Breast self-examination

The Assessment and Comparison of the Knowledge of Breast Self-Examination and Breast Carcinoma Among Health Care Workers and the General Population in an Urban Setting

Background Breast cancer is one of the common causes of cancer related mortality in women. Early detection and treatment can combat the morbidity and mortality of breast cancer. Most first-world countries have a screening program to facilitate early detection of breast malignancy. A lack of similar programs in developing countries, compounded with ignorance and financial crunch, often leaves women vulnerable due to late detection and complications. Identification of early physical changes in breasts through regular breast self-examination (BSE) can potentially aid in the early detection of breast lumps. Ideally, all women should have access to screening programs, although, practically, it is difficult to achieve mass screening in resource-poor areas. BSE cannot completely bridge this gap in health care; however, it can undoubtedly aid in increased awareness, identification of danger signs, and timely approach to the health care center for intervention. Materials and method A cross-sectional study was conducted at Bharati Vidyapeeth Medical College, Pune, India. The participants were administered a pretested questionnaire to collect information about their understanding of BSE. The data were analyzed using the Statistical Package for Social Sciences (SPSS) statistical software, Version 25. Mean and frequencies were used to compare participants from various backgrounds. Results The total sample consisted of 1,649 women from various educational backgrounds. Every doctor had heard about BSE compared to 81% of women from the general population; 84% of doctors and less than 40% of women representing the general population were taught to perform BSE; however, only around 34% of all women perform BSE. Women from the general population were largely unaware of the correct age to begin BSE, the frequency of performance, its correlation with the menstrual cycle, and the steps necessary to perform it. Women employed in the health care industry were better informed than the general population but still needed to be aware of BSE's details. Conclusion The study highlighted the lack of information regarding breast malignancy and self-examination among women from all educational and professional backgrounds. Women in the health care sector are better informed about the topic than the general population but still lack adequate information. There is a dire need to train women about the procedure, frequency, and correct time of conducting BSE and the telltale signs of breast carcinoma. Women in the health care industry can be educated and trained as educators on the topic, who can further disseminate the information to the general population to promote early detection of breast malignancy.

Presentation of self-detected breast mass in minority women with limited access to care: Can self-examination assist in early cancer detection?

OBJECTIVE

The United States Preventive Services Task Force recommends against breast self-examination. However, racial disparities exist in mammogram screening. We aimed to evaluate the presentation of women with newly diagnosed breast cancer in the underserved African-American and Hispanic community to provide insight regarding breast cancer screening in this population.

METHODS

This retrospective cohort study included women newly diagnosed with breast cancer from 1/1/2016 to 1/1/2018 in an inner city public community hospital. Data was collected via chart review. Patients were divided based on whether they presented with self-detected breast mass. Logistic regression was used for analysis.

RESULTS

59 women were newly diagnosed with breast cancer. 34 women (58%) were African-American, 20 (34%) were Hispanic, and 5 (8%) were other race. Of 59 women, 36 (61%) presented with self-detected breast mass, and only 21 (36%) reported prior mammography. For women who presented with breast mass, the odds of having prior mammography were 78% lower (OR = 0.22, 95% CI 0.07-0.69, p = 0.009), while the odds of having invasive ductal carcinoma were 4.33 times higher (OR = 4.33, 95% CI 1.09-17.25, p = 0.037), as compared to the odds for women not presenting with breast mass.

CONCLUSION

Many of our newly diagnosed breast cancer patients were African-American or Hispanic women presenting with self-detected breast mass without prior screening mammography. Further studies should evaluate whether supplemental screening methods, such as breast self-examination or clinical examination, can help with early breast cancer detection in minority women with limited access to care, and such disparities should be considered by organizations when creating screening guidelines.

