Breast Cancer Knowledge Among Male High School Students in Saudi Arabia
Samia Al-Amoudi1&Moaiad Tariq Abdul-Aziz AlHomied2&
Nasser Youssef Nasser AlSayegh2&Osama Naseem Ismail Radi2&
Mohammed Majed Suliman Zagzoog2&Omar Faisal Mubarak Aloufi2&
Abdullah Abdulkarim Ali Al-Harbi2&Safwan Tayeb2&Mohammed Hassanien3&
Mahmoud Al-Ahwal2&Basem Eldeek4&Steve Harakeh5
Published online: 26 November 2015
#American Association for Cancer Education 2015
Abstract Breast cancer (BC) accounts for 24 % of all women cancer cases diagnosed in Saudi Arabia each year. Awareness is extremely important in combating this disease. This study was undertaken to assess male high school students’response to BC. This cross-sectional survey was performed on male high school students across schools in Jeddah. A question- naire gathered data on respondent demographics, beliefs about BC, BC risk factors, early screening methods, and role of men in BC. Statistical analysis was done using SPSS 20. A total of 824 students participated, with an average age of 17.0 years.
There was more than 50 % agreement that early detection of BC enhances the chances of recovery, that BC is treatable, and that clinical breast examination and breastfeeding provide pro- tection from BC. Around half the survey population thought
that BC was fatal and contagious. Fewer than 50 % thought that BC was inherited and related to smoking, consumption of contraceptive pills, repeated exposure to radiation, obesity, and wearing a bra and that breast tumors were all malignant and spread to different parts of the body. Others knew that mammograms should be performed periodically. A high per- centage persuaded their relatives to have mammograms and provided them with psychological support. Knowledge of BC among male high school students in Saudi Arabia is still lim- ited, and, therefore, programs and activities need to be established to increase awareness among high school students.
Keywords Breast cancer . Awareness . Male high school students . Knowledge . Jeddah . Saudi Arabia
Introduction
According to the Saudi Cancer Registry, breast cancer (BC) is considered the most common type of cancer among Saudi women and represents 24 % of all female cancer diagnoses annually in Saudi Arabia [1–3]. Considering the rapid growth and aging of the Saudi population, it is expected that the inci- dence of BC will steadily increase at an estimated rate of about 350 % and that the mortality rate will increase by 160 % by the year 2025 [4].
Studies in Saudi Arabia among young Saudi women showed a limited level of knowledge about BC [5]. As such, measures need to be taken to face the upcoming challenges, such as information campaigns to raise awareness and pro- mote screening as a means of early detection. Women empowered with this knowledge are more likely to detect BC at an early stage and, thus, more likely to be successfully treated. Campaigns should target both men and women as BC Implications and Contributions This study contributes to the
development of an effective program aimed at promoting knowledge among high school students regarding breast cancer and ways to help their family members in the prevention and management of the disease.
* Samia Al-Amoudi
1 Sheikh Mohammed Hussien Al-Amoudi Center of Excellence in Breast Cancer, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
2 Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
3 Clinical Biochemistry, Medical Education, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
4 Department of Medical Education, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
5 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
is a disease that affects the whole family, not just females.
Therefore, both men and women should have good knowl- edge and awareness about BC to help fight this disease. This study assesses the knowledge of Saudi male high school stu- dents regarding BC.
Methods
This study was conducted under the auspices of the Al- Amoudi Center of Excellence in Breast Cancer at King Abdulaziz University, Jeddah, Saudi Arabia. After receiving ethical approval from the University Ethical Committee and Ministry of Education, the BC questionnaire was distributed to consenting students. The questionnaire included questions related to demographics, beliefs and risk factors, early screening methods, and the role of men in dealing with BC. Twelve gov- ernmental and private high schools were randomly selected. A map of Jeddah was used to locate the schools in each area, and a team of six second year medical students were instructed on how to distribute and collect the questionnaires. Three random classes were chosen from each grade in every high school, with an average of 20 male students in each class in the private schools and an average of 30 male students in the governmental schools.
Statistical Analysis
The data were analyzed using the Statistical Package for Social Sciences (SPSS 20). The qualitative data were present- ed in the form of numbers and percentages. Chi-square was used as a test of significance for comparison of qualitative data of the studied group. Results were considered significant at ap value≤0.05.
Results
Eight hundred and twenty-four male students agreed to par- ticipate out of 835 contacted (98.7 % response rate). The sam- ple comprised 287 first year, 258 second year, and 279 third year male high school students with an average age of 17.0 years (range, 14–21 years). The most common levels of education of the respondents’parents were high school and university. About 32.8 % of the respondents had a family history of breast cancer (Table1).
