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Saad Saud Saad Alhumaidi et al, 2019;3(7):620–624.

International Journal of Medicine in Developing Countries.

The role of primary care centers in Saudi Arabia in the early detection of breast cancer

Saad Saud Saad Alhumaidi1*, Abdullah Yahya Abdullah Alshehri1, Abdullah Abed Abdullah Altowairqi1, Ahmad Atea Khodran Alharthy1, Bader Abdulrahman Dakhel Al Malki1

Correspondence to: Saad Saud Saad Alhumaidi

*Intern at College of Medicine, Taif University, Taif, Saudi Arabia.

Email: dr.alhumaidi.saad [at] gmail.com

Full list of author information is available at the end of the article.

Received: 16 January 2019 | Accepted: 04 February 2019


ABSTRACT

Breast cancer is one of the leading causes of death globally, still its early diagnosis could improve prognosis and reduce the mortality rate to a larger extent. Primary care units could play an important role in the early detection of breast cancer through various national screening programs providing awareness for the general public regarding the disease and its early diagnosis. However, data on the role of primary care units in screening for the breast cancer in Saudi Arabia is very limited. The aim of the current study was to evaluate the role of primary care units in Saudi Arabia in the early detection of breast cancer. A systemic review of the literature was performed using PubMed database targeting studies published between 2008 and 2018. The Search terms used for systematic search included “early detection,” “breast cancer,” and “Saudi Arabia.” Selection criteria required the studies to mention the age group of the included female subjects and the region in Saudi Arabia where the data collection was performed. A total of 83 articles were collected. Studies on animals were excluded ending up with 20 studies which were selected for the final screening. A total of seven studies were considered as eligible to be included in the systematic review covering a total of 5,254 Saudi females. The study concludes that the primary care units in different regions of Saudi Arabia play a pivotal role in educating females on the importance of early diagnosis and the treatment of breast cancer. Educational programs and awareness campaigns are recommended to increase the knowledge and awareness of breast cancer in the Saudi population.


Keywords:

Breast cancer, early detection, early diagnosis, Saudi Arabia.


Introduction

In 2010, Breast cancer was ranked as the ninth leading cause of mortality in females in Saudi Arabia [1]. Furthermore, about a quarter of all cancer cases registered in Saudi women were diagnosed with breast cancer [2]. It is also expected that the incidence will increase in the upcoming years because of the increasing population and prolonged survival [3]. Primary healthcare units have a crucial role in educating females in the Saudi community about the early detection of breast cancer and influencing their behavior, especially in rural areas [4]. Primary healthcare units can also spread awareness among females on breast cancer. Moreover, primary healthcare units can promote screening programs for breast cancer as they have a principal role in breast cancer screening since they are in direct contact with a large number of females in the community [5]. Mammography is the gold standard tool for the early detection and an improved opportunity for management and cure [6]. The center for disease control and prevention proposes mammography for the screening of breast cancer every 2 years for females aging between 50 and 74 years old. This population constitutes 5.1% of the Saudi population [7]. Other techniques for screening are thought to be of value in early diagnosis of breast cancer, like clinical breast examination and breast self-examination for instance. However, they are not recommended by the current guidelines for screening of breast cancer [8]. Screening attitude is mainly influenced by the level of knowledge and assumed risk factors reported in the medical literature [9]. Mortality with breast cancer has significantly decreased in the developed countries owing to education programs for healthcare professionals in addition to increasing awareness of the community toward the early detection of breast cancer. Yet, attitudes toward screening for breast cancer in the Gulf area are unsatisfactory [10]. Therefore, the aim of this systematic review was to analyze the medical literature in order to investigate the role of primary care units in the early detection of breast cancer, particularly in the Kingdom of Saudi Arabia.


Data Collection

This systemic review of the literature was done using PubMed database in the duration between 2008 and 2018, in order to evaluate the role of primary care units in the early detection of breast cancer in Saudi Arabia. Search terms included were a combination of “early detection,” “breast cancer,” and “Saudi Arabia.” All the titles in addition to abstracts appeared from this search were reviewed thoroughly. The results were then filtered to include original research articles investigating how primary care units in Saudi Arabia can influence the early detection of breast cancer. Additionally, the selected studies mentioned the age group of the included females in addition to the region in Saudi Arabia that was examined. Only studies published in the English language were classified as related articles which can be further evaluated in the second step. The following step was determining the inclusion criteria to choose the studies that will be considered in the systematic review. Abstracts were revised manually to choose the appropriate abstracts to be considered. The inclusion criteria were mentioning the age group of the included females and city where the study was done. Furthermore, references of selected studies were revised in order to define any related articles. Finally, the required data sets were collected from the final record of eligible articles and summarized. Data were statistically described in terms of frequencies (number of cases) and valid percentages for categorical variables. Mean, standard deviations, minimum, and maximum were used to describe the numerical variable. All statistical calculations were done using computer program IBM statistical package for the social science (SPSS; IBM Corp, Armonk, NY) release 21 for Microsoft Windows. Before conducting any study-related procedures, institutional approval was obtained. There was no need to obtain consent form as the study is not involving any interventions on patients.


