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Abstract

Introduction

Breast and cervical cancers represent two important causes of cancer-associated deaths in females. Uptake in prevention towards these cancers remains low in the United Arab Emirates.

Objectives

This study aimed to understand the knowledge, attitudes and practices of females residing in the Al Ain city, UAE, towards cervical and breast cancer prevention.

Methods

This cross-sectional survey was conducted with 300 women, aged 30 years and above. The primary outcome measure was cervical and breast cancer prevention knowledge. The knowledge was queried through a number of items, with the resulting aggregate scores categorized into good and low knowledge. Chi-square test was conducted to investigate the association between prevention knowledge and sociodemographic factors. Additional outcomes included attitude towards and uptake of cervical and breast cancer screening.

Results

Of the participants surveyed, 36.7% had good knowledge on breast cancer prevention, while 5.3% on cervical cancer prevention. Although the majority of the participants believed that prevention methods could save lives, they reported negative attitudes, considering screening unnecessary and painful. The self-reported screening uptake was 23% and 31.3% for mammography and Pap smear, respectively.

Conclusions

The study reported that the knowledge and uptake of women was low for both breast and cervical cancer prevention. Targeted campaigns not only to increase knowledge but also to resolve misconceptions to change negative attitudes may lead to an increase in uptake.

Keywords

cervical cancer breast cancer human papilloma virus vaccination screening United Arab Emirates

Introduction

Two leading causes of cancer-associated morbidity and mortality among women globally are breast and cervical cancers. Breast and cervical cancer are ranked as the first and fourth causes of cancer-associated deaths, respectively, among women worldwide. Although the age-standardised incidence (45.5/100,000 for breast cancer and 6.2/100,000 for cervical cancer) and mortality (16.6/100,000 for breast cancer and 3.5/100,000 for cervical cancer) rates in the Middle East and North Africa (MENA) region as estimated in 2020¹ are lower than other WHO regions, evidence suggests that women present at very advanced stages of the disease and at younger age.^2-4 Advancements in health research have led to the development of several prevention options that have reduced the burden of these cancers significantly. Modalities such as breast self-examination (BSE), clinical breast examination (CBE) and mammography can lead to early detection of breast cancer, thus preventing mortality.^5,6 In the UAE, it is recommended for women aged 40–69 years to have clinical breast examination annually and mammography every two years.⁶ Similarly, for cervical cancer prevention, options such as Papanicolaou (Pap) smear, that is, microscopic examination of abnormal cells, Human Papilloma Virus (HPV) test and HPV vaccination (HPVV) have been introduced. In the United Arab Emirates (UAE), Pap smear is offered to sexually active women aged 25–49 years every three years and those of 50–65 years every 5 years.⁷ Whereas the vaccination is available for women aged 13–26 years. Despite the opportunistic availability of these options in the UAE, participation of women remains low, that is, 13.9% for mammography and 28.0% for Pap smear.⁸

Evidence suggests that knowledge and perceptions about preventive health increase the likelihood of practice and health services uptake.⁹ It is therefore essential to have proper knowledge and positive behaviour for the perusal of preventive health activities. Studies have been carried out previously in certain Gulf Cooperation Council (GCC) countries such as Qatar, Oman, Saudi Arabia and Jordan to understand breast and cervical screening knowledge and uptake among women populations.^10-12 Few studies conducted in the UAE suggest mixed results indicating low-moderate levels of breast screening knowledge about BSE, CBE and mammography among women.^13,14 Similarly, limited studies carried out on assessment of cervical cancer and its screening knowledge in the UAE indicate low awareness and uptake levels in the women as well as the health care practitioners (HCPs).^15-17 Similar findings on awareness and uptake of HPVV were reported.¹⁸ This cross-sectional study was conducted to understand knowledge, attitude and practices of women living in Al Ain, UAE, towards breast and cervical cancer prevention, including screening as well as HPV vaccination.

Methods

Participant Recruitment and Sample Size Estimation

This observational cross-sectional study is being reported in conformation with STROBE guidelines.¹⁹ It was conducted with participants that were conveniently sampled from waiting areas of primary health care clinics in the city of Al Ain during 2016. Women aged 30 years and above, able to speak English or Arabic, from Emirati as well as non-Emirati background and able to provide consent were eligible.

