title: Awareness of breast cancer and barriers to breast screening uptake in Bangladesh: A population based survey.
abstract: OBJECTIVE
  To investigate the awareness of breast cancer (BCa) and BCa screening amongst women at midlife in Bangladesh.
  
  
  METHODS
  A nationally representative cross-sectional survey of women aged 30-59 years was conducted in 7 districts of the 7 divisions in Bangladesh, using a multistage cluster sampling technique. The factors associated with the awareness of BCa and breast assessment of asymptomatic women were investigated separately, using multivariable logistic regression.
  
  
  RESULTS
  Of the 1590 participants, mean age 42.3 (±8.0) years, 81.9% had ever heard of BCa and 64.2% of any methods of BCa screening, respectively. Awareness of BCa was associated with being aged 40-49 years (adjusted OR 2.04, 95% CI 1.46-2.84), aged 49-59 years (1.96, 1.32-2.91), being overweight (1.46, 1.07-2.01) and obesity (1.62, 1.01-2.62), while inversely associated with rural dwelling (0.37, 0.22-0.61), primary education (0.44, 0.27-0.70), having no education (0.23, 0.14-0.36) and parity (0.62, 0.44-0.87). Of the 750 women who were aware of clinical breast examination (CBE) or mammography, reasons provided for not undergoing screening included that they had no symptoms (92%) and that they did not know screening was needed (40%). 8% of women reported CBE. Women with no education were less likely to have undergone CBE (0.38, 0.141.04; p=0.059).
  
  
  CONCLUSIONS
  Lack of understanding of the assessment of asymptomatic women is the key obstacle to BCa screening uptake in Bangladesh. Health education programs, especially BCa awareness programs, have the potential to increase BCa awareness and down-staging of the disease.
authors.affiliation: Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Population Sciences, University of Dhaka, Dhaka 1000, Bangladesh.
authors.forename: Rakibul M
authors.initials: RM
authors.lastname: Islam
authors.affiliation: Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Bell
authors.affiliation: Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Baki
authors.initials: B
authors.lastname: Billah
authors.affiliation: Department of Population Sciences, University of Dhaka, Dhaka 1000, Bangladesh.
authors.forename: Mohammad B
authors.initials: MB
authors.lastname: Hossain
authors.affiliation: Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: susan.davis@monash.edu.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Davis
mesh_terms: D000328:Adult; D000367:Age Factors; D001459:Bangladesh; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D010298:Parity; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D011795:Surveys and Questionnaires
keywords: Awareness; Bangladesh; Barriers; Breast cancer; Screening