Date Published: July 21, 2017
Publisher: Public Library of Science
Author(s): Tam Truong Donnelly, Al-Hareth Al-Khater, Salha Bujassoum Al-Bader, Mohamed Ghaith Al-Kuwari, Mariam Ali Abdul Malik, Nabila Al-Meer, Rajvir Singh, Magdalena Grce.
In the Middle East, Qatar in particular, the incidence of breast cancer has substantially increased in recent years, and is expected to double by 2030. This diagnosis also occurs at a later stage in the disease. Early detection along with proper treatment reduces radical mastectomy and mortality rates, yet only one-third of Arab women in Qatar participate in breast cancer screening (BCS) activities of any sort. Many women in the conservative Qatari society rely on male family members for support and protection. This study investigates the attitudes and perceptions of Arab men in regards to breast cancer screening and what they see as both incentives and barriers to women’s participation in BCS activities.
A qualitative methodology using purposive sampling technique was chosen in order to explore participant’s attitudes, beliefs and health-related actions. Individual in-depth interviews with open-ended questions were conducted with 50 Arab men during October 2011 to May 2012. Data collection, analysis, and interpretation occurred simultaneously. NVivo 9, a qualitative data analysis software program was used to organize themes and subthemes.
It was found that most men understood the importance of regular BCS in early detection of breast cancer. They felt they had an important role in encouraging the women in their lives to participate in BCS activities, but were adamant that any examination must be done by a female health care professional. Few knew details about screening guidelines in Qatar, but most had a basic knowledge of some screening activities. Most indicated an interest in learning more about BC and screening activities in order to better help and inform their female family members.
Because Arab men perceive that their opinions and support are a major factor influencing female family members’ participation in breast cancer screening, it is important that any program instituted to increase such screening participation be aimed at both men and women. More information is needed by both sexes as to the need for and benefits of regular screening activities, the techniques used, and the newly revised guidelines in Qatar. Such a program needs to be introduced in the near future in order to avert, at least partially, the expected doubling in breast cancer cases by 2030 in the Middle East.
While incidence of breast cancer in the Middle East region is lower than in other western countries, it has substantially increased in the last quarter century . Furthermore, the diagnosis of breast cancer in this region often occurs at a later stage in the progress of the disease and in a higher proportion of women in their thirties and forties [1, 2, 3, 4] than in industrialized nations. Breast cancer that presents at a younger age is generally more aggressive with a possibly poorer prognosis [5, 6, 7, 8]. Later stage presentation of breast cancer is related to more prevalent use of mastectomy, with more than 80% of Arab women receiving modified radical mastectomy (MRM) . It has been seen that widespread screening in countries with available treatment opportunities can reduce the need for radical mastectomies .
Ethics approval for this research study was obtained from the Hamad Medical Corporation Research Committee (Ethics Approval Reference No: RC/1744/2010), the Qatar Supreme Council of Health (Ethics Assurance No: SCH-AUCQ-050), and the University of Calgary’s Conjoint Health Research Ethics Board (Ethics ID: E-23551). Because little research has been conducted in Qatar, participants might not be familiar with the research process. Careful explanation of the project was exercised by the research team. To make the information accessible to everyone, all the information from the project was translated into Arabic and was available in both Arabic and English. Prior to the start of the study, communities were made aware of the study through announcements in local newsletter, newspaper, community- based organizations, and by word-of-mouth. Project staff connected with all sites at the start of the project. An introductory letter written in both Arabic and English was sent to the hospitals and community clinic sites. This letter explained the purpose of the study, its objectives, research question, and participants’ recruitment criteria. Formal and informal presentations were made to all staff at the hospital and community health clinics at the start of the project and posters in Arabic with the project information were distributed prior to the start of the study. Written and oral consent to participate in this study was obtained from each participant. Throughout the interview, permission to continue with the process was also obtained intermittently and orally. Prior to conducting an interview, each participant was given an explanation of the study and informed of his rights according to the standard interview guideline. Participants were assured that all information would remain confidential and interview questionnaires were stripped of identifying information to preserve confidentiality. At the end of the interview each participant was provided a small reimbursement of $50 for his time and effort. According to the Council for International Organizations of Medical Science, compensating for participants’ inconvenience and time spent is acceptable practice . All participants’ names used in this paper are pseudonyms. Pseudonyms are used in referring to comments by the participants.
In this study, we examine Arab men’s perceptions about breast cancer screening activities and their influence on the women’s health. It was found that there are both facilitators and barriers to women’s participation in breast cancer screening activities. As with many countries in the world, Arabs in Qatar characteristically are adherent to patriarchal customs and traditions. Both sexes believe that the role of men is to protect and support their wives and families. This encompasses financial support as well as protection of women’s modesty [37, 38, 39]. Most men participants appreciated the importance of regular breast cancer screening in promoting women’s health and in early detection of breast cancer. They felt they had an important role in encouraging the women in their lives to participate in breast cancer screening activities, but were adamant that any examination must be performed by a female health care professional. Many participants strongly objected to having a male doctor perform clinical breast examinations unless it is under extraordinary circumstances where women would not have any other choices. This may be a non-issue in Qatar, where there are a number of clinics with female doctors who can be called on to examine women, and several men indicated that they were aware of their existence. Nevertheless, the fear that a woman’s breasts may be exposed and palpitated by a male health care professional can be a contributing factor in the reluctance of women to participate in such screening activities or in getting their husbands’ or fathers’ approval for breast examinations.
The incidence and mortality rates of breast cancer are rising in Qatar. Detection of breast cancer in late stages will also lead to a high percent of radical mastectomies and increased morbidity. If the theory—and evidence—based interventions developed is to create changes in breast health seeking behavior of Arab women, tailoring breast cancer screening interventions to the population’s unique needs and practices need to be taken . Since Arab men’s opinions and support are major factors influencing their female family members’ participation in breast cancer screening, it is important that any program instituted to increase such participation be aimed at giving more information about breast cancer to not only Arab women, but also Arab men in Qatar. It is evident that Arab men are supportive of women’s health. To fully support Arab women’s breast health and to assist women to engage in breast cancer screening examination, more information is needed by the public as to the need for regular screening activities, the techniques used, the most current guidelines for breast cancer screening in the country, and the assurance of culturally appropriate and professionalism in all health care services. Given the expected doubling in breast cancer cases in the Middle East by 2030, a promotional program needs to be introduced in the near future in order to avert, at least partially, the social stigma, the social the high incidence and mortality rates of breast cancer cases in Qatar.