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Practice and barriers of mammography among Malaysian women in the general population

Al-Naggar RA, Bobryshev YV

Asian Pac J Cancer Prev, 2012;13(8):3595-600.
PMID: 23098439

OBJECTIVE: The objective of this study was to determine the practice and barriers of mammography and associated factors among Malaysian women in the general population.
METHODOLOGY: A cross-sectional study was conducted among 200 women in Shah Alam, Selangor; Malaysia. The questionnaire contained 27 questions and was comprised of two sections; socio-demographic characteristics and practices, knowledge and barriers of mammography. All the data were analyzed using the Statistical Package for the Social Sciences (SPSS) 13.0.
RESULTS: Of the 200 Malaysian women who participated in this study, the majority were under the age of 50 years (65.5%), Malay (86%), and married (94.5%). Regarding any family history of cancer in general, the majority of the participants had none (78%). However, some did report a close relative with breast cancer (16.5%). While the majority of them knew about mammography (68%), 15% had had a mammogram once in their life and only 2% had the procedure every two or three years. Univariate analysis showed that age, family history of cancer, family history of breast cancer, regular supplement intake, regular medical check-up and knowledge about mammogram were significantly associated with mammogram practice among the general population (p=0.007, p=0.043, P=0.015, p=0.01, p=0.001, p<0.001; respectively). Multivariate analysis using multiple linear regression test showed that age, regular medical check-up and knowledge about mammography testing were statistically associated with the practice of mammography among the general population in Malaysia (p=0.035, p=0.015 and p<0.001; respectively). Lack of time, lack of knowledge, not knowing where to go for the test and a fear of the test result were the most important barriers (42.5%, 32%, 21%, 20%; respectively).
CONCLUSION: The practice of mammogram screening is low among Malaysian women.

Matched MeSH terms: Breast Neoplasms/diagnosis; Breast Neoplasms/epidemiology; Breast Neoplasms/prevention & control*; Breast Self-Examination/trends; Breast Self-Examination/statistics & numerical data*
Fulltext Practice of breast self-examination among women in Malaysia

Al-Naggar RA, Bobryshev YV, Al-Jashamy K

Asian Pac J Cancer Prev, 2012;13(8):3829-33.
PMID: 23098479

OBJECTIVES: The objective of this study was to examine the practice and associated factors of breast self- examination (BSE) among Malaysian women.

METHODS: For this cross-sectional study 250 women were selected by a simple random sampling technique. The questionnaire was consisted of three parts: socio-demographic characteristics, knowledge about BSE, and practice of BSE. Obtained data was analyzed using SPSS version 13. T-test and ANOVA test were used to explore the relation between socio-demographic characteristics and the practice of BSE.

RESULTS: About 32% of the participants reported that they have had family history of cancer and about 20% of the participants reported that they have had family history of breast cancer. The majority of the participants (88.8%) have heard about breast cancer and 78.4% of the participants have heard about BSE. Race, marital status, residency, regular exercise, awareness about breast cancer, belief that breast cancer can be detected early, belief that early detection improves the chance of survival, family history of cancer, family history of breast cancer, awareness about BSE, and belief that BSE is necessary, significantly influenced the practice of BSE among women. Practice of BSE on monthly basis was found to be 47.2% among the study participants.

CONCLUSION: The socio-demographic characteristics significantly influence the practice of BSA among women in Malaysia. The findings of this study might not only influence the planning of specific screening interventions and strategies in Malaysia but might also be important for the relevant international communities, interested in the peculiarities of BSE incidence in different countries.

Matched MeSH terms: Breast Neoplasms/diagnosis; Breast Neoplasms/epidemiology; Breast Neoplasms/prevention & control*; Breast Self-Examination/trends*; Breast Self-Examination/statistics & numerical data
Fulltext Modification of MCF-10A cells with pioglitazone and serum-rich growth medium increases soluble factors in the conditioned medium, likely reducing BT-474 cell growth

