Breast Cancer Screening: What Every Woman in Our Region Needs to Know

Why Is Breast Cancer Diagnosed at a Later Stage in Our Region?

In many countries across the Middle East and North Africa, women reach a doctor carrying a lump they can feel with their fingers, often already at stage three or four. A study published in 2020 in Women's Health Reports tracked trends in staging at diagnosis in Lebanon over several years and found that organised screening campaigns were significantly associated with a higher proportion of cases diagnosed at stage one or two, providing direct evidence that screening saves lives. The five-year survival rate for stage one breast cancer exceeds 90 percent in settings with access to modern treatment, compared with a much lower rate for stage four disease.

Documented barriers delay Arab women from attending screening: embarrassment about physical examination, especially with a male doctor, fear of a bad diagnosis or of family reaction, scarcity of specialist facilities outside urban centres, and a widespread absence of awareness that breast cancer is highly treatable when caught early. The fear of knowing is more dangerous than early-stage disease itself. A diagnosis found by screening at stage one or two leaves time for choices, for less intensive treatment, and for full recovery in most cases.

The common belief that breast cancer is a disease of older women also reduces vigilance among women in their forties and younger. A 2024 study published in the Eastern Mediterranean Health Journal examined data from the region and concluded that there is no solid evidence that incidence rates in younger Arab women are higher than in the West, but that late diagnosis makes these cases appear more severe by the time they reach treatment. The problem is not biology but the delay in reaching care.

What Risk Factors Should You Know About?

Risk factors do not mean inevitable disease but they determine who should start screening earlier or more intensively. Most women who develop breast cancer have no classical high-risk factors at all, which is why minimum screening thresholds apply to everyone and not just those with elevated risk.

Family history is one of the strongest risk factors. A mother, sister or daughter diagnosed with breast cancer, especially before age 50, roughly doubles personal risk and may warrant genetic testing for BRCA1 and BRCA2 mutations. This test is available in some major hospitals in the region, though not universally accessible.

Other risk factors include high breast density (visible on a mammogram, not related to breast size), a first period before age 12 or menopause after 55, having no children or first pregnancy after 35, obesity after menopause, and prolonged use of combined hormone therapy. Breastfeeding for more than a year is associated with a modest reduction in risk, one of the well-documented protective factors alongside physical activity and a healthy body weight.

When Should You Start Mammography and How Often?

Screening recommendations vary between organisations and this is a genuine source of confusion. A 2022 systematic review of global breast cancer screening guidelines published in the journal Breast found that the majority recommend starting annual or biennial screening between the ages of 40 and 50 for average-risk women. The United States Preventive Services Task Force updated its recommendation in 2024 to begin annual screening at age 40 for all women. What all guidelines agree on is that screening should not be delayed past age 50.

Women with elevated risk factors, such as a strong family history or a known BRCA mutation, may be advised to begin before 40 and to add annual breast MRI alongside mammography. This requires an individual assessment with your doctor. If your doctor has not discussed a starting age for screening with you, raise it at your next appointment.

In the regional reality, organised and free national screening programmes do not exist in most Arab countries as they do in Western Europe, so screening in most settings is initiated by the individual. Identify what is available in your city, whether in public hospitals, private imaging centres or through volunteer breast cancer associations that organise periodic free screening campaigns in several Arab countries including Jordan, Egypt, Morocco and the UAE.

How to Perform a Correct Breast Self-Examination

Breast self-examination is not a substitute for mammography, but it keeps you familiar with the normal feel of your breasts so that any new change is noticed promptly. It is best done about a week after your period ends, when the breasts are least likely to feel lumpy from hormonal changes. After menopause, choose a fixed day each month and do it consistently.

Begin in front of a mirror with your arms at your sides to check the overall appearance, then raise both arms above your head. Look for any change in size or shape, dimpling or puckering of the skin, or a change in the nipple. Lie on your back and use the pads of your three middle fingers to examine each area of the breast in small overlapping circular movements, covering the entire breast from the armpit to the breastbone and from the collarbone to the lower fold. The movement should be systematic from a fixed starting point to ensure full coverage.

You are looking for what is new or different from your normal, not for pain. Early breast cancer is usually painless, which is one reason why relying on pain as a warning sign delays presentation.

What Happens at a Mammogram Appointment?

A mammogram is a low-dose X-ray of the breast that shows the internal tissue. The appointment usually takes twenty to thirty minutes. Each breast is compressed between two plates for a few seconds while the image is taken. This compression is necessary to reduce the radiation dose and obtain a clear image. It can be uncomfortable and occasionally briefly painful, but it lasts only seconds.

