Determinants of cancer screening awareness and participation among Indonesian women

According to a study presented at the ESMO Asia 2017 Congress, studies showed that just one in five Indonesian women are aware of cervical cancer screening. The research covered nearly 5,400 women and also showed that only 5 percent knew about mammography for early detection of breast cancer.

Lead author Dr Sumadi Lukman Anwar, oncologist in training, Gadjah Mada University and Dr. Sardjito General Hospital, Yogyakarta, Indonesia said, “Early detection of cervical and breast cancers leads to better treatment, with improved survival and quality of life.”

Many patients in Indonesia are diagnosed with breast and cervical cancer at a very late stage where options for cure becoming limited. To improve the outcome of screening, there needs to be better awareness amongst Indonesians.

Since 2015, the Indonesian ministry of Health (PERMENKES No.15/2015) funds cervical and breast cancer screening to all women in Indonesia aged 40 and above. They do not receive a letter inviting them to get screened, and in most cases, it is their own initiative to get an appointment in primary healthcare.

The research assessed levels of awareness and participation in screening programmes for cervical and breast cancer and factors that influence these levels. The study used data from the Indonesian Family Life Survey (IFLS). The current study is a collaborative work led by PILAR Research & Education and Gdjah Mada University. The researchers are from the University College London, King’s College London and University of Manchester.

The 5,397 participants of the study completed questionnaires about awareness and participation in cervical screening, mammography and breast self-examination. Other information collected included marital status, education, household expenditure, lifestyle, and location to health facilities.

Data included were the levels of awareness and participation in screening, and whether they differed by any of the population characteristics. Results showed that only 20 percent of women were aware of cervical pap smears. Of those who were aware, only 28 percent had a cervical smear performed.

From the participants, only 5 percent were aware of mammography. From those, only 5 women had received a mammogram in the previous year. Around 12 percent of women had done breast self-examination in the past year.

There was an association on higher education and household expenditure with greater awareness on cervical smears and mammography, and greater participation in cervical smears and breast self-examination. The participants with health insurance, shorter distance to health services and who took part in community activities had greater awareness and participation.

According to Anwar, he said, “We found very low levels of awareness of screening programmes for cervical and breast cancers in Indonesian women, and participation was even lower with indications of a social gradient. Health practitioners need to be aware of subgroups of women at risk who may benefit from improved information and communication concerning the availability of cancer screening. If further research supports the role of social participation, a campaign may be needed that is socially and culturally adapted for women in Indonesia and communicated using existing community networks and media they frequently use. Most people own mobile phones so the potential use of social media could also be explored.”

Medical Oncologist Dr Wen-son Hsieh, ICON-SOC and Farrer Park Hospital in Singapore said, “Cervical cancer is the 4th most common cancer in women worldwide and 8% of the cases occur in the developing world. This is at least partly due to the low incidence of screening procedures being performed in the developing world.”

Education about screening is not spread amongst the population, thus, a lot of work and investment still needs to be done in this field.

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