Khoo BY, Miswan N, Balaram P, Nadarajan K, Elstner E

Int J Mol Sci, 2012;13(5):5607-27.
PMID: 22754319 DOI: 10.3390/ijms13055607

In the present study, we aimed to preincubate MCF-10A cells with pioglitazone and/or serum-rich growth media and to determine adhesive and non-adhesive interactions of the preincubated MCF-10A cells with BT-474 cells. For this purpose, the MCF-10A cells were preincubated with pioglitazone and/or serum-rich growth media, at appropriate concentrations, for 1 week. The MCF-10A cells preincubated with pioglitazone and/or serum-rich growth media were then co-cultured adhesively and non-adhesively with BT-474 cells for another week. Co-culture of BT-474 cells with the preincubated MCF-10A cells, both adhesively and non-adhesively, reduced the growth of the cancer cells. The inhibitory effect of the preincubated MCF-10A cells against the growth of BT-474 cells was likely produced by increasing levels of soluble factors secreted by the preincubated MCF-10A cells into the conditioned medium, as immunoassayed by ELISA. However, only an elevated level of a soluble factor distinguished the conditioned medium collected from the MCF-10A cells preincubated with pioglitazone and serum-rich growth medium than that with pioglitazone alone. This finding was further confirmed by the induction of the soluble factor transcript expression in the preincubated MCF-10A cells, as determined using real-time PCR, for the above phenomenon. Furthermore, modification of the MCF-10A cells through preincubation did not change the morphology of the cells, indicating that the preincubated cells may potentially be injected into mammary fat pads to reduce cancer growth in patients or to be used for others cell-mediated therapy.

Matched MeSH terms: Breast/drug effects; Breast/pathology; Breast Neoplasms/drug therapy*; Breast Neoplasms/metabolism; Breast Neoplasms/pathology
Awareness of breast cancer and screening procedures among Malaysian women

Kanaga KC, Nithiya J, Shatirah MF

Asian Pac J Cancer Prev, 2011;12(8):1965-7.
PMID: 22292634

Breast cancer is the most frequently occurring cancer in women globally and early detection increases the survival rate of patients. Therefore, this study was done to determine factors which influence the awareness of breast cancer and practice of screening procedures. A cross-sectional study was performed on 125 women aged 19-60 years in urban and rural areas in Malaysia using a validated questionnaire covering knowledge of breast cancer and screening practices. A total of 99.2% respondents knew that breast cancer is the leading cancer with a mean knowledge of 67.3 ± 15.3% for urban and 50.2 ± 14.7% for rural women Mann Whitney U showed rural women had significantly less awareness compared to urban women (p< 0.05). Spearman correlation test showed a significant positive relationship between education and awareness (p< 0.05). Regarding awareness of the screening methods, 92.8%, 50.4% and 47.2% of respondents correctly answered questions on capability of BSE, CBE and mammography, respectively. In conclusion, the study showed awareness of breast cancer and practice of screening procedures increases with higher education and urban living. Therefore, there is an urgent need for an intensive breast cancer awareness campaign and availablity of screening centres prioritized in rural areas.

Matched MeSH terms: Breast Neoplasms/diagnosis*; Breast Neoplasms/prevention & control; Breast Neoplasms/psychology*; Breast Self-Examination/methods; Breast Self-Examination/psychology
Breast cancer in Sabah, Malaysia: a two year prospective study

Leong BD, Chuah JA, Kumar VM, Yip CH

Asian Pac J Cancer Prev, 2007 Oct-Dec;8(4):525-9.
PMID: 18260722

INTRODUCTION: Malaysian women have a 1 in 20 chance of developing breast cancer in their lifetime. Sabah, formerly known as North Borneo, is part of East Malaysia with a population of 3.39 million and more than 30 ethnic groups. We conducted a 2 year prospective epidemiological study to provide unreported data of breast cancer from this part of the world and to recognise which particular group of patients are more likely to present with advanced disease.

METHODS: All newly diagnosed breast cancers seen at the Queen Elizabeth Hospital, Kota Kinabalu, from January 2005 to December 2006 were included in the study. Patient and tumour characteristics, including age, race, education, socioeconomic background, parity, practice of breast feeding, hormonal medication intake, menopausal status, family history, mode of presentation, histology, grade, stage of disease and hormonal receptors status were collected and analysed.

RESULTS: A total of 186 patients were seen. The commonest age group was 40 to 49 years old (32.3%). Chinese was the commonest race (30.6%) followed by Kadazan-Dusun (24.2%). The commonest histology was invasive ductal carcinoma (88.4%). Stages at presentation were Stage 0- 4.8%, Stage I- 12.9%, Stage II- 30.1%, Stage III- 36.6% and Stage IV- 15.6%. The estrogen and progesterone receptor status was positive in 59.1% and 54.8% of cases, respectively. 73.7% of Chinese patients presented with early cancer compared to 36.4% of the other races. Patients who presented with advanced disease were also poor, non-educated and from rural areas. 20.4% of patients defaulted treatment; most of them opted for traditional alternatives.

CONCLUSIONS: Sabahan women with breast cancer present late. Great efforts are needed to improve public awareness of breast cancer, especially among those who have higher risk of presenting with advanced disease.

