Breast cancer in the Arabian gulf countries: Defining mammographic density presentation and optimising diagnosis of breast cancer

Abstract

Aims: 1) to report participation rates in breast self-examination (BSE), clinical breast examination (CBE) and mammography among women living in Ras Al Khaimah (RAK) and to examine their beliefs, attitudes and knowledge regarding breast cancer and early detection practices, 2) to report mammographic density patterns and their associations with demographic and reproductive factors in RAK and Riyadh. Methods: In the first study, 102 women were interviewed and a total of 366 and 792 mammographs were collected for the second and third studies, respectively. The first and second studies were carried out in RAK whereas the third study was conducted in Riyadh. The American College of Radiology, Breast Imaging Reporting and Data System (ACR, BI-RADS) 5th version and the Laboratory for Individualized Breast Radiodensity Assessment (LIBRA) software were used to estimate mammographic density. Results: In the first study BSE was practiced and CBE and mammography were performed on 51, 40 and 38 women, respectively. Only 4% were aware about the appropriate age to start mammography screening and 84.3% did not know the correct screening interval. Reasons for not planning to undergo CBE or mammography screenings were fear of cancer, pain during the examination and absence of doctor’s recommendation. In the second study, 22%, 43%, 24% and 11% women were allocated to BI-RADS a, b, c and d, respectively. Emirati women were significantly less likely to have increased mammographic density than Western women. In the third study, a mean percent density of 10.3cm2 and dense breast area of 19.1cm2 were reported. BMI, menopausal status and age at menarche remained significant predictors for mammographic density. Conclusions: This thesis has two main outcomes. First, establishing culturally sensitive public awareness and education programs is a priority in RAK. Second, mammography would be considered a modality of choice for breast cancer screening among Emirati and Saudi women.