Breast Cancer Knowledge and Awareness Among Kurdish Women in Sulaymaniyah, Kurdistan Rejoin Iraq

1. INTRODUCTION

Breast cancer is the most prevalent cancer worldwide and the leading cause of cancer-related deaths among women, making it a serious public health concern and challenge. This is particularly true in developing nations where the rate of breast cancer-related deaths among women is rapidly rising [1], [2]. This may be due to specific lifestyle choices and more prevalent reproductive factors in the developed world. Although rates are rising quickly in many developing countries, the difference may be exaggerated due to a lack of awareness, screening, and diagnosis in these countries [3].

According to the World Health Organization (WHO), approximately 627,000 women died from breast cancer in 2018, representing about %15 of all female cancer deaths [4]. In Iraq, breast cancer had the highest percentage and incidence rate among the top ten cancers in 2019, at 34.08% and 35.95/100,000, respectively. In Iraq, the highest percentage and incidence rate of the top ten cancers in 2019 was breast cancer (34.08% and 35.95/100,000, respectively). In addition, the highest mortality rate for breast cancer was approximately one-third [5].

Numerous risk factors can increase the likelihood of developing breast cancer, including long-term use of hormone replacement therapy, minimal to no breastfeeding, having fewer children or being nulliparous, family history, early menarche, being overweight or obese, physical inactivity, alcohol use, late menopause and late age at first birth [3].

The most typical symptom that women with breast cancer present is a breast lump. It could be a sign of serious breast cancer or a benign pathology, such as fat necrosis, fibroadenoma, or an acute or persistent breast abscess. Possible signs of breast cancer include skin changes, nipple discharge, and a palpable breast lump. The three modalities of triple assessment include physical examination, imaging (mammography and/or ultrasound), and biopsy (fine needle aspiration [FNA] cytology and core biopsy), as the name suggests. When combined, these modalities will produce more reliable outcomes for breast cancer screening and diagnosis than when used separately. Pathological examination of a biopsy such as (FNA, open excisional and core biopsy, stereotactic biopsy, ultrasound-guided core biopsy, and sentinel node biopsy), from a breast lump helps differentiate the types of cancer and determine the survival rate. Mammography is a valuable diagnostic tool that can identify early signs of the disease. Treatment and prognosis for breast cancer are influenced by comorbidities, tumor-node-metastasis staging, lymph vascular spread, histological grade, hormone receptor status, and menopausal status of the patient. Common treatments include surgical excision of the breast tissue, radiotherapy, hormone therapy, and chemotherapy [6].

To decrease the morbidity and mortality from breast cancer, it is essential to have sufficient knowledge and awareness of the clinical manifestations of the disease and to detect it early using mammography, clinical breast examination, or breast self-examination (BSE) [7], [8]. Unfortunately, just a few women utilize those procedures to evaluate their breasts [9], [10]. The BSE method is a cost-effective, non-invasive, simple, and accessible method for all women to help detect abnormal lumps or masses in their breasts early [9]. However, a significant number of women are not even aware of how to perform BSE [11], [12]. The aim of this study is to assess the level of knowledge and awareness regarding breast cancer among Kurdish women in Sulaymaniyah City.

2. MATERIALS AND METHODS

3. RESULTS

The mean age of participants was 39.4 years with a standard deviation of 10.7 years. More than half (59.8%) of the participants were aged between 30 and 50 years, while 18.6% were older than 50 years. The majority (90.4%) resided in urban areas and (66.1%) were university graduates. Approximately 75.1% of the participants were employed in service occupations and (72.1%) were single. In addition, (75.4%) of the participants have a family history of breast cancer (Table 1).

