• Désirée Schliemann, Mila Nu Nu Htay, Maznah Dahlui, Darishiani Paramasivam, Christopher R Cardwell, Nor Saleha Binti Ibrahim Tamin, Saunthari Somasundaram, Conan Donnelly, Tin Tin Su, and Michael Donnelly.
• Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, United Kingdom D.Schliemann@qub.ac.uk.
• BMJ Open. 2020 Aug 20; 10 (8): e036503.

ObjectiveTo evaluate the impact of a mass media campaign in terms of improving breast cancer (BC) symptoms awareness and screening uptake.DesignBefore-and after-study with comparator groups.SettingSelangor State, Malaysia.ParticipantsMalaysian women aged >40 years (n=676) from randomly selected households.InterventionA culturally adapted mass media campaign (TV, radio, print media and social media).Primary And Secondary Outcome MeasuresThe primary endpoint was BC symptoms awareness, which was assessed with the Breast Cancer Awareness Measure precampaign and postcampaign. Secondary outcomes included campaign reach, self-efficacy to notice BC symptoms and clinical outcomes. Clinical breast examination and mammogram screening data were collected from hospitals and clinics.ResultsMost participants recognised at least one of the campaign materials (65.2%). The odds of seeing the campaign were lowest for Chinese women (adjusted OR 0.25, 95% CI 0.15 to 0.40) compared with Malays and for women aged >70 years (adjusted OR 0.47, 95% CI 0.23 to 0.94) compared with younger women. Participants who recognised the campaign were significantly more likely to have improved awareness postcampaign compared with non-recognisers particularly for key symptoms such as 'a lump or thickening in your breast' (88.9% vs 62.1%) and 'discharge or bleeding from nipple' (79.7% vs 55.3%). Improvement in symptoms awareness scores was not associated with sociodemographic variables.ConclusionsImplementation in Malaysia of an evidence-based mass media campaign from the UK that was culturally adapted appeared to lead to improved awareness about some BC symptoms, though various modes of media communication and perhaps other health education approaches may be required to extend the reach to diverse, multiethnic populations and all age groups.© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

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