Approximately 67.3 % agreed that early detection of breast cancer enhances the probability of recovery and is treatable (60.0 %) and that breast feeding provides protection from BC (52 %). The sample described BC as fatal (50.7 %), conta- gious (50.1 %), related to smoking (44.8 %), inherited (42.1 %), and related to the use of contraceptive pills (13.9 %), repeated exposure to radiation (32.4 %), obesity (26.9 %), wearing a bra (25.6 %) and that all tumors are
malignant (36.6 %) and BC spreads to the different parts of the body (23.9 %) (Table2).
Analysis of the data related to knowledge about risk factors showed a significant difference existed (except for the ques- tion on whether breast feeding provides protection against BC) among the different high school levels, with those in level three showing the highest knowledge.
Concerning early methods for screening, 64.7 % were aware of clinical breast examination and there was a signifi- cant difference among students from the different year levels, with those in the third year showing the best knowledge.
Nearly half (49.8 %) knew about breast self-examination, with third year students having significantly better knowledge, and that mammograms should be performed periodically (49 %).
Regarding mammography, 16.2 % answered that mammo- grams should be repeated and 16 % knew the correct age for starting mammogram examinations (Table3).
Table 4 shows the reported correct knowledge regarding the role of men in BC; 79.4 % persuaded their relatives (mothers and/or sisters) to have mammograms and 71.1 % provided their relatives with psychological support, 46.8 % said they would accompany their relatives for mammograms, and 42 % thought it was appropriate to speak publicly about BC. Among the respondents, 19 % knew that men could also develop BC, and 4.6 % said that they had accompanied their relatives for a mammogram examination. Analysis of the data Table 1 Characteristics of the student population
Variables Frequency (percent)
Level of high school education
First year 287 (34.8)
Second year 258 (31.3)
Third year 279 (33.9)
Level of education of the mother
Illiterate 18 (2.2)
Primary school 107 (13.0)
Middle school 108 (13.1)
High school 217 (26.3)
Bachelor’s degree 239 (29.0)
Beyond bachelor’s degree 85 (10.3) Missing
Level of education of the father
Illiterate 11 (1.3)
Primary school 69 (8.4)
Middle school 73 (8.9)
High school 227 (27.5)
Bachelor’s degree 223 (27.1)
Beyond bachelor’s degree 177 (21.5)
Missing 44 (5.3)
Was one of your family members diagnosed with breast cancer?
Yes 270 (32.8)
showed that there was a significant difference between the responses of second and third year high school students compared with those of first year students when it came to the psychological support that men offered to their mothers or sisters.
Discussion
In breast cancer, early detection saves lives. Low awareness can delay diagnosis and this will affect survival [6].
Empowerment of women and the community as a whole is an essential step toward increasing awareness and advancing
health issues and health rights. Empowerment comes through health education and knowledge.
In closed and conservative societies like in Saudi Arabia, it is not easy to discuss breast cancer among males as it is thought to be a woman’s issue. Moreover, some still think a diagnosis of BC is a death sentence and a taboo. The male role is important in these communities, where women depend on men for transportation as women are not allowed to drive in Saudi Arabia, thus reducing access to screening services.
Indeed, some women will not even have a mammogram with- out first obtaining approval from their male guardian. This is a purely sociocultural issue and has nothing to do with religion.
Another deterrent is that a woman may want to avoid knowing that she has cancer because this might prevent marriage Table 2 Correct knowledge
regarding risk factors associated with breast cancer
Variables 1st year high
school (n=287)
2nd year high school (n=258)
3rd year high school (n=279)
Total (n=824)
Pvalue
Early detection of BC enhances the rate of recovery
180 (63.8) 168 (65.6) 201 (72.3) 549 (67.3) 0.069
BC is treatable 165 (58.7) 159 (62.4) 163 (59.1) 487 (60.0) 0.701
Breast feeding protects against BC
122 (42.7) 143 (55.9) 161 (58.1) 426 (52.0) <0.0001
BC is fatal 139 (49.6) 122 (48.2) 149 (54.2) 410 (50.7) 0.393
BC is contagious 130 (48.9) 120 (48.2) 138 (52.5) 388 (49.9) 0.499
BC is related to smoking 122 (42.7) 125 (48.8) 119 (43.3) 366 (44.8) 0.649
BC is inherited 111 (38.7) 107 (41.6) 128 (46.0) 346 (42.1) 0.295
BC is related to the use of contraceptive pills
34 (11.9) 38 (15.1) 41 (14.7) 113 (13.9) 0.939
Risk of BC is related to repeated exposure to radiation
73 (26.1) 82 (32.9) 106 (38.4) 261 (32.4) 0.210
BC is related to obesity 73 (26.1) 67 (27.1) 75 (27.7) 215 (26.9) 0.914
BC is related to wearing a bra 77 (27.0) 59 (23.0) 74 (26.7) 210 (25.6) 0.332 BC spreads to different parts
