title: Factors associated with low screening for breast cancer in the Palestinian Authority: relations of availability, environmental barriers, and cancer-related fatalism.
abstract: BACKGROUND
  The current study was conducted to assess screening behaviors in relation to cultural and environmental barriers among Palestinian women in the West Bank.
  
  
  METHODS
  The participants were 397 women, ages 30 to 65 years, residing in the Palestinian Authority, and a stratified sample method was used (98.3% participation rate). The participants completed questionnaires on breast examination behaviors and knowledge, on perceived cancer fatalism and health beliefs, and on environmental barriers scales.
  
  
  RESULTS
  Greater than 70% of the women had never undergone mammography or clinical breast examination (CBE), whereas 62% performed self breast examination (SBE). Women were more likely to undergo mammography if they were less religious (odds ratio [OR], 0.59; 95% confidence interval [95% CI], 0.47-0.81) and if they expressed lower personal barriers (OR, 0.59; 95% CI, 0.29-0.76) and lower fatalism (OR, 0.39; 95% CI, 0.28-0.63). A higher likelihood for CBE was related to being Christian (OR, 2.91; 95% CI, 1.49-5.73) and being less religious (OR, 0.32; 95% CI, 0.13-0.78), to perceived higher effectiveness of CBE (OR, 1.46; 95% CI, 1.20-1.79), and to perceived lower cancer fatalism (OR, 0.35; 95% CI, 0.28-0.60). Women were more likely to perform SBE if they were more educated, resided in cities, were Christian, were less religious, had a first-degree relative with breast cancer, perceived higher effectiveness and benefits of SBE, and perceived lower barriers and fatalism.
  
  
  CONCLUSIONS
  Participants reported a combination of personal, cultural, and environmental barriers, which should be addressed by educational programs and followed by the allocation of resources for early detection and treatment of breast cancer.
authors.affiliation: School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
authors.forename: Faisal
authors.initials: F
authors.lastname: Azaiza
authors.forename: Miri
authors.initials: M
authors.lastname: Cohen
authors.forename: Mariam
authors.initials: M
authors.lastname: Awad
authors.forename: Francoise
authors.initials: F
authors.lastname: Daoud
mesh_terms: D000328:Adult; D000368:Aged; D018912:Arabs; D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008327:Mammography; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D008877:Middle East