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 Table of Contents 
Year : 2001  |  Volume : 8  |  Issue : 3  |  Page : 73-78  

Knowledge and attitude towards screening mammography among 400 women in the eastern province of Saudi Arabia

College of Medicine, King Faisal University, Dammam, Saudi Arabia

Date of Web Publication30-Jul-2012

Correspondence Address:
Fatma A Al-Mulhim
Department of Radiology, King Fahd Hospital of the University, P.O. Box 40044, Al-Khobar 31952
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

PMID: 23008654

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Objective: Assess knowledge and attitude of Saudi females towards screening mammography.
Material and Methods: A sample of four hundred Saudi females were interviewed using a structured questionnaire.
Results: Positive family history of breast cancer was the most significant factor that was positively associated with individual knowledge and attitude towards screening mammography (p<0.00001). There was no significant association with the level of education. Poor knowledge and attitude were observed among 41.8% of all participants, especially in relation to not having mammography done or not wishing to have it done. There were 51 (12.8%) participants who had not had mam­mography done, but wished to have it, 25 (6.3%) participants who were undecided about having mammography done in the future, while 67 (16.8%) wished to have it done every one to two years.
Conclusion: This study showed that there has been deficient knowledge and attitude towards screening mammography even among the highly educated, and stressed the need for health education on the importance of screening.

Keywords: Screening, mammography, breast cancer, Saudi Arabia.

How to cite this article:
Al-Mulhim FA. Knowledge and attitude towards screening mammography among 400 women in the eastern province of Saudi Arabia. J Fam Community Med 2001;8:73-8

How to cite this URL:
Al-Mulhim FA. Knowledge and attitude towards screening mammography among 400 women in the eastern province of Saudi Arabia. J Fam Community Med [serial online] 2001 [cited 2021 Dec 4];8:73-8. Available from:

   Introduction Top

Screening mammography (SM) is an impor­tant tool for detecting early breast cancer. SM refers to x-ray examination of the breast for women who are asymptomatic, that is, have no apparent breast problems. [1] Esti­mates of SM sensitivity range from 75 to 90%, with specificity ranging from 90 to 95%. [2]

The positive predictive value of SM for breast cancer ranges from 20% in women under the age of 50 years, to 60 and up to 80% in women aged 50-69 years. Ran­domized clinical trials have demonstrated a 30% reduction in breast cancer mortality in women 50-69 years who are screened annually or biannually with mammograms. The data on women under age 50 years are less clear. [2] Conclusions on the value of SM in these women have been hampered by in­adequately designed studies, including the failure of randomization and inadequate sample size, low compliance in the inter­vention group, and high screening rates (cross-over) in the control groups. [3],[4] A few studies have suggested adverse effects on mortality in the early years after screening implementation, but both the occurrence and potential etiology of these effects are poorly understood. [4],[5]

In many countries, screening programs are mandatory for women over 50 years of age. This is due to the higher incidence of breast cancer in older women there, consideration of cost-benefit ratio, and past fears about radiation risks in younger women. [6],[7] One review discounts the last factor, indicating that even in women as young as 25, the benefits of mammographic screening far outweigh any risks. [8] Given the fact that the majority of breast cancer patients in Saudi Arabia are younger than those in the West, mainly because of the nature of the population pyramid of Saudi Arabia, the right population for screening needs to be defined and access to spe­cialized medical services must be assured. [9] The lack of public knowledge about cancer is a potential barrier preventing people from participating in such studies and in cancer control activities. [10],[11] The aim of this study is to assess the knowledge and attitude of Saudi females about SM as the first step towards the early detection of breast cancer.

   Material and Methods Top

This study was conducted in the period January-to-June, 2000. The study population was women in the 30-65 year age group working in schools in the Eastern province. The total number of women was about 2000, and was composed of teachers, clerks, and those in administrative and miscellan­eous jobs. A simple random sampling approach was adopted and a 25% target sample size was set. Thus, the estimated sample size was 500 women. Participants were interviewed using a structured questionnaire, consisting of the "yes" or "no", and "uncertain" question format.

