INTRODUCTION

Breast cancer is the most common cancer among women around the world, claiming the lives of most of them annually and influencing the countries at all levels of modernization [1]. Either in developed or less developed countries women suffer from breast cancer. It is guesstimated that over 508,000 women passed away in 2011 as a result of breast cancer, worldwide. Though

breast cancer is considered to be a disease of the developed world, nearly half of the cases and 58% of deaths happen in less developed countries [2]. Occurrence amounts vary considerably from 19.3 per 100,000 women in Eastern Africa to 89.7 per 100,000 women in Western Europe. In the majority of the developing countries, the occurrence amounts are less than 40 per 100,000 [2]. The lowest occurrence rates are found in most African countries but in these countries also the breast cancer occurrence rates are enhancing. The survival rates of this cancer change to a high extent throughout the world, ranging from 80% or over in North America, Sweden, and Japan, to about 60% in middle-income countries, and less than 40% in low-income countries [3]. Lacks of early detection programs that result in a high proportion of women presenting with late-stage disease, as well as the lack of adequate diagnosis and treatment facilities are the causes of low survival amounts in less developed countries [4]. During the 5 years from 2012 to 2016, the breast cancer occurrence rate raised somewhat by 0.3% annually, usually because of the increasing rates of local stage and hormone receptor-positive disease. On the contrary, the breast cancer death rate continues to decrease, dropping by 40% from 1989 to 2017 and averting 375,900 breast cancer deaths. Especially, the pace of the decrease has slowed from an annual decrease of 1.9% from 1998-2011 to 1.3% during 2011-2017, largely driven by the trend in white women. Hence, the black-white disparity in breast cancer mortality has remained constant since 2011 after widening over the past 3 decades. Nevertheless, the death rate remains 40% more in blacks (28.4 vs. 20.3 deaths per 100,000) despite a lower occurrence rate (126.7 vs. 130.8); this disparity is magnified among black women aged <50 years, who have a death rate double that of whites [5]. An early and efficient breast cancer diagnosis is a vital part of any strategy aimed at reducing breast cancer mortality in developing countries. In these countries, the influence of breast cancer screening has never been formally measured, and data from the major screening trials need to be considered in this context. Screening asymptomatic women via breast self-examination, clinical examination, or mammography can play a critical role in reducing breast-cancer mortality in developing countries. However, major programs should not be fulfilled until enough diagnostic and therapeutic facilities exist. The most basic interventions in early detection, diagnosis, surgery, radiation therapy, and drug therapy must be integrated, organized, and resourced appropriately within existing healthcare structures [6]. When resources become available for screening, they should be invested in screening mammography, as it is the only modality that has been shown to decrease breast cancer mortality thus far. Clinical breast examination (CBE) and breast self-examination (BSE) are the significant parts of routine breast care in countries with access to mammography and are critical for general breast health education in all countries [7].

Objective:

Our study was designed to measure the level of awareness of breast cancer among women in Saudi Arabia. We involved causes, risk factors, signs and symptoms, BSE, and general perceptions about breast cancer.

METHODS:

Our study is a cross-sectional one and was designed to measure the level of awareness of breast cancer among women in Saudi Arabia. We involved causes, risk factors, signs and symptoms, BSE, and general perceptions about breast cancer. Participants were invited to fill online questionnaires written in the Arabic language and selected randomly from different cities in Saudi Arabia. A total of 1709 women aged above 16 volunteered and successfully filled the questionnaire d, during the period from 12-4-2020 to 1-5-2020. A self-administered close-ended questionnaire was designed. It consisted of 27 questions that were guided by study objectives and review of the literature and all personal information was kept confidential and used only for statistical analysis. The data were represented and statically analyzed using Statistical Package for Social Sciences (SPSS Inc, Chicago, IL, USA) V.24. All categorical variables are presented as numbers and percentages. Permission was obtained from everyone at the beginning of the survey link, before starting to answer the questions. Ethical approval was obtained from the Institutional Review Board (IRB) of the University of Hail.

RESULTS:

The Socio-demographic Nature of the Sample

Details of the age structure of participants and other socio-demographic characteristics are shown in Table 1. Of the participants, 27.6% between 16-24 years, 63.3% of them had a diploma/university degree and most of them were married (59.3%). The majority of participants were from the Eastern region 41.8%. According to nationality, most of the respondents were Saudi (96%). Regarding the level of education, most women had a diploma/university degree (63.3%). The monthly income of half of the respondents was moderate (5000-10000 SR) (50.1%).