TABLE 1: Distribution of women with respect to breast cancer based on socio-demographic characteristics

It was shown that 68.8% of the female participants were aware of breast cancer, while 74.8% were unaware that the mouse mammary virus can cause breast cancer. More than half (56.1%) and nearly two-thirds (64.5%) of the participants knew that breast cancer can be detected at an early stage, and is curable. In addition, 53.2% reported being aware of screening tools. The percentage of participants who were aware about self-breast examination and mammography was (75.1% and 72.4%), respectively. The vast majority (93%) of the targeted population knew that the most common presenting sign is a painless lump, (76.7%) recognized changes in the breast shape and (68.1%) were aware of nipple discharge. Genetics was identified as the most common risk factor for breast cancer (56.5%) followed by obesity (48. 8%). Only (50.2%) of the respondents knew that breast cancer can be prevented through regular exercise and weight control. The most common source of information for the participants’ knowledge was a physician (55.8%) with social media being the second most common source (37.9%) (Table 2).

TABLE 2: Distribution of knowledge and awareness of women regarding breast cancer

The results presented in Table 3 indicated that 31.9% of participants had adequate knowledge and awareness regarding breast cancer, 21.9% had moderate knowledge, and 46.2% had inadequate knowledge.

TABLE 3: Overall knowledge and awareness of women regarding breast cancer

TABLE 4: Association between socio-demographic characteristics and overall, knowledge and awareness of women regarding breast cancer

The results of the present study revealed a statistically significant association between participant’s knowledge and awareness with their age groups, area of residence, and marital status. In addition, there was a highly significant association between education level and occupation. However, no statistically significant association was found with having a family history of breast cancer (P > 0.05).

4. DISCUSSION

The present study was carried out among Kurdish women to assess the level of knowledge and awareness regarding breast cancer, as breast cancer is the most prevalent cancer among women.

Results of the present study show more than half of the participants were between (30 and 50) years old and (18.6%) were older than 50 years. The majority of the participants in this study (90.4%) were living in urban areas. Regarding educational level (66.1%) of them were university graduates and (2.3%) were illiterate. As expected nearly (75.1%) were employees and (9.6%) were students. Moreover, three-fourths (75.4%) have a family history of breast cancer. These findings are consistent with the study conducted by Halmata et al., [13] which showed that (47.1%) of the participant aged between 35 and 50 years old. On the other hand, a study by Osei-Afriyie et al. [14] revealed that more than half of their participants (55.8%) were between 20 and 24 years old, while only a few (1.3%) were 30 years and above; they reported that (16.4%) were currently married and the majority (83.1%) were single. Moreover, a study by Ahmed et al. in Bangladesh shows that the majority of the women who participated were unmarried (92.4%). More than half (6 1.2%) of the participants came from an urban area and (96%) had no personal history of a breast problem. This may be due to that Bangladesh has made major progress toward achieving the Millennium Development Goals regarding health. Since the 1990s, the health systems have increasingly changed their attention equally toward preventative care and health promotion due to advancements in modern science and technology, as well as the increased involvement of non-governmental organizations and United Nations agencies [15].

The findings of this study were consistent with those of a previous study conducted by Al-Mousa et al. [16], which also examined women’s knowledge and awareness of breast cancer. The study findings were similar to the previous study conducted by Al-Mousa et al. [16] in Jordan who confirmed that approximately (76.0%) of participants were aware that breast cancer is the most common cancer among women. In addition, almost all (95.0%) of participants were aware that breast cancer is curable if detected at an early stage and that early detection improves the chance of survival. The rise in public understanding and awareness of breast cancer following the establishment of the Jordan Breast Cancer Program in 2007 and the Stay in My Life, Get Screened, and Do Not Wait for the Signs campaigns may be responsible for this.

Furthermore, a study by Al-Mousa et al. [16] reported that the knowledge was generally good regarding the symptoms of breast cancer, including swollen axillary glands, bloody discharge from the nipple painless breast lump, and nipple changes (inversion/retraction). Due to the fact that early-stage of breast cancer is frequently more curable, early detection significantly improves survival rates, considering this crucial.

