Evaluation of Mammogram Services in the Gaza Strip Governorates
Anwar Mousa Jad Allah
أنور موسى جادالله
Breast cancer is by far the most frequently diagnosed cancer and cause of death among women worldwide, Palestine is not an exception. In 2012, some of 1.7 million of women were diagnosed with breast cancer. Worldwide, there is a variation in the breast cancer survival rates which greatly ranging from 80% or over in North America, Sweden and Japan to around 60% and 40% in low and middle-income countries. The 5- year’s survival rate among Palestinian women is between 30% and 40%; this reflects the late diagnosis of breast cancer and the poor prognosis. Within the Gaza Strip context, there is a pressing need for implementing the early detection strategies including mammography-screening programs in order to detect breast cancer cases in early stages. The overall aim of this study was to evaluate the current mammogram services in the Gaza Strip in order to propose recommendations to increase the uptake rate of mammogram services The design of this study is a descriptive analytical cross sectional design. It is a mixed methods study; it involves both quantitative and qualitative data. The quantitative data were collected from women who came to utilize the health services within the study settings. In total, 400 women participated in the study (160 women who visited the study settings to utilize mammogram services and 240 women who visited the study settings to utilize other health services). Qualitative data were collected through in-depth interviews with all the Directors of Mammography units in the Gaza Strip. Analysis of quantitative data were conducted using SPSS program, the analysis involved conducting frequency distributions, cross tabulation, general scores, mean percentages, and Chi-square. For qualitative data, an open coding thematic analysis method was used. Findings of the study showed that more than two-thirds of the study participants have good knowledge of the early detection of the breast cancer and methods used in the early detection of the breast cancer(78.7% and 70.2%) respectively. The findings of the study did not show significant relationship between women’s age, educational level of women, income status, and marital status and mammogram services utilization but showed significant relationship between employment status and mammogram services utilization (P=0.023). Additionally, the findings have showed a significant relationship between conducting mammogram and other factors, namely, family history of breast cancer, previous problems in the breast/s, having knowledge about early detection of breast cancer, methods used for early detection, and having knowledge about the importance of the early detection of breast cancer(P=0.000). Participants of the study have positive beliefs and conceptions about mammogram and its importance in the early detection of breast cancer (68.24% and 63%) respectively. The study findings have identified some barriers to mammogram services utilization, including pain, discomfort, fear from mammogram procedures and result, and time consumed in the process.While, cost, culture and religion were not barriers, thus, there were no accessibility problems. The findings of the study have also showed that mammogram services is timely affordable for more than two-thirds (73.7%) of study participants but there was a lack of information accessibility. Additionally, more than two-thirds (76.05%) of cases were satisfied with the accessibility and affordability of mammogram services. There is a need to develop a national policy for early detection of breast cancer screening including clear guidelines for mammogram, and organized health education programs to increase awareness and to increase the uptake of mammogram screening services. There is also a need to increase the number of mammogram units that could be used primarily for screening purposes, at least one unit in each governorate, finally, it is important to supply the currently working units with the required spare parts and films.