Results

A total of 83 articles were retrieved by searching PubMed using the combination of the three terms “early detection,” “breast cancer,” and “Saudi Arabia.” Following the exclusion of animal studies and including only studies on humans, 20 articles appeared. After searching the abstracts and checking for the eligibility criteria in identified potential abstracts, a total of seven articles [1117] were considered as eligible to be included in our systematic review that was published between 2008 and 2018 covering a total of 5,254 Saudi females. Among 5,254 recruited females, two studies [14,17] recruited females including all age groups with an age range 15–65 years old in Mahfouz et al. [14] and 18 to 65 years old in Amin et al. [17]. On the other hand, Sait et al. [16] recruited adolescent females in school age (between 12 and 18 years) to assess their knowledge about the early detection of breast cancer through primary care units. Turning to the study design, all the studies [1117] had a cross-sectional study design. Additionally, only Abdel-Aziz et al. and Mahfouz et al. had multi-center recruitment for participants which empower their study design, especially with a considerably large sample size of 816 and 1,092 participants, respectively.

According to the extracted results, all the studies considered the major objective as assessing the role of primary care units in the early detection of breast cancer either through assessment of the knowledge of the general population or healthcare professionals themselves, who are working in primary care units as in Yousuf et al. [15] about the issue. The seven selected studies examined four different regions in Saudi Arabia including Al Hassan [11,17], Al Sharqia [12], Riyadh [13], and Jeddah [15,16]. The included studies are discussed in details in Table 1.


Discussion

Breast cancer is the most common type of cancer in females globally. It is strongly related to increased mortality and worsened prognosis in advanced stages. Due to advances in medicine, breast cancer now can be detected very early, which makes cure rates and improve prognosis drastically. Primary care units have a very critical core in the screening of breast cancer and increase the awareness of the community on its importance. The present systematic review examined the literature thoroughly to investigate the role of primary care units in the early detection of breast cancer in Saudi Arabia. Seven studies were selected for this purpose. It was revealed that primary care units are the primary source of information about breast cancer and the importance of its early detection. Moreover, it was found that the level of knowledge of Saudi females regarding the early detection of breast cancer in addition to its risk factors is very poor. Additionally, a small sector of the population utilizes the service of breast cancer screening in primary care units although the service is provided for free by the government.

Awareness and knowledge of females about breast cancer and its risk factors are the main determinants for the early detection of the disease and consequently, reducing mortality. This was discussed through Bcheraoui et al. [12] which included females from Al Sharqia. The study examined the knowledge of Saudi females on breast cancer screening in the primary care units. Females included were 50 years and older. Bcheraoui et al. [12] found that there was a very low frequency of breast cancer screening in Al Sharqia, which requires education and awareness campaigns to improve this attitude through primary care units. Similar conclusions were made in Abha by Mahfouz et al. [14]. However, Mahfouz et al. [14] included females with a wider age range from 15 to 65 years with an average 33.63 ± 11.91 years and a median of 30 years. Mahfouz et al. [14] was a large multi-center cross-sectional study with a sample size of 1,092 female. The study revealed that only 22% of females knew about mammography, while 41.5% knew about breast self-examination, while 29.7% performed the test. The study insisted on the importance of educational programs for the community as well as medical personnel in primary care units. Healthcare professionals in primary care units were also targeted by Yousuf et al. [15] in Jeddah. The study examined the level of knowledge of nurses working in primary care units in addition to their practice toward early screening of breast cancer. Yousuf et al. [15] reported that the level of knowledge of nurses was considered low although the majority of nurses (62.8%) performed breast self-examination. It is worth mentioning that 81% of nurses did not have a clinical breast examination. The mean age of the included nurses was 36.9 years old.

Table 1. A summary of the studies included in the review and their results.

