Barriers of Breast Cancer Screening and Early Detection among Iraqi Women in Dhi-Qar City


  • Jawad K. Al-Diwan Prof. MBChB, MSc, DCN, FICMS, FFPH, Department of Family and Community Medicine, College of Medicine, Baghdad University, Iraq
  • Afiaa Muhsin Obaid MBChB, FIBMS(FM), Al-Yarmook Teaching Hospital, Iraq
  • Alhan H. Sultan MBChB, FABHS(FM), FCS, Al-Kadhimiya Teaching Hospital, Iraq


Breast cancer, Barriers, Screening, Early detection, Cancer


Introduction: Breast Cancer patients in Iraq are often presented younger than those in high-income countries and diagnosed in advanced stages that led to a higher mortality rate. It is due to absence of screening program. Objectives:  Publication on the urgent need of Iraq for breast cancer screening is scarce. Therefore this study was carried out among Iraqi women in southern Iraq. Methods:  A total of 307 women were selected from (hospitals and PHCCs) in different areas in Dhi-Qar (Al-Gharraf, Al-Dawwaya ,Al-Shattrah and Al-Nassyria) at time of visit. An interview was carried out to fill the questionnaire, knowledge was scored as poor(0-2), fair(3-5) and good(6-8); score was used[12],[13]. Variables were expressed by frequency and percentage. Results: the age of the participants was 31.44±8.34. age at menarche was 13.08 ± 1.47, the age of marriage for married women was 23.75 ± 4.03. ( Table 3) show distributed barriers of consulting early detection center of cancer which were related in person himself, like lack of awareness on visit the doctor only when the sign and symptoms appear  (82.73%), there is no benefit from early detection of breast cancer (3.25%), lack of knowledge of location of clinics for early detection of cancer. (59.61%), Lack of knowledge of the priority of the visit when an early examination is desired or symptoms appear; is to Radiologist (14.33%), or General surgeon (5.86%), or Specialized in screening and early detection of cancer (37.79%), or Obstetrics & Gynecology specialist (37.45%), laboratory specialist (4.56%). Other barriers related with socioeconomic conditions shown in (table 4) participants answered with yes when we asked them is the cost of examination high? Were (14.65%), is the cost of going to health institution is high? (17.26%), There is no financial possibility to commit to multiple visits to the cancer early detection center: (33.87%). And in sociocultural barriers Shamed of the examination: was  (28.01%), and the effect of advising some women not to go for the examination: was (6.19%).. Good knowledge about risk factors that increase probability of breast cancer was evident among the participants, (55.4%) have score of knowledge (6-8). Conclusion: We concluded that there were many different barriers to screening and early detection of breast cancer, some of them individual specific barriers, and others correlated with socioeconomics conditions so as to there were barriers include health organization services.


WHO, "International Agencyfor Research on Cancer. 2018 Cancer istatisticworldwide [Internet]," 08 November 2018. [Online]. Available:

B. F. C. M. F. J. W. E. F. D. Jemal A, "Global cancer statistics.," CA Cancer J Clin , vol. 61, p. 69 90., 2011.

I. (2020b)., "Estimated age-standardized mortality rates (World) in 2020, breast, females, all ages. CANCER TODAY. Retrieved July 28, 2022, from:," Lyon: International Agency for Research on Cancer., 2020.

M. N. J. J. &. A. N. Maallah, "Barriers Impeding Early Detection of Breast Cancer in Iraq:," A Critical Analysis., 2022.

H. M. C. A. M. D. N. S. Pati S, "Patient navigation pathway and barriers to treatment seeking in cancer in India: A qualitative inquiry.," Cancer Epidemiol, vol. 37, p. 973 8., 2013.

P. M. P. A. Shadap A, "A descriptive study to assess the knowledge on breast cancer and utilization of mammogram among women in selected villages of Udupi district, Karnataka.," NUJHS, vol. 4, p. 84, 2014.

N. Alwan, "Iraqi initiative of a regional comparative breast cancer research project in the Middle East.," Journal of Cancer Biology and Research, , vol. 2, no. 1, 2014.

H. A.-G. I. I. F. &. A.-A. A. Al-Shamsi, "Cancer in the Arab World.," Singapore: Springer., 2022.

S. Levine, " 6 Facts About Healthcare in Iraq.," 18 July, 2022 . [Online]. Available: Retrieved on from:

K. Y. D. R. G. A. Tripathi N, "detection of cancer amongst Indian rural women.," South Asian J Cancer, vol. 3, pp. 122-127, 2014.

M. M. &. C. Constantinou, "Global Perceptions of Women on Breast Cancer and Barriers to Screening," Current Oncology Reports, 2021.

