Abstract

INTRODUCTION

Breast cancer (BC) is a major life-threatening global concern including Malaysia.[1,2,3,4,5] Increase incidence of BC is observed both in developed and developing countries.[6,7,8,9,10] Globally, BC is also the most common cause of cancer death, the most frequently diagnosed cancer, and now represents one in four of all cancers in women.[11] The incidence rates of BC in the developing countries are escalating because of increasing life expectancy, growing urbanization, particularly in younger women, and greater adoption of Western lifestyles.[12,13,14,15] Another study reported that “the increasing toll of BC in developing nations is really a devastating situation.”[16] The emergence of BC and subsequent complications of cancer tend to be more aggressive in young women compared to older population mainly due to lack of awareness and resulting in lower survival rates.[17,18,19,20,21] Therefore, early detection, accurate diagnosis, and self-awareness of BC are more crucial among young female for the treatment outcome.[20,21,22] The WHO stated, 7% of BC cases in Malaysia occur in women under the age of 35, 14% occur in women under 40%, and 28% in women under the age of 45. Forty-eight percent of the cases occur in women under the age of 50.[23] The majority of Malaysian does not go for screenings and perform breast self-examinations (BSEs) because of unawareness about a deadly issue of BC. There are a number of barriers, including psychological, social, and behavioral in relation to a mammogram in Malaysia.[24,25,26] The understanding of the causes, signs, and symptoms of BC is undeniably important to prevent BC.[27,28] A study reported that most of the women are aware that a lump in the breast or under the armpit is a symptom of BC, but they had less knowledge of nonlump symptoms.[29,30] Early detection of lumps can reduce the mortality and morbidity of BC.[31,32] Malaysian women present with a lump in the breast, usually painless, grow slowly and may alter the contour or size of the breast. Later, may have skin changes, an inverted nipple or blood stained nipple discharge. The lymph gland in the armpit will be swollen may be due to the proliferation of cancer cells.[33,34] The exact cause of BC is unknown and also not well understood.[35,36,37] Women with a family history of BC have an increased risk. The BRCA I and BRCA II gene carriers have at least 56–85% increased risk.[38,39] Other risk factors include exposure to radiation, a history of benign breast lumps, obesity, high fatty diet, early menarche, and late menopause.[40,41] Women with higher educational level are more likely to recognize earlier than others.[30,42] In general, most of the females have low knowledge on the risk factors of BC.[43,44,45] Early discovery of breast lumps through BSE is important for prevention and early detection of this disease. BSE is an easy screening and inexpensive method to detect BC.[46] Women will be more likely to find the breast lump themselves, but most of the women do not have sufficient knowledge of BSE.[47,48] Furthermore, most women have a lack of awareness to go for mammography excluding educated population.[21,49] One study revealed that most of the rural women with BC refused surgery because of fear of death.[49] Nearly all respondents opined that there are substantial benefits of mammograms and early detection, but there are practical barriers to conducting mammograms, especially financial constraint, even they were advised by a medical doctor.[49] Mammography above the age 50 years with or without clinical breast examination decreases both morbidity and mortality of BC, but women with a family history of BC, mammography suggested at the 40–49 age.[39,50,51] Mammography is advisable every 1–2 years, but below 35 years, the ultrasound scans of the breast may be helpful to detect early signs.[52] Low participations in screening programs have been attributed to many factors, including lack of knowledge. Therefore, many women miss early detection and treatment opportunities due to lack of knowledge, information, and awareness of BC, as well as cancer screening practices. Hopefully, the outcome of this study will help raise awareness among females and improve future research in BC. The purpose of this study was therefore to determine the knowledge, perception, and behavioral practice on BC screening and to find an association between sociodemographic data with knowledge and perception of BC and practice of BSE among female staff and students of University Kuala Lumpur, Royal College of Medicine Perak (UniKL RCMP), Perak, Malaysia.

MATERIALS AND METHODS

This was a cross-sectional, descriptive study to identify the level of awareness and practice about BC screening among the students and staff of UniKL RCMP, Malaysia. It was conducted on both the Campuses of UniKL RCMP, and the study period was from October 2015 to January 2016. All the female students and staff who agreed to participate and were available during the study period were included. Of the 800 students and staff, approximately 200 females were calculated as the sample size using the Epi Info 6.04d (January 2001, Centers for Disease Control and Prevention) application with the prevalence to the previous study. Targeted samples were informed about the study, and the consent was taken through the informed consent form. Study participants were distributed a questionnaire which was prepared and validated by an expert panel. Ethical approval was also obtained from the Ethics Committee of UniKL RCMP, Malaysia. Participants’ responses and information were kept strictly confidential, and the raw data were then collected and entered into the Microsoft Excel and was analyzed by using the SPSS version 21.0 (IBM Corporation, Armonk, NY).

RESULTS

DISCUSSION

The current study found that there were 43.8% of participants who had a family history of BC. The top risk factors chosen by participants were excessive smoking, sedentary lifestyle, high junk food consumption, stress, high alcohol consumption, high animal fat diet, and prolonged use of dark hair dye. The majority participants were aware of genetic linkage of BC. A very small group of participants were not aware that overweight and postmenopausal age may be causes of BC. Early discovery of breast lumps through BSE is important for prevention and early detection of this disease. BSE is an easy screening method which cost nothing and absolutely privacy maintained.[10,20,21,49] In the previous studies, most of the women did not have sufficient knowledge of BSE.[10,20,21,49] Our study found out that most of the participants knew that BSE is important for early detection of a breast lump. Although the majority study participants know how to perform BSE, but just over one-sixth to one-third of them does BSE 1–3 times per year.

Furthermore, most women had a lack of awareness to go for mammography with the exception of an educated community.[10,20,21,49] Although the majority of the study of participants knew about mammogram and its utility to detect BC very early and maintain their health but did not do because they have not passed on tertiary care hospital as they were mainly belonging 20–24 ages. A small group has a misconception regarding mammogram is painful, and almost one-third demanded the test should be conducted by female doctors. This can be explained as the study population was not much aware of the procedure, mainly Muslims have a conservative attitude. The majority participants were aware of BC treatment options like surgery and chemotherapy; these findings were similar to a number studies.[10,20,21,49] The greater part of participants thought that BC was not easily cured, but a minor portion thought that it was easily cured. The study participants also described that they will feel depressed, life must go on, and embarrassed if diagnosed as BC. Television and newspapers were cited as the most important sources of information regarding BC.[10,20,21,49] In our study, the internet was the most preferable source and the least choice was a radio. Women with a high awareness of BC opted for breast examination biannually by the physician and those with poor awareness did not think that breast examination is the screening approach.[10,20,21,49] The participants, by and large, thought that performing BSE is the preventive method for BC. They also gave their opinions on increasing publicity through mass media and campaign. The participants were being asked whether they are interested to attend BC awareness campaign and most of them agreed.

CONCLUSIONS

The majority of study participants had good knowledge of BC and usually perform BSE. Only a few of them went for mammography because it is recommended only who are above 50 years, but most of the study participants were much younger. Participants were aware of causes, risk factors, treatments, and preventive methods, even though they have no family history of BC. Most of them were interested to join awareness campaign. Knowledge of the participants was adequate, but the level of practice was low. Therefore, a wider multicenter study is advocated to prevent and early diagnosis of BC.