Knowledge, Barriers and Attitudes Towards Breast Cancer Mammography Screening in Jordan

  • Abu-Helalah, Munir Ahmad (Epidemiology and Preventive Medicine, Department of Public Health, Faculty of Medicine, Mutah University) ;
  • Alshraideh, Hussam Ahmad (Operational Research, Department of Industrial Engineering, Faculty of Engineering, Jordan University of Science and Technology) ;
  • Al-Serhan, Ala-Aldeen Ahmad (Medical Student, Faculty of Medicine, Mutah University) ;
  • Kawaleet, Mariana (Medical Student, Faculty of Medicine, Mutah University) ;
  • Nesheiwat, Adel Issa (Medical Student, Faculty of Medicine, Mutah University)
  • Published : 2015.05.18


Background: Breast cancer is the most common type of cancer in Jordan. Current efforts are focused on annual campaigns aimed at increasing awareness about breast cancer and encouraging women to conduct mammogram screening. In the absence of regular systematic screening for breast cancer in Jordan, there is a need to evaluate current mammography screening uptake and its predictors, assess women's knowledge and attitudes towards breast cancer and screening mammograms and to identify barriers to this preventive service. Materials and Methods: This cross-sectional study was conducted in six governorates in Jordan through face-to-face interviews on a random sample of women aged 40 to 69 years. Results: A total of 507 participants with mean age of $46.8{\pm}7.8$ years were interviewed. There was low participation rate in early detection of breast cancer practices. Breast self-examination, doctor examination and periodic mammography screening were reported by 34.9%, 16.8% and 8.6% of study participants, respectively. Additionally 3.8% underwent breast cancer screening at least once but not periodically, while 87.6% had never undergone mammography screening. Reported reasons for conducting the screening were: perceived benefit (50%); family history of breast cancer (23.1%); perceived severity (21.2%); and advice from friend or family member (5.8%). City residents have shown higher probability of undergoing mammogram than those who live in towns or villages. Results revealed negative perceptions and limited knowledge of study participants on breast cancer and breast cancer screening. The most commonly reported barriers for women who never underwent screening were: fear of results (63.8%); no support from surrounding environment (59.7); cost of the test (53.4%); and religious belief, i.e. Qadaa Wa Qadar (51.1%). Conclusions: In the absence of regular systematic screening for breast cancer in Jordan, the uptake of this preventive service is very low. It is essential for the country of Jordan to work on applying regular systematic mammography screening for breast cancer. Additionally, there is a need for improvement in the current health promotion programmes targeting breast cancer screening. Other areas that could be targeted in future initiatives in this field include access to screening in rural areas and removal of current barriers.


