Journal of Cancer Education

, Volume 33, Issue 2, pp 391–397 | Cite as

Low Awareness of Breast Cancer and Considerable Barriers to Early Presentation Among Saudi Women at a Primary Care Setting

  • Noura Khamis Al-Khamis


In Saudi Arabia, breast cancer is diagnosed at advanced stage compared to Western countries. Nevertheless, the perceived barriers to delayed presentation have been poorly examined. Additionally, available breast cancer awareness data are lacking validated measurement tool. The aim of this study is to evaluate the level of breast cancer awareness and perceived barriers to seeking medical care among Saudi women, using internationally validated tool. A cross-sectional study was conducted among adult Saudi women attending a primary care center in Riyadh during February 2014. Data were collected using self-administered questionnaire based on the Breast Cancer Awareness Measure (CAM-breast). Out of 290 women included, 30 % recognized five or more (out of nine) non-lump symptoms of breast cancer, 31 % correctly identified the risky age of breast cancer (set as 50 or 70 years), 28 % reported frequent (at least once a month) breast checking. Considering the three items of the CAM-breast, only 5 % were completely aware while 41 % were completely unaware of breast cancer. The majority (94 %) reported one or more barriers. The most frequently reported barrier was the difficulty of getting a doctor appointment (39 %) followed by worries about the possibility of being diagnosed with breast cancer (31 %) and being too busy to seek medical help (26 %). We are reporting a major gap in breast cancer awareness and several logistic and emotional barriers to seeking medical care among adult Saudi women. The current findings emphasized the critical need for an effective national breast cancer education program to increase public awareness and early diagnosis.


Awareness Barriers Breast cancer Primary care Saudi Arabia 



Prof. Riaz Qureshi, Dr. Noura AL-Rowais, Dr. Raba’a AL-Momen, Dr. Salwa Tayel, and Dr. Amna Siddiqui.

Compliance with Ethical Standards

The study obtained all required ethical approvals from the Institutional Review Board (IRB) of King Saud University.


