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Breast cancer is the leading cause of cancer death in the United Arab Emirates (UAE) despite the fact that 98% of women can survive breast cancer if it is diagnosed at an early stage. Breast cancer is curable if it is detected early through clinical breast examinations by doctors, breast screening imaging techniques such as mammography, or by breast self-examinations. However, breast screening participation is low among women in the UAE. A recent study established that only 13.95% of females over the age of 40 in the UAE had a mammogram in a two-year period. Furthermore, there is often a delay in seeking medical attention once breast changes are noticed, with women in the UAE waiting months or not seeking medical advice at all until the symptoms change. A delay in seeking help after breast cancer symptoms appear can lead to an increase in tumour size, advanced disease stages, and poorer prognosis, such as low survival rates and premature death. Early detection and participation in screening for breast cancer, and other forms of cancer, is essential to give a person more treatment options, improve the conditions of survivorship, and increase their chance of survival. This blog will address two key questions: first, what barriers exist in Ras Al Khaimah that make women reluctant to seek breast cancer screening? And second, what can we do to help alleviate these barriers, improve breast cancer awareness, and increase women’s breast screening participation?

What are barriers to breast screening for women?

In a recent study, numerous barriers to breast screening participation in Ras Al Khaimah were identified by women, nurses, and health organizations. Stemming from multiple influences, these barriers included:

• Individual or interpersonal factors, such as embarrassment, fear, perceived pain, lack of knowledge about the effectiveness of screening, or not having concurrent symptoms for clinical breast examinations and mammograms.
• Community factors, such as lack of accurate information and resources from health professionals, and lack of recommendations from doctors.
• Organizational factors, such as limited availability of screening services year-round, lack of specialist doctors and staff in breast clinics, and a heavy reliance on insurance to cover the relatively high cost of screening.
• Impacts of policy and regulatory environments, such as the need to send patients outside of Ras Al Khaimah for cancer treatment due to lack of availability of services, and limited time and resources to organise breast cancer campaigns.

What strategies are currently benefiting Women?

Despite the barriers identified, women generally had positive attitudes towards the health benefits of breast cancer screening, and were encouraging of other women who were reluctant to participate in screening programs. Women were generally familiar with, and participated in, the free breast screening services available in Ras Al Khaimah, such as ‘Pink Caravan’.

WhatsApp was the social medium most preferred by women for receiving breast screening information. It was also important and reassuring for women to receive breast cancer information directly from doctors and nurses, and to receive SMS reminders for follow-up examinations from breast screening clinics. Additionally, women desired breast screening campaigns to be ongoing rather than once a year and appreciated the flexibility of group bookings for breast screenings.

To help facilitate patient education about breast screening, some representatives of health organizations recommended that nurses, or other trained health personnel, raise women’s awareness of breast cancer before the doctor consultation. Patient education could be implemented in group formats, by having print media available to read, or by watching an audio-visual presentation.

What does this mean?

Based on our consultation with women in Ras Al Khaimah and our research into what is available to them in the community and from organizations, our recommendations to improve breast cancer awareness and breast screening participation in the emirate are:

• Better use of social media: Breast cancer and breast screening information and events should be shared more using social media and through mobile apps, particularly WhatsApp.
• Nurses should have a role in educating women: Women should receive information directly from trained nurses and other health personnel in addition to their doctors. These key health professionals can help meet community demands for timely, accurate, and reliable information outside of scheduled campaigns by giving both individual or group education sessions in clinics or hospitals. Through this strategy, women get the opportunity to ask questions so that any personal barriers can be identified and addressed.
• Maintain regular contact with women: Contacting women to help them schedule their screening appointments is more effective than simply making a recommending to women to have a mammogram without following up.
• Send reminders for appointments: Reminders should also be sent out to encourage women to have regular general health checks, regardless of whether they have symptoms or not. This would help foster a culture of preventative health, provides a good opportunity for patient education, and will help address the UAE’s health priorities, including breast cancer.

Along with these recommendations, it is important for women to have regular general health check-ups, participate in breast screening, see a doctor for any change in the breast, learn more about women’s health issues, and motivate other women to undergo breast screening as well.

To learn more about breast cancer awareness and breast screening participation in Ras Al Khaimah, check out our open-access working paper that this blog is based on:“Development and Implementation of Public Awareness Campaigns around Breast Cancer in the UAE: A Ras Al Khaimah Case Study”