Author(s) Year Study design Sample size Age City involved Objective Results
Abdel-Aziz et al. [11] 2018 Multi-center cross-sectional 816 Aged ≥ 30 years Al Hassa Investigating the role of primary care units in resolving barriers toward breast cancer screening in Al Hassa, Saudi Arabia. Low utilization of breast cancer screening is significantly positively associated with woman's age, higher educational status, higher family income, using hormonal contraception and positive history of previous breast cancer.
Personal fears (especially fear of doctors/examiners, fear of hospitals and health facilities and fear of consequences/results) were the major factors that hinder women from utilizing the free of charge.
Breast Cancer. Educational interventions aim at improving breast cancer knowledge and addressing barriers should be incorporated as a core component of the screening program in primary care units in Saudi Arabia.
Bcheraoui et al. [12] 2015 cross-sectional 1,135 Aged 50 years or older Al Sharqia To investigate the knowledge and practices of breast cancer screening among Saudi women visiting primary care units, aged 50 years or older in order to inform the breast cancer national health programs. Results show very low rates of breast cancer screening in the Kingdom of Saudi Arabia. This calls for educational campaigns to improve breast cancer screening.
Al-Amri et al. [13] 2015 case-control study 349 Mean age 48.5 ± 7.1 years Riyadh Identify the different risk factors related to breast cancer among females participating in the breast-screening program in primary care units in Riyadh, KSA. Age at marriage, menopause after 50 years of age
and family history of breast cancer was found to be risk factors for breast cancer while menopause before 50 years of age, number of pregnancies and practicing breastfeeding were protective factors against breast cancer. There was no effect of body mass index or physical inactivity.
Mahfouz et al. [14] 2013 A multicenter cross-sectional study 1,092 From 15 to 65 years with an average of 33.63±11.91 years and a median of 30 years Abha To evaluate breast cancer knowledge, attitudes, and related practices in women attending urban primary health care centers in Abha City southwestern Saudi Arabia Only 22.0 % heard about mammography, and 41.5 % heard about breast self-examination. More than half of the women in the study identified changes occurring in case of breast cancer and identified risk factors. Only 8.3 % were examined by clinical breast examination, 6.2 % were examined by mammography, and 29.7 % performed breast self-examination.
There is an urgent need for continuing medical education programs for health care workers in the region concerning breast cancer.
Yousuf et al. [15] 2012 Cross-sectional study 210 Mean age of the was 36.9 Jeddah To investigate nurses’ knowledge of breast cancer and practice of early screening in primary care units in Jeddah city Only 11% scored <50% of the total score for general epidemiological knowledge on breast cancer, about 35% scored <50% of the total score for breast cancer risk factors. 67% scored >75% of the total score on breast cancer signs. Majority of nurses 62.8% practiced breast self-examination, About 81% of the nurses had not had a clinical breast examination and only 14% had had mammography. The results of the study failed to show any correlation between the knowledge scores with age, education, year of experience, family history of Breast cancer and marital status of the nurses.
Sait et al. [16] 2010 Cross-sectional study 337 Age range 12–18 Jeddah To assess the breast cancer knowledge level of Saudi Female school students The limited knowledge level of breast cancer in the younger generation might be an obstacle to screening programs and early diagnosis. Awareness programs should be developed including lectures, seminars, workshops and on hands training.
Amin et al. [17] 2009 Cross-sectional descriptive 1315 Age ranged from 18 to 65 years Al Hassa To assess level and determinants of knowledge about, risk factors for and utilization of screening methods used for breast cancer early detection among adult Saudi women visiting primary care units in Al Hassa, KSA. Included women, irrespective of their educational status, had knowledge deficits regarding breast cancer risk factors and underutilization of the recommended breast cancer screening. Several barriers are contributing to such knowledge deficits and screening behavior.

Furthermore, risk factors for breast cancer in Saudi Arabia were also examined. Al Amri et al. [13] examined the risk factors of breast cancer in Riyadh in females with mean age 48.5 ± 7.1 years old. Al Amri et al. [13] found that major risk factors were the age at marriage and at menopause in addition to family history of breast cancer in first-degree relatives. Body mass index and physical activity did not appear to affect the incidence of breast cancer. Finally, to our knowledge, this is the first systematic review to provide an updated insight on the role of primary care units in different areas in the Kingdom of Saudi Arabia about the early detection. This should be a guide for decision-makers to develop awareness campaigns and educational programs through primary care units.