The variables in the questionnaire con­cerned: marital status, number of children, level of education, occupation, history of pre­vious mammography, family history of breast cancer, number of mammography tests done, who made the decision about mam­mog­raphy, motive for doing mam­mog­raphy, rea­sons for not doing mammography, sources of knowledge about mammography, and a series of seven questions describing the positive, or negative attitude towards mammography screening.

The data was analyzed using the Statistical Package for Social Sciences (SPSS PC). Frequency distribution tables were generated and a chi-squared test was done to assess the significance of dif­ferences between categories. Significant variables were further analyzed using multiple logistic regression with the attitude towards screening mammography as the dependent variable. A p-value of 0.05 or less was considered as indicative of statistical significance.

   Results Top

The total number of females who par­ticipated in the study was 500, with a response rate of 80.0%. The reasons for non-response were that 100 women were excluded from the study: 75 had not heard about SM, 15 were below the age of 30, and 10 with incomplete questionnaires were rejected.

The mean age of the sample was 35.9 ± 5.7 years, with a range of 30-65 years. The majority of participants (92.8%) were within the age groups 30-44 years. Schoolteachers constituted 74.5% of the sample, while housewives, university teachers and others formed 14.5%, 2,5% and 8.5%, respective­ly. The majority of participants (90.5%) were married [Table 1].
Table 1: Socio-demographic variables

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Regarding experience with mammog­raphy, 58 (14.5%) women had previous experience with mammography. Of these, 36 (62.1%) had had it done once, 18 (31.0%) two times, and 4 (6.9%) three times. The decision for mammography had been made by 28 (48.3%) of the participants them­selves, while for the remaining number the decision had been made by others.

A total of 89 (22.3%) participants were motivated to have mammography done, 56 (62.9%) of whom had it done for fear of cancer and 14 (15.7%) because they knew of people who had cancer.

However, 371 (92.8%) participants had had no motivation for mammography. The reasons for non-motivation were that they had had no breast problems (66.9%), were afraid of discovering that they had cancer (13.2%), or were too busy (10.0%). Among the rest, the reasons were that they were not old enough, could not afford the cost, were afraid of radiological hazards, or uncertain of its benefits.

On the source of knowledge about mammography, 128 (32.0%) of the participants stated the source of their knowledge. The sources consisted of the mass media (31.3%), private doctors (16.4%), personal knowledge and convic­tion (40.6%), husband (7.0%), and another relative (4.7%) [Table 2].
Table 2: Experience with mammography

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[Table 3] shows the attitude towards SM. Almost half of the sample had a positive attitude towards mammography. This atti­tude was expressed in the wish to have mam­mog­raphy done, having had mammog­raphy done before and the desire to have it done every 1-2 years. The other half who had a negative attitude towards mammog­raphy stated that they had not had mam­mography done and had no wish to have it done, were not decided what to do in the future, or would discuss the matter first with the doctor.
Table 3: Attitude towards mammography

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On the effect of variables on participants' attitudes, significantly more younger partici­pants had a positive attitude than older ones (P<0.01). Also, significantly more partici­pants with a positive family history of breast cancer displayed a positive attitude than those with a negative family history (P< 0.0001). However, no significant relation­ship was observed on the positive attitude towards SM with any of the other variables studied [Table 4]. Multiple logistic re­gres­sion analysis revealed that the only variable that was significantly and positively asso­ciated with a positive attitude towards mam­mography was a positive family history of breast cancer (P < 0.00001).
Table 4: Variables affecting attitudes towards mammography

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   Discussion Top

Mammography, a screening procedure, is an x-ray examination of the breast that has decreased the risk of death from breast cancer by 25 to 30%. It can detect breast can­cer or carcinoma in situ at 5 to 10 mm in diameter. Most physicians cannot reliably detect lesions smaller than 10 mm on physical examination, and patients generally seek medical attention for lesions that are 25 mm or larger. [12]

