Worldwide, breast cancer (BC) represents 10% of all cancers diagnosed annually and constituted 22% of all new cancers in women in 2000, making it by far the most frequently occurring cancer in women. It will also become an important challenge to health services in developing countries in the coming decades [1
The incidence, mortality, and survival rates for BC vary across the world's regions because of underlying differences in known risk factors, access to effective treatment, and the availability of organized screening programs [2
]. Fatality rates tend to be higher in low-resource countries [1
In Egypt, cancer registries reveal that BC is the most frequently occurring cancer among women, representing 18.9% of the total cancer cases (35.1% in women and 2.2% in men), with an age-adjusted rate of 49.6 per 100.000 persons [3
]. BC among Egyptian patients has a younger age distribution, with the majority of cases occurring at 30–60 years of age. The median age at diagnosis is 49 years, 1 decade younger than the corresponding age in Europe and North America [4
The etiology of BC is multi-factorial and cannot be directly linked to any single factor. The epidemiological literature supports a highly complex interplay between different exposures and host characteristics and between exogenous and endogenous hormones and an individual's genetic makeup [5
]. A woman's age is the strongest risk factor for BC, and older women have a 10 times increased risk compared with younger women. Reproductive risk factors associated with the risk of BC include: menarche before the age of 11 years, menopause after the age of 54 years, and an age greater than 40 years at first full-term pregnancy [6
]. The higher the number of full-term pregnancies, the greater the protection. Women who breastfeed have a reduced risk compared with women who do not breastfeed [7
]. Current knowledge suggests that oral contraceptive use is one of the weakest risk factors for BC [5
Prevention or identification of BC at an early stage is of paramount importance in saving and improving the quality of life. Breast health awareness appears to be a pragmatic method for this. Creating breast health awareness appears to be an important prerequisite for early detection of BC in low-income countries [8
]. Although breast awareness has long been advocated as a health promotion intervention in many parts of the world, evidence suggests that women in general are still not breast aware.
Methods for early detection must be considered the best second choice for reducing the mortality, amongst which breast self-examination (BSE), clinical breast examination (CBE) by the treating physician, as well as ultrasound and mammography, are the secondary preventive methods used for screening in the early detection of BC [9
]. According to the American Cancer Society (ACS), BSE is an option for women starting from the early 20's [10
The combination of BSE and CBE seems to be an important available alternative in slum areas [11
]. In areas where access to CBE and mammograms is difficult, BSE still detects BC early enough for treatment options.
BC is usually diagnosed at an advanced stage in Egypt, and studies revealed that population screening is rarely practiced in Egypt [9
]. Women living in slum areas suffer from the unavailability of services and poor health [15
Given the importance of the BC problem in Egypt in terms of magnitude and severity, and that only few studies examined the awareness of BC among Egyptian women [16
], this study was performed to evaluate the effect of a breast health awareness intervention program on the knowledge of a sample of women living in an urban slum area in Alexandria, Egypt.