Why aren't more women in Iran seeking out breast screening? A new study shows that social, cultural, and religious factors constitute major barriers to mammography adherence, and the authors call for breast health educational programs to do more to encourage women to get screened.
In Iran, 70% of breast cancer is detected at an advanced stage, when it is too late for successful treatment, according to the authors. Furthermore, the age of breast cancer onset among Iranian women is reported to be up to 10 years earlier than in the developed countries, they claim.
However, despite an annual increase in the incidence rate of breast cancer among Iranian women, there is no routine mammography breast cancer screening in the country.
The study by Mahsa Khodayarian and colleagues from the Shahid Sadoughi University of Medical Sciences in Yazd, and published online on 11 June in Health Promotion Perspectives, was based on interviews with 14 women, including one oncology nurse and one breast cancer survivor. It aimed to explore the reasons why women don't respond to calls for mammography screening in the city of Yazd.
"Breast cancer is the most frequently diagnosed cancer among women in countries of the Eastern Mediterranean Regional Office and the fifth common cause of death among women in Iran," stated the authors, noting that epidemiological studies based on age-specific incidence show breast cancer as the most prevalent cancer in Yazd province.
Two main categories of attitudes kept women from screening, according to the authors:
- Psychological barriers, including embarrassment, worry about being diagnosed with cancer, preoccupation with underlying disease, misconception about mammography, need for an accompanying person, and internalizing the experiences of the others
- Maladaptive coping modes, which included religious faith, fatalism, avoidance, and denial
Barriers to mammography adherence could be reduced by changing women's attitude toward how they view cancer and the need for early detection through mammography. For this to be possible, health educators need to combat deep-rooted ideas such as the belief that any breast cancer detected is "God's will" or "God's punishment of past deeds," as well as the belief that all cancer leads to death, no matter how early detected.
Another commonly held view is that only God can cure disease, not medicine or science. Furthermore, ignorance, the fear of mammography, and the lack of breast health awareness need to be addressed, the authors wrote.
They also described a sociocultural context in which unmarried women are hesitant to approach gynecologists for intimate health problems for fear of what their families and the wider community might assume about their behavior. This reluctance to visit a doctor might be compounded by the need to find a chaperone for such a consultation.
"Lack of mass media education and screening programs, poverty, poor access to healthcare facilities, cultural barriers, and poor breast awareness are associated with lower breast cancer survival in the developing countries," the authors noted.
They suggested that a persuasion-based health monitoring approach should be applied to health education programs, and these programs should provide clear motivational messages in an attempt to persuade women to undergo mammography.