Barriers;mammogram;screening;breast cancer;Jordan


  1. Yucel SC, Orgun F, Tokem Y, et al (2014). Determining the factors that affect breast cancer and self breast examination beliefs of Turkish nurses in academia. Asian Pac J Cancer Prev, 15, 1275.
  2. Yusof A, Chia YC, Hasni YM (2014). Awareness and prevalence of mammography screening and its predictors - a cross sectional study in a primary care clinic in Malaysia. Asian Pac J Cancer Prev, 15, 8095-9.
  3. Valdini A, Cargill LC (1997). Access and barriers to mammography in New England community health centers. J Family Pract 45, 243-9.
  4. Wu T-Y, West B, Chen Y-W, et al (2006). Health beliefs and practices related to breast cancer screening in Filipino, Chinese and Asian-Indian women. Cancer Detection Prev, 30, 58-66.
  5. Sadikoglu G, Ozcakir A, Dogan F, et al (2010). Mammography utilization among Turkish women. Asian Pac J Cancer Prev, 11, 377-81.
  6. Sarma EA (2013). Barriers to screening mammography. Health Psychol Rev, 1-21.
  7. Schueler KM, Chu PW, Smith-Bindman R (2008). Factors associated with mammography utilization: a systematic quantitative review of the literature. J Women's Health, 17, 1477-98.
  8. Semiglazov VF, Sagaidak VN, Moiseyenko VM, et al (1992). Study of the role of breast self-examination in the reduction of mortality from breast cancer. The Russian Federation/World Health Organization Study. Eur J Cancer, 29, 2039-46.
  9. Somanchi M, Juon HS, Rimal R (2010). Predictors of screening mammography among Asian Indian American women: a cross-sectional study in the Baltimore-Washington metropolitan area. J Women's Health, 19, 433-41.
  10. Soskolne V, Marie S, Manor O (2007). Beliefs, recommendations and intentions are important explanatory factors of mammography screening behavior among Muslim Arab women in Israel. Health Educat Res, 22, 665-76.
  11. Spaczynski M, Nowak-Markwitz E, Januszek-Michalecka L, et al (2009). Women's social conditions and their participation in Cervical Cancer Population Screening Program in Poland. Ginekol Pol, 80, 833-8 (in Polish).
  12. Tarawneh M, Nimri O, Arkoob K, et al (2013). Cancer incidence in jordan 2010. non-communicable diseases directorate, jordan cancer registry. Minist Health.
  13. Radi SM (2013). Breast cancer awareness among Saudi females in Jeddah. Asian Pac J Cancer Prev, 14, 4307-12.
  14. Ramirez A, Westcombe A, Burgess C, et al (1999). Factors predicting delayed presentation of symptomatic breast cancer: a systematic review. Lancet, 353, 1127-31.
  15. Keshavarz Z, Simbar M, Ramezankhani A (2011). Factors for performing breast and cervix cancer screening by Iranian female workers: a qualitative-model study. Asian Pac J Cancer Prev, 12, 1517-22.
  16. Lopez ED, Khoury AJ, Dailey AB, et al (2009). Screening mammography: a cross-sectional study to compare characteristics of women aged 40 and older from the deep South who are current, overdue, and never screeners. Women's Health Issues, 19, 434-45.
  17. Morales LS, Rogowski J, Freedman VA, et al (2004). Sociodemographic differences in use of preventive services by women enrolled in Medicare + Choice plans. Prev Med, 39, 738-45.
  18. Murabito JM, Evans JC, Larson MG, et al (2001). Family breast cancer history and mammography: Framingham Offspring Study. Am J Epidemiol, 154, 916-23.
  19. Nur N (2010). Breast cancer knowledge and screening behaviors of the female teachers. Women Health, 50, 37-52.
  20. Ogden J 2000. Health psychology: a textbook, open university press. Buckingham.
  21. Opoku SY, Benwell M, Yarney J (2012). Knowledge, attitudes, beliefs, behaviour and breast cancer screening practices in Ghana, West Africa. Pan African Medical Journal, 11.
  22. Peek ME, Han JH (2004). Disparities in screening mammography. J General Int Med, 19, 184-94.
  23. Petroc-Nustas WI (2001). Factors associated with mammography utilization among Jordanian women. J Transcult Nurs, 12, 284-91.
  24. Praznowska B, Puto G, Huras H (2010). Factors influencing the frequency of performing mammographic examinations- preliminary research. Med Ogolna, 16.
