br The aim of this exploratory
The aim of this exploratory study was to provide initial infor-mation about the knowledge of BC and its screening practices among Yemeni women attending PHCCs in Ghail Bawazir, Hadhramout Province.
Table 7 Barriers to Practicing BSE, CBE, and Mammogram and the Use of BC Screening Methods
Had no health problems 86
Lack of information 95
Afraid of result 33
Lack of interest (unnecessary 9
Level of limited knowledge of the use 184
of BC screening
Abbreviations: BSE ¼ Breast self-examination; CBE ¼ Clinical breast examination.
Women Attending PHCC in Ghail Bawazir District, Yemen
Many studies from Yemen have shown that BC is the most commonly occurring type of cancer among Yemeni women.8,10,11 Despite the ascending increase in the incidence of BC among women within the last decade,16 it Y27632 is reported that like the rest of the Arab women, Yemeni women are diagnosed at advanced stages of the diseases, which will eventually lead to poor prognosis.6-8 Recently, a study conducted to measure the Years Lost due to Disability (YLD), among other measures, for Yemeni women living with BC found that the rate of YLD has increased approximately twofold between 1990 and 2010, with a more substantial increase in older age groups (22.4 per 100,000 women in 1990 to 43.1 per 100,000 women in 2010) than in the younger age groups (2.1 per 100,000 women in 1990 to 4.2 per 100,000 women in 2010).16
Detecting BC at an early stage remains the most essential step for BC control.12,17 The results demonstrated that although the majority of the women participants claimed that they have heard information about BC and as much as two third of them demon-strated good overall knowledge about the topic, only around half of the women knew about the risk factors for BC and screening modalities. In the current study, more than half of the participating women never performed BC screening using BSE and CBE, and very few had a mammogram. Screening practices for BC (BSE, CBE, or mammogram) were generally less than average, most likely to be affected by several negative perceptions about BC and screening practices among this population14, and these screening practices were considered as tools for early diagnosis of BC.18 Re-ports from this study are useful for examining the factors associated with screening practices and for designing and implementing in-terventions targeting prevention practices of this population. For BC, primary health care clinics in Yemen are a venue to include primary prevention (which incorporates educating attending women on BC risk factors and influencing behavior change to avoid these risk factors) and secondary prevention such as screening practices for the detection of cancer in its early stages.
A comparison of women with knowledge of BC risk factors or warning signs and an education level of lower than secondary to those with a higher education level showed that there were no statistical differences between the groups despite the higher per-centage of those with an education level lower than secondary showing limited level of knowledge. Previous studies have identified that a low level of education is a proxy measure for a lower socio-economic status, which has been proven in western studies to be associated with the late-stage diagnosis of BC and higher rates of mortality.19,20 The results demonstrated that although the majority of the women participants claimed that they have heard information about breast and as much as two thirds of them demonstrated good overall knowledge of the topic, only around half of the women knew about the risk factors for BC and screening modalities. The multiple logistic regression analysis conducted in this study confirmed that level of education and knowledge of warning signs and BSE were predictors of performance of BSE in this population. Despite the fact that the effectiveness of BSE as a screening modality has been a debate,21,22 it is recommended that women practice this type if self-detected. Our study revealed that around one third of the
participants (30.3%) had performed BSE; however, it was not regularly practiced. Authors from Saudi Arabia, Yemen, and Iran have shown that BSE examination was performed with regular base in their study population by 4.0%, 4.2%, and 7.1%, respectively.23-
25 The low rate of practicing BSE was also extended to CBE, and the use of mammogram could be included as barriers among the study women. Knowledge of BSE showed to be significantly asso-ciated with performance of CBE in this study, thereby highlighting the importance of BSE. CBE is recommended once every 3 years for
women in their 20s and 30s and annually for women aged 40 years and older.26
In this study, mammography was noted to be a rare practice, and none of the study factors showed significant association with its