Assessing personal and health system barriers to breast cancer early diagnosis practices for women over 20 years old in Cluj-Napoca, Romania.

Background and aims: Breast cancer diagnosis is established late in Romania. This led to 3918 potentially avoidable deaths by breast cancer in 2020. Statistics show that women seldom perform monthly breast self-examinations or mammographies. This research aims to identify personal and health system barriers to breast cancer screening, with the purpose of enabling participation in future breast screening programs. Methods: A quantitative cross-sectional, online survey of a convenience sample of 184 women aged 20-65 years old from Cluj-Napoca, Romania was used to evaluate the practice of breast self-exam and mammographies and personal and health system barriers against them. Results: The sample's mean age was 34.73 years (SD=11.31, range 20-65). Women in the sample had a high level of education, most holding a Master's degree (36.4%). The majority declared practicing breast self-examinations from time to time (57.2%) and only (35.5%) did it monthly as per existing guidelines. Personal barriers to breast examination were lack of knowledge (16.3%) and mistrust in self examination (10.3%). Women with higher education engaged in the examination of the breast at least once (X2= (0.047, N = 184), p = 0.003, (CI 95%: 5.515-6.773). Concerning health system barriers, access to information from public health authorities on the availability of mammographies was rated very poor (21.7%). The cost was not a significant barrier to mammographies for 72.8% of the women in the sample. Conclusions: Our study contributes to the limited data on preventive practices for breast cancer in Romania, the EU country that ranks last for breast control among females and where 13% of the 9000+ cases diagnosed annually are stage IV cancers. Based on the reported factors of a successful breast cancer screening program by our sample, we suggest valuable insights to be taken into consideration when organizing a future breast screening program. Both personal and system barriers to breast self-exam and mammographies must be considered in organizing breast cancer screenings. The focus should be on educational initiatives to improve women's knowledge about the process of self-screening and on improving access to information on the availability of free screening and mammograms as part of a well-promoted screening program designed with a simple enrolment process.