Random Cross-Sectional Determination of the Level of Awareness Among Female Saudi Patients About Breast Cancer

The purpose of this study was to randomly determine the level of awareness and knowledge among female Saudi patients about the risk factors and symptoms of breast cancer as well as any awareness about the practices for breast cancer self-examination. A random cross-sectional survey was conducted over 4 months at two private medical clinics in Riyadh, Saudi Arabia. The 4-month period was from December 2013 to March 2014. The survey instrument was a questionnaire that was both self-explanatory and user-friendly. Our study subjects included 174 randomly selected Saudi female patients with no medical history of breast cancer. These patients visited these private clinics for medical advice or for consultation on problems unrelated to breasts. Participants' perception of risk factors regarding early menses showed only 47.1 %. The most common risk factor known by the participants was a family history of breast cancer (84 %). The most widely recognized symptoms of breast cancer were occurrence of breast lumps (86.2 %) and breast pain (93.7 %). Awareness of information regarding breast self-examination (BSE) was 81.6 % in general. Many were aware of the opinion that proper and assisted knowledge about BSE can help in early detection of breast cancer. The patients were also aware that BSE is the most widely used method of screening for breast cancer in clinics and hospitals. All the participants showed sufficient knowledge about the risk factors and symptoms of breast cancer. These baseline findings are encouraging for providing more self-explanatory information (to patients) and guidance to health authorities for developing effective breast health care programs in the entire Kingdom for the female population and not only for patients visiting health care clinics for advice on other medical issues.

Addressing women's breast cancer risk and perceptions of control in medical settings

Many women with family histories of breast cancer deal with two distinct but related issues: their objective physical risk and the emotions this risk engenders. Studies indicate that approximately 70% of African American and white women are concerned about their chances of developing breast cancer someday and perceive themselves to be at risk. Health care providers, including psychologists, need to be aware of the special needs and psychosocial concerns of high-risk women with family histories of breast cancer, since perceptions of breast cancer risk influence screening practices. Providers need training in understanding the significance of specific family patterns of breast cancer, screening guidelines appropriate for women at risk, and the benefits and risks of available prevention options, including genetic screening. Delivering accurate information about both established risk factors known to elevate personal risk, such as age and family history, and factors which women associate with breast cancer, such as bumping and bruising a breast, smoking, and oral contraceptive use, is essential for promoting accurate risk perceptions and appropriate screening schedules.

Awareness and Practice of Breast Self-Examination among Market Women in Abakaliki, South East Nigeria

BACKGROUND

Breast cancer is the most common female malignancy and commonly associated with high levels of morbidity and mortality in developing countries due to late presentation. Breast self-examination (BSE) can help in early detection of the disease.

AIMS

This study aims to determine the awareness and practice of BSE among market women in Abakailiki, Southeast Nigeria.

SUBJECTS AND METHODS

This cross-sectional descriptive study involved the use of questionnaire among market women in Abakaliki. Inclusion criteria were women from the age of 18 years and above who own or sell in a shop, while females less than 18 years of age and women who came to the market to buy products were excluded. Questionnaires were distributed randomly among women who met the criteria in every shop visited based on willingness to participate. Analysis was done using Epi info version 3:5:3 (Atlanta Geogia USA.2008). The association between variables was tested using Chi square for trend statistics. Significance was set at P < 0.05. Binomial logistic regression analysis was used to test for relationship between the age group categories against ever heard of BSE.

RESULTS

The age range of participants was between 20 and 65 years, with a mean age of 34.3 (10.8) years. The age range between 20 and 29 years constituted the highest age group 35.3% (84/238). Majority 54.2% (129/238) had a maximum of secondary education. Of the 238 participants, 77.7% have heard of breast cancer, of which 73.9% thought that early detection would aid treatment. Only 38.9% (6/195), 13% and 13.4% have heard of BSE, clinical breast examination and mammography, respectively. Just 23.9% have been taught how to perform BSE, while 21.8% had done it in the past. One person 0.4% knew the correct frequency of BSE, and also did it regularly. There was a statistically significant difference between the level of education and awareness of BSE. However, there was no statistical significant difference between participants age and awareness of BSE.

CONCLUSION

There was a low level of awareness of BSE among market women in Abakiliki, and there is a need to increase the level of awareness through campaigns.

Eliciting women's preferences for a training program in breast self-examination: a conjoint ranking experiment

OBJECTIVES

Although the clinical grounds for recommending breast self-examination (BSE) have been extensively debated in the literature, there has been no investigation into women's preferences for BSE training. The aim of this study was to test the conjoint ranking method using data on women's preferences for different BSE training programs. Different econometric specifications were tested and sample subgroup differences were investigated.

