Knowledge and Acceptance Towards Mammography as Breast Cancer Screening Tool Among Yogyakarta Women and Health Care Providers (Mammography Screening in Indonesia)

Abstract

Annual mammography remains the gold standard of asymptomatic breast cancer screening for women starting at the age of 40. However, Indonesia has not designated mammography as its national screening program. To help policymakers decide whether mammography should be introduced into a national program, it is important to comprehensively understand the knowledge and acceptance of both consumers and providers. A total of 25 subjects including a range of women and health care professionals (HCPs) in Yogyakarta Province were recruited using purposive, maximum variation sampling and then interviewed in-depth. The interviews were recorded and all data were taken and transcribed from the audio recording, which were subsequently translated to English and analyzed thematically. Almost all of Yogyakarta women had heard about the term of mammography. However, only few of them have let themselves be screened, mainly because of their perceived lack of urgency to screen for asymptomatic breast cancer. Another important reason was the high cost of mammography. Meanwhile, several HCPs believed that breast cancer has not been a priority for the government and hence the government limited mammography screening's access and excluded it from the national insurance coverage. Most women in Yogyakarta have a good understanding about breast cancer screening, but their acceptance of mammography as a breast cancer screening tool is significantly influenced by high cost, limited access, and lack of urgency.

Knowledge, attitude and uptake of mammography among female health workers in two tertiary health facilities of Sokoto state, Nigeria

“…21 The test is expensive is another reason giving for not utilizing mammography services, some studies have reported cost as a barrier to the uptake of mammography. 1,11 The issue of cost can be reduced if mammography is incorporated into social health insurance schemes. Other studies found that cost was not a barrier to uptake of mammography as breast cancer screening was free or covered by health insurance.…”

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Globally, breast cancer is the most common cancer in women, and is the second leading cause of cancer deaths among females; after lung cancer. [1][2][3] There is an estimated 1,384, 155 new cases worldwide and over 459,000 related deaths annually. 4 Since 2008, estimates of the World Health Organization (WHO) showed that, worldwide, the incidence of breast cancer has increased by more than 20%, and mortality has increased by 14%.

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“…5,6 Annual mammography remains the gold standard of asymptomatic breast cancer screening for women starting at the age of 40. 1,2,5 The recommended interval between two screens varies from 1-3 years. 5 The high cost of mammography, fear or irradiation, difficulty accessing health care services generally are some of the reasons that prevents large scale screening in most countries.…”

Paving the road for early breast cancer presentation

“…However, in Indonesia, there is limited access to it. Mammography has not been designated as an organized national screening program and is not covered by Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS Kesehatan) -Indonesian national health insurance, therefore, it is costly and individuals have limited access to this procedure (Choridah et al, 2019). A substantial effort is being made to establish an organized breast screening program through the National Movement of Breast and Cervical Cancer Screening, by promoting regular BSE at least monthly, as a breast cancer screening modality besides regular CBE in the Community Healthcare Centers (CHCs, Indonesian: Pusat Kesehatan Masyarakat -Puskesmas; Ministry of Health RI, 2015a).…”

“…In Indonesia, breast self-examination (BSE) is a breast cancer screening modality that besides clinical breast examination (CBE) is widely promoted by the government (Ministry of Health RI, 2015a). Because mammography has not been designated as an organized program and is not covered by the national health insurance, it is costly and there has been limited access to the procedure (Choridah et al, 2019). The American Cancer Society (ACS)…”