title: Exploring Knowledge, Attitudes, and Practices Related to Breast and Cervical Cancers in Mongolia: A National Population-Based Survey.
abstract: BACKGROUND
  Mongolia bears the second-highest cancer burden in the world (5,214 disability-adjusted life years per 100,000 people, age standardized). To determine drivers of the growing burden of noncommunicable diseases, including breast and cervical cancers, a national knowledge, attitudes, and practices (KAP) survey was implemented in 2010.
  
  
  METHODS
  This paper analyzed the results of the 2010 KAP survey, which sampled 3,450 households nationally. Reflecting Mongolian screening policies, women aged 30 and older were included in analyses of questions regarding breast and cervical cancer (n = 1,193). Univariate and multivariate odds ratios (MORs) were derived through logistic regression to determine associations between demographic covariables (residence, age, education, employment) and survey responses.
  
  
  RESULTS
  This study found that 25.7% (95% confidence interval [CI]: 23.3-28.3) and 22.1% (95% CI: 19.8-24.5) of female participants aged 30 years or older self-rated their knowledge of breast and cervical cancers, respectively, as "none." Employment and education were associated with greater awareness of both cancers and participation in screening examinations (p < .05). Clinical breast examinations were more common among rural than urban participants (MOR: 1.492; 95% CI: 1.125-1.979). Of all female participants, 17% (95% CI: 15.3-18.5) knew that cervical cancer is vaccine preventable.
  
  
  CONCLUSIONS
  Our results suggest that cancer control in Mongolia should emphasize health education, particularly among lower-educated, rural, and unemployed women. The health infrastructure should be strengthened to reflect rural to urban migration. Finally, although there is awareness that early detection improves outcomes, a significant proportion of women do not engage in screening. These trends warrant further research on barriers and solutions.
  
  
  CONCLUSIONS
  The rising burden of breast and cervical cancers, particularly in low- and middle-income countries, necessitates the development of effective strategies for cancer control. This paper examines barriers to health service use in Mongolia, a country with a high cancer burden. The 2010 national knowledge, attitude and practices survey data indicate that cancer control efforts should focus on improving health education among lower-educated, rural, and unemployed populations, who display the least knowledge of breast and cervical cancers. Moreover, the findings support the need to emphasize individual risk for disease in cancer education and ensure that the health-care infrastructure reflects Mongolia's urbanization.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA Pooja.yerramilli@uphs.upenn.edu.
authors.forename: Pooja
authors.initials: P
authors.lastname: Yerramilli
authors.affiliation: Public Health Institute, Ministry of Health of Mongolia, Ulaanbaatar, Mongolia.
authors.forename: Otgonduya
authors.initials: O
authors.lastname: Dugee
authors.affiliation: Public Health Institute, Ministry of Health of Mongolia, Ulaanbaatar, Mongolia.
authors.forename: Palam
authors.initials: P
authors.lastname: Enkhtuya
authors.affiliation: Harvard Global Equity Initiative, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Felicia M
authors.initials: FM
authors.lastname: Knaul
authors.affiliation: Harvard Global Equity Initiative, Harvard Medical School, Boston, Massachusetts, USA School of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Alessandro R
authors.initials: AR
authors.lastname: Demaio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D008986:Mongolia / Q000453:epidemiology; D012424:Rural Population; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology
keywords: Asia; Cancer; Global health; Noncommunicable disease; Public health