Adequate sample for this study was statistically estimated using sample size estimation formula for prevalence study with absolute precision, n = z² p (1−p)/d², where n is the estimated sample size, p is the expected prevalence of people with good knowledge of breast cancer, obtained from a similar study,²⁰ and d is the desired margin of error. The value of z used was 1.96 (at a 5% level of significance); anticipated prevalence of BSE practice of 23% as reported by a study in the region by Ravichandran et al²⁰ was used and margin of error was pegged at 5 percentage points. The calculated sample size was 276. The final sample size was rounded up to a total of 300 participants in order to accommodate for anticipated non-response. Ethical approval for the study was taken from Ambulatory Health Services (AHS) Ethics Research Committee.

Data Collection Measures

Data was collected using a structured survey (refer to the Supplementary Material) developed after careful literature review. It was based on validated tools such as breast and cervical cancer awareness measures (CAM), and questionnaires used in previous studies,^20-23 tailored according to recommendation of breast and cervical screening within the UAE.^6-8 It consisted of four sections: The first section addressed questions on sociodemographic (age, marital status, residence, nationality, residence, socioeconomic and educational status) and health related (pre-existing medical conditions, medication and alternative medicine usage history, family history of cancer, regular visit to a doctor and previous invitation by a doctor for screening test) characteristics. The next section assessed their breast cancer prevention knowledge (screening, i.e. BSE, CBE and mammography), practices (uptake and doctor’s recommendation) and attitudes. It was followed by a section on cervical cancer prevention knowledge (Pap smear and HPVV), practices (uptake of screening and doctor’s recommendation of screening and vaccination) and attitudes. The last section enquired about the participants’ sources of information on prevention of both cancers. The main outcome measures were breast and cervical cancer prevention knowledge, uptake and attitudes. The questionnaire was reviewed by experts and pilot tested by 10 participants to ensure clarity, readability and cultural suitability, followed by use for actual data collection. Data was collected by medical students verbally and face to face from participants after obtaining written consent from participants. The details of participants were de-identified, and the identity of any participant could not be ascertained in any way.

Data Analysis

Descriptive statistics were used to summarize variables including the characteristics of the participants, those related to attitude towards cancer screening and practice of cancer screening, among others. Using descriptive analysis, categorical variables were summarized by frequencies and percentages while continuous variables were presented as mean and standard deviation. Knowledge of breast and cervical cancers was computed separately. Each knowledge item question was assigned a score of 1 if correctly answered. Overall scores were then computed by adding all the scores for each participant. The total scores were further computed by calculating the percentage score for each participant. A percentage score of 50 and above was regarded as having good knowledge and otherwise was considered low knowledge for both breast and cervical cancers. Participants with incomplete data were excluded from the analysis. The categories of knowledge were summarized and presented as frequencies and percentages. Further inferential statistics were employed to investigate the association between knowledge of breast and cervical cancers with sociodemographic factors. Chi-square test and Fisher’s exact test were used for the purpose as appropriate.

Results

Demographic Characteristics of the Participants

A total of 300 participants were enrolled in the study. Table 1 presents the demographic characteristics of the participants. The majority of participants were young (80.3%), married (63.3%), Emirati national (73%) and employed (88.7%). Most of the participants (92%) were based in Abu Dhabi Emirate including Al Ain (82%) and Abu Dhabi (10%). Forty-eight percent of the participants had a university education, whereas only four percent did not complete any level of formal education. A sizable portion (46.7%) of the participants had a history of one chronic condition or the other. The majority reported not using any current medication (63.3%), herbal medication (86.7%) and other alternative medication (91.7%). While only few participants (35.7%) had the habit of visiting a doctor regularly, about three fourth (76.7%) reported being invited for screening tests in the past.

Table 1.

Demographic Characteristics of Respondents (N = 300).

Demographic Characteristics	Frequency	Percentage
Age (years)
30–39	129	43
40–49	112	37.3
50–59	46	15.3
60–69	13	4.3
Marital status
Single	57	19.0
Married	190	63.3
Divorced	38	12.7
Widowed	15	5.0
Nationality
Emirati	219	73.0
Non-Emirati	81	27.0
Current residence
Al Ain	246	82.0
Abu Dhabi	30	10.0
Others	24	8.0
Employment status
Unemployed	80	26.7
Own business	34	11.3
Employed	186	62.0
Highest education
Cannot read and write	12	4
Elementary	25	8.3
Intermediate	29	9.7
High school	90	30
University	130	43.3
Post-graduate	14	4.7
History of NCDs
Yes	140	46.7
No	160	53.3
Current use of any medication
Yes	110	36.7
No	190	63.3
Use of herbal medication
Yes	40	13.3
No	260	86.7
Use of other alternative medicine like cupping/roqya
Yes	25	8.3
No	275	91.7
Regular visit to doctor
Yes	107	35.7
No	193	64.3
Ever invited for screening test
Yes	230	76.7
No	70	23.3