Conclusion

From this review, it is concluded that primary care units in different regions in Saudi Arabia play a pivotal role in educating the Saudi community, especially females, on the importance of the early detection of breast cancer. The level of knowledge in the Saudi community about breast cancer screening program is considered unsatisfactory. Therefore, more educational programs and awareness campaigns are required to increase the awareness of the community about screening programs available in the Kingdom of Saudi Arabia.


Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

Not applicable.


Author details

Saad Saud Saad Alhumaidi1, Abdullah Yahya Abdullah Alshehri1, Abdullah Abed Abdullah Altowairqi1, Ahmad Atea Khodran Alharthy1, Bader Abdulrahman Dakhel Al Malki1

  1. Intern at College of Medicine, Taif University, Taif, Saudi Arabia

References

  1. Bowser D, Marqusee H, El Koussa M, Atun R. Health system barriers and enablers to early access to breast cancer screening, detection, and diagnosis: a global analysis applied to the MENA region. Public Health. 2017;152:58–74. https://doi.org/10.1016/j.puhe.2017.07.020
  2. Youlden DR, Cramb SM, Dunn NA, Muller JM, Pyke CM, Baade PD. The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival, and mortality. Cancer Epidemiol. 2012;36(3):237–48. https://doi.org/10.1016/j.canep.2012.02.007
  3. Shulman LN, Willett W, Sievers A, Knaul FM. Breast cancer in developing countries: opportunities for improved survival. J Oncol. 2010; 2010:595167.
  4. Al-Foheidi M, Al-Mansour MM, Ibrahim EM. Breast cancer screening: review of benefits and harms, and recommendations for developing and low-income countries. Med Oncol. 2013;30(2):471. https://doi.org/10.1007/s12032-013-0471-5
  5. Donnelly TT, Al Khater AH, Al-Bader SB, Al Kuwari MG, Al-Meer N, Malik M, et al. Arab women's breast cancer screening practices: a literature. Asian Pac J Cancer Prev. 2013;14(8):4519–28. https://doi.org/10.7314/APJCP.2013.14.8.4519
  6. Al Diab A, Qureshi S, Al Saleh KA, Al Qahtani FH, Aleem A, Alghamdi MA, et al. Review on breast cancer in the Kingdom of Saudi Arabia. Middle-East J Sci Res. 2013;14(4):532–43.
  7. Akhtar SS, Nadrah HM, Al-Habdan MA, El Gabbani SA, El Farouk GM, Abdelgadir MH, et al. First organized screening mammography programme in Saudi Arabia: preliminary analysis of pilot round. East Mediterr Health J. 2010;16(10):1025–31. https://doi.org/10.26719/2010.16.10.1025
  8. Ravichandran K, Al-Hamdan NA, Mohamed G. Knowledge, attitude, and behavior among Saudis toward cancer preventive practice. J Family Community Med. 2011;18(3):135. https://doi.org/10.4103/2230-8229.90013
  9. Elobaid YE, Aw TC, Grivna M, Nagelkerke N. Breast cancer screening awareness, knowledge, and practice among arab women in the United Arab Emirates: a cross-sectional survey. PLoS One. 2014 29;9(9):e105783. https://doi.org/10.1371/journal.pone.0105783
  10. Saggu S, Rehman H, Abbas ZK, Ansari AA. Recent incidence and descriptive epidemiological survey of breast cancer in Saudi Arabia. Saudi Med J. 2015;36(10):1176. https://doi.org/10.15537/smj.2015.10.12268
  11. Abdel-Aziz SB, Amin TT, Al-Gadeeb MB, Alhassar AI, Al-Ramadan A, Al-Helal M, et al. Perceived barriers to breast cancer screening among Saudi women at primary care setting. Asian Pac J Cancer Prev. 2017;18(9):2409–17.
  12. El Bcheraoui C, Basulaiman M, Wilson S, Daoud F, Tuffaha M, AlMazroa MA, et al. Breast cancer screening in Saudi Arabia: free but almost no takers. PLoS One. 2015;10(3):e0119051. https://doi.org/10.1371/journal.pone.0119051
  13. Al-Amri FA, Saeedi MY, Al-Tahan FM, Ali AM, Alomary SA, Arafa M, et al. Breast cancer correlates in a cohort of breast screening program participants in Riyadh, KSA. J Egypt Natl Canc Inst. 2015;27(2):77–82. https://doi.org/10.1016/j.jnci.2015.04.002
  14. Mahfouz AA, Hassanein MH, Nahar S, Farheen A, Gaballah II, Mohamed A, et al. Breast cancer knowledge and related behaviors among women in Abha city, southwestern Saudi Arabia. J Cancer Educ. 2013;28(3):516–20. https://doi.org/10.1007/s13187-013-0495-8
  15. Yousuf SA, Al Amoudi SM, Nicolas W, Banjar HE, Salem SM. Do Saudi nurses in primary health care centres have breast cancer knowledge to promote breast cancer awareness? Asian Pac J Cancer Prev. 2012;13(9):4459–64. https://doi.org/10.7314/APJCP.2012.13.9.4459
  16. Sait WA, Al-Amoudi SM, Tawtai DA, Abduljabbar HS. The knowledge of breast cancer among young Saudi females. Saudi Med J. 2010;31(11):1242–4.
  17. Amin TT, Al Mulhim AR, Al Meqihwi A. Breast cancer knowledge, risk factors and screening among adult Saudi women in a primary health care setting. Asian Pac J Cancer Prev. 2009;10(1):133–8.


