Half of women in Saudi Arabia fail to check breasts for signs of cancer, study finds

Half of women quizzed in Saudi Arabia’s Jeddah have never or rarely perform self-checks for signs of breast irregularities – potentially increasing their risk of late-stage cancer diagnosis.

The research, published in Cureus, examined breast cancer awareness and screening practices among 454 Saudi women in Jeddah, aged 18 and above, found that only 4.4 percent of women examined their breasts at least once a week, while a staggering 50.2 percent rarely or never checked their breasts. This aligns with nationwide data, indicating that 42.8 percent of Saudi women never perform self-examinations.

Breast cancer remains a major threat to women’s health worldwide. In Saudi Arabia, breast cancer represents 29.7 percent of cancer cases among women, according to the latest data available.

In addition, 32.8 percent of women are not very confident and 23.1 percent are not confident at all that they could identify changes in their breasts.

While survival rates have improved in recent decades, thanks to advances in screening and treatment, late diagnosis continues to impact outcomes, Ghala Yasin, the author of the study, ‘Breast cancer screening awareness and associated factors among Saudi females; A cross sectional study’, notes that awareness and promoting early detection through screening remain crucial to reducing the burden of breast cancer in the Kingdom.

Fatal spread of tumours

Breast cancer is a disease in which abnormal breast cells grow out of control and form tumors. If left unchecked, the tumors can spread throughout the body and become fatal.

Most people will not experience any symptoms when the cancer is still early. Hence the importance of early detection, the World Health Organization says. Breast cancer can have combinations of symptoms, especially when it is more advanced. Symptoms of breast cancer can include a breast lump or thickening, often without pain, change in size, shape or appearance of the breast, dimpling, redness, pitting or other changes in the skin, change in nipple appearance or the skin surrounding the nipple (areola), and abnormal or bloody fluid from the nipple.

People with an abnormal breast lump should seek medical care, even if the lump does not hurt.

Breast cancer cells begin to grow inside the milk ducts and/or the milk-producing lobules of the breast. The earliest form (in situ) is not life-threatening. As cancer cells spread into nearby breast tissues, they form tumors that cause lumps.

Invasive cancers can spread to nearby lymph nodes or other organs (metastasize). Metastasis can be fatal.

Treatment is based on the person, the type of cancer and its spread. Treatment combines surgery, radiation therapy and medications.

Importance of mammogram screening

Yasin’s study also found a high level of awareness regarding the Kingdom’s Ministry of Health’s (MOH) breast cancer screening program.

In Saudi Arabia, mammogram screenings (MS) are provided free of charge to all KSA citizens. MOH advises that women aged 40 and above, even without a family history of breast cancer, should undergo mammogram screenings. For those with a family history of breast cancer, screening should begin 10 years earlier than the age of breast cancer onset in their family member.

According to MOH policy, women aged 40 to 50 years are recommended to have mammogram screening every two years, while those aged 51 to 69 should undergo screening every one to two year

While 65.9 percent of participants in the survey were aware of MOH’s breast cancer screening program, only 29.1 percent reported receiving screening invitations. Even fewer (25.3 percent) had actually undergone screening.

This aligns with previous studies demonstrating inadequate breast health knowledge among Saudi women. In one survey, only 25 percent of women aged 50-74 had sufficient knowledge of self-exams. Another study found 75 percent of university students and staff had poor awareness of breast cancer signs.

Researchers identified income level as a predictor of breast cancer awareness, with higher-income participants demonstrating greater knowledge. Those without underlying medical conditions also had higher awareness levels.

Need to overcome cultural barriers

Yasin emphasized tailoring awareness campaigns and education programs to address knowledge gaps among specific populations. Alongside awareness, improving screening rates is imperative, she said, adding that healthcare centers, must actively reach out to women due to cultural barriers inhibiting self-referral.

“The findings underscore the urgent need for targeted interventions to promote regular breast screening, raise confidence upon noticing changes in the breasts, and encourage doctor consultations when the changes are observed,” she said, in the study’s findings. “While the awareness of the MOH’s BC screening program was significantly high, the actual participation in the screening was not as robust.”

“This could be due to fear, discomfort, societal norms, or practical issues such as time constraints and accessibility. Further research is needed to better understand and address these barriers. This points to the need for further research to understand the gap and devise strategies to increase participation. Income and dyslipidemia emerged as significant associated factors with the awareness of breast cancer signs. Therefore, future interventions should consider these factors to design effective awareness campaigns,” Yasin said.

Female gender at higher risk

“Ultimately, enhancing breast cancer screening awareness and practices can contribute significantly to early detection, thereby improving the prognosis and survival rates among Saudi females.”

In 2022, there were 2.3 million women diagnosed with breast cancer and 670,000 deaths from the disease were reported globally, according to the World Health Organization.

Breast cancer occurs in every country in women at any age after puberty, but with higher risks in later life. The female gender is the highest at risk from the disease. Approximately 99 percent of breast cancers occur in women and 0.5–1 percent of the cases occur in men. The treatment protocol for breast cancer in men follows the same principles of management as applicable for women.