Breast cancer and breast cancer screening use - beliefs and behaviours in a nationwide study in Malaysia

Abstract

Background Many upper-middle-income countries (UMICs), including Malaysia, continue to face low breast cancer (BC) screening rates and patients with delayed presentation of BC. This study investigated the role of beliefs about BC and use of screening (e.g. beliefs about whether or not screening reduced the possibility of dying from BC). Methods A nationwide cross-sectional study was conducted in which a total of 813 women (aged ≥ 40 years old) were randomly selected and surveyed using the validated Awareness and Beliefs about Cancer (ABC) measure. The association between BC screening use, sociodemographic characteristics, and negative beliefs about BC screening were analysed using stepwise Poisson regressions. Results Seven out of ten Malaysian women believed that BC screening was necessary only if and when they started experiencing cancer symptoms. Women > 50 years and from households with more than one car or motorcycle were 1.6 times more likely to attend a mammogram or a clinical breast examination (mammogram: PR = 1.60, 95% CI = 1.19–2.14, CBE: PR = 1.61, 95%CI 1.29–1.99). Approximately one quarter of women (23%) reported anticipated anxiety about attending BC screening to the extent that they would avoid undergoing the procedure. Women who held negative beliefs about BC screening were 37% less likely to attend a mammogram (PR = 0.63, 95% CI = 0.42–0.94) and 24% less likely to seek a CBE (PR = 0.75, 95% CI = 0.60–0.95). Conclusions There is a need for public health strategies designed to change beliefs about BC screening among Malaysian women as a way of increasing uptake and impacting on late presentation and advanced cancer. The results provide insights about targeting of public health strategies – women with BC screening uptake-inhibiting beliefs tend to be under 50 years, in the lower income group (that do not own a car or a motorcycle) and more likely to be ethnic Malay or Indian (compared to Chinese-Malay).