Stigma Around Breast Screening and Breast Cancer Treatment for older womenBreast cancer is one of the most prevalent cancers among women in Singapore, and early detection through screening and treatment are essential to improve outcomes. However, despite the importance of breast cancer screening and treatment, there remains a significant stigma surrounding these topics particularly among older women. This stigma can result in older women avoiding screenings and seeking treatment early, which can negatively impact their health outcomes. In this article, we will explore the stigma surrounding breast cancer screening for older women and suggest ways to overcome it. Factors Contributing to StigmaWhile breast cancer is the number one cancer among women in Singapore, only two in five women have kept up with their regular screening mammogram, according to the National Population Health Survey 2020.Some factors for the low screening rate and stigma on breast cancer screening among older women include: Perceived costs versus the benefits of breast cancer screeningPerceived high breast cancer screening costs versus the benefits of breast cancer screening among women in Singapore was identified as the most common obstacle to breast cancer screening in Singapore.Fear of breast cancer screeningAnother common factor is the fear of the screening procedure itself, such as the potential of pain during a mammogram, or exposure to radiation from mammograms, as well as the fear of potential outcomes arising from the breast cancer screening[1]. These outcomes include the fear of being diagnosed with breast cancer and the resulting financial burden of the treatment, the fear of a diminished quality of life, the fear of treatment side effects and of having to take medication for life. Personal prioritiesWomen may not place priority on breast cancer screening as there are many other commitments that are deemed as more important. Common reasons include having “no time” due to personal or professional responsibilities and the “inconvenience”[1] in having to personally attend the screening that may or may not be nearby.Modesty, embarrassment and distrust of breast cancer screeningModesty and embarrassment related to cultural beliefs[1] were frequently cited as reasons for women not undergoing breast cancer screening, as seen in several studies. The presence of male staff during the procedure, as well as previous negative screening experiences (either personal or witnessed in others) were identified as significant barriers to breast cancer screening. Perceived susceptibility to breast cancer“I’m healthy” was commonly cited as a reason for avoiding breast cancer screening among women who have not undergone a mammogram before. Malay women were found to indicate this more often as a reason to avoid screening[1] compared with their Chinese and Indian counterparts.Another common reason cited for avoiding breast cancer screening was the perception of not being at risk. Women often cited a lack of family history, feeling healthy, and having undergone a prior mammogram with normal results as reasons for exemption from regular screening. Some women also believed that actively seeking cancer screening would increase their risk of getting breast cancer1 and that getting regular screening meant that something was wrong with them.Perceived severity of breast cancerFalse beliefs, where women believe their health outcomes were beyond their control, were also identified as a significant barrier to breast screening uptake. Women aged 60 years and above were more likely to cite these false beliefs compared to younger women. [1]Benefits of regular breast cancer screeningMammography lowers a woman’s risk of dying from breast cancer. It’s recommended for women aged 50 to 69 years old to have mammograms on a regular basis[2]. A meta-analysis that combined the results from six randomised controlled trials[2] found that:Women aged 50-59 who got mammograms on a regular basis had a 14 percent lower risk of dying from breast cancer than women who didn’t get mammograms. Women aged 60-69 who got mammograms on a regular basis had a 33 percent lower risk of dying from breast cancer than women who didn’t get mammograms.For women aged 50 and above, they are encouraged to go for a mammogram screening once every two yearsunless the doctor advises otherwise. For women aged 40 to 49, a yearly mammogram is recommended.  Do consult a doctor on the benefits and limitations of doing a mammogram at this age.How to address breast cancer screening stigma Understand the importance of going for a mammogramIt’s important to know that going for regular breast cancer screening is the right thing to do. In Singapore, Breast cancer is the most common cancer among women, accounting for all female cancers between 2015 and 2019. However, the good news is that early detection significantly increases the chances of surviving breast cancer. Mammograms are one of the most reliable screening tools for breast cancer, as they can detect suspicious areas before they can be felt by hand. Mammograms are also particularly effective for women aged between 50 and 70 years old. Manage the anxiety about going for a mammogramBe prepared for the breast cancer screening by managing anxiety and obtaining all the necessary information, including what to expect and what to wear etc. The imaging centre will be able to provide a preparation list for you.  Talking to someone who has undergone breast screening previously, or consulting with a doctor[5], or breast cancer specialist, can also help to alleviate any fears or uncertainties that an older woman may have on breast cancer screening. It’s natural to feel some discomfort during the screening procedure as breast compression is required to obtain a clear image. However, the level of pain can vary among individuals. Women can share their pain concerns with the radiographer conducting the screening, who will then make adjustments for better comfort Go with a friend for the mammogramHaving someone to accompany a woman for her mammogram can help lighten the mood and keep her relaxed. Women can encourage their girlfriends, especially those who have never undergone breast cancer screening before, to get screened together with them.  Women can use this opportunity to meet up and help promote good health for everyone. Stay calm after going for a mammogramWaiting for the screening results can be agonising for some women but instead of dwelling on the outcome, try to keep calm and keep themselves busy with activities they enjoy. It’s also helpful to keep in mind the following facts:No screening test is entirely accurate, and women may be asked to undergo further tests, such as a repeat mammogram or ultrasound scan. In most cases, these additional tests will show that everything is clear. Only one in 10 breast lumps are cancerous5 so there’s no need to worry too much.  There are various effective breast cancer treatment options available today, and survival rates have significantly improved. By taking the time to get regular screening, women can catch any potential issues early, which can increase their chances of successful treatment and recovery. Breast cancer screening is a quick and mostly painless process and it could save lives. Women should not let fear keep them from taking care of their health. This Mother’s Day, women can give the gift of health to their mother by encouraging her to get a mammogram. Show love and appreciation by scheduling a mammogram for mum and joining her for the appointment. Together, let’s make women’s health and well-being a priority. References Academy of Medicine Singapore, “Barriers to breast cancer screening in Singapore: A literature review”, https://annals.edu.sg/barriers-to-breast-cancer-screening-in-singapore-a-literature-review/ Susan G.Komen, “Breast Cancer Screening for Women at Average Risk, https://www.komen.org/breast-cancer/screening/when-to-screen/average-risk-women/ Singapore Cancer Society, “Mammogram”, https://www.singaporecancersociety.org.sg/get-screened/breast-cancer/mammogram.html Health Promotion Board, “Singapore Cancer Registry Annual Report 2019”, https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-2019_annual-report_final.pdf Healthub, “5 Ways to Psych Yourself for a Mammogram”, https://www.healthhub.sg/live-healthy/1839/5-ways-to-psych-yourself-for-a-mammogram