Barriers to healthcare seeking, beliefs about ovarian cancer and the role of socio-economic position. A cross-sectional multilevel study in Dubai, a multicultural society

  • Sallam Saki
    Department of Public Health, Dubai Medical College, Dubai, United Arab Emirates.
  • Noor Radhi Ali
    Department of Public Health, Dubai Medical College, Dubai, United Arab Emirates. https://orcid.org/0000-0001-6827-3732
  • Safa Sofi Saki
    Department of Public Health, Dubai Medical College, Dubai, United Arab Emirates.
  • Zainab Sadeq AlRabeea
    Department of Public Health, Dubai Medical College, Dubai, United Arab Emirates.
    https://orcid.org/0000-0002-8656-4557
  • Fatima Najim AlRemeithi
    Department of Public Health, Dubai Medical College, Dubai, United Arab Emirates.
  • Frederick Robert Carrick
    University of Central Florida College of Medicine, Orlando, FL, United States.
  • Mahera Abdulrahman
    Health Regulation Sector, Dubai Health Authority, Dubai, United Arab Emirates.

ABSTRACT

Background: Studies have shown that public awareness of ovarian cancer is weak, and women are often diagnosed at late stages when treatment is difficult. This study aimed to determine the barriers for seeking early medical care and level of knowledge and awareness among women regarding ovarian cancer.

Design and methods:
 A structured questionnaire was designed and adapted from the validated cancer awareness measure.

Results
: The recognition level of ovarian cancer symptoms among women in this study varied from 12-51%, and the most alarming ones, back pain, eating difficulties, and persistent abdominal pain, were missed by most of the surveyed women. The most recognized ovarian cancer risk factors were never being pregnant, having a history of infertility, and going through menopause, while the least recognized was having personal or family history of breast cancer. Non-UAE nationals women with higher educational levels had better knowledge of ovarian cancer compared to their peers.

Conclusions:
 A change or implementation model is highly recommended in order to improve women's awareness of ovarian cancer symptoms. Strengthening education among women with regards to risk factors, early symptoms, and the need to seek early medical help should help to increase ovarian cancer awareness and reduce a delay in the diagnosis.

REFERENCES

Lockwood-Rayermann S, Donovan HS, Rambo D, Kuo C-W J. Women's awareness of ovarian cancer risks and symptoms. Am J Nurs 2009;109:36. DOI: https://doi.org/10.1097/01.NAJ.0000360309.08701.73

Ministry of Health. Cancer Registry Report 2014 Available at: https://www.mohap.gov.ae/Files/MOH_OpenData/520/UAE%20Cancer%20Registry%20Report%202014_En.pdf

Keng SL, Wahab SBA, Chiu LB, Yusuf A. Awareness of ovarian cancer risk factors among women in Malaysia: A preliminary study. Asian Pac J Cancer Prev 2015;16:537-40. DOI: https://doi.org/10.7314/APJCP.2015.16.2.537

No authors listed. Committee Opinion No. 716: The role of the obstetrician–gynecologist in the early detection of epithelial ovarian cancer in women at average risk. Obstet Gynecol 2017;130:e146-9. DOI: https://doi.org/10.1097/AOG.0000000000002299

Ebell MH, Culp MB, Radke TJ. A systematic review of symptoms for the diagnosis of ovarian cancer. Am J Prev Med 2016;50:384-94. DOI: https://doi.org/10.1016/j.amepre.2015.09.023

Brain KE, Smits S, Simon AE, et al. Ovarian cancer symptom awareness and anticipated delayed presentation in a population sample. BMC Cancer 2014;14:171. DOI: https://doi.org/10.1186/1471-2407-14-171

Gajjar K, Ogden G, Mujahid MI, Razvi K. Symptoms and risk factors of ovarian cancer: A survey in primary care. ISRN Obstet Gynecol 2012;2012:754197. DOI: https://doi.org/10.5402/2012/754197