The Awareness about Signs and Risk Factors of Breast Cancer

Most of our participants knew that breast cancer was one of the most common cancers among females (84.7%). Approximately 50 percent of the respondents knew that breast cancer could occur in men (49.1%); and 51.6% of the participants revealed the wrong answer, which they thought that women under the age of 30 could not develop breast cancer. Moreover, 42.5% of participants believed that pain was not a common sign related to breast cancer. 31.5% of the women were aware of the fact that exposure to chest injury could not cause breast cancer, while 42.2% of respondents did not know. 71.9% of the participants reported their knowledge about performing breast self-examination and by doing it monthly it could be detected in an early stage. More than 50 percent of the participants knew that the best time to do monthly breast examination was after menstruation (55.1%). The majority of women had good knowledge regarding nipple color or shape-changing in breast cancer (75.4%). Only 9.5% of the participants knew that the chance of recovery from breast cancer was very high if detected early, which reflected the poor knowledge according to this point about the disease. 75.4% of the participants thought that a family history of breast cancer could be an etiology to have the disease. Similarly, 75.4% of the women knew the impact of hormone replacement therapy in increasing the risk of the disease. Most of the participants (73.8%) believed that there was a relationship between eating fat and fewer vegetables and increasing the risk of having breast cancer. Most participants had wrong ideas in the relationship between exercise and breast cancer; they thought that exercise can enhance the risk of breast cancer, while only 12.8% did not agree. 49.2% of women had the wrong idea and thought that having children before the age of 30 could be a risk factor for breast cancer. The majority of respondents knew that using oral contraceptives would not increase the risk of having breast cancer (71%). 36.1% of women knew that exposure to radiation like x-ray could increase the risk of breast cancer. Most of the women thought that breastfeeding could increase the risk of breast cancer (71.7%), while only 21.1% knew that there was not a relationship between these two. 35.2% of the participants agreed that plastic and reconstructive surgeries of the breast caused breast cancer, and 33% of them did not agree.

The Correct and Incorrect Respondent Answers about the Risk Factors of Breast Cancer

Data revealed that almost half of the participants (49.1%) knew that breast cancer could occur in both women and men. Surprisingly, only 15% were aware that breast cancer could occur in early ages “under the age of 30”. Regarding symptoms of breast cancer, 42.5% of participants knew painless tumors in case of breast cancer; while 36.7% of the sample thought that it might be painful. Only 31.5% of respondents knew that exposure to chest injury would not cause breast cancer. 71.9% were aware of the breast self-examination, monthly, and knew that it was one of the best ways for early detection of cancer. Additionally, 55.1% of the women knew that the best time to do breast examination was immediately after their menstruation every month. The participants’ knowledge of warning signs including change in color/shape of nipple showed a high percentage (75.4%). Regarding the risk factors, our results revealed a poor knowledge about the correlation between the detection of breast cancer in the early stages and the chance of recovery; only 6% of participants answered the question correctly. 73.8% of respondents were not aware of the relationship between family history and increase risk of breast cancer, and did not have the idea that if the first relative degree was diagnosed with breast cancer it could double the risk of developing breast cancer. The majority of participants knew there was a link between an increased risk of breast cancer and the use of hormone replacement therapy (73.8%). 43.7% of the participants knew the relationship between eating habits and the increasing risk of breast cancer; some types of fat, such as polyunsaturated fat, increase the occurrence of breast tumors. About half of the respondents (49.2%) knew that emotional states like stress and tension would not increase the risk of having breast cancer. Only 7.0% and 6.1% of our sample knew that doing exercise and having children before the age of 30 were not associated with the increasing risk of breast cancer. 36.1% of the participants knew that obesity was known as a risk factor for the development of breast malignancy. Most women knew that using oral contraceptives would cause a slight rise in breast cancer occurrence (71.7%), especially in women who took them before the first pregnancy. Only 35.2% of the participants were aware of the fact that chest x-ray might increase the risk of developing breast cancer. Unfortunately, 84.0% of the participants thought that breastfeeding was linked with the increased risk of breast cancer; while in fact, breastfeeding did not have a significant correlation with increasing the occurrence of breast cancer. 

Table 2.  Shows that the majority of respondents (84.7%) said that breast cancer was one of the most common cancers among females around the world, while the women under the age of 30 could not develop breast cancer (recorded the lowest percentage of 15). In the part of the risk factors, 75.4% of respondents said that hormone replacement therapy increased the risk of breast cancer while using oral contraceptives increased the risk of breast cancer at the lowest recorded percentage (6%).

Table 3. Shows that the majority of respondents’ answers are correct about awareness of the signs and risk factors of breast cancer by a recorded high percent, and this means that the level of women’s awareness is high.

Table 4 clarifies the relationship between age group and awareness of breast cancer. There is a statistically significant relationship between age group and awareness of breast cancer (p. value >0.05).

Table 1. The Demographic Characteristics of Participants.

Table 2. Knowledge of the respondents about, self-examination and risk factors of breast cancer

Table 3. the correct and the incorrect answers about the knowledge of the respondents about the breast cancer

Table 4. The relationship between age group and awareness of breast cancer.