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. 2025 Aug 1;8(8):e2525652.
doi: 10.1001/jamanetworkopen.2025.25652.

Breast and Cervical Cancer Gaps in Displaced Lebanese Women in Syria

Ahmad Al-Bitar  1 , Ayla Kouli  1 , Omran Janoud  1 , Ali Harb  1 , Hassan Fawaz  1 , Maher Saifo  1   2
Affiliations

Breast and Cervical Cancer Gaps in Displaced Lebanese Women in Syria

Ahmad Al-Bitar et al. JAMA Netw Open. .

Abstract

Importance: Breast and cervical cancers are leading causes of cancer mortality in low-resource countries, yet awareness remains critically understudied among displaced populations in humanitarian crises. Lebanese women displaced to Syria represent a group navigating compounded vulnerabilities associated with conflict, displacement, and a collapsed health care system and may experience important gaps in cancer knowledge and access.

Objective: To evaluate knowledge of breast and cervical cancer risk factors and symptoms and screening for early cancer detection among displaced Lebanese women in Syria.

Design, setting, and participants: This cross-sectional study measured breast cancer, cervical cancer, and human papillomavirus (HPV) knowledge using a survey containing validated, Arabic-translated scales administered via structured interviews from November to December 2024. Lebanese women (aged ≥18 years) displaced to Syria and visiting outpatient health care facilities in Damascus were included. Women who were not Lebanese and with acute or severe physical or mental health conditions were excluded.

Exposure: Breast cancer and cervical cancer knowledge.

Main outcomes and measures: The primary outcome was knowledge of cancer symptoms, risk factors, and screening practices. Analyses included Fisher exact test, Kruskal-Wallis test, Mann-Whitney U test, and Spearman rank correlation.

Results: Among 378 displaced Lebanese women in Syria (median [IQR] age, 30 [23-39] years), 196 (51.9%) were married, 187 (49.5%) held a university degree, and 222 (58.7%) were unemployed. Only 85 participants (22.5%) had ever undergone breast imaging, 64 (16.9%) had undergone a Papanicolaou test, 274 (72.5%) rarely or never examined their breasts, and 135 (35.7%) ignored observed breast changes. Knowledge gaps were prominent, with 348 (92.1%) having a low awareness of HPV and only 4 (1.1%) correctly identifying age as an important risk factor for breast cancer. Higher educational attainment was significantly associated with improved screening rates and knowledge of breast and cervical cancer (χ23 = 11.661; P = .009), whereas financial status showed no association.

Conclusions and relevance: These findings suggest that displaced women during humanitarian crises may face substantial breast and cervical cancer screening barriers, underscoring the need for crisis-responsive health care.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Distribution of Answers Regarding the Item Testing Knowledge About Predisposing Risk Factors
BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared); HRT, hormone replacement therapy.
Figure 2.
Figure 2.. Knowledge of Each Item on the Cervical Cancer Knowledge Scale
Figure 3.
Figure 3.. Knowledge of Each Item on the Human Papillomavirus (HPV) Testing Knowledge Scale
See this image and copyright information in PMC

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References

    1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893-2917. doi: 10.1002/ijc.25516 - DOI - PubMed
    1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108. doi: 10.3322/caac.21262 - DOI - PubMed
    1. Youlden DR, Cramb SM, Dunn NAM, Muller JM, Pyke CM, Baade PD. The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality. Cancer Epidemiol. 2012;36(3):237-248. doi: 10.1016/j.canep.2012.02.007 - DOI - PubMed
    1. Global breast cancer initiative implementation framework: assessing, strengthening and scaling up of services for the early detection and management of breast cancer. World Health Organization. February 3, 2023. Accessed July 5, 2025. https://www.who.int/publications/i/item/9789240067134
    1. World Health Organization. Comprehensive Cervical Cancer Control: A Guide to Essential Practice. World Health Organization; 2014. - PubMed