  25. Program JBC. Jordan breast cancer program [Online].
  26. Al-Naggar RA, Bobryshev YV (2012). Practice and barriers of mammography among Malaysian women in the general population. Asian Pac J Cancer Prev, 13, 3595-600.
  27. Fouladi N, Pourfarzi F, Mazaheri E, et al (2013). Beliefs and behaviors of breast cancer screening in women referring to health care centers in northwest Iran according to the champion health belief model scale. Asian Pac J Cancer Prev, 14, 6857-62.
  28. Gang M, Kim JI, Oh KO, et al (2013). Factors associated with mammography adherence among married Chinese women in Yanbian, China. Asian Pac J Cancer Prev, 14, 7207-13.
  29. Gariballa S, Peet S, Fotherby M, et al (1996). The knowledge of hospital patients about vascular diseases and their risk factors. Postgrad Med J, 72, 605-8.
  30. Gonzalez P, Castaneda SF, Mills PJ, et al (2012). Determinants of Breast, Cervical and Colorectal Cancer Screening Adherence in Mexican-American Women. J Commun Health, 37, 421-33.
  31. Grunfeld E, Ramirez A, Hunter M, et al (2002). Women's knowledge and beliefs regarding breast cancer. British J cancer, 86, 1373-8.
  32. Hamed H, Fentiman I (2001). Benign breast disease. Int J Clin Practice, 55, 461-4.
  33. Im Kim J, Oh KO, Li CY, et al (2011). Breast cancer screening practice and health-promoting behavior among Chinese women. Asian Nurs Res, 5, 157-63.
  34. Jing L (2011). Survey of 1616 cases of gynecological diseases in different nationalities married women. Bull Dis Control Prev, 26, 67-8.
  35. Kerlikowske K, Grady D, Rubin SM, et al (1995). Efficacy of screening mammography: a meta-analysis. Jama, 273, 149-54.
  36. Bland M (2000). An Introduction to Medical Statistics, Oxford University Press.
  37. Chua MST, Mok TS, Kwan WH, et al (2005). Knowledge, perceptions, and attitudes of Hong Kong Chinese women on screening mammography and early breast cancer management. Breast J, 11, 52-6.
  38. Amin TT, Al Mulhim A, Al Meqihwi A (2009). Breast cancer knowledge, risk factors and screening among adult Saudi women in a primary health care setting. Asian Pac J Cancer Prev, 10, 133-8.
  39. Azaiza F, Cohen M (2006). Health beliefs and rates of breast cancer screening among Arab women. J Women's Health, 15, 520-30.
  40. Cohen EL, Wilson BR, Vanderpool RC, et al (2015). Identifying sociocultural barriers to mammography adherence among appalachian kentucky women. Health Commu, 10, 1-11.
  41. Costanza ME, Stoddard AM, Gaw VP, et al (1992). The risk factors of age and family history and their relationship to screening mammography utilization. J Am Geriat Soc, 40, 774-8.
  42. Department of Statistics J (2013). Poverty status in jordan.
  43. Donnelly TT, Al Khater A-H, Al-Bader SB, et al (2014). Factors that influence awareness of breast cancer screening among arab women in qatar: results from a cross sectional survey. Asian Pac J Cancer Prev, 15, 10157.
  44. DU J-l, ZHOU C-y, ZENG L-f (2011). Analysis on the General Survey Result of Gynecological Diseases in Tujia-Miao Autonomous Prefecture from 2006 to 2010 in Xiangxi. Chinese Primary Health Care, 9, 023.
  45. Al-Dubai SAR, Ganasegeran K, Alabsi AM, et al (2012). Exploration of barriers to breast-self examination among urban women in Shah Alam, Malaysia: a cross sectional study. Asian Pac J Cancer Prev, 13, 1627-32.

Cited by

  1. Low Coverage and Disparities of Breast and Cervical Cancer Screening in Thai Women: Analysis of National Representative Household Surveys vol.16, pp.18, 2016,
  2. Knowledge, attitudes and barriers towards breast cancer health education among community pharmacists vol.7, pp.3, 2016,
  3. Women’s Performance of Breast Cancer Screening (Breast Self-Examination, Clinical Breast Exam and Mammography) vol.06, pp.01, 2017,
  4. Breast cancer screening practices of African migrant women in Australia: a descriptive cross-sectional study vol.17, pp.1, 2017,
  5. The Jordanian primary healthcare practitioner in cancer control vol.18, pp.03, 2017,
  6. Evaluation of Breast Cancer Knowledge and Awareness Among Hospital Staff in a Women Heath Hospital in Turkey vol.32, pp.1, 2017,