Adeyemi A, Afolabi A, Adedeji O. Ovarian cancer symptom awareness and its response among female health workers. J Adv Med Medical Res 2015;5:978-86. DOI: https://doi.org/10.9734/BJMMR/2015/13354

Kemp Z, Ledermann J. Update on first-line treatment of advanced ovarian carcinoma. Int J Womens Health 2013;5 45-51. DOI: https://doi.org/10.2147/IJWH.S30231

Neal RD, Tharmanathan P, France B, et al. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer 2015;112: S92-107. DOI: https://doi.org/10.1038/bjc.2015.48

Weller D, Vedsted P, Rubin G, et al. The Aarhus statement: improving design and reporting of studies on early cancer diagnosis. Br J Cancer, 2012;106:1262-7. DOI: https://doi.org/10.1038/bjc.2012.68

Schmidt M, Schmidt SAJ, Sandegaard JL, et al. The Danish National Patient Registry: a review of content, data quality, and research potential. Clinical epidemiology 2015;7:449-90. DOI: https://doi.org/10.2147/CLEP.S91125

Jones S, Magee C, Francis J, et al. Australian women’s awareness of ovarian cancer symptoms, risk and protective factors, and estimates of own risk. Cancer Causes Control 2010;21:2231-39. DOI: https://doi.org/10.1007/s10552-010-9643-1

Low EL, Waller J, Menon U, et al. Ovarian cancer symptom awareness and anticipated time to help-seeking for symptoms among UK women. J Fam Plann Reprod Health Care 2013;39:163-71. DOI: https://doi.org/10.1136/jfprhc-2012-100473

Macleod U, Mitchell ED, Burgess, et al. Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers. Br J Cancer 2009;101:S92-101. DOI: https://doi.org/10.1038/sj.bjc.6605398

Bagiella E, Chang H. Power analysis and sample size calculation. J Mol Cell Cardiol 2019;133:214:6. DOI: https://doi.org/10.1016/j.yjmcc.2019.01.006

Stubbings S, Robb K, Waller J, et al. Development of a measurement tool to assess public awareness of cancer Br J Cancer 2009;101:S13-7. DOI: https://doi.org/10.1038/sj.bjc.6605385

Simon AE, Wardle J, Grimmett C, et al. Ovarian and cervical cancer awareness: development of two validated measurement tools. J Fam Plann Reprod Health Care 2012;38:167-74. DOI: https://doi.org/10.1136/jfprhc-2011-100118

Nersesian S, Glazebrook H, Toulany J, et al. Naturally killing the silent killer: NK cell-based immunotherapy for ovarian cancer. Front Immunol 2019;10:1782-6. DOI: https://doi.org/10.3389/fimmu.2019.01782

Al-Azri M, Al-Saidi M, AL-Mutair E, Panchatcharam SM. Awareness of risk factors, symptoms and time to seek medical help of ovarian cancer amongst Omani women attending teaching hospital in Muscat Governorate, Oman. Asian Pac J Cancer Prevent 2018;19:1833-43.

Freij M, Al Qadire M, Khadra M, et al. Awareness and knowledge of ovarian cancer symptoms and risk factors: A survey of Jordanian women. Clin Nurs Res 2018;27:826-40. DOI: https://doi.org/10.1177/1054773817704749

Okunowo AA, Adaramoye VO. Women's knowledge on ovarian cancer symptoms and risk factors in Nigeria: An institutional-based study. J Epidemiol Glob Health 2018;8:34-41. DOI: https://doi.org/10.2991/j.jegh.2018.07.002

Ma J, Jemal A. Temporal trends in mortality from major cancers by education in the United States, 2001-2016. JNCI Cancer Spectr 2019;8:1-4. DOI: https://doi.org/10.1093/jncics/pkz087

McCaffery K, Wardle J, Waller J. Knowledge, attitudes, and behavioral intentions in relation to the early detection of colorectal cancer in the United Kingdom. Prev Med 2003;36:525-35. DOI: https://doi.org/10.1016/S0091-7435(03)00016-1