Cancer Screening
Do Elderly Women in Malaysia Go for Mammogram Screening?
Last reviewed: March 2026
Key Findings
- Mammogram screening uptake among elderly Malaysian women was found to be notably low, consistent with the national range of 3.6% to 30.9% among the general female population reported in contemporaneous studies.
- Key barriers to mammogram screening included lack of knowledge about breast cancer risk, embarrassment, fear of cancer diagnosis, and the perception that screening was unnecessary at older ages.
- Physician recommendation was one of the strongest facilitators of mammogram uptake, with women who received a doctor’s recommendation being significantly more likely to undergo screening.
- The study highlighted the need for targeted health education and screening promotion programmes tailored specifically for elderly women in Malaysia.
Background and Context
Breast cancer is the most common cancer affecting women in Malaysia, contributing to approximately 33.9% of all female cancer cases during the 2012–2016 reporting period according to the National Cancer Registry. The total number of women diagnosed with breast cancer in Malaysia increased by 18% from 18,206 cases in 2007–2011 to 21,634 cases in 2012–2016. Alarmingly, nearly half of all breast cancer cases in Malaysia are diagnosed at advanced stages (Stage III or IV), significantly reducing survival rates and treatment options.
Mammography remains the gold standard for breast cancer screening and has been shown to reduce breast cancer mortality through early detection. Malaysia’s clinical practice guidelines recommend biennial mammography screening for women aged 50–74 years in the general population, with more frequent screening for high-risk women. Despite these recommendations and the availability of subsidised mammography services through government and non-governmental programmes, mammogram uptake among Malaysian women has remained persistently low.
This study by Rahmah, Aniza, and Che Engku Nor Bahiyah, published in the Malaysian Journal of Public Health Medicine in 2013, specifically examined mammogram screening behaviour among elderly women in Malaysia — a population at heightened risk for breast cancer but potentially subject to unique barriers to screening participation.
Study Design and Methods
The study employed a cross-sectional design to assess the prevalence and determinants of mammogram screening uptake among elderly women. Data were collected using structured questionnaires that assessed sociodemographic characteristics, knowledge about breast cancer, attitudes toward screening, and self-reported mammogram screening history. The study population was drawn from healthcare settings in Malaysia, with a focus on women aged 50 years and above.
The questionnaire instrument assessed multiple dimensions potentially associated with screening behaviour, including awareness of breast cancer risk factors, knowledge of mammography benefits and procedures, perceived susceptibility to breast cancer, and experience of barriers such as cost, access, embarrassment, and fear. Statistical analyses were conducted to identify factors significantly associated with mammogram uptake.
Mammogram Uptake Among Elderly Women
The findings revealed that mammogram screening uptake among the elderly women studied was substantially below optimal levels. This was consistent with broader national data showing that mammography uptake among the general Malaysian female population ranged between approximately 3.6% and 30.9% in community-based studies, with rates varying markedly by geographic region, ethnicity, and socioeconomic status. The National Health and Morbidity Survey 2019 subsequently reported that the national prevalence of mammography among women was only 21%, with states on the east coast of Peninsular Malaysia such as Kelantan recording rates as low as 7%.
The low uptake among elderly women was particularly concerning given that breast cancer risk increases with age, and the 50–74 age group represents the primary target population for mammography screening under Malaysian clinical guidelines. The gap between screening recommendations and actual uptake pointed to significant systemic and individual-level barriers that required targeted intervention.
Barriers to Screening
Several barriers were identified as contributing to low mammogram uptake among elderly women. Knowledge deficits emerged as a primary obstacle — many women had limited understanding of breast cancer risk factors, the purpose and benefits of mammography, and the importance of screening in the absence of symptoms. The misconception that breast cancer screening was unnecessary if no breast changes were noticed was particularly prevalent among older women.
Embarrassment associated with the mammography procedure, which requires breast compression, was reported as a significant deterrent. Cultural modesty norms, particularly pronounced among Malay Muslim women, contributed to reluctance to undergo a procedure perceived as exposing and uncomfortable. Fear of receiving a cancer diagnosis also discouraged some women from seeking screening, reflecting an avoidance coping strategy observed in cancer screening studies worldwide.
Practical access barriers, including distance to mammography facilities, transportation difficulties, and the cost of screening (which could range from RM120 to RM250 at private facilities), further limited uptake. While government subsidies and free screening programmes existed, awareness of these programmes among elderly women was often inadequate.
| Barrier Category | Key Factors |
|---|---|
| Knowledge | Limited awareness of breast cancer risk with age; misunderstanding of screening purpose |
| Psychosocial | Embarrassment; fear of cancer diagnosis; cultural modesty concerns |
| Access | Distance to facilities; transportation difficulties; cost |
| Health system | Lack of physician recommendation; absence of organised call-recall system |
Facilitating Factors
Physician recommendation emerged as one of the most powerful facilitators of mammogram uptake. Women who received a direct recommendation from their healthcare provider to undergo mammography were substantially more likely to do so. This finding aligns with subsequent research demonstrating that physician recommendation increased the odds of mammogram uptake more than sevenfold (OR = 7.61, 95% CI: 3.81–15.20) in Malaysian primary care settings. The pivotal role of physician recommendation underscores the importance of integrating routine breast cancer screening discussions into primary care consultations for women aged 50 and above.
Higher levels of breast cancer knowledge, perceived susceptibility to the disease, and exposure to health education campaigns were also associated with increased screening uptake. Social influence from peers, family members, and community health workers additionally contributed to positive screening behaviour.
Implications for Policy and Practice
The study’s findings pointed to several actionable recommendations for improving mammogram screening rates among elderly Malaysian women. Strengthening physician-initiated screening recommendations through clinical practice prompts and electronic health record reminders could leverage the significant influence of healthcare provider endorsement. Developing age-appropriate and culturally sensitive health education materials about breast cancer screening, disseminated through community health programmes, mosques, community centres, and media channels familiar to elderly women, could address knowledge barriers.
Expanding the availability and accessibility of subsidised mammography services, particularly in underserved areas and among lower-income populations, was identified as essential. The implementation of organised call-recall systems, whereby eligible women receive personalised invitations to attend screening, has proven effective in increasing uptake in other countries and warranted consideration for Malaysia.
Limitations
The study’s cross-sectional design limited causal inference regarding the relationship between identified factors and screening behaviour. Self-reported mammogram screening history may have been subject to recall bias. The study population may not have been fully representative of elderly women across Malaysia’s diverse geographic and ethnic landscape. Additionally, the study was conducted prior to the implementation of certain policy changes and expanded screening programmes, which may have subsequently altered the screening landscape.
Significance for Malaysian Public Health
This research contributed important evidence on the unmet screening needs of elderly Malaysian women at a time when breast cancer remained a leading cause of cancer morbidity and mortality in the country. The study’s findings have been widely cited in subsequent research on breast cancer screening in Malaysia and have informed discussions about the need for targeted, culturally appropriate screening promotion strategies for older women. As Malaysia continues to develop its cancer control programmes, ensuring equitable access to and uptake of mammography among all eligible women, including the elderly, remains a public health priority.
Rahmah MA, Aniza I, Che Engku Nor Bahiyah CE. Do elderly women in Malaysia go for mammogram screening? Malaysian Journal of Public Health Medicine. 2013;13(2):20–26.