Date of Award
Doctor of Philosophy (PhD)
Prof. Tar Ching Aw
Prof. Hassib Narchi
Dr. Michal Grivna
Breast cancer is the commonest type of malignancy in the United Arab Emirates (UAE) with more than 65% of women diagnosed at an advanced stage. Routine clinical screening has aided in the early detection of breast cancer. However, more than 71% of breast tumors are self-detected. Therefore, exploring factors influencing delayed presentation to treatment after self-detection of breast tumors by Emirati and Arab women in the UAE is essential for improving the survival and the development of effective and targeted health intervention programs. This project explores the reasons behind delayed presentation to treatment by symptomatic women. It uses several approaches, including the development of a multidimensional model of help-seeking grounded in data from in-depth interviews with late presenters and nested in the theory of illness behavior. The study shows that despite continued emphasis on screening for breast cancer, delay is still prevalent amongst women. In the UAE, there is therefore a need for continued emphasis on the message regarding early detection for breast cancer symptoms. The results include the significant influence of social and cultural factors and life expectations on women with breast cancer. The suitability of the national breast cancer screening guidelines was reviewed through a 5- year survival analysis of breast cancer cases. The results show the importance of cultural and psychosocial beliefs in women’s decision to seek medical attention. Delays of more than 3 months were highly associated with a decrease in survival time (pvalue=0.039), although lead-time bias could well be a possible explanation. The relatively younger age at diagnosis in Arab women compared to Western women indicates a need to start clinical screening at younger ages. The establishment of a national cancer registry could help in the generation of accurate data to determine trends and for comparison with other countries in the region. The delayed presentation model can also serve as a reference for future studies on health behaviors modification and health promotion initiatives.
I wish to express my deepest appreciation to my major supervisor Prof. Tar Ching Aw for his continuous supervision, endless support and patience. He has been extremely generous in supplying me the necessary guidance required to complete this work. Also, I would like to thank my second supervisor Dr. Michal Grivna for his encouragement and professional experience and his valuable feedback. Moreover, I am greatly thankful to Dr. Jennifer Lim and Dr. Saima Hamid for their encouragement and professional feedback in qualitative research. I also wish to present my thanks to Tawam Hospital oncology clinic, radiotherapy and breast center staff who helped in conducting this study. Many thanks to Dr. Maria Amir (Head of Tawam Hospital cancer registry) and cancer registry staff for their cooperation and efforts made in the data collection. I also acknowledge the support given by the General Authority of Islamic Affairs and Endowments and the Cultural and Religious Centers in Al Ain for their cooperation and high level of professionalism. I am greatly thankful to all the women who participated in this study through sharing their perceptions, experiences and knowledge in order to help other women in the future. Finally, I would like to acknowledge my family for their spiritual support, they have been of great help and support to me.
Elobaid, Yusra E., "BREAST CANCER PRESENTATION DELAY AMONG WOMEN IN THE UNITED ARAB EMIRATES" (2014). Dissertations. 31.