METHODS

Postal data were collected from 1258 women with and without previous participation in a BSE training program. The women ranked eight hypothetical training programs that were defined in terms of three attributes. Inclusion of a payment attribute enabled the calculation of marginal willingness-to-pay (WTP) estimates.

RESULTS

The marginal WTP for individual training in comparison to group training with 18 to 20 participants was estimated to be 225 Danish Kroner (DKK) to 462 DKK. The marginal WTP for training in groups of eight to 10 participants was 180 DKK to 270 DKK. The respondents also preferred to receive instruction using their own breasts, although this was valued lower than a small group size. The results were similar regardless of whether or not the women had previously participated in BSE training. Around 20% of respondents violated a basic assumption of economic theory, in which the cheaper of two otherwise identical goods should be preferred.

CONCLUSIONS

Conjoint ranking can provide comprehensive information about benefit assessment. The approach is cognitively demanding, however, and may cause some respondents to violate the axiom of nonsatiation.

Seminar in breast self-examination for female medical students integrated into a human gross anatomy course

A breast self-examination (BSE) seminar for first-year female medical students is presented and a single-gender approach for other subjects in the medical curriculum is discussed. In 1999 a small group seminar on BSE was offered at the Hannover Medical School to female medical students as part of their curriculum in human gross anatomy. An evaluation questionnaire was answered by 94 students (87% of participants). Frequencies of answers to two open questions were used as indicators of: 1) the acceptance of a single-gender course and 2) an increased awareness of breast cancer prevention. A linear regression analysis was carried out to identify the most important predictors for the global course evaluation and a heightened interest in breast cancer prevention. The mean global rating of the seminar was 13.8 (minimum: 1 point; maximum: 15 points). Factors that significantly influenced the global rating were the course atmosphere, the teacher's enthusiasm, and the professional interest of the students. An increased concern for breast cancer prevention was significantly dependent on the professional interest and the self-awareness of the women. The results suggest that there is a need for single-gender seminars in academic medicine and that instruction of female students in BSE is an ideal subject for this approach. Because of the prevalence of breast cancer, it is recommended that such a seminar become an integral part of the preclinical curriculum for all female medical students.

Results of a community pharmacy-based breast cancer risk-assessment and education program

We tested the hypothesis that an education program addressing breast cancer screening schedules and modalities coupled with a breast cancer risk assessment provided by community pharmacists can increase women's confidence in performing screening practices endorsed by the American Cancer Society (ACS). This randomized, paired, pre-post study was conducted in six community pharmacies and two health-screening fairs; subjects were 140 women over 18 years of age. The pharmacist-administered program used the Breast Cancer Risk-Assessment Tool (Gail model) software provided by the National Cancer Institute of the National Institutes of Health. In addition, pharmacists provided education and training on breast self-examination (BSE), clinical breast examination (CBE), and mammography. Adherence to ACS guidelines for monthly BSE increased from 31% to 56% (p<0.001) for all women 6 months after the program. Performance of monthly BSE by women considered at high risk for developing breast cancer increased from 20% to 60% (p<0.005). The mean number of BSEs performed over 6 months increased from 2.69 to 4.09 (p<0.001). Women's confidence performing correct BSE improved from 6.41 to 7.04 (p<0.001) on a scale of 0-10. Adherence to ACS guidelines for CBE and mammography did not reveal statistically significant improvements except for better adherence to CBE in women aged 40-49 years (81% to 97%, p<0.025). The strength of the pharmacists' intervention may not appear as manipulation of high-risk patients' behavior but as improvement of self-directed behaviors, such as BSE, across all age groups.

From "reducing" to "coping with" uncertainty: reconceptualizing the central challenge in breast self-exams

An ideology of uncertainty reduction pervades scholarly and popular discourse on breast self-exams (BSE). Women are encouraged to understand BSE as an activity that reduces uncertainty about their health. Moreover, uncertainties about the procedure itself are conceived as barriers to BSE. In turn, reducing these uncertainties is seen as the key to promoting BSE. We argue that the ideology of uncertainty reduction is both descriptively and prescriptively inadequate and potentially a threat to women's health. We further contend the ideology should be replaced by a framework that illuminates processes of coping with uncertainty. Several major characteristics of such a framework, as well as implications for medical practice, are discussed and illustrated within the context of BSE.

