Public Awareness of Warning Signs and Symptoms of Cancer in Oman: A Community-Based Survey of Adults

  • Al-Azri, Mohammed (Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University Hospital) ;
  • Al-Hamedi, Ibtisam (Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University Hospital) ;
  • Al-Awisi, Huda (Nursing Directorate, Sultan Qaboos University Hospital) ;
  • Al-Hinai, Mustafa (Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University Hospital) ;
  • Davidson, Robin (Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University Hospital)
  • Published : 2015.04.14


Background: The majority of deaths from cancer occur in low and middle income countries, partly due to poor public awareness of the signs and symptoms of cancer. Materials and Methods: A community based survey using the Cancer Awareness Measure (CAM) questionnaire was conducted in three different communities in Oman. Omani adults aged 18 years and above were invited to participate in the study. Results: A total of 345 responded from 450 invited participants (response rate=76.7%). The majority of respondents were unable to identify the common signs and symptoms of cancer identified in the CAM (average awareness was 40.6%). The most emotional barrier to seeking help was worry about what the doctor might find (223, 64.6%); a practical barrier was too busy to make an appointment (259, 75.1%) and a service barrier was difficulty talking to the doctor (159, 46.1%). The majority of respondents (more than 60% for seven out of ten symptoms) would seek medical help in two weeks for most signs or symptoms of cancer. Females were significantly more likely than males to be embarrassed (p<0.001), scared (p=0.001), and lack confidence talking about their symptoms (p=0.022). Conclusions: Urgent strategies are needed to improve public awareness of the signs and symptoms of cancer in Oman. This might leads to earlier diagnosis, improved prognosis and reduced mortality from cancer.