Early breast cancer is potentially curable; in Saudi Arabia it is the most common cancer in women. However, our experience indicates that the pattern of the disease is different than that reported in the litera­ture. [9],[13] Published data from the Saudi National Cancer Registry indicate that breast cancer is the most frequent malig­nancy in adult women, accounting for 18% of the total. A review of studies on the relationship of age to the incidence of breast cancer in North America and Europe shows that the incidence in women younger than 40 years ranges from 8 to 15%, as compared with the 35% observed in King Faisal Spe­cialist Hospital. The low frequency of early stage disease reflects delayed presentation and referral, and is a cause for serious con­cern. The delay may be due to ignorance of the disease, little education and/or the in­accessability of specialized medical care. [9]

The evaluation of public awareness and misperception about cancer is of funda­mental importance for the successful imple­men­tation of activities on cancer control. [10],[14]

This study shows that there is poor knowl­edge and considerable negative atti­tude towards mammography in all identified age groups, and on all educational levels. Little work has been done by the media or pri­vate doctors on community education for disease prevention. Participants with per­sonal or family experience with cancer were more aware of the importance of screening for the disease. The data also suggest that for effective cancer control in Saudi Arabia there should be comprehensive cancer health education.

A joint effort by the primary care physician and community oncologist in this task will be necessary and the development of more widespread screening and educational programs will be of benefit to the women of the Kingdom. The develop­ment and implementation of a comprehen­sive Breast Cancer Program in which additional resources are allocated towards its control would be an important first step towards raising the national consciousness on this disease.

   Acknowledgment Top

I am grateful to Dr. A. G. Elzubier, FRCP, Assistant Professor, for his invaluable assistance and help in the statistical analysis.

   References Top

1.Ferrini R, Mannino E, Ramsdell E,Hill L, Screening mammography for breast cancer: American college of preventive medicine September/October 1996;12(5):340-41.   Back to cited text no. 1
2.Elwood JM, Cox B, Richardson AK, The effectiveness of breast cancer screening by mammography in younger women. Online J Clin Tril 1993;2:Doc no 32.  Back to cited text no. 2
3.Miller AB, Baines CJ, To T, et al. Canadian national breast screening study 1: breast cancer detection and death rates among women ages 40-49 years. Can Med Assoc J 1992;147:1459-98.  Back to cited text no. 3
4.Nyyystrom L, Rutqvist I, Wall S, et al. Breast cancer screening with mammography: overview of Swedish randomized trials. Lancet 1993;341:973-8.  Back to cited text no. 4
5.Vogel V. Screening younger women for breast cancer. J Natl Cancer Inst 1994;16:55-60.  Back to cited text no. 5
6.Fox SA, Klos DS, Tsou CV. Underuse of screening mammography by family physicians. Radiology 1988;166: 431-3.   Back to cited text no. 6
7.American Cancer Society. 1989 survey of physi­cians attitudes and practices in early cancer detection. CA Cancer J Clin 1990;40:77-101.  Back to cited text no. 7
8.Mattler FA, Upton AC, Kesey CA, et al. Benefits versus risks from mammography. Cancer 1996;77:903-9.  Back to cited text no. 8
9.Ezzat A, Raja M, Rostom A, Zwaan F, Ingemansson S, AL-Abdulkareem A. An over­view of breast cancer. Annals of Saudi Medicine 1997;17(1): 10-5.  Back to cited text no. 9
10.Luther SL, Price JH. Measuring common public misperception about cancer. J Cancer Ed 1987; 2(3):177-87.  Back to cited text no. 10
11.Ibrahim EM, AL-Muhana FA, Saied I, et al. Public knowledge, misperception, and attitude about cancer in Saudi Arabia. Annals of Saudi Medicine 1991; 11(5): 518-23.  Back to cited text no. 11
12.Anman K, Shea S. Screening mammography under age 50. Jama 1999; 28(281):1470-2.  Back to cited text no. 12
13.El-Hassan AY,AL-Mulhim FA, Ibrahim EM, Al-Awami M. Retrospective appraisal of 3300 con­secutive mammograms. Annals of Saudi Medi­cine 1990; 10(3):285-90.  Back to cited text no. 13
14.National survey on breast cancer: a Measure of progressing public understanding Washington DC. US Government Printing Office. Dept. of Health Education and Welfare publication 1980; 81:2306.  Back to cited text no. 14


  [Table 1], [Table 2], [Table 3], [Table 4]


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