Breast Cancer Screening among Women in Thailand: Analyses of Population-Based Household Surveys
Suwanna Mukem MSc*, Hutcha Sriplung MD*, Edward McNeil MSc*, Viroj Tangcharoensathien MD, PhD**
Affiliation : * Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand ** International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
Objective : The incidence of breast cancer is the highest among female cancers in Thailand and has been steadily increasing
during the past few decades. The present study aimed to determine uptake rates of breast cancer screening including breast
self-examination (BSE), clinical breast examination (CBE), and mammography screening, and to identify enabling factors
and barriers associated with screening uptake.
Material and Method: Secondary data from two population-based household surveys were used, the 2007 Health and
Welfare Survey that comprised 18,474 women aged 20 years and older, and the 2009 Reproductive Health Survey that
comprised 26,951 women aged 30 to 59 years. Multivariate logistic regression analyses were performed to identify factors
associated with screening.
Results : In 2007, the uptake rate of BSE was 40.1% (18.4% for monthly BSE), 29.0% for CBE, and 5.9% for mammography.
In 2009, the uptake rate of any type of breast examination was 57.9%, while the mammography rate among women who
had breast examinations was 29.6% (10.1% of all women in 2009). Frequency of CBE was found to be positively associated
with BSE and mammography screening. Factors independently associated with screening uptake were having education at
the bachelor’s level or higher, being in the richest wealth quintile based on household asset index, and being covered by
the Civil Servant Medical Benefit Scheme. Women living in Bangkok metropolis and in the municipal areas of other provinces
had higher rates of mammography, while women living in the north and northeast regions and non-municipal areas were
more likely to perform BSE and have CBE performed than those living in Bangkok and municipal areas, respectively.
Common factors associated with less screening across the two surveys were age 55 and over, being single or widowed,
being Muslim or Christian, and having no health insurance. Lack of knowledge and awareness of breast cancer screening
were found to be barriers for screening among all women, especially those with low educational levels.
Conclusion : A low uptake of monthly BSE and mammography was observed. Early detection and awareness should be
encouraged through proper BSE technique and effective CBE. Increased uptake of CBE should lead to a higher rate of
mammography. Increased knowledge, awareness, and participation in screening activities for selected groups, such as older
women, those who are not married, non-Buddhists, and those with low education are recommended.
Keywords : Breast cancer screening, Breast self-examination, Clinical breast examination, Mammogram, Mammography, Thailand