Knowledge of Breast and Cervical Cancers

The overall proportion of the participants with good knowledge of breast cancer was 36.7 percent (95% confidence interval = 31.4%–42.3%). On the other hand, only 5.3 percent exhibited good knowledge of cervical cancer as illustrated in Table 2. Specific knowledge item scores are presented in Table 3.

Table 2.

Breast and Cervical Cancer Prevention Knowledge Among the Participants.

Knowledge level	Breast cancer		Cervical cancer
Knowledge level	n	% (95% CI^a)	N	% (95% CI^a)
Low^b	190	63.3 (57.7–68.6)	284	94.7 (91.4–96.7)
Good^c	110	36.7 (31.4–42.3)	16	5.3 (3.3–8.5)

^aCI, confidence interval.

^bLow knowledge level for breast and cervical cancers: Score of less than 50.

^cGood knowledge level for breast and cervical cancers: Score of 50 and above.

Table 3.

Summary of Responses to Breast and Cervical Cancer Prevention Knowledge Testing Questions (N = 300).

Questions	Responses
	Correctly Answered		Wrongly Answered
	n	%	n	%
Breast cancer screening
Have you ever heard about breast cancer screening?	199	66.8	99	33.2
Do you know what the recommendations in the UAE for breast cancer screening are?	139	46.6	159	53.4
Have you ever heard of a mammogram?	126	42.0	174	58.0
What is a mammogram?	109	36.7	188	63.3
What is the importance of a mammogram?	44	15.0	249	85.0
What is the recommended age to start having mammograms?	71	23.8	227	76.2
What is the recommended frequency of a mammogram?	55	18.5	242	81.5
Have you ever heard of a breast self- exam?	151	59.0	105	41.0
When is a breast self- exam usually performed?	81	27.3	216	72.7
When is the best time to perform a breast self-exam?	61	21.7	220	78.3
What do you look for during a breast self-exam?	118	40.0	177	60.0
When should you visit your doctor for a breast health check-up?	53	18.2	239	81.8
Cervical cancer screening
Have you ever heard about cervical cancer screening?	146	48.7	154	51.3
Do you know what the recommendations in the UAE for cervical cancer screening are?	92	30.7	208	69.3
What is Pap smear test?	100	33.3	200	66.7
What is the recommended age to start having a Pap smear test among married women?	55	18.3	245	81.7
What is the recommended frequency of a Pap smear?	9	3.0	289	97.0
What is the importance of a Pap smear test?	32	10.8	265	89.2
Have you ever heard of a Human Papilloma Virus Vaccine (HPVV)?	59	19.7	241	80.3
What is the relation between the vaccine and cervical cancer?	34	11.3	266	88.7
Who should get the vaccine?	23	7.7	277	92.3
If changes in the cervix cells were detected, does this mean that the woman definitely has cervical cancer?	59	19.7	241	80.3
If a woman receives the three doses of the vaccine, does she need to continue having the Pap smear regularly?	57	19.0	243	81.0

Good knowledge of breast cancer was seen to be significantly (P = .016) highest among those aged 40–49 years (47.3%), followed by those within the age bracket of 30–39 years (33.3%), 50–59 years (23.9%) and finally 60–69 years (23.1%). Married participants had significantly higher level of breast cancer knowledge than their unmarried counterpart (43.7% vs 24.5%; P < .001). Location was also found to be significantly associated with good knowledge of breast cancer with 39.1 percent of those living in Abu Dhabi Emirate having good knowledge of breast cancer as compared to others with just 8.3 percent (P = .003). Similarly, family history of cancer (59.5% against 33.5%), visiting a doctor on a regular basis (49.5% against 29.5%) as well as past invitation to screening test (59.5% against 33.5%) were significantly associated with good knowledge of breast cancer (P = .002, P < .001 and P = .002, respectively). There were no significant differences in breast cancer knowledge based on nationality, employment status, level of education, history of chronic diseases and the use of any medication. On the other hand, no significant difference was observed in knowledge of cervical cancer based on any of the demographic or health-related factor (Table 4).

