Does Performance of Breast Self-exams Increase the Probabilityof Using Mammography: Evidence from Malaysia

Objectives: Breast self-examination (BSE) was evaluated to see if it is a significant predictor of mammography.
Methods: The decisions of females above age 40 in Malaysia to test for breast cancer using BSE and mammographyare jointly modeled using a bivariate probit so that unobserved attributes affecting mammography usage arealso allowed to affect BSE. Data come from the Malaysia Non-Communicable Disease Surveillance-1, whichwas collected between September 2005 and February 2006.
Results: Having ever performed BSE is positivelyassociated with having ever undergone mammography among Malay (adjusted OR=7.343, CI=2.686, 20.079) andChinese (adjusted OR=3.466, CI=1.330, 9.031) females after adjusting for household income, education, maritalstatus and residential location. Neither relationship is affected by jointly modelling the decision problem. Althoughthe association is also positive for Indian females when mammography is modelled separately (adjusted OR=5.959,CI=1.546 - 22.970), the relationship is reversed when both decisions are modelled separately.
Conclusions: DeemphasizingBSE in Malaysia may reduce mammography screening among a large proportion of the population.Previous work on the issue in developed countries may not apply to nations with limited resources.