Breast Cancer Screening in Sarawak, Borneo: 10 Years' Community Outreach Program.

Abstract

Background: Sarawak isthe largest state in Malaysia, with a population of 2.9 millionwith 45% living more than 100 km from urban cities. These communities face the risk of delayed breast cancer diagnosis due to limited access to healthcare services. Sarawak has only four government hospitals with diagnostic mammogram facilities.

Objective: Sarawak Breast Cancer Support Group (SBCSG) has spearheaded breast cancer education and early screening outreach since 2012, with a special focus on rural communities. This paper describes the results from our 10-year program.

Methods: These programs were organized or co-organized by SBCSG from 2013 to 2023, involving local organizers and the Ministry of Health Malaysia. Women aged 18 years and above were invited to participate in clinical breast examination, and those with abnormal findings were referred to the nearest clinic or hospital for further management.

Results: We screened 2050 women, with 7.1% exhibiting abnormal breast findings. Urban screening sites reported higher abnormal findings in (9% [85/949] vs. 5% [61/1101]; p = 0.003), Malays demonstrated the highest percentage of abnormal breast findings (9.5%, 28/296). Women with fewer than three children were more likely to exhibit abnormal findings (8.3% [85/1021] vs. 5.9% [61/1029]; p = 0.003). Subjects screened at urban sites and between the ages of 30-59 were 1.6 and 2.3 times more likely to exhibit abnormal findings, respectively.

Conclusion: Screening site was the strongest independent variable for detecting breast abnormality, which could be linked to reproductive health, as women in rural areas tend to have more children, a trend that can be attributed to socioeconomic and cultural norms.