Table 4.

Association Between Demographic Factors and Breast and Cervical Cancer Knowledge.

Demographic Factor	Breast Cancer					Cervical Cancer
	Knowledge Level				P-Value	Knowledge Level				P-Value
	Low^a		Good^b			Low^a		Good^b
	n	%	n	%		n	%	N	%
Age (years)
30–39	86	66.7	43	33.3	.016^c	121	93.8	8	6.2	.742
40–49	59	52.7	53	47.3		106	94.6	6	5.4
50–59	35	76.1	11	23.9		45	97.8	1	2.2
60–69	10	76.9	3	23.1		12	92.3	1	7.7
Marital status
Unmarried	83	75.5	27	24.5	<.001^c	105	95.5	5	4.5	.644
Married	107	56.3	83	43.7	<.001^c	179	94.2	11	5.8	.644
Nationality
Emirati	140	63.9	79	36.1	.726	206	94.1	13	5.9	.571
Non-Emirati	50	61.7	31	38.3	.726	78	96.3	3	3.7	.571
Current residence
Abu Dhabi Emirate	168	60.9	108	39.1	.003^c	262	94.9	14	5.1	.372
Others	22	91.7	2	8.3	.003^c	22	91.7	2	8.3	.372
Employment status
Unemployed	53	66.3	27	33.8	.527	73	91.3	7	8.7	.144
Employed	137	62.3	83	37.7	.527	211	95.9	9	4.1	.144
Highest education
Cannot read and write	11	91.7	1	8.3	.083	12	100	0	0	.142
Elementary	16	64.0	9	36.0		21	84.0	4	16.0
Intermediate	15	51.7	14	48.3		27	93.1	2	6.9
High school	62	68.9	28	31.1		88	97.8	2	2.2
University	80	61.5	50	38.5		123	94.6	7	5.4
Post-graduate	6	42.9	8	57.1		13	92.9	1	7.1
History of NCDs
Yes	93	66.4	47	33.6	.298	132	94.3	8	5.7	.784
No	97	60.6	63	39.4	.298	152	95.0	8	5.0	.784
Family history of cancer
Yes	15	40.5	22	59.5	.002^c	37	100	0	0.0	.235
No	175	66.5	88	33.5	.002^c	247	93.9	14	6.1	.235
Current use of any medication
Yes	77	70.0	33	30.0	.068	104	94.5	6	5.5	.943
No	113	59.5	77	40.5	.068	180	94.7	10	5.3	.943
Use of herbal medication
Yes	25	62.5	15	37.5	.906	37	92.5	3	7.5	.457
No	165	63.5	95	36.5	.906	247	95.0	13	5.0	.457
Use of other alternative medicine
Yes	16	64.0	9	36.0	.942	22	88.0	3	12.0	.139
No	174	63.3	101	36.7	.942	262	95.3	13	4.7	.139
Regular visit to doctor
Yes	54	50.5	53	49.5	<.001^c	101	94.4	6	5.6	.875
No	136	70.5	57	29.5	<.001^c	183	94.8	10	5.2	.875
Ever invited for screening test
Yes	15	40.5	22	59.5	.002^c	37	100	0	0	.235
No	175	66.5	88	33.5	.002^c	247	93.9	16	6.1	.235

^aLow knowledge level: Score of less than 50.

^bGood knowledge level: Score of 50 and above.

^cP value statistically significant: ≤0.05.

Attitude

Most of the participants showed positive attitudes regarding the importance of doctor visits for a regular breast health exam (78.3%), lifesaving ability of early screening and early detection of breast cancer (84.4%) as they agreed with these statements (Figure 1). A considerable proportion of the participants showed a poor attitude towards mammogram as they agreed that a mammogram can cause unnecessary fear and panic among women (56%), a mammogram is a waste of resources (48.6%) and that a mammogram can be painful (49.3%). Nevertheless, most of them (80.7%) still agreed that they would perform mammogram based on doctor’s advice. Additionally, a majority of the participants (67.4%) believed that visiting a doctor for breast clinical examination may lead to unnecessary fear and anxiety, a woman cannot detect breast cancer by herself (67%), a breast self-exam is painful and unnecessary (61.7%) and that a breast self-exam can lead to necessary fear and anxiety among women (68.3%).

Figure 1.

Participants’ responses (%) to breast and cervical cancer attitude statements (N = 300).