of the body
54 (19.5) 66 (26.2) 71 (26.3) 191 (23.9) 0.033
All breast tumors are malignant 103 (36.4) 88 (34.4) 106 (38.8) 297 (36.6) 0.205 The data are presented as frequency (percent) unless otherwise specified
BCbreast cancer
*Significant at the 0.05 level
Table 3 Correct knowledge regarding early screening for breast cancer
Variables 1st year high school
(n=287)
2nd year high school (n=258)
3rd year high school (n=279)
Total (n=824)
Pvalue
Clinical examination of the breast 170 (60.1) 164 (64.8) 187 (69.5) 521 (64.7) 0.001*
Routine self-examination of the breast 126 (44.5) 126 (49.2) 155 (55.8) 407 (49.8) 0.043*
Periodic examination using mammograms 124 (45.6) 129 (51.6) 137 (50.0) 390 (49.0) 0.720
Frequency at which mammogram examination should be repeated
49 (17.6) 46 (18.3) 35 (12.9) 130 (16.2) 0.620
Starting age for women to start mammogram examination
41 (14.5) 49 (19.1) 40 (14.6) 130 (16.0) 0.570
The data are presented as frequency (percent) unless otherwise specified
*Significant at the 0.05 level
proposals to her daughters (assumed heredity) or she might lose her husband’s support or suffer being abandoned by her husband. There are no studies to confirm the extent of these issues. By carrying such studies as this one, we tend to break the silence and encourage the young male generation to get involved in BC and be aware of the importance of early de- tection. In a previous study [5], high school female students were asked the same questions, with some modifications re- garding breast self-examination, symptoms, and breast surgery.
In this study, we found better knowledge was acquired by those in the higher classes of high school (third year students).
Thus, age and educational level indicate more knowledge and experience.
We found that two thirds of male students knew that early detection was important; however, 49.3 % believed that breast cancer was fatal compared with the female survey, where 32.6 % saidBno^ and 63.2 % stated they did not know. As for whether BC can be treated, 77.7 % female students stated Byes^and 16.0 % did not know compared with 40 % of male students who did not know. Of the male students, 50.1 % thought BC was contagious. Knowledge about some risk fac- tors was assessed and found inadequate as 57.9 % believed it was inherited. Obesity was considered a risk factor among 26.9 % and wearing bra in 74.4 % compared with 44.2 % of female students who stated wearing a bra was a risk factor. This low level of knowledge regarding risk factors is comparable with results obtained from female high school students [5,7].
Early detection tools include breast self-examination, clin- ical breast examination, and mammography. These tools are controversial, but still it is important to increase awareness concerning them; hence, they are the only methods used [8].
Screening mammography has been shown in many studies to allow early detection and, thus, lowers mortality [9].
In this assessment of student knowledge, it is clear that they have an idea about breast self-examination and clinical breast examination. However, what is more serious is the lack of knowledge about the role of mammography as a method for
early detection. This is similar to what has been published on female high school students [7], where only 30 % knew what mammography was, but better than the very low level (10 %) among men in general [10].
In conclusion, knowledge among male high school stu- dents in Saudi Arabia toward BC is still limited, and, there- fore, it is extremely essential to establish programs and activ- ities that increase awareness among both male and female high school students and the community at large.
Acknowledgments This study was sponsored by Sheikh Mohammed Hussien Al-Amoudi Center of Excellence in Breast Cancer. We also express our gratitude to the team members of the center: Sara Bugshan and Karen Lopez for their help and assistance during the preparation of this paper.
Compliance with Ethical Standards This study received an ethical approval from King Abdulaziz University Ethical Committee and Minis- try of Education.
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Table 4 Role of men regarding breast cancer
Variables 1st year high school
(n=287)
2nd year high school (n=258)
3rd year high school (n=279)
Total (n=824)
Pvalue
Persuasion of relatives and others to have mammograms
219 (77.1) 211 (82.1) 219 (79.3) 649 (79.4) 0.277
Psychological support 179 (64.4) 193 (75.7) 204 (73.6) 576 (71.1) 0.024*
Accompany mother/sister for mammogram 120 (43.2) 115 (45.8) 140 (51.5) 375 (46.8) 0.051
Speaking about BC to students 93 (33.1) 115 (45.5) 131 (47.8) 339 (42.0) 0.110
Men can get BC 51 (17.9) 60 (23.4) 45 (16.2) 156 (19.0) 0.241
Whether accompanied relatives for mammogram 14 (5.0) 11 (4.4) 12 (4.4) 37 (4.6) 0.726
The data are presented as frequency (percent) unless otherwise specified
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