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Barriers to Breast and Cervical Cancer Screening in Singapore: a Mixed Methods Analysis

  • Malhotra, Chetna (Lien Centre for Palliative Care, Duke-NUS Medical School) ;
  • Bilger, Marcel (Program in Health Services and Systems Research, Duke-NUS Medical School) ;
  • Liu, Joy (Lien Centre for Palliative Care, Duke-NUS Medical School) ;
  • Finkelstein, Eric (Lien Centre for Palliative Care, Duke-NUS Medical School)
  • Published : 2016.08.01

Abstract

Background: In order to increase breast and cervical cancer screening uptake in Singapore, women's perceived barriers to screening need to be identified and overcome. Using data from both focus groups and surveys, we aimed to assess perceived barriers and motivations for breast and cervical cancer screening. Materials and Methods: We conducted 8 focus groups with 64 women, using thematic analysis to identify overarching themes related to women's attitudes towards screening. Based on recurring themes from focus groups, several hypotheses regarding potential barriers and motivations to screen were generated and tested through a national survey of 801 women aged 25-64. Results: Focus group participants had misconceptions related to screening, believing that the procedures were painful. Cost was an issue, as well as efficacy and fatalism. Conclusions: By identifying barriers to and motivators for screening through a mixed-method design that has both nuance and external validity, this study offers valuable suggestions to policymakers to improve breast and cervical cancer screening uptake in Singapore.