Matched MeSH terms: Breast Neoplasms/metabolism; Breast Neoplasms/epidemiology*; Breast Neoplasms/pathology; Carcinoma, Ductal, Breast/epidemiology; Carcinoma, Ductal, Breast/pathology
Fulltext Psychosocial predictors of breast self-examination among female students in Malaysia: a study to assess the roles of body image, self-efficacy and perceived barriers

Ahmadian M, Carmack S, Samah AA, Kreps G, Saidu MB

Asian Pac J Cancer Prev, 2016;17(3):1277-84.
PMID: 27039760

BACKGROUND: Early detection is a critical part of reducing the burden of breast cancer and breast selfexamination (BSE) has been found to be an especially important early detection strategy in low and middle income countries such as Malaysia. Although reports indicate that Malaysian women report an increase in BSE activity in recent years, additional research is needed to explore factors that may help to increase this behavior among Southeastern Asian women.

OBJECTIVE: This study is the first of its kind to explore how the predicting variables of self-efficacy, perceived barriers, and body image factors correlate with self-reports of past BSE, and intention to conduct future breast self-exams among female students in Malaysia.

MATERIALS AND METHODS: Through the analysis of data collected from a prior study of female students from nine Malaysian universities (n=842), this study found that self-efficacy, perceived barriers and specific body image sub-constructs (MBSRQ-Appearance Scales) were correlated with, and at times predicted, both the likelihood of past BSE and the intention to conduct breast self-exams in the future.

RESULTS: Self-efficacy (SE) positively predicted the likelihood of past self-exam behavior, and intention to conduct future breast self-exams. Perceived barriers (BR) negatively predicted past behavior and future intention of breast self-exams. The body image sub-constructs of appearance evaluation (AE) and overweight preoccupation (OWP) predicted the likelihood of past behavior but did not predict intention for future behavior. Appearance orientation (AO) had a somewhat opposite effect: AO did not correlate with or predict past behavior but did correlate with intention to conduct breast self-exams in the future. The body image sub-constructs of body area satisfaction (BASS) and self-classified weight (SCW) showed no correlation with the subjects' past breast self-exam behavior nor with their intention to conduct breast self-exams in the future.

CONCLUSIONS: Findings from this study indicate that both self-efficacy and perceived barriers to BSE are significant psychosocial factors that influence BSE behavior. These results suggest that health promotion interventions that help enhance self-efficacy and reduce perceived barriers have the potential to increase the intentions of Malaysian women to perform breast self-exams, which can promote early detection of breast cancers. Future research should evaluate targeted communication interventions for addressing self-efficacy and perceived barriers to breast self-exams with at-risk Malaysian women. and further explore the relationship between BSE and body image.

Matched MeSH terms: Breast Neoplasms/diagnosis*; Breast Neoplasms/epidemiology; Breast Neoplasms/psychology; Breast Self-Examination/psychology; Breast Self-Examination/statistics & numerical data*
Recurrent mutation testing of BRCA1 and BRCA2 in Asian breast cancer patients identify carriers in those with presumed low risk by family history

Kang PC, Phuah SY, Sivanandan K, Kang IN, Thirthagiri E, Liu JJ, et al.

Breast Cancer Res Treat, 2014 Apr;144(3):635-42.
PMID: 24578176 DOI: 10.1007/s10549-014-2894-x

Although the breast cancer predisposition genes BRCA1 and BRCA2 were discovered more than 20 years ago, there remains a gap in the availability of genetic counselling and genetic testing in Asian countries because of cost, access and inaccurate reporting of family history of cancer. In order to improve access to testing, we developed a rapid test for recurrent mutations in our Asian populations. In this study, we designed a genotyping assay with 55 BRCA1 and 44 BRCA2 mutations previously identified in Asian studies, and validated this assay in 267 individuals who had previously been tested by full sequencing. We tested the prevalence of these mutations in additional breast cancer cases. Using this genotyping approach, we analysed recurrent mutations in 533 Malaysian breast cancer cases with <10 % a priori risk, and found 1 BRCA1 (0.2 %) and 5 BRCA2 (0.9 %) carriers. Testing in a hospital-based unselected cohort of 532 Singaporean breast cancer cases revealed 6 BRCA1 (1.1 %) and 3 BRCA2 (0.6 %) carriers. Overall, 2 recurrent BRCA1 and 1 BRCA2 mutations in Malays, 3 BRCA1 and 2 BRCA2 mutations in Chinese and 1 BRCA1 mutation in Indians account for 60, 24 and 20 % of carrier families, respectively. By contrast, haplotype analyses suggest that a recurrent BRCA2 mutation (c.262_263delCT) found in 5 unrelated Malay families has at least 3 distinct haplotypes. Taken together, our data suggests that panel testing may help to identify carriers, particularly Asian BRCA2 carriers, who do not present with a priori strong family history characteristics.