M. S. L. D. S. L. S. S. Q. H. Lu M, "A systemic review of interventions to increase breast and cervical cancer screening uptake among Asian women.," BMC Public Health, vol. 12, p. 413, 2012.

Y. R. K. R. V. D. A. D. G. Neha Tripathi, "Barriers for early detection of cancer amongst Indian rural women," South Asian Journal of Cancer, vol. 3, no. 2, pp. 125-126, 2014.

CDC, "Breast Cancer," centers for diseases control and prevention, 26 September 2022. [Online]. Available:

T. C. R. J. M. R. B. R. F. K. e. a. Paskett ED1, "Racial differences in knowledge, attitudes, and cancer screening practices among a triracial rural population.," Cancer , vol. 101, p. 2650 9, 2004.

S. M. T. S. Sim HL, "Breast cancer knowledge and screening practices: A survey of 1,000 Asian women.," Singapore Med J , vol. 50, p. 137 44, 2009.

D. P. A. W. .. Weir R, "Risk factors for breast cancer in women," NZHTA Report ; 10., 2007.

T. L. Defny D’almeida, "Barriers for Early Detection of Breast Cancer among South Indian Women," Indian Journal of Community Medicine, vol. 46, no. 4, p. 708, 2021.

C. A. S. L. M. J. Sharma K, "A systematic review of barriers to breast cancer care in developing countries resulting in delayed patient presentation.," J Oncol , vol. 121873, 2012.

J. K. A. P. D. A. Lakshmi KM, "Assess the awareness regarding Early Identification, prevention and management of breast cancer among early adult women.," AJNER, vol. 9, no. 04, p. 8, 2019.

J. S. K. B. K. P. B. J. V. S. Srivastava K, "Awareness of breast cancer risk factors and practice of breast self examination among nurses of tertiary care hospital," IJFCM, vol. 3, pp. 75-78, 2016.

L. B. J. D. M. V. K. B. Z. A. C. e. a. Ferrat E, "Understanding barriers to organized breast cancer screening in France: Women’s perceptions, attitudes, and knowledge.," Fam Pract, vol. 30, pp. 445-451, 2013.

F. Z. H. R. K. R. &. D. Z. Francies, "Breast cancer in low-middle income countries: abnormality in splicing and lack of targeted treatment options.," American Journal of Cancer Research,, vol. 10, no. 5, p. 1568–1591., 2020.

N. &. K. D. Alwan, "Cancer control in war-torn Iraq.," The Lancet Oncology, , vol. 19, no. 3, pp. 291-292, 2018.

H. M.-H. L. R. Z. S. T. M. A.-R. O. A.-G. I. K. O. A. S. S. S. N. P. A. M. Z. &. A. H. M. Mahdi, "Cancer Burden Among Arab-World Females in 2020: Working Toward Improving Outcom," JCO Global Oncology, 8, e2100415, 2020.

R. o. I. (. Ministry of Health and Environment, "Annual Report Iraqi Cancer Registry 2020.," Iraqi Cancer Board, 2020.

"Alwan, N. (2022). General Oncology care in Iraq. In: Al-Shamsi H, Abu-Gheida I, Iqbal F, Al-Awadhi A. Cancer in the Arab World.," Singapore: Springer, , pp. 353-362., 2022.

A. M. S. N. N. H. A. S. S. M. Gangane N, "Prevalence and risk factors for patient delay among women with breast cancer in rural India.," Asia Pac J Public Health, vol. 28, p. 72 82., 2016.

w. b. group, "Iraq Rural Population 1960-2022," macrotrend, 2022. [Online]. Available:

N. T. F. M. M. S. S. &. S. W. Alwan, "The Stage of Breast Cancer at the Time of Diagnosis: Correlation with the Clinicopathological Findings among Iraqi Patients.," Journal of Neoplasm, 2(3), 22., vol. 2, no. 3, p. 22, 2017.

S. Foran, "Access to quality health care in Iraq: a gender and life-cycle perspective.," United Nation Office for the Coordination of the Humanitarian Affairs. , (2008). [Online]. Available: Retrieved 24 August 2022 from:

G. L. M. D. Ilaboya D, "Perceived barriers to early detection of breast cancer in Wakiso District, Uganda using a socioecological approach.," Global Health., vol. 14, no. 1, p. 9, 2018.

J. T. D. U. E. e. a. S. Subramanian, "“Cost of cervical cancer treatment: implications for providing coverage to low-income women under the Medicaid expansion for cancer care,”," Women’s Health Issues, vol. 20, no. 6, pp. 400–405,, 2010.

M. S. G. S. J. R. B. K. a. K. V. G. Narayana, "“Knowledge, attitude, and practice toward cervical cancer among women attending obstetrics and gynecology department: a cross-sectional, hospital-based survey in South India," Indian Journal of Cancer, , vol. 54, no. 2, p. 481–487, 2017.