Management of familial breast cancer risk

Women who are members of breast cancer families are at increased risk for breast cancer. The cloning of BRCA1 and BRCA2 has made it possible to identify mutation carriers within some of these families. Management of breast cancer risk in these families, which presents enormous challenges to patients and clinicians, is addressed. Management should begin with a full evaluation of the patient, including construction of a three-generation pedigree, ascertainment of non-genetic factors that may impact on risk, information on previous and current breast health, practice of and attitudes toward screening, and the psychosocial impact of family history on the individual. Patient priorities in risk management should be explicitly reviewed; these may include survival, cancer prevention, breast preservation, optimization of quality of life or minimization of disruption of day-to-day activities. Approaches to risk management involve screening (usually considered the mainstay), anti-estrogens, prophylactic surgery and/or lifestyle modifications. Specific gene therapy may become available in the future. Management decisions should be individualized to reflect risk levels and patient priorities and goals, within bounds that are medically and scientifically reasonable. An explicit examination of different time-frames (1, 5, 10 years) is recommended given the rapid evolution of knowledge in this area.

Socioeconomic Factors, not Ethnicity, Predict Breast Self-Examination

The American Cancer Society has recommended monthly breast self-examinations (BSEs) to aid in the early detection of breast cancer. Compliance with BSE recommendations has been shown to be decreased in certain ethnic groups. This investigation evaluates relevant variables involved in BSE compliance in an urban breast cancer screening center. A survey over a 1-year period (June 1996-June 1997) was given to all patients on their initial visit to the Breast Health Center at Tulane University Medical Center. Demographic and socioeconomic factors associated with the compliance of BSE were explored. The overall rate of BSE was relatively high at 80%. There was no difference between ethnic groups in rates of BSE (Caucasians 21% versus African Americans 20%). Statistically significant variables associated with BSE noncompliance were high school education (did not complete high school 16% versus completed high school 33%; p < 0.0004), employment status (employed 16% versus unemployed 31%; p < 0.0004), and marital status (married 15% versus single/divorced 22%; p < 0.05). While the majority of women in our study practiced BSE and ethnicity did not predict BSE, several socioeconomic factors were predictive of BSE compliance. Efforts to increase community outreach to lower socioeconomic patients as well as efforts to ensure proficient BSE techniques by patients may help detect early breast cancer.

Acculturation and breast self-examination among immigrant Latina women in the USA

This article is an extension of previous work, which identified acculturation as an important variable in predicting breast self-examination (BSE) in this sample of women. Here, acculturation is further examined as an intervening factor in predicting BSE. This paper presents the association between level of acculturation to mainstream culture in the USA and the practice of BSE among a population of low-income immigrant Mexican and Puerto Rican women (n = 111) in an urban area of the Midwest in the USA. The majority of women (84.7%) scored a low level of acculturation and 85% did not practice correct BSE. The crude odds ratio indicated that Latina women having a high level of acculturation (15.3%) were twice as likely to practice correct BSE than women with low acculturation. We would suggest that a clearer understanding of the variables that define the performance of BSE will assist in enabling nurses globally to incorporate assessments in their practice that will lead to more successful interventions.

Mortality, health services use, and health behavior in a cohort of well older adults

OBJECTIVES

To construct an evidence-based Good Health Behavior Score and examine the relationship between aggregate health behaviors, mortality, and health services utilization in the last year of life in a cohort of well older adults.

DESIGN

A prospective cohort.

SETTING

A large health maintenance organization.

PARTICIPANTS

1867 older enrollees who responded to a health promotion survey.

MEASUREMENTS

A baseline self-administered questionnaire was used to ascertain health behaviors in 1987-1988, and vital status was determined 48 months later. A Good Health Behavior Score was calculated, and a Cox proportional hazards model was used to compare high, middle, and low score groups regarding risk of death. For those who died, differences in amount and type of health services utilization in relation to the summary score were compared for the year before death.

RESULTS

During the 4 years of follow-up, the mortality rate for the mid-level score group was 50% less, and in the highest score group was 70% less, than in the lowest score group. Among decedents, no significant differences were found between high and low Good Health Behavior score groups for inpatient and outpatient utilization, pharmacy use, or total cost during the last year of life.