Matched MeSH terms: Breast Neoplasms/diagnosis; Breast Neoplasms/genetics*; Breast Neoplasms/epidemiology*; Hereditary Breast and Ovarian Cancer Syndrome/genetics; Hereditary Breast and Ovarian Cancer Syndrome/epidemiology
P27 V109G Polymorphism is associated with lymph node metastases but not with increased risk of breast cancer

Naidu R, Har YC, Taib NA

J Exp Clin Cancer Res, 2007 Mar;26(1):133-40.
PMID: 17550142

The p27 V109G polymorphism was investigated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in a hospital-based Malaysian population. Peripheral blood samples were collected from 230 breast cancer patients and 200 normal and healthy women who had no history of breast disease or breast cancer. We evaluated the association between the p27 polymorphism and breast cancer risk, and clinico-pathological parameters in the population. The distribution of genotype and allele frequencies of p27 V109G polymorphism were not significantly different between the breast cancer cases and normal subjects (P=0.376). Women who were homozygous (OR=1.73; 95% CI, 0.62-4.92) or heterozygous (OR=1.26; 95% CI, 0.75-2.12) for G allele, or carriers of G allele genotype (OR=1.34; 95%, 0.83-2.16) or G allele (OR=1.36; 95% CI, 0.90-2.05) were not associated with breast cancer risk. No significant correlation was noted between G allele genotype and breast cancer risk among patients under 50 (OR=1.28; 95% CI, 0.62-2.66) or 50 years and older (OR=1.38; 95% CI, 0.71-2.66) at diagnosis. The G allele genotype was significantly associated with lymph node metastases but independent of ER status and histological grade. In conclusion, the polymorphic variant at codon 109 of p27 gene may not be a marker for determining patients' risk of developing breast cancer but it may be a potential genetic marker for poor prognosis, thereby a marker for tumor prognosis.

Matched MeSH terms: Breast Neoplasms/genetics*; Breast Neoplasms/epidemiology; Breast Neoplasms/pathology; Breast Neoplasms/chemistry; Carcinoma, Ductal, Breast/genetics*; Carcinoma, Ductal, Breast/epidemiology; Carcinoma, Ductal, Breast/pathology; Carcinoma, Ductal, Breast/chemistry
Knowledge of breast cancer and breast self-examination practice among Iranian women in Hamedan, Iran

Akhtari-Zavare M, Ghanbari-Baghestan A, Latiff LA, Matinnia N, Hoseini M

Asian Pac J Cancer Prev, 2014;15(16):6531-4.
PMID: 25169482

BACKGROUND: In Iran, breast cancer is the most prevalent cancer in women and a major public health problem.
METHODS: A cross sectional study was carried out to determine knowledge on breast cancer and breast self- examination (BSE) practices of 384 females living in the city of Hamadan, Iran. A purposive sampling method was adopted and data were collected via face-to-face interviews based on a validated questionnaire developed for this study.
RESULTS: Among respondents 268 (69.8%) were married and 144 (37.5%) of the respondents reported having a family history of breast cancer. One hundred respondents (26.0%) claimed they practiced BSE. Level of breast cancer knowledge was significantly associated with BSE practice (p=0.000). There was no association with demographic details (p<0.05).
CONCLUSION: The findings showed that Iranian women's knowledge regarding breast cancer and the practice of BSE is inadequate. Targeted education should be implemented to improve early detection of breast cancer.

Matched MeSH terms: Breast Neoplasms/diagnosis*; Breast Neoplasms/prevention & control; Breast Self-Examination*
Perception of breast health amongst Malaysian female adolescents

Che CC, Coomarasamy JD, Suppayah B

Asian Pac J Cancer Prev, 2014;15(17):7175-80.
PMID: 25227810

BACKGROUND: Breast cancer is the most common cancer among women in Malaysia, about one in 19 women being at risk. This study aimed to investigate knowledge and practice of breast self-examination (BSE), as well as knowledge of risk factors for breast cancer amongst female adolescents in Malaysia. Subsequently, relationships between demographic characteristics and knowledge level of BSE, risk factors for breast cancer and BSE practice were assessed.
MATERIALS AND METHODS: A descriptive, cross sectional survey was conducted using a sample of 500 Malaysian adolescents from the age of 15 to 19 years. A self-administered questionnaire was used to gather socio- demographic characteristics, knowledge of BSE, knowledge of risk factors for breast cancer and BSE practices.
RESULTS: The findings of this study indicated that female adolescents in Malaysia demonstrated an inadequate knowledge level of BSE and risk factors for breast cancer. Only 27.8% of female adolescents performed BSE regularly. BSE practice, knowledge of BSE and knowledge of risk factors for breast cancer showed significant positive relationships.
CONCLUSIONS: The study highlighted the importance of planning and implementing breast health education programs for female students in secondary schools in Malaysia. It will also provide the health care providers an avenue to stress on the importance of imparting breast health education to adolescents.