  1. 1.
    Bray F, Ren JS, Masuyer E, Ferlay J (2013) Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer 132:1133–1145CrossRefPubMedGoogle Scholar
  2. 2.
    Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin D, Forman D, Bray, F 2013 GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. URL: (Last accessed May 20, 2016)
  3. 3.
    Saudi Cancer Registry (2010) Cancer Incidence Report, Saudi Arabia, 2010. Revised April 2016. URL: (Last accessed May, 20, 2016).
  4. 4.
    Radi SM (2013) Breast cancer awareness among Saudi females in Jeddah. Asian Pac J Cancer Prev 14:4307–4312CrossRefPubMedGoogle Scholar
  5. 5.
    Amin TT, Al Mulhim AR, Al Meqihwi A (2009) Breast cancer knowledge, risk factors and screening among adult Saudi women in a primary health care setting. Asian Pac J Cancer Prev 10:133–138PubMedGoogle Scholar
  6. 6.
    Hussein DM, Alorf SH, Al-Sogaih YS, Alaskar RS, Al-Mahana AM, Alsalhowb WF, Alibrahim AK, Saka MY, Alhazimi AM, Baghirova A, Hindawi SI (2013) Breast cancer awareness and breast self-examination in Northern Saudi Arabia. A preliminary survey. Saudi Med J 34:681–688PubMedGoogle Scholar
  7. 7.
    Sait WA, Al-Amoudi SM, Tawtai DA, Abduljabbar HS (2010) The knowledge of breast cancer among young Saudi females. Saudi Med J 31:1242–1244PubMedGoogle Scholar
  8. 8.
    Abdel Hadi MS (2000) Breast cancer awareness among health professionals. Ann Saudi Med 20:135–136CrossRefPubMedGoogle Scholar
  9. 9.
    Moawed SA, Bin Jumah JA (2013) Knowledge & practice of Saudi women about the prevention of breast cancer. Int J Appl Sci Technol 3:8–13Google Scholar
  10. 10.
    Alam AA (2006) Knowledge of breast cancer and its risk and protective factors among women in Riyadh. Ann Saudi Med 26:272–277CrossRefPubMedGoogle Scholar
  11. 11.
    Mahfouz AA, Hassanein MH, Nahar S, Farheen A, Gaballah II, Mohamed A, Rabie FM, Aftab R (2013) Breast cancer knowledge and related behaviors among women in Abha City, southwestern Saudi Arabia. J Cancer Educ 28:516–520CrossRefPubMedGoogle Scholar
  12. 12.
    Almutairi KM, Ahmad M, Vinluan JM, Almutairi A (2016) Random cross-sectional determination of the level of awareness among female Saudi patients about breast cancer. J Cancer Educ 31:131–135CrossRefPubMedGoogle Scholar
  13. 13.
    Dardas N (2013) Knowledge and awareness about breast cancer among primary care attendees in Al-Khobar City, eastern Saudi Arabia. Int J Med Health Sci 2:95–105Google Scholar
  14. 14.
    Jahan S, Al-Saigul AM, Abdelgadir MH (2006) Breast cancer. Knowledge, attitudes and practices of breast self examination among women in Qassim region of Saudi Arabia. Saudi Med J 27:1737–1741PubMedGoogle Scholar
  15. 15.
    Habib F, Salman S, Safwat M, Shalaby S (2010) Awareness and knowledge of breast cancer among university students in Al Madina Al Munawara Region. Middle East. J Cancer 1:159–166Google Scholar
  16. 16.
    Yousuf SA, Al Amoudi SM, Nicolas W, Banjar HE, Salem SM (2012) Do Saudi nurses in primary health care centres have breast cancer knowledge to promote breast cancer awareness? Asian Pac J Cancer Prev 13:4459–4464CrossRefPubMedGoogle Scholar
  17. 17.
    El Saghir NS, Khalil MK, Eid T, El Kinge AR, Charafeddine M, Geara F, Seoud M, Shamseddine AI (2007) Trends in epidemiology and management of breast cancer in developing Arab countries: a literature and registry analysis. Int J Surg 5:225–233CrossRefPubMedGoogle Scholar
  18. 18.
    Rudat V, Brune-Erbe I, Noureldin A, Bushnag Z, Almuraikhi N, Altuwaijri S (2012) Epidemiology of breast cancer patients at a tertiary care center in the Eastern Province of Saudi Arabia. Gulf J Oncolog:45–49Google Scholar
  19. 19.
    Al-Hamdan N, Ravichandran K, Al-Sayyad J, Al-Lawati J, Khazal Z, Al-Khateeb F, Abdulwahab A, Al-Asfour A (2009) Incidence of cancer in Gulf Cooperation Council countries, 1998-2001. East Mediterr Health J 15:600–611PubMedGoogle Scholar
  20. 20.
    United Nations (2015) World Population Prospects, the 2015 Revision. URL: (Last accessed May, 20, 2016)
  21. 21.
    El Bcheraoui C, Basulaiman M, Wilson S, Daoud F, Tuffaha M, AlMazroa MA, Memish ZA, Al Saeedi M, Mokdad AH (2015) Breast cancer screening in Saudi Arabia: free but almost no takers. PLoS One 10 e0119051Google Scholar
  22. 22.
    Sharma K, Costas A, Shulman LN, Meara JG (2012) A systematic review of barriers to breast cancer care in developing countries resulting in delayed patient presentation. J Oncol 2012 121873Google Scholar
  23. 23.
    Abolfotouh MA, BaniMustafa AA, Mahfouz AA, Al-Assiri MH, Al-Juhani AF, Alaskar AS (2015) Using the health belief model to predict breast self examination among Saudi women. BMC Public Health 15:1163CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Cancer Research UK (2011). Breast Cancer Awareness Measure (Breast CAM) ToolkitGoogle Scholar
  25. 25.
    Linsell L, Forbes LJL, Burgess C, Kapari M, Thurnham A, Ramirez AJ (2010) Validation of a measurement tool to assess awareness of breast cancer. Eur J Cancer 46:1374–1381CrossRefPubMedGoogle Scholar
  26. 26.
    Forbes LJ, Atkins L, Thurnham A, Layburn J, Haste F, Ramirez AJ (2011) Breast cancer awareness and barriers to symptomatic presentation among women from different ethnic groups in East London. Br J Cancer 105:1474–1479CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Al-Zalabani AH, Alharbi KD, Fallatah NI, Alqabshawi RI, Al-Zalabani AA, Alghamdi SM (2016) Breast Cancer Knowledge and Screening Practice and Barriers Among Women in Madinah, Saudi Arabia. J Cancer EducGoogle Scholar
  28. 28.
    Peacey V, Steptoe A, Davídsdóttir S, Baban A, Wardle J (2006) Low levels of breast cancer risk awareness in young women: an international survey. Eur J Cancer 42:2585–2589CrossRefPubMedGoogle Scholar
  29. 29.
    Linsell L, Burgess CC, Ramirez AJ (2008) Breast cancer awareness among older women. Br J Cancer 99:1221–1225CrossRefPubMedCentralPubMedGoogle Scholar
  30. 30.
    Tria Tirona M (2013) Breast cancer screening update. Am Fam Physician 87:274–278PubMedGoogle Scholar
  31. 31.
    McCready T, Littlewood D, Jenkinson J (2005) Breast self-examination and breast awareness: a literature review. J Clin Nurs 14:570–578CrossRefPubMedGoogle Scholar
  32. 32.
    Al-Amoudi SM, Sait WA, Abduljabbar HS (2010) Health care provider’s role in facing the future burden of breast cancer in Saudi. Saudi Med J 31:1359–1362PubMedGoogle Scholar
  33. 33.
    Al Mulhim FA, Syed A, Bagatadah WA, Al Muhanna AF (2015) Breast cancer screening programme: experience from Eastern province, Saudi Arabia. East Mediterr Health J 21:111–119CrossRefPubMedGoogle Scholar
  34. 34.
    Madkhali NA, Santin O, Noble H, Reid J (2016) Understanding breast health awareness in an Arabic culture: qualitative study protocol. J Adv NursGoogle Scholar
  35. 35.
    Puschel K, Coronado G, Soto G, Gonzalez K, Martinez J, Holte S, Thompson B (2010) Strategies for increasing mammography screening in primary care in Chile: results of a randomized clinical trial. Cancer Epidemiol Biomark Prev 19:2254–2261CrossRefGoogle Scholar

Copyright information

© American Association for Cancer Education 2016

Authors and Affiliations

  1. 1.Family and Community Medicine DepartmentKing Khalid University HospitalRiyadhKingdom of Saudi Arabia

Personalised recommendations