Study identifies barriers to breast health care in Pakistan

Among most women in Pakistan, there is limited awareness of breast cancer occurrence, detection, and screening practices, or the importance of self-breast exams and clinical breast exams, according to a study in the August issue of the Journal of the American College of Radiology. In Pakistan, breast cancer is the most common cancer affecting women and the incidence is rising. It is usually diagnosed in later stages and often at a younger age compared with populations in the West.

"Breast cancer care in limited-resource countries generally suffers because of multiple obstacles, including a lack of recognition of breast health as a public health priority, a shortage of trained and social or cultural barriers. An improved understanding of existing obstacles in breast cancer care is critical to identify those factors that may be correctable and thereby devise effective interventions for improving early breast cancer detection and treatment in disadvantaged countries," said Sughra Raza, MD, co-author of the study.

Questionnaires were developed to address demographics, financial and educational levels, knowledge regarding breast cancer occurrence and treatment, and religious and that may affect seeking care for . Using the questionnaires, one-on-one surveys were administered by community health workers in Karachi to 200 women and 100 .

Survey results showed that women's knowledge of breast cancer incidence, diagnosis and treatment was proportionate to educational level, while willingness to address breast health issues and interest in early detection were high regardless of education level. Very few women had ever undergone clinical breast examinations or mammography. Among general practitioners, most understood major risk factors and importance of early detection. However, 20 percent did not believe breast cancer occurs in Pakistan, and 30 percent believed that it is a fatal disease. Female general practitioners were more likely to perform clinical breast examinations than male general practitioners.

"Although there is limited awareness regarding breast cancer occurrence, detection, and , as well as the importance of self-breast exams and clinical breast exams, the majority of women are very keen to learn more, to participate in their own care and to lower their risk," said Raza.

"Awareness and educational activities, including training female clinical health workers to perform clinical breast exams, will be beneficial, as we begin instituting awareness, detection and treatment programs in the face of a rapidly rising incidence and late-stage detection of in Pakistan," said Raza.

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