Matched MeSH terms: Breast Neoplasms/diagnosis; Breast Neoplasms/psychology*; Breast Self-Examination*
Non-practice of breast self examination and marital status are associated with delayed presentation with breast cancer

Ghazali SM, Othman Z, Cheong KC, Hock LK, Wan Mahiyuddin WR, Kamaluddin MA, et al.

Asian Pac J Cancer Prev, 2013;14(2):1141-5.
PMID: 23621202

Delay in seeking treatment for breast cancer is a barrier to the early diagnosis and management of the disease, resulting in a poorer prognosis. We here estimated the prevalence of delayed presentation for breast cancer and identified possible influential sociodemographic factors in a cross-sectional study of 250 patients diagnosed with primary breast cancer at the Radiotherapy and Oncology Clinic in Kuala Lumpur Hospital. Data were collected by face-to-face interview using a structured questionnaire and from medical records. We examined associations between delayed presentation (presenting to a physician more than 3 months after self-discovery of a symptom) and sociodemographic characteristics, practice of breast self examination (BSE), history of benign breast disease, family history of breast cancer and type of symptom, symptom disclosure and advice from others to seek treatment using multiple logistic regression. Time from self-discovery of symptom to presentation ranged from tghe same day to 5 years. Prevalence of delayed presentation was 33.1% (95%CI: 27.4, 39.3). A significantly higher proportion of delayers presented with late stages (stage III/IV) (58.3% vs. 26.9%, p<0.001). Divorced or widowed women (OR: 2.23, 95% CI: 1.11, 4.47) had a higher risk of delayed presentation than married women and women who never performed breast self examination were more likely to delay presentation compared to those who regularly performed BSE (OR: 2.74, 95% CI: 1.33, 5.64). Our findings indicate that delayed presentation for breast cancer symptoms among Malaysian women is high and that marital status and breast self examination play major roles in treatment-seeking for breast cancer symptoms.

Matched MeSH terms: Breast Neoplasms/diagnosis*; Breast Neoplasms/epidemiology; Breast Self-Examination/methods*
Fulltext Beliefs and behavior of Malaysia undergraduate female students in a public university toward breast self-examination practice

Akhtari-Zavare M, Juni MH, Said SM, Ismail IZ

Asian Pac J Cancer Prev, 2013;14(1):57-61.
PMID: 23534796

BACKGROUND: Breast cancer is the most common cancer and the second principal cause of cancer deaths among women worldwide, including Malaysia.

METHODS: A cross-sectional study was carried out among 262 female undergraduate students in University Putra Malaysia using a validated questionnaire which was developed for this study.

RESULTS: The mean age of respondents was 22∓2.3 years. Most of them were single (83.1%), Malay (42.3%) and 20.7% reported having a family history of breast cancer. Eighty-seven (36.7%) claimed they had practiced BSE. Motivation and self-efficacy of the respondents who performed BSE were significantly higher compared with women who did not (p<0.05).There was no association between BSE practice and demographic details (p<0.05). Logistic regression analysis indicated that women who perceived greater motivation (OR=1.089, 95%CI: 1.016-1.168) and had higher confidence of BSE (OR=1.076, 95%CI: 1.028-1.126) were more likely to perform the screening.

CONCLUSIONS: The findings show that Malaysian young female's perception regarding breast cancer and the practice of BSE is low. Targeted education should be implemented to improve early detection of breast cancer.

Matched MeSH terms: Breast Neoplasms/diagnosis*; Breast Neoplasms/psychology*; Breast Self-Examination/psychology*
Fulltext Ethnic differences in survival after breast cancer in South East Asia

Bhoo-Pathy N, Hartman M, Yip CH, Saxena N, Taib NA, Lim SE, et al.

PLoS One, 2012;7(2):e30995.
PMID: 22363531 DOI: 10.1371/journal.pone.0030995

The burden of breast cancer in Asia is escalating. We evaluated the impact of ethnicity on survival after breast cancer in the multi-ethnic region of South East Asia.