Most centres now offer 3D mammography (tomosynthesis), which produces more detailed images particularly in women with dense breast tissue. A 2025 study from the UAE found that awareness of breast density and its effect on mammogram accuracy remains low in the region. If your mammogram report says your breast density is high, ask your doctor whether an additional ultrasound should be performed alongside future mammograms.

Results usually arrive within a few days. A normal result does not mean you are safe indefinitely; it means your next scheduled mammogram is on time. A result that calls you back for additional images does not mean cancer. Most of these callbacks are resolved by a repeat view or ultrasound and turn out to be benign findings.

What Holds Arab Women Back From Screening and How Can This Change?

Fieldwork across the region consistently identifies similar barriers: embarrassment about physical examination, uncertainty about who performs the examination and whether a female technician is available, fear of a bad result, cost, and a pattern of prioritising family health over one's own. Each of these barriers is surmountable.

Requesting a female mammographer is a legitimate right in most facilities. If this is unavailable, a female supervising doctor can often be requested. Breast self-examination is something every woman can learn and perform entirely in the privacy of her own home. The social stigma around breast cancer decreases when women in a community speak about their screening experiences matter-of-factly, without dramatic framing.

Cost is a real barrier but solutions exist in many settings. Public hospitals in several Arab countries offer mammography at low or no cost. Voluntary associations focused on breast cancer in Jordan, Egypt, Morocco, the UAE and elsewhere organise periodic free screening campaigns. Identifying these resources in your city before delay becomes a habit is an investment in your own future.

Are AI-Assisted Mammogram Readings Reliable?

Some imaging centres now use artificial intelligence as an aid alongside the radiologist in reading mammograms, and this is increasingly common in Gulf hospitals. These systems do not make diagnoses independently. They flag areas that the radiologist should review more carefully, functioning as a second pair of eyes rather than replacing clinical judgement.

What matters to you as a patient is who reads your images. It is reasonable to ask whether a breast imaging specialist, a radiologist with subspecialty training in breast imaging, reviews your mammogram. In large tertiary hospitals the answer is usually yes. In smaller facilities a general radiologist may read the images, which is acceptable but carries less specialised expertise.

What Happens After an Abnormal Result?

An abnormal or suspicious mammogram result does not mean cancer. Most such cases are resolved by further investigation. The next common step is a breast ultrasound to characterise the area of concern more precisely. Some cases require a needle biopsy, a small tissue sample taken under local anaesthesia for microscopic examination.

A core needle biopsy is a simple outpatient procedure that usually takes less than half an hour and causes minimal discomfort. Its result determines whether a lesion is benign or malignant. If cancer is confirmed at an early stage, survival rates are high, which is the entire point of early detection. The Oman study published in 2014 that reviewed age at diagnosis found that younger age at diagnosis was associated with more advanced stage, reinforcing the value of routine screening that catches the cancer before it grows.

Between an abnormal mammogram and a biopsy result, anxiety is entirely understandable. Having someone accompany you to appointments, accessing a breast cancer support group if one exists in your country, or speaking with a counsellor are all reasonable steps during this period. Uncertainty about a result is far better than a delayed diagnosis discovered at an advanced stage.

Sources

• El Khoury CJ, Adib SM, Chaaya M et al: Trends in Breast Cancer Staging at Diagnosis Associated with Screening Campaigns in Lebanon, Women's health reports (New Rochelle, N.Y.), 2020
• Rawashdeh M, El-Sayed MZ, Umar M et al: Breast density awareness and cancer risk in the UAE: Enhancing Women's engagement in early detection, Radiography (London, England : 1995), 2025
• Alkhalawi E, Altoukhi H: No evidence that breast cancer occurs at higher rates among young Arab women, Eastern Mediterranean health journal, 2024
• Siddiqui R, Alsuwaidi SA, Irkorucu O et al: The Increasing Importance of Breast Cancer in the United Arab Emirates, Asia-Pacific journal of clinical oncology, 2025
• US Preventive Services Task Force, Nicholson WK, Silverstein M et al: Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement, JAMA, 2024
• Ren W, Chen M, Qiao Y et al: Global guidelines for breast cancer screening: A systematic review, Breast (Edinburgh, Scotland), 2022
• Mehdi I, Monem EA, Al Bahrani BJ et al: Age at diagnosis of female breast cancer in Oman: Issues and implications, South Asian journal of cancer, 2014