CONCLUSION

An easily developed and simple health behavior score can predict short term mortality quite strongly. Medical care costs in the last year of life were similar in individuals with higher and lower health behavior scores.

Unsolved problems in early breast cancer detection: focus on the underserved

In the last decade, numerous research and programmatic efforts have attempted to improve cancer screening practices among women from diverse race/ethnic backgrounds on the assumption that observed differences in breast cancer survival were largely due to differences in early detection practices. Recent data from the 1992 National Health Interview Survey and a 1992 survey in San Francisco Bay Area multiethnic communities indicate that rates of self-reported breast cancer screening tests among African American, Hispanic, and white women no longer differ significantly. However, there are large, persistent socioeconomic differences as reflected in educational and income levels, the recency of immigration, and English language proficiency. This emphasizes the continuing need for interventions tailored specifically for the underserved, with the racial, ethnic, and cultural composition of the intended audience informing educational messages and strategies. However, effective research interventions are complex and costly throughout the spectrum of outreach, inreach, and follow-up. Thus the generalizability of these strategies to under-founded providers and agencies in low-income communities may be limited. Therefore, as ongoing research continues to refine strategies, the application of effective community-based intervention should seek out potential partnerships with programs that provide the critical access to services. Cancer control scientists are well positioned to advocate for community-based infrastructures that facilitate translation of research into practice.

How compliant is compliant? Evaluating adherence with breast self-exam positions

The present study examined compliance with the three recommended breast self-examination (BSE) positions over a 6-month follow-up period. An ongoing behavioral measure that provided information about the type of exam performed during each BSE occasion was employed. Results indicated that adherence to all three position types was obtained in only 40% of the exams. Forty-two percent of exams were comprised of only one position, with the supine position being the most frequently practiced exam type. Implications of these results with regard to BSE research and current breast cancer screening recommendations are discussed.

Screening and self examination for breast cancer

Breast cancer is the major form of cancer in women, with nearly 30,000 new cases and over 15,000 deaths in the United Kingdom each year. Breast screening by mammography has been shown in randomised trials to reduce mortality from breast cancer in women aged 50 and over. An NHS breast screening programme has been in operation in the United Kingdom since 1988. Its aim is to reduce mortality from breast cancer by 25% in the population of women invited to be screened. The uptake of mammography among the eligible population may be the single most important determinant if the programme is to be effective. Primary care teams have an important part to play in encouraging women to attend for screening and in providing information, advice, and reassurance at all stages of the screening process. To date, routine breast self examination has not been shown to be an effective method of screening for breast cancer and should not therefore be promoted as a primary screening procedure. There is, however, a case to be made for women to become more "breast aware."

The effects of teaching breast self-examination: reported confidence and frequency of practise over a six-year period

Breast self-examination (BSE) was taught to 614 women. They were randomly assigned to one of three groups identified as content only, content plus supervised practise on a model with implanted lumps and content plus individual instruction on their own breasts. They were followed for 6 years. Reported frequency of practise and level of confidence increased at a significant level within all groups. The increase persisted at each of four follow-ups. An analysis of variance determined there was no significant difference between groups in the changes in frequency and confidence. Thus, the method of teaching had little impact on the long-range practise of BSE in terms of these two variables. It was observed that 10.8% of the group receiving individual instruction would not accept teaching on their own breasts. Less than 1.5% in each of the other groups would not accept all aspects of the teaching protocol for their respective group. This development should be taken into account in determining whether practise on one's own body is a necessary component of BSE teaching programs.

Mammographic screening for breast cancer: background of a pilot program in the Canton of Vaud

For several years now, substantial efforts have been devoted to the development and the implementation of a screening program for breast cancer in the Canton of Vaud. A four-year pilot phase is now starting, involving two regional hospitals with their catchment areas; women over 50 and under 70 years old will be invited to participate in the program. A double view mammography will be made, with a double reading made by the hospital radiologists; a third reading will be made in case of discrepancy between the two first radiologists. Patients classified as positive for screening (e.g., with a suspect radiological image) will be referred to their practitioner for further diagnosis and treatment. The medical and public health background of this program is discussed, more specifically the reasons for developing a screening program, the choice of mammography rather than other tools, and the need to implement screening as an organized program.