Evaluating knowledge, attitudes, and practices toward breast cancer and breast cancer screening among females in Arab countries of the Middle East: A systematic literature review.

Abstract

e18761 Background: Among all types of cancer, breast cancer (BC) is the most diagnosed cancer in women and is the leading cause of cancer-related deaths in females globally. Developing countries possess approximately 60% to 70% of all worldwide breast cancer deaths. Despite the increasing efforts to expand awareness and encourage screening, breast cancer is still the most frequently diagnosed form of the disease in Arab countries. In this study, we aim to systematically review the knowledge, attitudes, and practices of middle-eastern Arab women toward the recognition of early breast cancer symptoms, risk factors, and screening. Methods: A literature search was conducted on PubMed and Scopus to identify relevant literature. Search terms included “Knowledge” OR “attitude” OR “practice” AND “breast cancer” AND “Arab region” OR “middle east region”, and other relevant and equivalent terms. All English language studies which achieved the inclusion criteria were included. Each article was independently screened by two researchers in two levels (title/abstract and full-text screening). Data extracted included, but was not limited to, country, study design, study population, sample size, level of knowledge, attitudes, practices, conclusions, and limitations for each study. Results: Out of the 1182 publications identified, 14 cross-sectional studies were included with respondents aged 15 and above. Study populations varied from females attending healthcare centers, to country residents and students. Five studies reported the level of overall BC knowledge, where respondents with low levels of knowledge ranged from 19.7% to 67%. The most chosen risk factors for BC were personal or family history (n = 5), and prior radiation (n = 2). A breast lump or mass was the most chosen warning sign (n = 5), followed by an armpit lump (n = 2). Regarding screening, women who had ever performed breast self-examination (BSE) ranged from 30.3% in Yemen to 57.5% in Oman, while those who consistently performed BSE ranged from 17.4% to 27.9%. Women who had ever undergone mammography ranged from 1.6% to 40%. Barriers to screening included system-related barriers (n = 2), feeling healthy (n = 2), fear of the results (n = 2), and others. Better screening practices were mostly associated with a higher level of education (n = 5), and personal or family history (n = 4). Conclusions: The majority of Arab women in the middle east had heard about breast cancer, but had a low level of knowledge, attitudes, and practices toward breast cancer and its screening methods, which was also variable among different counties. Multiple barriers to screening were found. Such findings can raise the need for programs that elevate knowledge, and provide accessible screening programs that solve for the barriers to screening in the Arab region.