What affects mammography uptake among Malay-Muslim women?

Multiple levels of influence, from personal perceptions and beliefs to provider-related factors, affect mammography uptake among Malay-Muslim women, according to a recent Singapore study.

Of 271 surveyed women, 59.6 percent had undergone a mammography at least once, while 31.0 percent had done so within the last 2 years. Nearly 32 percent of women eligible for mammograms took the procedure. [BMC Womens Health 2022;22:383]

In unadjusted analysis, 25 variables emerged to be potentially predictive of having ever undergone mammography. These included basic demographic characteristics, as well as clusters of variables categorized as interpersonal barriers, structure barriers, and Punishing Allah Reappraisal, among others. Perceived benefits, susceptibilities, and importance, as well as external cues to action also potentially affected mammography uptake.

The final multivariable logistic regression model named seven variables to be significantly and independently correlated with having undergone mammography at least once: age (adjusted odds ratio [aOR], 1.07, 95 percent confidence interval [CI], 1.01–1.14; p<0.01), scores on the Punishing Allah Reappraisal domain of the Psychological Measure of Islam Religiousness (high vs low: aOR, 0.32, 95 percent CI, 0.13–0.79; p<0.05), and perceived importance (disagree vs agree: aOR, 0.12, 95 percent CI, 0.02–0.66; p<0.01).

Other important correlates included a recommendation from the personal doctor (aOR, 4.12, 95 percent CI, 2.04–8.33; p<0.01), perceived benefits of mammography (disagree vs agree: aOR, 0.05, 95 percent CI, 0.01–0.30; p<0.01), and believing that they must first need to have symptoms before a mammogram (aOR, 0.33, 95 percent CI, 0.16–0.70; p<0.01).

Similarly, perceived benefit and susceptibility, as well as the need for prior symptoms before screening, were significant correlates of regular mammography uptake among Malay-Muslim women.

Semi-structured and in-depth interviews of 23 Malay-Muslim women aged 40–69 years validated these findings. Those who had undergone screening said that one of their main reasons was that mammography could facilitate the early detection of breast cancer, allowing for timely and effective treatment.

Most screeners also said that being reminded or encouraged by family, friends, and their doctor helped them push through with mammography.

In terms of barriers, perceptions of low susceptibility, high costs of screening, and negative outcomes of mammography were strong impediments against the uptake of the procedure. Moreover, two participants were under the incorrect belief that mammography would trigger cancer cells to spread.

Religious beliefs and a general distrust of doctors were likewise prominent barriers against mammography uptake.

“Breast cancer screening interventions and its accompanying health messages should be jointly developed with religious leaders and the Islamic Religious Council of Singapore,” the researchers said. “We need to reduce perceptions on punishing appraisals and clarify religious teachings on health preventive measures so as to reduce mental conflicts.”

“In a multi-ethnic population in Singapore, ethnic-specific screening interventions should be part of the strategy to reach out to minority ethnic groups so as to increase equity in mammography uptake,” they added.