title: Does performance of breast self-exams increase the probability of using mammography: evidence from Malaysia.
abstract: OBJECTIVE
  Breast self-examination (BSE) was evaluated to see if it is a significant predictor of mammography.
  
  
  METHODS
  The decisions of females above age 40 in Malaysia to test for breast cancer using BSE and mammography are jointly modeled using a bivariate probit so that unobserved attributes affecting mammography usage are also allowed to affect BSE. Data come from the Malaysia Non-Communicable Disease Surveillance-1, which was collected between September 2005 and February 2006.
  
  
  RESULTS
  Having ever performed BSE is positively associated with having ever undergone mammography among Malay (adjusted OR=7.343, CI=2.686, 20.079) and Chinese (adjusted OR=3.466, CI=1.330, 9.031) females after adjusting for household income, education, marital status and residential location. Neither relationship is affected by jointly modelling the decision problem. Although the association is also positive for Indian females when mammography is modelled separately (adjusted OR=5.959, CI=1.546 - 22.970), the relationship is reversed when both decisions are modelled separately.
  
  
  CONCLUSIONS
  De-emphasizing BSE in Malaysia may reduce mammography screening among a large proportion of the population. Previous work on the issue in developed countries may not apply to nations with limited resources.
authors.affiliation: Texas A and M University, USA. dunn.econ@gmail.com
authors.forename: Richard A
authors.initials: RA
authors.lastname: Dunn
authors.forename: Andrew
authors.initials: A
authors.lastname: Tan
authors.forename: Ismail
authors.initials: I
authors.lastname: Samad
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001364:Awareness; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D016504:Breast Self-Examination; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005189:False Positive Reactions; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008296:Malaysia; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening; D008875:Middle Aged; D011379:Prognosis; D011795:Surveys and Questionnaires