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    • In the Middle East late diagnosis has been attributed

    2018-11-05

    In the Middle East, late diagnosis has been attributed to the lack of knowledge about BC, and to the limited access to information on screening programs (Altwalbeh, El Dahshan, & Yassin, 2015; Lodhi, Ahmad, Shah, & Naeem, 2010). However, there is scant published literature from this region on the reasons for delayed presentation of female BC (Lannin et al., 1998). There has been also little comparison between communities and countries about similarities and differences in reasons for such delays.
    Methods
    Results
    Discussion Despite advancements in BC treatment, well-established screening services in the emirate of Abu Dhabi, and the availability of health coverage, there is still a considerable lack of awareness from women about breast health, regular screening, and BC signs/symptoms and predisposing factors. This study provides an understanding of women׳s help-seeking behavior and factors influencing the time interval between presentation of symptoms and seeking medical treatment. Unlike other studies, it C 21 puts more emphasis on the social and cultural dimensions of this issue. It reveals cultural and religious aspects of BC and the distinct way United Arab Emirates society reacts to BC. This study is consistent with other studies (Burgess, Hunter, & Ramirez, 2001; Unger-Saldaña & Infante-Castañeda, 2011) in that breast lump was the most common symptom reported by women and often perceived to be non-serious. Not perceiving painless breast lumps as a threat to life was also seen among Saudi women (Altwalbeh et al., 2015) and therefore delaying seeking help reflects the lack of knowledge in regards to BC and its presentation. This initial symptom did not raise enough concern for prompt follow up. Some women compared it with previous knowledge and experiences (Khakbazan, Roudsari, Taghipour, & Pour, 2014). The attribution of the symptom to common conditions and experience is a factor in causing delay (Smith, Pope, & Botha, 2005; Unger-Saldaña & Infante-Castañeda, 2011). However, similar to a study conducted in Ethiopia (Dye, Bogale, Hobden, et al., 2012), changes in the nature of symptoms over time alerted the attention of women and motivated them to seek medical attention. For example, a woman who had a breast lump for two years was motivated by the occurrence of bleeding to seek medical attention. It describes the social norms of the society with regard to expectation from women and how they should behave if confronted with BC. Society expected women to suffer in silence and to behave as a role model for other women. The picture of a role model should not be distorted by BC. There have been few studies in the Middle East exploring factors influencing late presentation or delay or help-seeking behavior for BC (Alhurishi, Lim, Potrata, & West, 2011). All of them used quantitative research methods to examine late presentation, and most examined only patient-related factors (Abdel-Fatah et al., 1999; Elzawawy, 1999, 1991; Harirchi, Ghaemmaghami, & Karbakhsh, 2005; Montazeri, Ebrahimi, Mehrdad, et al., 2003; Stapleton, Mullan, Dey, et al., 2011). A lack of knowledge was not the only reason for delay; a complex array of personal, social, and cultural factors appears to influence a woman׳s decision on how soon to ask for appropriate clinical advice (Khakbazan et al., 2014). Our study shows that cultural and societal beliefs have a great effect on women׳s attitudes and behaviors towards symptoms recognition, appraisal, screening and presentation for medical treatment. Fear about society reaction to women with BC, and failing to meet community expectations about health and disease strongly influenced decision making more than the fear of death from impending disease. This fear held the women back from seeking medical advice and imposed an attitude of silence. Culturally, cancer is often stigmatized at times and our study found that this negatively influenced symptom disclosure and social interaction. In contrast, other studies (Abdullah, Abdullah, Yip, et al., 2013; Burgess et al., 2001; Lam, Tsuchiya, Chan, et al., 2009; Lu, Lin, & Lee, 2010; O׳Mahony, Hegarty, & McCarthy, 2011; Unger-Saldaña & Infante-Castañeda, 2011) reported that symptom disclosure and social interaction was perceived as supportive and led to informal and emotional support.