Matched MeSH terms: Breast Neoplasms/diagnosis; Breast Neoplasms/ethnology*; Breast Neoplasms/mortality*; Breast Neoplasms/pathology
Fulltext Practice and barriers toward breast self-examination among young Malaysian women

Al-Naggar RA, Al-Naggar DH, Bobryshev YV, Chen R, Assabri A

Asian Pac J Cancer Prev, 2011;12(5):1173-8.
PMID: 21875261

INTRODUCTION: The etiology of breast cancer is still unknown and adequate primary prevention strategies or interventions are still not possible. Therefore, early detection remains the first priority and regular practice of breast self-examination (BSE) influences treatment, quality of life, survival, and prognosis of breast cancer patients.
OBJECTIVES: The objective of this study was to determine the practices and barriers towards breast self-examination among young Malaysian women.
METHODOLOGY: Cross-sectional study was conducted among 251 female students at the Management and Science University, Shah Alam, Selangor, Malaysia. Questionnaires were distributed at gathering places such as the university cafeteria, the university plaza, the Islamic center, and at the library. In addition, questionnaires were distributed in the lecture halls. The proposal of this study was approved by the Ethics and Research Committee of Management and Science University. Data was analysis using SPSS version 13, t-test was used to analyze the associated factors toward the practice of BSE.
RESULTS: A total number of 251 students participated in this study. The majority of them were older than 20 years old,of Malay racial origin, single and from urban areas (66.5%; 63.7%; 96%; 70.9% respectively). Regarding their lifestyle practices, the majority of participants do exercise, are non-smokers and do not drink alcohol (71.3%; 98.4%; 94.4% respectively). More than half of the study participants mentioned that they have practiced BSE (55.4%). Regarding the sources of information about BSE, the majority mentioned that radio and TV were their main sources of information (38.2%). Age, exercise and family history of cancer significantly influenced the practice of BSE (p = 0.045; p=0.002; p=0.017 respectively). Regarding the barriers to BSE, the majority who never practiced BSE mentioned that lack of knowledge, not having any symptoms, and being afraid of being diagnosed with breast cancer were the main barriers to practicing BSE (20.3%; 14.3%; 4.4% respectively).
CONCLUSION: More than half of the participants practiced BSE. Age, exercise and family history of cancer significantly influenced the practice of the BSE. Lack of knowledge, not having any symptoms and being afraid of being diagnosed with breast cancer were the main barriers to practicing BSE. There is an urgent need to develop a continuous awareness campaign among university students on the importance of performing BSE.

Matched MeSH terms: Breast Neoplasms/prevention & control*; Breast Self-Examination/trends; Breast Self-Examination/statistics & numerical data*
Dietary changes among breast cancer patients in Malaysia

Shaharudin SH, Sulaiman S, Shahril MR, Emran NA, Akmal SN

Cancer Nurs, 2013 Mar-Apr;36(2):131-8.
PMID: 22293157 DOI: 10.1097/NCC.0b013e31824062d1

BACKGROUND: Breast cancer patients often show an interest in making dietary changes after diagnosis of breast cancer to improve their health condition and prevent cancer recurrence.
OBJECTIVE: The objective of the study was to determine changes in dietary intake 2 years after diagnosis among breast cancer patients.
METHODS: One hundred sixteen subjects were asked to complete a semiquantitative food frequency questionnaire, diet recalls, and dietary changes questionnaire to assess dietary intake before and after diagnosis. The information on sociodemographic background, cancer treatment history, and anthropometric indices was also collected.
RESULTS: Seventy-two subjects considered diet as a contributing factor to breast cancer, and 67 subjects changed their dietary habits after breast cancer diagnosis. The reasons for changes in diet were physician and dietitian advice and desire to cure cancer. The sources of information were derived from their physician, mass media, and family members. Total energy, protein, total fat, fatty acids, and vitamin E intake were significantly decreased after diagnosis. Meanwhile, the intake of β-carotene and vitamin C increased significantly after diagnosis. The changes included reduction in red meat, seafood, noodles, and poultry intake. An increased consumption of fruits, vegetables, fish, low-fat milk, and soy products was observed. The subjects tended to lower high-fat foods intake and started to eat more fruits and vegetables.
CONCLUSION: Breast cancer patients had changed to a healthier diet after breast cancer diagnosis, although the changes made were small.
IMPLICATIONS FOR PRACTICE: This will be helpful to dietitians in providing a better understanding of good eating habits that will maintain patients' health after breast cancer diagnosis.

