Psychosocial Aspects of Female Breast Cancer in the Middle East and North Africa

Abstract

Breast cancer, the most common cancer among women in the Middle East and North Africa (MENA) region, is associated with social and psychological implications deriving from women’s socio-cultural contexts. Examining 74 articles published between 2007 and 2019, this literature/narrative review explores the psychosocial aspects of female breast cancer in the MENA region. It highlights socio-cultural barriers to seeking help and socio-political factors influencing women’s experience with the disease. In 17 of 22 Arab countries, common findings emerge which derive from shared cultural values. Findings indicate that women lack knowledge of breast cancer screening (BCS) and breast cancer self-examination (BSE) benefits/techniques due to a lack of physicians’ recommendations, fear, embarrassment, cultural beliefs, and a lack of formal and informal support systems. Women in rural areas or with low socioeconomic status further lack access to health services. Women with breast cancer, report low self-esteem due to gender dynamics and a tendency towards fatalism. Collaboration between mass media, health and education systems, and leading social-religious figures plays a major role in overcoming psychological and cultural barriers, including beliefs surrounding pain, fear, embarrassment, and modesty, particularly for women of lower socioeconomic status and women living in crises and conflict zones.

“Your Ovaries Are Expired, Like an Old Lady” Metaphor Analysis of Saudi Arabian Women’s Descriptions of Breast Cancer: A Qualitative Study

“…The instability of emotions in light of the transitional stages—which women went through feeling like they were “dreaming,” starting with breast cancer diagnosis, receiving different methods of active treatment, and dealing with short and long treatment consequences—was a very significant finding in this study. This is also evident in other studies conducted in the Middle East that identified depression, anxiety, poor body image, and fear of cancer recurrence ( Fearon et al, 2020 ; Salem and Daher-Nashif, 2020 ). It is worthy to mention that what makes findings of this study unique is the fact that these Saudi women drifted away from perceiving the disease as a monster or an enemy once they started to describe a spiritual acceptance of this illness as their destiny, as Divine will, beyond their choice or control.…”

“…Adding to those findings, the current study showed that some women expressed their frustration with the way that their closest relatives, including husbands and other family members, were treating and communicating with them. Some of the women expressed concerns regards their husband’s wishes to divorce or take a second wife ( Salem and Daher-Nashif, 2020 ). These concerns suggested that quality of life is influenced by marital relationships ( Wang et al, 2019 ).…”

Breast Cancer Knowledge, Attitudes and Practices amongst Women in Qatar

“…Reporting on the psychosocial aspects of female breast cancer in the Middle East and Africa, Salem and Daher-Nashif argue that sociocultural factors such as religion and cultural values have a marked influence on BSE and BCS behaviors. They contend that there is a fissure between their beliefs that diagnosis of cancer can be perceived as “a punishment or test that only God can heal” and the belief that “one’s body is a gift from God and that it is ones’ responsibility to care for it” [ 26 ]. This contradiction is reflected in some Muslim women’s screening behavior in Qatar whereby those with fatalistic views may be less inclined to screen, ascribing a cancer diagnosis to God’s will, whereas the women that engage in BCS may regard it as a proactive means of caring for their body.…”

Factors affecting delay in the presentation of breast cancer symptoms among women in Gaza, occupied Palestinian territory: a cross-sectional survey

“…There is an assumption that Muslim women will be afraid or embarrassed of physical examination when attending a health facility. [28][29][30][31][32][33] In oPt more than 90% of the women are Muslim. Very few women in our study, however, reported feeling embarrassed or worried about the relationship with their husband as barriers to early presentation.…”