Cancer symptoms;cancer signs;awareness;public;questionnaires;Oman


  1. Abyad A, Al-Baho AK, Unluoglu I, et al (2007). Development of family medicine in the Middle East. Fam Med, 39, 736-41.
  2. Al-Azri M, Al-Ramadhani R, Al-Rawahi N, et al (2014a). Patients' attitudes and experiences of relational continuity in semi-urban general practices in Oman. Fam Pract, 31, 303-10.
  3. Alazri M, Heywood P, Neal RD et al (2007). Continuity of Care: Literature review and implications. Sultan Qaboos Univ Med J, 7, 197-206.
  4. Al-Azri MH, Al-Awisi H, Al-Rasbi S, et al (2014b). Coping with a diagnosis of breast cancer among Omani women. J Health Psychol, 19, 836-46.
  5. Al-Lawati JA, Mabry R, Mohammed AJ (2008). Addressing the threat of chronic diseases in Oman. Prev Chronic Dis, 5, 99.
  6. Al-Moundhri M, Al-Bahrani B, Pervez I, et al (2004). The outcome of treatment of breast cancer in a developing country-Oman, Breast, 13, 139-45.
  7. Austoker J, Bankhead C, Forbes LJL, et al (2009). Interventions to promote cancer awareness and early presentation: systematic review. Br J Cancer, 101, 31-9.
  8. Bayrami R, Taghipour A, Ebrahimipour H (2014). Challenges of providing cervical cancer prevention programs in iran: a qualitative study. Asian Pac J Cancer Prev, 15, 10071-7.
  9. De Nooijer J, Lechner L, De Vries H (2001). Help-seeking behaviour for cancer symptoms: perceptions of patients and general practitioners. Psychooncol, 10, 469-78.
  10. De Nooijer J, Lechner L, De Vries H (2002). Early detection of cancer: knowledge and behavior among Dutch adults. Cancer Detect Prev, 26, 362-9.
  11. De Nooijer J, Lechner L, De Vries H (2003). Social psychological correlates of paying attention to cancer symptoms and seeking medical help. Soc Sci Med, 56, 915-20.
  12. Donnelly TT, Al Khater AH, 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, 10157-64.
  13. El Saghir NS, Khalil MK, EidT, El Kinge AR, et al (2007). Trends in epidemiology and management of breast cancer in developing Arab countries: a literature and registry analysis. Int J Surg, 5, 225-33.
  14. Feizi A, Kazemnejad A, Babaee G, Parsayekta Z, et al (2010). Public awareness of risk factors for cancer and its determinants in an Iranian Population. Asia Pac J Public Health, 22, 76-88.
  15. Forbes LJ., Warburton F, Richards MA, et al (2014). Risk factors for delay in symptomatic presentation: a survey of cancer patients. Br J Cancer, 111, 581-8.
  16. Forbes LJL, Simon AE, Warburton F, et al (2013). Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the international cancer benchmarking partnership): do they contribute to differences in cancer survival? Br J Cancer, 108, 292-300.
  17. Fouladi N, Ali-Mohammadi H, Pourfarzi F, et al (2014). Exploratory study of factors affecting continuity of cancer care: Iranian Women's perceptions. Asian Pac J Cancer Prev, 15, 133-7.
  18. Gajda M, Kaminska-Winciorek G (2014). Do not let to be late: overview of reasons for melanoma delayed diagnosis. Asian Pac J Cancer Prev, 15, 3873-7.
  19. Harford JB (2011). Breast-cancer early detection in low-income and middle-income countries: do what you can versus one size fits all. Lancet Oncol, 12, 306-12.
  20. Hashim SM, FahTS, Omar K, et al (2011). Knowledge of colorectal cancer among patients presenting with rectal bleeding and its association with delay in seeking medical advice. Asian Pac J Cancer Prev, 12, 2007-11.
  21. Hunter MS, Grunfeld EA, Ramirez AJ (2003). Help-seeking intentions for breast-cancer symptoms: A comparison of the self-regulation model and the theory of planned behaviour. Br J Health Psychol, 8, 319-33.
  22. Jassem J, Ozmen V, Bacanu F, et al (2014). Delays in diagnosis and treatment of breast cancer: a multinational analysis. Eur J Public Health, 24, 761-7.
  23. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90.
  24. Karadag G, Gungormus Z, Surucu R, et al (2014). Awareness and practices regarding breast and cervical cancer among Turkish women in gazientep. Asian Pac J Cancer Prev, 15, 1093-8.
  25. Kumar S, Burney I, Al-Ajmi A, et al (2011). Changing trends of breast cancer survival in sultanate of oman. Oncol, 2011, 316243.
  26. Lostao L1, Joiner TE, Pettit JW, et al (2001). Health beliefs and illness attitudes as predictors of breast cancer screening attendance. Eur J Public Health, 11, 274-9.
  27. MacDonald S, Macleod U, Campbell NC, et al (2006). Systematic review of factors influencing patient and practitioner delay in diagnosis of upper gastrointestinal cancer. Br J Cancer, 94, 1272-80.
  28. Macleod U, Mitchell ED, Burgess C, et al (2009). Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers. Br J Cancer, 101, 92-101.
  29. Ministry of Health (2010). Early detection and screening for breast cancer- operational guidelines. oman: ministry of health, department of family and community health. directorate general of health affair (Accessed 21.1.2015).
  30. Ministry of Health (2012). Glimpses of Health System and Health Status in the Sultanate of Oman. (Accessed 21.1.2015).
  31. Mohamed IE, Skeel WK, Tamburrino M, et al (2005). Understanding locally advanced breast cancer: what influences a woman's decision to delay treatment? Prev Med, 41, 399-405.
  32. Moore MA, Sangrajrang S, Bray F (2014). Asian Cancer Registry Forum 2014 - regional cooperation for cancer registration: priorities and challenges. Asian Pac J Cancer Prev, 15, 1891-4.
  33. Nooyi SC, Al-Lawati JA (2011). Cancer incidence in Oman, 1998-2006. Asian Pac J Cancer Prev, 12, 1735-8.
  34. Rahim HF, Sibai A, Khader Y, et al (2014). Non-communicable diseases in the Arab world. Lancet, 383, 356-67.
  35. Rastad H, Khanjani N, Khandani BK (2012). Causes of delay in seeking treatment in patients with breast cancer in Iran: a qualitative content analysis study. Asian Pac J Cancer Prev, 13, 4511-15.
  36. Ravichandran K, Mohamed G, Al-Hamdan NA (2010). Public knowledge on cancer and its determinants among Saudis in the riyadh region of Saudi Arabia. Asian Pac J Cancer Prev, 11, 1175-80.
  37. Richards MA (2009). The National Awareness and Early Diagnosis Initiative in England: assembling the evidence. Br J Cancer, 101, S1-4.
  38. Robb K, Stubbings S, Ramirez A, et al (2009). Public awareness of cancer in Britain: a population-based survey of adults. Br J Cancer, 101, 18-23.
  39. Sathian B, Nagaraja SB, Banerjee I, et al (2014). Awareness of breast cancer warning signs and screening methods among female residents of Pokhara valley, Nepal. Asian Pac J Cancer Prev, 15, 4723-6.
  40. Sheikh I, Ogden J (1998). The role of knowledge and beliefs in help seeking behaviour for cancer: a quantitative and qualitative approach. Patient Educ Couns, 35, 35-42.
  41. Simon AE, Juszczyk D, Smyth N, et al (2012). Knowledge of lung cancer symptoms and risk factors in the UK: development of a measure and results from a populationbased survey. Thorax, 67, 426-32.
  42. Simon AE, Waller J, Robb K, et al (2010). Patient delay in presentation of possible cancer symptoms: the contribution of knowledge and attitudes in a population sample from the united Kingdom. Cancer Epidemiol Biomarkers Prev, 19, 2272-7.
  43. Smith LK, Pope C, Botha JL (2003). Patients' help-seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet, 366, 825-31.
  44. Stubbings S, Robb K, Waller J, et al (2009). Development of a measurement tool to assess public awareness of cancer. Br J Cancer, 101, 13-7.
  45. World Health Organization (2010). Country cooperation strategy for WHO and Oman 12010-2015. (Accessed 21.1.2015).
  46. World Health Organization (2014). Cancer- Fact sheet. (Accessed 21.1.2015).
  47. Yaw YH, Shariff ZM, Kandiah M, et al (2014). Diet and physical activity in relation to weight change among breast cancer patients. Asian Pac J Cancer Prev, 15, 39-44.

Cited by

  1. Knowledge and Awareness of Colorectal Cancer Early Warning Signs and Risk Factors among University Students in Jordan pp.1543-0154, 2016,
  2. Awareness of Stomach and Colorectal Cancer Risk Factors, Symptoms and Time Taken to Seek Medical Help Among Public Attending Primary Care Setting in Muscat Governorate, Oman pp.1543-0154, 2017,