Keywords

Breast cancer;cervical cancer;screening;focus groups;fear;attitude;motivation

Acknowledgement

Supported by : Singapore Ministry of Health

References

  1. Abdul Rashid RM, Mohamed M, Hamid ZA, et al (2013). Is the phone call the most effective method for recall in cervical cancer screening?--results from a randomised control trial. Asian Pac J Cancer Prev, 14, 5901-4. https://doi.org/10.7314/APJCP.2013.14.10.5901
  2. Alexandraki I, Mooradian AD (2010). Barriers related to mammography use for breast cancer screening among minority women. J Natl Med Assoc, 102, 206-18. https://doi.org/10.1016/S0027-9684(15)30527-7
  3. Azami-Aghdash S, Ghojazadeh M, Sheyklo SG, et al (2015). Breast cancer screening barriers from the womans perspective: a meta-synthesis. Asian Pac J Cancer Prev, 16, 3463. https://doi.org/10.7314/APJCP.2015.16.8.3463
  4. Bayrami R, Taghipour A, Ebrahimipour H (2015). Personal and socio-cultural barriers to cervical cancer screening in Iran, patient and provider perceptions: a qualitative study. Asian Pac J Cancer Prev, 16, 3729-34. https://doi.org/10.7314/APJCP.2015.16.9.3729
  5. Bonfill X, Marzo M, Pladevall M, et al (2001). Strategies for increasing women participation in community breast cancer screening. Cochrane Database Syst Rev, 2943.
  6. Chaowawanit W, Tangjitgamol S, Kantathavorn N, et al (2016). Knowledge, Attitudes and Behavior of Bangkok Metropolitan Women Regarding Cervical Cancer Screening. Asian Pac J Cancer Prev, 17, 945-52. https://doi.org/10.7314/APJCP.2016.17.3.945
  7. Donnelly TT, Khater AH, Al-Bader SB, et al (2013). Arab women's breast cancer screening practices: a literature review. Asian Pac J Cancer Prev, 14, 4519-28. https://doi.org/10.7314/APJCP.2013.14.8.4519
  8. Donnelly TT, 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.
  9. Driscoll SD (2015). Barriers and facilitators to cervical cancer screening in high incidence populations: A synthesis of qualitative evidence. Women Health, 1-20.
  10. Finkelstein EA, Bilger M, Flynn TN, et al (2015). Preferences for end-of-life care among community-dwelling older adults and patients with advanced cancer: A discrete choice experiment. Health Policy, 119, 1482-9. https://doi.org/10.1016/j.healthpol.2015.09.001
  11. Hou SI, Sealy DA, Kabiru CW (2011). Closing the disparity gap: cancer screening interventions among Asians--a systematic literature review. Asian Pac J Cancer Prev, 12, 3133-9.
  12. Kerlikowske K, Grady D, Rubin SM, et al (1995). Efficacy of screening mammography: A meta-analysis. JAMA, 273, 149-54. https://doi.org/10.1001/jama.1995.03520260071035
  13. Khazaee-pool M, Majlessi F, Foroushani AR, et al (2014). Perception of breast cancer screening among Iranian women without experience of mammography: a qualitative study. Asian Pac J Cancer Prev, 15, 3965-71. https://doi.org/10.7314/APJCP.2014.15.9.3965
  14. Lee YY, Jun JK, Suh M, et al (2014). Barriers to cancer screening among medical aid program recipients in the Republic of Korea: a qualitative study. Asian Pac J Cancer Prev, 15, 589-94. https://doi.org/10.7314/APJCP.2014.15.2.589
  15. Loewenstein G, Brennan T, Volpp KG (2007). Asymmetric paternalism to improve health behaviors. JAMA, 298, 2415-7. https://doi.org/10.1001/jama.298.20.2415
  16. Loy EY, Molinar D, Chow KY, et al (2015). National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicators. J Med Screen, 22, 194-200. https://doi.org/10.1177/0969141315589644
  17. Lu M, Moritz S, Lorenzetti D, et al (2012). A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women. BMC public health, 12, 413-. https://doi.org/10.1186/1471-2458-12-413
  18. Masi CM, Blackman DJ, Peek ME (2007). Interventions to enhance breast cancer screening, diagnosis, and treatment among racial and ethnic minority women. Med Care Res Rev, 64, 195-242. https://doi.org/10.1177/1077558707305410
  19. Ministry of Health. 2015. Preventive Health Screening [Online]. Available: https://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Preventive_Health_Screening.html.
  20. Othman NH, Devi BC, Halimah Y (2009). Cervical cancer screening: patients understanding in major hospitals in Malaysia. Asian Pac J Cancer Prev, 10, 569-74.
  21. Parsa P, Kandiah M, Abdul Rahman H, et al (2006). Barriers for breast cancer screening among Asian women: a mini literature review. Asian Pac J Cancer Prev, 7, 509-14.
  22. Sano H, Goto R, Hamashima C (2014). What is the most effective strategy for improving the cancer screening rate in Japan? Asian Pac J Cancer Prev, 15, 2607-12. https://doi.org/10.7314/APJCP.2014.15.6.2607
  23. Schroy Iii PC, Glick JT, Robinson PA, et al (2008). Has the surge in media attention increased public awareness about colorectal cancer and screening? J Community Health, 33, 1-9. https://doi.org/10.1007/s10900-007-9065-5
  24. Schueler KM, Chu PW, Smith-Bindman R (2008). Factors associated with mammography utilization: a systematic quantitative review of the literature. J Womens Health (Larchmt), 17, 1477-98. https://doi.org/10.1089/jwh.2007.0603
  25. Seetoh T, Siew WF, Koh A, et al (2014). Overcoming barriers to mammography screening: a quasi-randomised pragmatic trial in a community-based primary care setting. ann acad med singapore, 43, 588-94.
  26. Seow A, Huang J, Straughan PT (2000). Effects of social support, regular physician and health-related attitudes on cervical cancer screening in an Asian population. Cancer Causes Control, 11, 223-30. https://doi.org/10.1023/A:1008954606992
  27. Seow A, Straughan P, Ng E, et al (1998). A randomized trial of the use of print material and personal contact to improve mammography uptake among screening non-attenders in Singapore. Ann Acad Med Singapore, 27, 838-42.
  28. Seow A, Straughan PT, Ng EH, et al (1997). Factors determining acceptability of mammography in an Asian population: a study among women in Singapore. Cancer Causes Control, 8, 771-9. https://doi.org/10.1023/A:1018439623384
  29. Seow A, Wong ML, Smith WCS, et al (1995). Beliefs and attitudes as determinants of cervical cancer screening: a community-based study in Singapore. Prev Med, 24, 134-41. https://doi.org/10.1006/pmed.1995.1026
  30. Straughan PT, Seow A (2000). Attitudes as barriers in breast screening: a prospective study among Singapore women. Social Scie Med, 51, 1695-703. https://doi.org/10.1016/S0277-9536(00)00086-1
  31. Tsunematsu M, Kawasaki H, Masuoka Y, et al (2013). Factors affecting breast cancer screening behavior in Japanassessment using the health belief model and conjoint analysis. Asian Pac J Cancer Prev, 14, 6041-8. https://doi.org/10.7314/APJCP.2013.14.10.6041
  32. Vecchia C, Decarli A, Gentile A, et al (1984). "PAP" Smear and the risk of cervical neoplasia:quantitative estimates from a case-control study. Lancet, 324, 779-82. https://doi.org/10.1016/S0140-6736(84)90705-0
  33. Vito CD, Angeloni C, Feo ED, et al (2014). A large crosssectional survey investigating the knowledge of cervical cancer risk aetiology and the predictors of the adherence to cervical cancer screening related to mass media campaign. Bio Med Res Int, 2014, 1-6.
  34. Wang SC (2003). The singapore national breast screening programme: principles and implementation. Ann Acad Med Singapore, 32, 466-76.
  35. Yeoh KG, Chew L, Wang SC (2006). Cancer screening in Singapore, with particular reference to breast, cervical and colorectal cancer screening. J Med Screen, 13, 14-9. https://doi.org/10.1258/096914106776179764