How to Cite this Article
Pubmed Style

Alhumaidi SSS, Alshehri AYA, Altowairqi AAA, Alharthy AAK, Malki BADA. The role of primary care centers in Saudi Arabia in the early detection of breast cancer. IJMDC. 2019; 3(7): 620-624. doi:10.24911/IJMDC.51-1547634537


Web Style

Alhumaidi SSS, Alshehri AYA, Altowairqi AAA, Alharthy AAK, Malki BADA. The role of primary care centers in Saudi Arabia in the early detection of breast cancer. http://www.ijmdc.com/?mno=26506 [Access: May 27, 2019]. doi:10.24911/IJMDC.51-1547634537


AMA (American Medical Association) Style

Alhumaidi SSS, Alshehri AYA, Altowairqi AAA, Alharthy AAK, Malki BADA. The role of primary care centers in Saudi Arabia in the early detection of breast cancer. IJMDC. 2019; 3(7): 620-624. doi:10.24911/IJMDC.51-1547634537



Vancouver/ICMJE Style

Alhumaidi SSS, Alshehri AYA, Altowairqi AAA, Alharthy AAK, Malki BADA. The role of primary care centers in Saudi Arabia in the early detection of breast cancer. IJMDC. (2019), [cited May 27, 2019]; 3(7): 620-624. doi:10.24911/IJMDC.51-1547634537



Harvard Style

Alhumaidi, S. S. S., Alshehri, . A. Y. A., Altowairqi, . A. A. A., Alharthy, . A. A. K. & Malki, . B. A. D. A. (2019) The role of primary care centers in Saudi Arabia in the early detection of breast cancer. IJMDC, 3 (7), 620-624. doi:10.24911/IJMDC.51-1547634537



Turabian Style

Alhumaidi, Saad Saud Saad, Abdullah Yahya Abdullah Alshehri, Abdullah Abed Abdullah Altowairqi, Ahmad Atea Khodran Alharthy, and Bader Abdulrahman Dakhel Al Malki. 2019. The role of primary care centers in Saudi Arabia in the early detection of breast cancer. International Journal of Medicine in Developing Countries, 3 (7), 620-624. doi:10.24911/IJMDC.51-1547634537



Chicago Style

Alhumaidi, Saad Saud Saad, Abdullah Yahya Abdullah Alshehri, Abdullah Abed Abdullah Altowairqi, Ahmad Atea Khodran Alharthy, and Bader Abdulrahman Dakhel Al Malki. "The role of primary care centers in Saudi Arabia in the early detection of breast cancer." International Journal of Medicine in Developing Countries 3 (2019), 620-624. doi:10.24911/IJMDC.51-1547634537



MLA (The Modern Language Association) Style

Alhumaidi, Saad Saud Saad, Abdullah Yahya Abdullah Alshehri, Abdullah Abed Abdullah Altowairqi, Ahmad Atea Khodran Alharthy, and Bader Abdulrahman Dakhel Al Malki. "The role of primary care centers in Saudi Arabia in the early detection of breast cancer." International Journal of Medicine in Developing Countries 3.7 (2019), 620-624. Print. doi:10.24911/IJMDC.51-1547634537



APA (American Psychological Association) Style

Alhumaidi, S. S. S., Alshehri, . A. Y. A., Altowairqi, . A. A. A., Alharthy, . A. A. K. & Malki, . B. A. D. A. (2019) The role of primary care centers in Saudi Arabia in the early detection of breast cancer. International Journal of Medicine in Developing Countries, 3 (7), 620-624. doi:10.24911/IJMDC.51-1547634537