title: Association of Knowledge and Cultural Perceptions of Malaysian Women with Delay in Diagnosis and Treatment of Breast Cancer: a Systematic Review.
abstract: BACKGROUND
  Breast cancer is the most common cancer and the leading cause of cancer mortality among women of all ethnic and age groups in Malaysia. Delay in seeking help for breast cancer symptoms is preventable and by identifying possible factors for delayed diagnosis, patient prognosis and survival rates could be improved.
  
  
  OBJECTIVE
  This narrative review aimed to understand and evaluate the level of in-depth breast cancer knowledge in terms of clinical breast examination and breast self-examination, and other important aspects such as side-effects and risk factors in Malaysian females. Since Malaysia is multicultural, this review assessed social perceptions, cultural beliefs and help-seeking behaviour in respect to breast cancer among different ethnic groups, since these may impinge on efforts to 'avoid' the disease.
  
  
  METHODS
  A comprehensive literature search of seven databases was performed from December 2015 to January 2015. Screening of relevant published journals was also undertaken to identify available information related to the knowledge, perception and help-seeking behaviour of Malaysian women in relation to breast cancer.
  
  
  RESULTS
  A total of 42 articles were appraised and included in this review. Generally, women in Malaysia had good awareness of breast cancer and its screening tools, particularly breast self-examination, but only superficial in-depth knowledge about the disease. Women in rural areas had lower levels of knowledge than those in urban areas. It was also shown that books, magazines, brochures and television were among the most common sources of breast cancer information. Delay in presentation was attributed mainly to a negative social perception of the disease, poverty, cultural and religion practices, and a strong influence of complementary and alternative medicine, rather than a lack of knowledge.
  
  
  CONCLUSIONS
  This review highlighted the need for an intensive and in-depth breast cancer education campaigns using media and community health programmes, even with the existing good awareness of breast cancer. This is essential in order to avoid misconceptions and to frame the correct mind-set about breast cancer among women in Malaysia. Socio-cultural differences and religious practices should be taken into account by health care professionals when advising on breast cancer. Women need to be aware of the risk factors and symptoms of breast cancer so that early diagnosis can take place and the chances of survival improved.
authors.affiliation: School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia E-mail : Tahir.pks@gmail.com.
authors.forename: Tahir Mehmood
authors.initials: TM
authors.lastname: Khan
authors.forename: Jamie Pik Yan
authors.initials: JP
authors.lastname: Leong
authors.forename: Long Chiau
authors.initials: LC
authors.lastname: Ming
authors.forename: Amer Hayat
authors.initials: AH
authors.lastname: Khan
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D016504:Breast Self-Examination / Q000523:psychology*; D057210:Delayed Diagnosis; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008296:Malaysia; D010342:Patient Acceptance of Health Care; D010465:Perception; D011379:Prognosis; D012307:Risk Factors