Matched MeSH terms: Breast Neoplasms/diagnosis; Breast Neoplasms/diet therapy; Breast Neoplasms/nursing*; Breast Neoplasms/epidemiology
Is breast self examination (BSE) still relevant? A study on BSE performance among female staff of University of Malaya

Dahlui M, Ng C, Al-Sadat N, Ismail S, Bulgiba A

Asian Pac J Cancer Prev, 2011;12(2):369-72.
PMID: 21545196

OBJECTIVES: This study aimed to determine the rate of breast self examination (BSE) among the female staff of University of Malaya and to determine the role of BSE in detecting breast abnormalities.
METHODS: A total of 1598 questionnaires were posted to all female staff, aged 35 years and above. Their knowledge on breast cancer, practice of BSE and detection rate of breast abnormality as confirmed by CBE was determined.
RESULTS: The response rate for this study was 45 percent (714 respondents). The rate of respondents having awareness on breast cancer was 98.7 percent. Eighty four percent (598) of the respondents had performed BSE in their lifetime. However, in only 41% was it regular at the recommended time. Forty seven percent (334) had undergone CBE at least once in a lifetime but only 26% (185) had CBE at least once in the past 3 years, while 23% (165) had had a mammogram. There was a significant relationship between CBE and BSE whereby those who had CBE were twice more likely to do BSE. Nineteen percent (84 respondents) of those who did BSE claimed they had detected a breast lump. Of these, 87% (73) had gone for CBE and all were confirmed as such.
CONCLUSION: BSE is still relevant as a screening tool of breast cancer since those who detect breast lump by BSE will most probably go for further check up. CBE should be done to all women, especially those at highest risk of breast cancer, to encourage and train for BSE.

Matched MeSH terms: Breast Neoplasms/diagnosis*; Breast Neoplasms/prevention & control*; Breast Self-Examination/statistics & numerical data*
Fulltext Knowledge, attitudes and practice of breast self-examination among women in a suburban area in Terengganu, Malaysia

Rosmawati NH

Asian Pac J Cancer Prev, 2010;11(6):1503-8.
PMID: 21338188

INTRODUCTION: Breast cancer is the most frequently diagnosed cancer in Malaysian women, irrespective of age group and ethnicity. The observed low survival rates are related to late stage at presentation despite the availability of breast self examination (BSE) as a reliable screening method for early detection.

MATERIALS AND METHODS: This cross-sectional study was designed to determine the knowledge, attitude and practice towards BSE amongst women aged 15 years old and above. Systemic random sampling was applied and information gathered through guided interview by using a structured questionnaire.

RESULTS: A total of 86 respondents were recruited, with a mean age of 40.5 years (SD: 15.51), more than 80% having a secondary or tertiary level of education. The total score was 16.9 (total mean percent: 60.4%) for knowledge, 37.1 (77.3%) for attitude and 9.56 (34.1%) for practice. The proportions of respondents with good score for knowledge, attitude and practice were 38.4%, 73.3% and 7.0%, respectively. Not knowing the correct method of BSE, lack of knowledge on cancer signs and lack of motivational support from parents, spouse or friends appeared to be related with the poor practices.

CONCLUSION: Enhancement of breast cancer awareness and focusing on recognized barriers by health care professionals with the involvement of spouses, family and community would have a substantial beneficial impact on BSE practice.

Matched MeSH terms: Breast Neoplasms/diagnosis*; Breast Neoplasms/epidemiology; Breast Neoplasms/prevention & control*; Breast Self-Examination
Fulltext The usage and knowledge of mammography among women in sub-urban area in Terengganu, Malaysia

Rosmawati NH

Asian Pac J Cancer Prev, 2010;11(3):767-71.
PMID: 21039051

INTRODUCTION: Breast cancer is the leading cancer in women today and the major challenge is late presentation then later contributes to poor outcome and high fatality rate. Mammography is effective in early detection of breast cancer and consequently significantly improves the breast cancer survival.

MATERIALS AND METHODS: This cross-sectional study was used to study the knowledge and awareness towards mammogram amongst women aged 15 years old and above. A systemic random sampling was applied and information gathered through guided interview by using a structured questionnaire.

RESULTS: Eighty-six respondents were recruited. The mean age of respondents was 40.5 years (SD: 15.51) and more than 80% had secondary and tertiary level of education. The percentage of respondents ever performed mammogram was 10.5% (95% CI: 4.0%-17.0%). The rate of correct answers was between 8.1% and 48.8%. Most of the respondents do not sure the answer (45.3%-61.6%) rather than wrongly answer (4.7%-43.0%). Only about 8% truly answer that mammogram should be done once in a life. There are 10.5% of women claimed that mammogram had no serious side effect and not a painful procedure. Nearly half of respondents (48.8%) correctly mentioned that Mammogram can detect breast cancer in early stage.

CONCLUSION: Only a small percentage of women ever performed mammogram and there are seriously unaware and poor knowledge pertaining to mammography screening for breast cancer among women in sub urban area. A massive health education campaign through multiple methods and agencies are needed to enhance the knowledge and awareness on mammogram.