With regards to cervical cancer, the majority believed that screening and early detection for cervical cancer can save lives (80.6%) and that they will perform a Pap smear if the doctor advises (71.3%). Slightly more than half believed that women and girls should receive HPVV (54%) and that they will give their daughter the HPVV if the doctor advises (58%). However, many (42.3%) agreed that HPVV can cause unnecessary side effects. The majority, nevertheless, agreed with negative statements such as a Pap smear can be painful (59%), a Pap smear is a waste of resources (53%) and a Pap smear can cause unnecessary fear and panic among women (60.7%).

Practice

Breast and cervical cancer screening-related practices did not seem to be popular among the surveyed women (Table 5). Only a low proportion reported that they had ever had a mammogram (23%), been advised by a health professional to perform a mammogram (11.3%), performed a breast self-exam (36%), been advised by a health professional to perform a breast self-exam (35%) and been examined by one’s doctor to check breast’s health (30.7%).

Table 5.

Proportion of Participants’ Responses to Questions on Practices Regarding Breast and Cervical Cancer Screening (N = 300).

Questions on Practice	Responses (%)
Questions on Practice	Yes	No	Don’t Know
Breast Cancer
Ever had a mammogram?	23	37.3	39.7
Ever been advised by a health professional to perform a mammogram?	11.3	12.3	76.3
Have you ever performed a breast self -exam?	36	27.3	36.7
Have you ever been advised by a health professional to perform a BSE?	35	24.3	40.7
Have you ever been examined by your doctor to check your breasts’ health?	30.7	29.7	39.7
Cervical cancer
Have you ever had a Pap smear test?	31.3	22.3	46.3
Have you ever been advised by a health professional to have a Pap test?	30.7	23.7	45.7
Have you ever been advised by a health professional to receive the HPVV?	12	37.7	50.3
Have you ever consented to give the HPVV to your daughter?	15.7	28.7	55.7

Regarding cervical cancer screening-related practices, only a few of the participants responded in the affirmative that they ever had a Pap smear (31.3%), been advised by a health professional to have a smear test (30.7%), been advised by a health professional to receive HPVV (12%) and consented to give HPVV to own daughter (15.7%).

Sources of Information

A wide range of sources of information were reported by the participants (Figure 2). The highest reported sources were internet (44.7%), doctor (41%), social media (36.3%) and television (31%). While the least sources of information included sources such as books (9.7%) and posters (9.3%), among others.

Figure 2.

Proportion of participants by sources of information (N = 300).

Discussion

This study aimed to understand the knowledge, attitudes and practices of women in the UAE regarding breast and cervical cancer prevention. It was found that the majority of women had low level of breast cancer prevention knowledge (63.3%) with lower uptake (36% for BSE, 30.6% for CBE and 23% for mammography). Same was the case for cervical cancer prevention with the majority having low knowledge (94.7%) and uptake (31.3%) of Pap test and not being recommended by HCP to get HPVV (12%). The attitudes exhibited by the participants were also less positive, perceiving screening as a waste of resources and source of fear. The study also reported internet, health care practitioners and social media to be the main sources of information.

Low levels of breast cancer prevention knowledge evident from our study are similar to findings from other studies conducted in the UAE and other GCC countries, indicating inadequate information of women specifically on mammography.^10,12,13 Our results indicating low levels of cervical prevention information also affirm to the findings obtained from two other studies conducted in the UAE, suggesting detailed knowledge levels to be low, despite high awareness of Pap smear.^15-17 Similarly, a previous study carried out to assess information on HPVV in 2013 in the UAE indicated it to be 22%, nearly similar to as reported in our study (19%).¹⁸ A systematic review summarizing the knowledge and acceptability of HPVV in countries of MENA region highlighted lack of awareness on the topic.²⁴ Persistent low levels of knowledge among UAE women population regarding breast and cervical cancer prevention indicate requirement of effective measures to disseminate proper information to reach the targeted groups. Numerous interventions utilising knowledge provision have been successful in enhancing screening uptake for breast and cervical cancers.^25,26 The significant association of certain sociodemographic factors with breast cancer knowledge as indicated in our study implies that older, unmarried women and those not accessing the health care regularly need to be focused for education delivery.

