared to lead to improved awareness about some BC symptoms, though various modes of media communication and perhaps other health education approaches may be required to extend the reach to diverse, multiethnic populations and all age groups.

Anticipated delay in help-seeking for cancer symptoms: Findings from a nationwide study of Malaysian adults

“…We have reported nation-wide awareness levels for the following cancer symptoms: 'lump' -74.5%, rectal bleeding -65.5% and 'persistent cough' -55.4% [8] whereas other (albeit smaller) studies reported proportions ranging from 28% to 91% for awareness of lump as a breast cancer symptom [9][10][11] and between 34% and 72% for rectal bleeding as a colorectal cancer sign [12][13][14]. Awareness about lung cancer symptoms is largely unexplored [15].…”

“…In Malaysia, breast, colorectal and lung cancer are the most common cancers (ASR 34.1/100,000, 25.9/100,00 and 19.1/100,000 respectively) [3]. About 50% of breast cancer cases, over 70% of colorectal cancer cases and over 90% of lung cancer cases are diagnosed at stage 3 or 4; and contribute to increasing cancer mortality (9,466 in 2012 vs 11,966 in 2016) [3]. In addition, there were 5,257 non-medically certified cancer deaths in 2012 and 6,731 in 2016.…”

Changing Health Beliefs about Breast Cancer Screening among Women in Multi-Ethnic Malaysia

“…These four items included emotion-related barriers, such as fear of finding out that something (about their breast health) was wrong, fear of attending screening because of their limited understanding about what they would be required to do, and a lack of encouragement and support from relatives to attend the screening, and a service-related barrier about not knowing how to access and use screening. In a related report, 40% of respondents stated that they discussed the BCAC-BC campaign with friends and family and 21.7% reported that they or their family or friends visited a doctor after seeing the campaign advertisement [39].…”

Conceptual Framework to Guide Early Diagnosis Programs for Symptomatic Cancer as Part of Global Cancer Control

“…Although some randomized control trials have been conducted, 120 , 142 the majority of early diagnosis programs are natural experiments and so evaluations more often take other forms such as before and after designs and interrupted time series analysis, commonly involving mixed-methods research. 22 , 25 , 27 , 40 , 135 , 143 - 145 …”

“…The campaign's logic model takes contextual factors into account, including differences in knowledge and cultural norms between the main ethnic groups in Malaysia (Malays, Chinese, and Indian) and health and media literacy. 27 Recently published findings indicate improvements in symptom awareness at follow-up across ethnic and social strata although, in common with the English experience, evidence of improvements in downstream outcomes was less clear. 28 …”