Misinformation, fear, finances keep early breast cancer detection low in Singapore

Despite years of targeted efforts, women in Singapore continue to be discouraged from seeking early evaluation and potential diagnosis of breast cancer, a recent study has found. The barriers to early presentation have remained consistent over the years and include lack of knowledge and awareness, misconceptions, and fears.

The findings highlight “the importance of enhanced awareness campaigns for breast screening programmes. It is also imperative to stress the importance of regular follow-up screening in women with an initial normal mammogram result,” the researchers said.

Semi-structured face-to-face interviews were conducted on a convenience sample of 23 patients (mean age 60±13 years) with locally advanced breast cancer (LABC). Content analysis revealed three main themes describing the barriers to presentation for early screening: knowledge, perception and fear, and financial and social reasons. [PLoS One 2021;16:e0252008]

The misconception that a breast lump had to be painful for it to be malignant was very common among the participants. Seventeen women (74 percent) neglected their breast lumps due to the lack of pain and other clearer symptoms, such as palpable lymph nodes and skin changes.

Seven women (21 percent) noted that they harboured misconceptions of invasive breast cancer (IBC), stemming from lack of knowledge of the disease. One, for instance, thought it was normal to have a breast lump after menopause.

Misinformation from the internet or from social circles emerged as a pressing problem. Nine women said they initially preferred alternative modes of treatment, which they found out from friends or through social media. Eight women admitted that they got their IBC information primarily online or from friends.

Aside from knowledge gaps, fear was also a strong deterrent to early presentation. Ten women (43 percent) said they were afraid of the pain from the screening process, which they have either experienced themselves or have heard of from other people. Twelve participants (52 percent) said that they were daunted by the treatment they may receive if diagnosed.

Eight women (35 percent) were afraid of the diagnosis itself because they viewed cancer as incurable or did not want to burden their families.

In turn, similar social considerations emerged as the third main barrier to early presentation. Six women, for instance, said that they were afraid of being dependent on their families, had other ongoing family issues, or were in a poor financial situation. Four women specifically named fraught finances, which would be exacerbated by their diagnosis, as their main reason for not presenting to early screening.

“[W]e found that barriers to early presentation in women with LABC are similar to those identified in previous studies and have persisted over the years. Misinformation through unreliable online sources and social circles further compound the problem,” the researchers said.

“There is a need for evaluation of and implementation of new strategies to engage women with LABC and encourage earlier presentation,” they added.