This study also reports lower participation of women in BSE and CBE which is lower than what was found in another study in the UAE in 2014¹⁴ but higher than an earlier study conducted in 2001.²⁷ However, the lower uptake for mammography is found to be similar as in other studies.¹⁴ Research has indicated that women tend to report at advanced stages of breast cancer, thus avoiding screening, possibly due to influence of cultural and behavioural factors.²⁸ Another possible reason could be lack of awareness of the breast cancer risk factors among women, as revealed in a recent study.²⁹ The Pap smear uptake was also found to be lower to what other studies had reported within the UAE and other GCC countries.^12,15,16 The reasons behind lower cervical screening warrant need of further exploration, as evidence indicates the effect of sociocultural barriers on uptake.³⁰ The lower uptake of HPVV as evident in our study, demonstrated through low recommendation rates by HCPs and consent provision levels of mothers, is concerning. Literature suggests that HPVV acceptability within the region, governed by diverse social, religious, cultural and financial domains, can be enhanced by providing more information to HCPs and general public on the role of vaccination in cervical cancer prevention.^24,31 Another noteworthy aspect is that recent studies have indicated a decrease in the cancer screening rates during COVID-19 pandemic in various regions of the world.^32-34 Thus, it would be of value to investigate breast and cervical cancer screening uptake during and post-COVID period within the MENA region that has not been conducted till now.

Another interesting result from the study regarding attitudes towards cancer prevention was that women perceived the role of screening, especially Pap smear and mammography, as unnecessary and means of causing unnecessary worry and anxiety. Similarly, the majority had the perception that these screening tests can be painful. Such attitudes can be a possible reason to deter women from screening uptake as shown in previous studies.³⁵ Behavioural counselling by health care practitioners and use of role modelling by women who had already taken the test can possibly encourage women and lead to mindset change.³⁰ However, it is encouraging that the majority of the women were of the view to take the screening tests if recommended by their doctors, although less towards HPVV.

Among the information resources, the majority of participants informed that they had received information from the internet, followed by the doctor and social media. A recent qualitative study also reported the role played by internet and social media in breast cancer and its prevention awareness in the UAE.³⁶ Thus, targeted digital media campaigns can effectively enhance screening, but it should also be noted that misleading information presented on the internet can be harmful. Similarly, it can also be inferred from the results that the health care practitioner has a crucial part in persuading and encouraging women for screening. Although a majority of the women reported that they had not been recommended to take the tests or get HPVV by the doctors. Active participation of doctors could be beneficial towards improving cancer screening practices among women.^37,38

A limitation of the study can be lack of generalization of results for overall UAE population, due to convenience sampling method. Additionally, the questionnaire employed was not validated, emphasizing the requirement for development of a validated breast and cervical screening questionnaire in the Arabic language. Further investigation for reasons of low proportion of women with good knowledge and practice levels is also warranted through future in-depth qualitative exploration.

Conclusion

In conclusion, this study adds to the existing literature on breast and cervical cancer prevention by encompassing a wide range of topics including assessment of women’s knowledge, behaviours and attitudes. It may provide important findings that may be used to design tailored health promotion strategies focussing on the knowledge gaps and misconceptions prevalent in the women. Future research to explore the barriers in detail is warranted, as is the practical intervention implementation to enhance the uptake by involvement of social media and health care practitioners.

Supplemental Material

Supplemental Material - Knowledge, Attitudes and Practices of Women in the UAE Towards Breast and Cervical Cancer Prevention: A Cross-Sectional Study

Supplemental Material for Knowledge, Attitudes and Practices of Women in the UAE Towards Breast and Cervical Cancer Prevention: A Cross-Sectional Study by Iffat Elbarazi, Zufishan Alam, Aminu S. Abdullahi, Shamma Al Alawi, Manal Al Khanbashi, Asma Rabaa, Aysha Al Aryani, Luai Ahmed and Fatma Al-Maskari in Cancer Control.

Footnotes

Acknowledgements

We would like to acknowledge all the participants of the study for their contribution.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by SUREPLUS grant, provided by United Arab Emirates University.

Ethical Statement

Informed Consent

Written informed consent was obtained from the patient(s) for their anonymized information to be published in this article and the consent forms were confidentially stored.

Statement of Human and Animal Rights

All procedures in this study were conducted in accordance with the Abu Dhabi Health Services Company (SEHA)-Ambulatory Health Services (AHS) Ethics Committee (APPROVAL NUMBER: N/A)-approved protocols.

ORCID iDs

Zufishan Alam

Luai Ahmed

Supplemental Material

Supplemental material for this article is available online.