Moreover, Younis et al. [17] reported that 90% of the participants knew that a lump is a sign of breast cancer. About the risk factors (78%) identified genetics as a risk factor while advanced age was (67%). Osei-Afriyie et al. [14] noted that the most frequently indexed risk factors for breast cancer were having a family history of breast cancer, genetics, female sex, and individual lifestyle. Meanwhile, the least known risk factors were null parity followed by early menopause and obesity. In addition, more than a third of their participants identified putting money in the brassiere was implicated as a possible risk factor for breast cancer.

Reports from previous studies by (Ahmed et al., Rahman et al., and Halmata et al., Younis et al.,) confirmed that the source of information were varied, which includes social media (74.7%), such as Facebook, Twitter, and Instagram, Radio/Television at (64%), family physicians (30%), health professionals (26.1%) family member (23.6%) and friends (18.8%). These findings are quite relevant today. They suggest that campaigns on social media can be effective in increasing awareness about breast cancer. Traditional media still holds a strong influence, followed by healthcare providers, who are reliable sources of information. This highlights the need for healthcare providers to be knowledgeable and proactive in educating their patients about breast cancer. Finally, family and community-based interventions can also play a useful role in raising awareness.

Similarly, Segni et al. [18] conducted a study to evaluate knowledge, attitude, and practice of BSE among 368 students on a regular basis among female health science students of Adama Science and Technology University in Ethiopia. They showed that only (8.7%) of them possessed reasonable knowledge while the rest (91%) possessed satisfactory to below-average knowledge of breast cancer. In addition, Ahmed et al. [19] conducted a study in Saudi Arabia that attempted to determine breast cancer awareness levels. Their results demonstrated that the knowledge of breast cancer to be (21.6%), (40%), (33.4%) and (5%) were standard, substandard, average, and below average, respectively. In addition, the level of awareness of Breast cancer among Saudi Medical Students was very low. Moreover, a study by Al-Mousa et al. [16] among Jordanian women depicts that more than one-half (53.7%) of the study sample have an intermediate level of knowledge and only a few (9.2%) of them were rated as having a good to excellent knowledge level regarding breast cancer risk factors. Furthermore, Younis et al. [17] in the United Arab Emirates stated that the percentage of their participants who had knowledge and awareness were poor (13%), moderate (77%), and good (10%). This suggests that adequate information or education about breast cancer may not be reaching particular groups of people. Therefore, it is important to focus on raising the proportion of people with inadequate knowledge and converting moderate awareness into good awareness.

Concerning the association between socio-demographic characteristics and overall knowledge and awareness. These findings were agreed with a previous study done by Al-Mousa et al. [16] in Jordan, who reported a significant positive relationship between the levels of education and the three study variables, knowledge about breast cancer risk factors, signs and symptoms, and awareness of breast cancer early detection and curability. Whereas, a study done by Younis et al. [17] revealed that there was no significant difference in the level of knowledge between the different age groups, marital status, level of knowledge between nulliparous, uniparous, and multiparous women, while they noted a weak positive correlation (P = 0.02) between the total knowledge and educational level of the participants.

5. CONCLUSION

According to the study’s findings, there was a generally inadequate level of knowledge of breast cancer, including its causes, risk factors, and symptoms. Thus, it’s critical to support the development of community-based initiatives and programs that address awareness gaps in the general public and highlight the importance of breast cancer prevention through various screening techniques. This might be accomplished by putting up stands manned by healthcare professionals who are knowledgeable about the subject and by handing out brochures about breast cancer in public areas. Media advertisements would also be effective means of spreading information to make sure women are equipped with the knowledge they need to choose preventative and risk management measures.

6. ACKNOWLEDGMENT

Gratitude is extended to all of the study participants for their participation and special thanks for their great assistance and collaboration in making the data collection process easier.

7. CONFLICTS OF INTERESTS

The author affirms that they have no conflicts of interest.

8. FUNDING

Author fees provided financial support for the study.