Mohammad Zamani  ( Student Research Center, Babol University of Medical Sciences, Babol, Iran. )
Houman Khakestariyan  ( Student Research Center, Babol University of Medical Sciences, Babol, Iran. )
Amin Zarghami  ( Department of Neurology, Ayatollah Rohani Hospital, Babol University of Medical Sciences, Babol, Iran. )

Madam, in recent issue of JPMA, Sarwar et al. well investigated the knowledge, attitude and practice (KAP) towards breast cancer screening programmes among Pakistani women and revealed that, awareness and practice regarding breast cancer and its screening techniques was very low.¹ As the authors truly discussed, this critical issue similarly applies in Iran and results from Iranian studies indicated that the knowledge status among Iranian women towards warning signs of breast cancer and how to perform the screening programmes is very poor.²
In developing countries, there are a series of limitations and barriers toward screening programme such as geographical isolation, lack of education and financial restrictions, which prevent the women from performing breast cancer screening programmes.³ Besides, there are other extrinsic factors including religion and culture, which can play an important role in screening delay among women. Embarrassment of patients in being examined by male doctors is another important intrinsic factor which can prevent them to perform the screening procedures. On the other hand, in Islamic cultures, it is seen that a woman\\\'s decision-making power may be limited by her husband and male dominated family atmosphere may be another barrier and she may not have autonomous decision-making in health-seeking behaviour.⁴ In Iran as the same as other Middle Eastern countries due to the misunderstanding of spirituality and religion among people which causes avoiding certain problems regarding their physical and sexual issues and also due to the weak and inefficient approach of policymakers on promoting the awareness of women regarding different aspects of the disease, the women\\\'s KAP status regarding breast cancer screening methods is very poor.⁵
Although the majority of Iranian women are unaware about breast cancer and benefits of the early detection practices, recent reports indicated the positive efficiency of educational interventions.⁶ Therefore, it is essential that policy makers provide evidenced based educational programme from an early age through schools, family and social media, in order to enhance the KAP status of breast cancer screening methods in Iranian women and neighboring countries in the Middle East.
Funding Source: No funding source to be declared.
Conflict of interests: The authors declared no conflict of interests.


References

1. Sarwar MZ, Shah SFH, Yousaf MR, Ahmad QA, Khan SA. Knowledge, attitude and practices amongst the Pakistani females towards breast cancer screening programme. J Pak Med Assoc. 2015; 65:1075-8.
2. Montazeri A, Vahdaninia M, Harirchi I, Harirchi AM, Sajadian A, Khaleghi F, et al. Breast cancer in Iran: need for greater women awareness of warning signs and effective screening methods. Asia Pac Fam Med. 2008; 7:6.
3. Yip C, Taib N. Breast health in developing countries. Climacteric. 2014; 17:54-9.
4. Taib N, Yip C, Low W. A Grounded Explanation of Why Women Present with Advanced Breast Cancer. World J Surg. 2014; 38:1676-8.
5. Zarghami A. Health knowledge, attitude, practice: the missing circle of breast cancer screening programs in Iran. Climacteric. 2015; 18:99.
6. Rezaeian M, Sharifirad G, Mostafavi F, Moodi M, Abbasi MH. The effects of breast cancer educational intervention on knowledge and health beliefs of women 40 years and older, Isfahan, Iran. J Educ Health Promot. 2014;3:43.