Access to healthcare is essential in the pursuit of universal health coverage. Components of access are availability, accessibility (spatial and non-spatial), affordability and acceptability. Measuring spatial accessibility is common approach to evaluating access to health care. This study aimed to determine the availability and spatial accessibility of subsidised mammogram screening in Peninsular Malaysia. Availability was determined from the number and distribution of facilities. Spatial accessibility was determined using the travel impedance approach to represent the revealed access as opposed to potential access measured by other spatial measurement methods. The driving distance of return trips from the respondent's residence to the facilities was determined using a mapping application. The travel expenditure was estimated by multiplying the total travel distance by a standardised travel allowance rate, plus parking fees. Respondents in this study were 344 breast cancer patients who received treatment at 4 referral hospitals between 2015 and 2016. In terms of availability, there were at least 6 major entities which provided subsidised mammogram programs. Facilities with mammogram involved with these programs were located more densely in the central and west coast region of the Peninsula. The ratio of mammogram facility to the target population of women aged 40-74 years ranged between 1: 10,000 and 1:80,000. In terms of accessibility, of the 3.6% of the respondents had undergone mammogram screening, their mean travel distance was 53.4 km (SD = 34.5, range 8-112 km) and the mean travel expenditure was RM 38.97 (SD = 24.00, range RM7.60-78.40). Among those who did not go for mammogram screening, the estimated travel distance and expenditure had a skewed distribution with median travel distance of 22.0 km (IQR 12.0, 42.0, range 2.0-340.0) and the median travel cost of RM 17.40 (IQR 10.40, 30.00, range 3.40-240.00). Higher travel impedance was noted among those who lived in sub-urban and rural areas. In summary, availability of mammogram facilities was good in the central and west coast of the peninsula. The overall provider-to-population ratio was lower than recommended. Based on the travel impedance approach used, accessibility to subsidised mammogram screening among the respondents was good in urban areas but deprived in other areas. This study was a preliminary study with limitations. Nonetheless, the evidence suggests that actions have to be taken to improve the accessibility to opportunistic mammogram screening in Malaysia in pursuit of universal health coverage.
BACKGROUND: Breast cancer is the most common cancer among women in Malaysia. Of the total cancer cases registered in the National Cancer Registry for 2006, 3,525 were female breast cancer cases. The overall age standardized rate was 39.3 per 100,000 population in 2006. An estimated 30%-40% were diagnosed in the late stages and this had resulted in poor survival rates. The purpose of the study was to determine the factors and barriers related to mammography screening uptake among hospital personnel.
METHODS: This mixed method explanatory study was carried out on a universal sampling of 707 female personnel aged 40 and above, from June 2007 until November 2007. The study was conducted at University Malaya Medical Centre, a tertiary hospital in Kuala Lumpur. Pre-tested self-administered questionnaires were mailed to eligible personnel.
RESULTS: The prevalence of mammography screening uptake was 80.3% (95%CI: 76.8%,83.5%) among 534 respondents. Personnel who had physician recommendation had significantly higher odds of mammography screening uptake compared to those who did not have recommendation, adjusted odds ratio of 21.25 (95%CI:12.71,36.56). Reported barriers can be grouped into several themes; negative perception of the procedure like embarrassment due to the presence of male technicians/radiographers; low confidence with radiologist/radiographers in detecting abnormality; lack of coping skills in dealing with expected results and pain during procedure.
CONCLUSIONS: The findings of this study highlighted that 20% of personnel did not undertake mammography screening although there is no cost incurred and the procedure is fully accessible to them. Opportunistic recommendation by physician and concerns on the procedure should be addressed.
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.
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.
Mammography utilization is low in Iran compared with other countries. Here a cross-sectional survey design was used to investigate psycho-social and individual factors associated with mammography among 400 women asymptomatic of breast cancer. The study was carried out at the four outpatient clinics of Tehran during the period from July through October, 2009. We found that mammography screening was related to higher self-efficacy and women's occupation. Future tailored interventions on potential psycho-social determinants and specific demographic factors are critical in increasing mammography screening rates among Iranian women.
Breast cancer is the most common cancer among Malaysian women and early detection can play an important role in reducing cancer morbidity and mortality. The aim of this cross-sectional study was to determine the rates and factors related to clinical breast examination (CBE) and mammography among 425 female teachers in Selangor, Malaysia. A self-administered questionnaire that included questions on socio-demography, cancer-related knowledge and practice and an adapted version of Champion's revised Health Belief Model Scale was employed. The mean age of participants was 37.2 ± 7.16 years. Only 25% of the women ever had a CBE. Of women over the age 40 (n=138), 13.6% reported having had a mammography. The results showed higher susceptibility to breast cancer, higher benefits of doing CBE and regular visits with a physician to be significant predictors for undergoing CBE (p < 0.05). In addition, higher a perceived susceptibility to breast cancer and regular undergoing CBE were significant predictors for having a mammography. The findings clearly suggest a need for improving women's awareness on breast cancer screening, its importance and recommended guidelines.
Study site: Secondary school teachers in Selangor, Malaysia.
OBJECTIVE: Poor health literacy is positively associated with poorer quality of health decision-making and health outcomes in women facing a cancer diagnosis. In developing countries, poor access to complete and accurate information continues to pose a challenge for women. This paper describes the knowledge of Malaysian women with regard to breast cancer and how participation in a self-management program can improve the situation.
METHODS: Secondary analysis of data collected during a clinical trial on women newly diagnosed with breast cancer (n=147) was performed to examine baseline knowledge of breast cancer profile. Knowledge levels of women in the experimental (n= 69) group attending a self-management program were compared to a control group (n= 78) to determine change in the level of knowledge over time.
RESULTS: At baseline, a high percentage of women were unaware of their breast cancer profile. Not a single woman had knowledge of all six basic characteristics; 83% did not know their HER2 status, type of breast cancer (68%), grade of cancer cell (64%), hormonal receptor status (55%), size of breast cancer (18%) and/or their stage of breast cancer (13%). At post intervention, there was significantly better knowledge within the experimental group.
CONCLUSION: Malaysian women in this cohort study demonstrated very low levels of knowledge of their cancer profile. Clinical implications for countering treatment-decision difficulties include the need for a shift in the way information and services are delivered to allow women to take a more active role in their own care. Multi-modal efforts including basic information dissemination to increase women's knowledge can contribute to narrowing of the gap in health disparity.