Appendix

References

International Agency for Research on Cancer . Estimated age-standardized incidence and mortality (World) in 2020, Northern Africa, Central and Western Asia hub, females all ages. Lyon, France: International Agency for Research on Cancer;2020. https://gco.iarc.fr/today/home Accessed 7/7/2022.

Al-Othman

Haoudi

Alhomoud

Alkhenizan

Khoja

Al-Zahrani

. Tackling cancer control in the Gulf cooperation Council countries. Lancet Oncol. 2015;16:246-257.

Ortashi

Alkalbani

. Cervical cancer screening in Arab countries. In: Handbook of healthcare in the Arab World. Cham: Springer; 2021:413-433.

American Cancer Society . American Cancer Society recommendations for the early detection of breast cancer. Atlanta, GA: American Cancer Society;2022. https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html Accessed 3/7/2022.

Landy

Pesola

Castañón

Sasieni

. Impact of cervical screening on cervical cancer mortality: estimation using stage-specific results from a nested case-control study. Br J Cancer. 2016;115(9):1140-1146.

United Arab Emirates Ministry of Health & Prevention . The National guidelines for breast cancer screening and diagnosis. Dubai, UAE: United Arab Emirates Ministry of Health and Prevention;2022. https://www.isahd.ae/content/docs/GuidelinesForBreastCancerScreening_Booklet.pdf Accessed 7/1/2022.

World Health Organization . WHO Guidelines for Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention. Geneva, Switzerland: WHO; 2013b.

United Arab Emirates Ministry of Health & Prevention . The National guidelines for cervical cancer screening. Dubai, UAE: United Arab Emirates Ministry of Health and Prevention;2022. https://www.isahd.ae/content/docs/MOHAPGuidelinesForCervicalCancerScreening.pdf Accessed 1/7/2022.

Jayanti

Burns

. The antecedents of preventive health care behavior: an empirical study. J Acad Market Sci. 1998;26(1):6-15.

10.

Abu-Helalah

Alshraideh

Al-Serhan

Kawaleet

Nesheiwat

. Knowledge, barriers and attitudes towards breast cancer mammography screening in Jordan. Asian Pac J Cancer Prev APJCP. 2015;16(9):3981-3990.

11.

Renganathan

Ramasubramaniam

Al-Touby

et al.

What do Omani women know about breast cancer symptoms?

Oman Med J. 2014 Nov;29(6):408.

12.

VHT

Channon

Ali

et al. Uptake of breast and cervical cancer screening in four 1Gulf Cooperation Council countries. Eur J Cancer Prev. 2019;28:451-456.

13.

Abduelkarem

Saif

Alshoaiby

. Evaluation of breast cancer awareness among female university students in university of Sharjah, UAE. Sci Res. 2015 Jan 9;4(01):9.

14.

Elobaid

Grivna

Nagelkerke

. Breast cancer screening awareness, knowledge, and practice among Arab women in the United Arab Emirates: a cross-sectional survey. PLoS One. 2014 Sep 29;9(9):e105783.

15.

Al Meer

Aseel

Al Khalaf

Al Kuwari

Ismail

MFS

. Knowledge, attitude and practices regarding cervical cancer and screening among women visiting primary health care in Qatar. East Mediterr Health J. 2011;17(11):855-861.

16.

Metwali

Al Kindi

Shanbleh

Al Akshar

Sarhan

. Evaluating awareness and screening of cervical cancer among women in Sharjah, United Arab Emirates. IOSR J Pharm. 2015;5(2):57-64.

17.

Badrinath

Ghazal-Aswad

Osman

Deemas

McIlvenny

. A study of knowledge, attitude, and practice of cervical screening among female primary care physicians in the United Arab Emirates. Health Care Women Int. 2004 Aug 1;25(7):663-670.

18.

Ortashi

Raheel

Shalal

Osman

. Awareness and knowledge about human papillomavirus infection and vaccination among women in UAE. Asian Pac J Cancer Prev APJCP. 2013;14(10):6077-6080.

19.

Von Elm

Altman

Egger

, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573-577.

20.

Ravichandran

Al-Hamdan

Mohamed

. Knowledge, attitude, and behavior among Saudis toward cancer preventive practice. J Family Community Med. 2011 Sep;18(3):135-142.

21.

Stubbings

Robb

Waller

et al. Development of a measurement tool to assess public awareness of cancer. Br J Cancer. 2009;101:S13-S17.

22.

