JMIR Publications

ABSTRACT

Background:

Routine mammography screening attendance in Singapore is low (<40%), limiting early breast cancer detection. Conventional tools such as focus group discussions, interviews, and Likert-scale surveys have limitations in capturing attitudes.

Objective:

To gain deeper insight into women’s attitudes and perceptions toward routine mammography screening, through the analysis of unstructured text data.

Methods:

We included 4,169 participants (aged 35-59) from the BREAst screening Tailored for HEr (BREATHE) study. Breast cancer awareness was assessed using true/false statements, with participants considered “BC-aware” if scored >80%. Participants were asked if knowledge of screening made them more willing to attend screening (motivated, neutral) and to explain their choice. The association between willingness to attend screening and initial breast cancer awareness was examined using logistic regression. Free-text responses were compared between BC-aware and unaware groups. Biterm topic modelling and sentiment analysis were used to discover latent topics and sentiments within each subgroup.

Results:

Seventy-nine percent were “BC-aware”, and 94% felt more motivated to attend screening. BC-aware participants were more motivated (OR [95% CI]BC-aware vs BC-unaware(ref): 2.67 [2.05 to 3.46], p<0.001) and less likely to find the procedure embarrassing, expensive, inconvenient, or painful. Free-text analysis showed motivated participants focused on early detection benefits, while neutral participants emphasized mammography experiences. In contrast to the motivated group, neutral participants displayed more negative sentiments towards regular screening. Word clouds echoed these patterns.

Conclusions:

This study used a novel approach to examine attitudes and behaviour towards routine screening. Negative mammogram experiences emerged as a key barrier to participation.