Matched MeSH terms: Breast Neoplasms/diagnosis*; Breast Neoplasms/prevention & control; Breast Self-Examination*
Fulltext Does performance of breast self-exams increase the probability of using mammography: evidence from Malaysia

Dunn RA, Tan A, Samad I

Asian Pac J Cancer Prev, 2010;11(2):417-21.
PMID: 20843127

OBJECTIVES: Breast self-examination (BSE) was evaluated to see if it is a significant predictor of mammography.

METHODS: The decisions of females above age 40 in Malaysia to test for breast cancer using BSE and mammography are jointly modeled using a bivariate probit so that unobserved attributes affecting mammography usage are also allowed to affect BSE. Data come from the Malaysia Non-Communicable Disease Surveillance-1, which was collected between September 2005 and February 2006.

RESULTS: Having ever performed BSE is positively associated with having ever undergone mammography among Malay (adjusted OR=7.343, CI=2.686, 20.079) and Chinese (adjusted OR=3.466, CI=1.330, 9.031) females after adjusting for household income, education, marital status and residential location. Neither relationship is affected by jointly modelling the decision problem. Although the association is also positive for Indian females when mammography is modelled separately (adjusted OR=5.959, CI=1.546 - 22.970), the relationship is reversed when both decisions are modelled separately.

CONCLUSIONS: De-emphasizing BSE in Malaysia may reduce mammography screening among a large proportion of the population. Previous work on the issue in developed countries may not apply to nations with limited resources.

Matched MeSH terms: Breast Neoplasms/diagnosis*; Breast Neoplasms/prevention & control*; Breast Self-Examination*
Fulltext Comparison of breast cancer in Indonesia and Malaysia--a clinico-pathological study between Dharmais Cancer Centre Jakarta and University Malaya Medical Centre, Kuala Lumpur

Ng CH, Pathy NB, Taib NA, Teh YC, Mun KS, Amiruddin A, et al.

Asian Pac J Cancer Prev, 2011;12(11):2943-6.
PMID: 22393968

INTRODUCTION: The age standardised incidence rate (ASR) of breast cancer in Malaysia which is a high middle- income country is similar to Indonesia, a low middle-income country. (Globocan 2008) It is however unknown whether the presentation of breast cancer differs between these two countries.

OBJECTIVE: We compared the stage, age at presentation, and pathological characteristics of breast cancer between two tertiary hospitals in Indonesia and Malaysia; Dharmais Cancer Centre (DCC), which is the national cancer referral centre in Indonesia, and University Malaya Medical Centre (UMMC), which is an academic hospital with established breast oncology services in Kuala Lumpur. One thousand, one hundred and fourteen consecutive women (477 in UMMC: 637 in DCC) who were newly diagnosed with breast cancer between January and December, 2010 were included. Patient's age, TNM stage at presentation, and pathological characteristics were compared. Estrogen receptor (ER) and progesterone receptor (PR) were considered positive if 10% or greater of invasive cell nuclei were stained while HER2 was considered positive with an immunohistochemistry staining intensity of 3+ . Logistic regression analyses were performed to identify differences.
RESULTS: Median age at diagnosis was 52 years in UMMC and 47 years in DCC, whereby patients in DCC were more likely to be very young at diagnosis (aged < 35 years) compared to their counterparts in UMMC (Odds ratio (OR): 2.09; 95%CI: 1.32-3.31). Approximately one third of patients in UMMC presented with TNM stage III or IV, compared to 63% in DCC. Patients in DCC were three times more likely to present with metastatic breast cancer compared to patients in UMMC (OR: 3.01; 95% CI: 2.02-4.48). The percentage of low grade tumours in DCC was higher than in UMMC (28% vs 11% respectively), and the difference persisted even after multivariate adjustment. Although the frequency of ER and PR positivity appeared to be higher in UMMC (65% and 55% respectively) compared to DCC (48% and 40% respectively), these differences were not statistically significant following adjustment for age, stage, HER2 status and grade. The frequency of HER2 positivity was 45% in DCC compared to 26% in UMMC, and remained significantly higher even after multivariate adjustment (multivariate OR:1.76; 95%CI:1.25-2.47, in DCC compared to UMMC). The proportion of triple negative breast cancer was however similar in the two centres (19% in UMMC vs 21% in DCC).
CONCLUSION: Indonesian women with breast cancer seem to present at a younger age and at later stages compared to Malaysian women. Their tumors were more likely to be of low grade and HER2 positive, even after adjustment for other factors, while hormone receptor positivity proved similar in the two groups. The higher HER2 positivity rate in Indonesian patients warrants further study.

Matched MeSH terms: Breast Neoplasms/diagnosis*; Breast Neoplasms/epidemiology; Breast Neoplasms/pathology*; Breast Neoplasms/chemistry

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