Predictors of Breast Cancer Screening Uptake: A Pre Intervention Community Survey in Malaysia

  • Published : 2012.07.31


Introduction: Despite health education efforts to educate women on breast cancer and breast cancer screening modalities, the incidence of breast cancer and presentation at an advanced stage are still a problem in Malaysia. Objectives: To determine factors associated with the uptake of breast cancer screening among women in the general population. Methods: This pre-intervention survey was conducted in a suburban district. All households were approached and women aged 20 to 60 years old were interviewed with pre-tested guided questionnaires. Variables collected included socio-demographic characteristics, knowledge on breast cancer and screening practice of breast cancer. Univariate and multivariate analysis were performed. Results: 41.5% of a total of 381 respondents scored above average; the mean knowledge score on causes and risks factors of breast cancer was 3.41 out of 5 (SD1.609). 58.5% had ever practiced BSE with half of them performing it at regular monthly intervals. Uptake of CBE by nurses and by doctors was 40.7% and 37.3%, respectively. Mammogram uptake was 14.6%. Significant predictors of BSE were good knowledge of breast cancer (OR=2.654, 95% CI: 1.033-6.816), being married (OR=2.213, 95% CI: 1.201-4.076) and attending CBE (OR=1.729, 95% CI: 1.122-2.665). Significant predictors for CBE included being married (OR=2.161, 95% CI: 1.174-3.979), good knowledge of breast cancer (OR=2.286, 95% CI: 1.012-5.161), and social support for breast cancer screening (OR=2.312, 95% CI: 1.245-4.293). Women who had CBE were more likely to undergo mammographic screening of the breast (OR=5.744, 95% CI: 2.112-15.623), p<0.005. Conclusion: CBE attendance is a strong factor in promoting BSE and mammography, educating women on the importance of breast cancer screening and on how to conduct BSE. The currently opportunistic conduct of CBE should be extended to active calling of women for CBE.


  1. Abdul Hadi M, Hassali MA, Shafie AA, Awaisu A (2010). Knowledge and perception of breast cancer among women of various ethnic groups in the state of Penang: a cross-sectional survey. Med Princ Pract, 19, 61-7.
  2. Agarwal G, Pradeep PV, Aggarwal V, Yip CH, Cheung PS (2007). Spectrum of breast cancer in Asian women. World J Surg, 31, 1031-40.
  3. Akhigbe AO, Omuemu VO (2009). Knowledge, attitudes and practice of breast cancer screening among female health workers in a Nigerian urban city. BMC Cancer, 9, 203.
  4. Bastiaannet E, Liefers GJ, de Craen AJ, et al (2010). Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat, 124, 801-7.
  5. Chee H, Rashidah S, Shamsuddin K, Intan O (2003). Factors related to the practice of breast self examination (BSE) and Pap smear screening among Malaysian women workers in selected electronics factories. BMC Womens Health, 3, 3.
  6. Dahlui M, Ng C, Al-Sadat N, Ismail S, Bulgiba A (2011). Is breast self examination (BSE) still relevant? A study on BSE performance among female staff of University of Malaya. Asian Pac J Cancer Prev, 12, 369-72.
  7. Dandash KF, Al-Mohaimeed A (2007). Knowledge, attitudes, and practices surrounding breast cancer and screening in female teachers of buraidah, saudi arabia. Int J Health Sci (Qassim), 1, 61-71.
  8. Department of Statistics Malaysia (2010). Population Distribution by Local Authority Areas and Mukims. [updated 2010; cited 2011 19 December 2011]; Available from:
  9. Dundar PE, Ozmen D, Ozturk B, et al (2006). The knowledge and attitudes of breast self-examination and mammography in a group of women in a rural area in western Turkey. BMC Cancer, 6, 43.
  10. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917.
  11. Forouzanfar MH, Foreman KJ, Delossantos AM, et al (2011). Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet, 378, 1461-84.
  12. Goodwin JS, Hunt WC, Key CR, Samet JM (1987). The effect of marital status on stage, treatment, and survival of cancer patients. JAMA, 258, 3125-30.
  13. Hisham AN, Yip CH (2004). Overview of breast cancer in Malaysian women: a problem with late diagnosis. Asian J Surg, 27, 130-3.
  14. Institute For Public Health (IPH) (2008). The Third National Health and Morbidity Survey (NHMS III) 2006, Volume 2. Ministry of Health, Malaysia.
  15. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90.
  16. Jemal A, Siegel R, Xu J, Ward E (2010). Cancer statistics, 2010. CA Cancer J Clin, 60, 277-300.
  17. Kravdal H, Syse A (2011). Changes over time in the effect of marital status on cancer survival. BMC Public Health, 11, 804.
  18. Leong BD, Chuah JA, Kumar VM, Yip CH (2007). Breast cancer in Sabah, Malaysia: a two year prospective study. Asian Pac J Cancer Prev, 8, 525-9.
  19. Ministry of Health Malaysia (2003). Clinical Practice Guidelines: Management of Cervical Cancer.
  20. Mittra I, Mishra GA, Singh S, et al (2010). A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening. Int J Cancer, 126, 976-84.
  21. Montazeri A, Vahdaninia M, Harirchi I, et al (2008). Breast cancer in Iran: need for greater women awareness of warning signs and effective screening methods. Asia Pac Fam Med, 7, 6.
  22. National Cancer Registry Report (2011). Malaysia Cancer Statistics - Data and Figure 2007. Ministry of Health Malaysia.
  23. Osborne C, Ostir GV, Du X, Peek MK, Goodwin JS (2005). The influence of marital status on the stage at diagnosis, treatment, and survival of older women with breast cancer. Breast Cancer Res Treat, 93, 41-7.
  24. Parsa P, Kandiah M (2010). Predictors of adherence to clinical breast examination and mammography screening among Malaysian women. Asian Pac J Cancer Prev, 11, 681-8.
  25. Parsa P, Kandiah M, Mohd Zulkefli NA, Rahman HA (2008). Knowledge and behavior regarding breast cancer screening among female teachers in Selangor, Malaysia. Asian Pac J Cancer Prev, 9, 221-7.
  26. Pathy NB, Yip CH, Taib NA, et al (2011). Breast cancer in a multi-ethnic Asian setting: results from the Singapore-Malaysia hospital-based breast cancer registry. Breast, 20, S75-80.
  27. Rosmawati NH (2010). Knowledge, attitudes and practice of breast self-examination among women in a suburban area in Terengganu, Malaysia. Asian Pac J Cancer Prev, 11, 1503-8.
  28. Taib NA, Akmal M, Mohamed I, Yip CH (2011). Improvement in survival of breast cancer patients - trends over two time periods in a single institution in an Asia Pacific country, Malaysia. Asian Pac J Cancer Prev, 12, 345-9.
  29. Taib NA, Yip CH, Ibrahim M, Ng CJ, Farizah H (2007). Breast cancer in malaysia: are our women getting the right message? 10 year-experience in a single institution in Malaysia. Asian Pac J Cancer Prev, 8, 141-5.
  30. Yang RJ, Huang LH, Hsieh YS, et al (2010). Motivations and reasons for women attending a breast self-examination training program: A qualitative study. BMC Womens Health, 10, 23.
  31. Yip CH, Smith RA, Anderson BO, et al (2008). Guideline implementation for breast healthcare in low- and middle-income countries: early detection resource allocation. Cancer, 113, 2244-56.
  32. Yip CH, Taib NA, Mohamed I (2006). Epidemiology of breast cancer in Malaysia. Asian Pac J Cancer Prev, 7, 369-74.

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