Donnelly

Al Khater

Al-Bader

et al. Arab women’s breast cancer screening practices: a literature review. Asian Pac J Cancer Prev APJCP. 2013;14(8):4519-4528.

23.

Hussain

Alkhenizan

McWalter

et al. Attitudes and perceptions towards HPV vaccination among young women in Saudi Arabia. Journal of Family & Community Medicine. 2016 Sep;23(3):145.

24.

Gamaoun

. Knowledge, awareness and acceptability of anti-HPV vaccine in the Arab states of the Middle East and North Africa Region: a systematic. East Mediterr Health J. 2018;24(6):538-548.

25.

Anastasi

Lusher

. The impact of breast cancer awareness interventions on breast screening uptake among women in the United Kingdom: a systematic review. J Health Psychol. 2019 Jan;24(1):113-124.

26.

Abiodun

Olu-Abiodun

Sotunsa

Oluwole

. Impact of health education intervention on knowledge and perception of cervical cancer and cervical screening uptake among adult women in rural communities in Nigeria. BMC Publ Health. 2014 Dec;14(1):1-9.

27.

Bener

Alwash

Miller

Denic

Dunn

. Knowledge, attitudes, and practices related to breast cancer screening: a survey of Arabic women. J Cancer Educ. 2001 Dec 1;16(4):215-220.

28.

Elobaid

Lim

Hamid

Grivna

. Breast cancer presentation delays among Arab and national women in the UAE: a qualitative study. SSM Popul Health. 2016 Dec 1;2:155-163.

29.

Abbas

Baig

. Knowledge and practice concerning breast cancer risk factors and screening among females in UAE. Asian Pac J Cancer Prev APJCP: APJCP. 2023;24(2):479.

30.

Gauss

Mabiso

Williams

. Pap screening goals and perceptions of pain among black, Latina, and Arab women: steps toward breaking down psychological barriers. J Cancer Educ. 2013;28(2):367-374.

31.

Baghi

Yousefi

Oskouee

Aghazadeh

. HPV vaccinations: a Middle Eastern and north African dilemma. Lancet Infect Dis. 2017 Jan 1;17(1):18-19.

32.

Alkatout

Biebl

Momenimovahed

et al. Has COVID-19 affected cancer screening programs? A systematic review. Front Oncol. 2021 May 17;11:675038.

33.

Smith

Perkins

. Low rates of HPV vaccination and cervical cancer screening: challenges and opportunities in the context of the COVID-19 pandemic. Prev Med. 2022 Jun 1;159:107070.

34.

Toh

Russell

Garland

Mulholland

Patton

Licciardi

. Human papillomavirus vaccination after COVID-19. JNCI Cancer Spectr. 2021 Apr 1;5(2):pkab011.

35.

Julinawati

Cawley

Domegan

Brenner

Rowan

. A review of the perceived barriers within the Health Belief Model on pap smear screening as a cervical cancer prevention measure. J Sci Res. 2013;3:677-692.

36.

Acharya

Sounderajah

Ashrafian

Darzi

Judah

. A systematic review of interventions to improve breast cancer screening health behaviours. Prev Med. 2021 Dec 1;153:106828.

37.

Abu Awwad

Hossain

Mackey

Brennan

Adam

. Women’s breast cancer knowledge and health communication in the United Arab Emirates. Healthcare. 2020;8(4):495.

38.

Musa

Achenbach

O’Dwyer

et al. Effect of cervical cancer education and provider recommendation for screening on screening rates: a systematic review and meta-analysis. PLoS One. 2017 Sep 5;12(9):e0183924.

Supplementary Material

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Knowledge,Attitudes and Practices of Women in the UAE Towards Breast and Cervical Cancer Prevention: A Cross-Sectional Study

Abstract

Introduction

Objectives

Methods

Results

Conclusions

Keywords

Introduction

Methods

Participant Recruitment and Sample Size Estimation

Data Collection Measures

Data Analysis

Results

Demographic Characteristics of the Participants

Knowledge of Breast and Cervical Cancers

Attitude

Practice

Sources of Information

Discussion

Conclusion

Supplemental Material

Supplemental Material - Knowledge, Attitudes and Practices of Women in the UAE Towards Breast and Cervical Cancer Prevention: A Cross-Sectional Study

Footnotes

Acknowledgements

Declaration of Conflicting Interests

Funding

Ethical Statement

Informed Consent

Statement of Human and Animal Rights

ORCID iDs

Supplemental Material

Appendix

References

Supplementary Material