Effectiveness of a comprehensive breast cancer-screening class for women residing in rural areas

Effect of direct education on breast self examination awareness and practice among women in Bolu, Turkey

AIMS

To evaluate breast self examination (BSE) practice and the effect of a training program conducted by healthcare professionals on BSE.

MATERIALS AND METHODS

Women were randomized into control and test groups with both groups completing a questionnaire and three independent interviews where their BSE practices were evaluated.

RESULTS

In all, 39.5% of the participants were previously provided information on BSE by healthcare professionals while 25.8% had no knowledge of BSE prior to enrollment. Compared to those informed about BSE through other means such as television, radio, and the internet, the scores of the first, second, and third visits were higher (p<0.05) in individuals who received BSE education from healthcare professionals and hospitals.

CONCLUSIONS

BSE training provided by healthcare professionals may increase early breast cancer diagnosis and treatment rates by improving BSE awareness and practice.

Breast and cervical carcinoma screening practices among women in rural and nonrural areas of the United States, 1998-1999

BACKGROUND

Prior studies have suggested that women living in rural areas may be less likely than women living in urban areas to have had a recent mammogram and Papanicolau (Pap) test and that rural women may face substantial barriers to receiving preventive health care services.

METHODS

The authors examined both breast and cervical carcinoma screening practices of women living in rural and nonrural areas of the United States from 1998 through 1999 using data from the Behavioral Risk Factor Surveillance System. The authors limited their analyses of screening mammography and clinical breast examination to women aged 40 years or older (n = 108,326). In addition, they limited their analyses of Pap testing to women aged 18 years or older who did not have a history of hysterectomy (n = 131,813). They divided the geographic areas of residence into rural areas and small towns, suburban areas and smaller metropolitan areas, and larger metropolitan areas.

RESULTS

Approximately 66.7% (95% confidence interval [CI] = 65.8% to 67.6%) of women aged 40 years or older who resided in rural areas had received a mammogram in the past 2 years, compared with 75.4% of women living in larger metropolitan areas (95% CI = 74.9% to 75.9%). About 73.0% (95% CI = 72.2% to 73.9%) of women aged 40 years or older who resided in rural areas had received a clinical breast examination in the past 2 years, compared with 78.2% of women living in larger metropolitan areas (95% CI = 77.8% to 78.7%). About 81.3% (95% CI = 80.6% to 82.0%) of 131,813 rural women aged 18 years or older who had not undergone a hysterectomy had received a Pap test in the past 3 years, compared with 84.5% of women living in larger metropolitan areas (95% CI = 84.1% to 84.9%). The differences in screening across rural and nonrural areas persisted in multivariate analysis (P < 0.001).

CONCLUSIONS

These results underscore the need for continued efforts to provide breast and cervical carcinoma screening to women living in rural areas of the United States.

Breast self-examination training: a brief review

A review of the literature on breast self-examination training indicated that any training in breast self-examination improves compliance, confidence, and proficiency; the evidence is unclear about the relative effectiveness of group or individual training; practice on breast models and on the woman's own breasts should be included in breast self-examination training; additional training sessions improve compliance and proficiency; reminders increase compliance, but the effect ceases when the reminders cease; and it is particularly important for older women to search their breasts slowly and thoroughly. Several other new approaches to breast self-examination training are discussed.

Factors influencing registered nurses teaching breast self-examination to female clients

A university hospital-based study was conducted to explore factors that influence nurses teaching breast self-examination (BSE) to female clients, using the PRECEDE (Predisposing, Reinforcing, and Enabling factors in Educational Diagnosis and Evaluation) model as an organizing framework. Female registered nurses (N = 140) from adult inpatient and outpatient units completed a questionnaire that included items about frequency of BSE, knowledge of breast cancer screening and BSE technique, health motivation, confidence and competence in performing BSE, and teaching BSE. Data analysis compared the characteristics of nurses who reported teaching BSE with nurses who did not teach. Nurses in the teaching group had more work experience in nursing and were more likely to have a friend with breast cancer than were those in the nonteaching group. The teaching group had more knowledge about breast cancer screening and BSE technique and reported more confidence and competence in performing BSE.

The practise of breast self-examination over a six-year period following teaching

The null hypothesis is that there is no difference in the performance of breast self-examination (BSE) with respect to three teaching methodologies. A total of 614 women were randomly assigned to a group receiving content only, one receiving content plus supervised practise on a model with implanted lumps or one receiving content plus instruction on their own breasts. It has been established that all groups increased significantly their frequency of practise and level of confidence (Alcoe SY, Gilbey VJ. McDermot RSR, Wallace DG. The effects of teaching breast self-examination: reported confidence and frequency of practise over a six-year period. Patient Educ Couns 1994; 23: 13-21). This paper considers the steps undertaken during BSE and the changes likely to be noticed through factors labelled Technique, Observation, Inspection and Palpation. The factors have been created from 35 items reflecting multiple aspects of the procedure as reported at four follow-ups. The group wherein teaching involved practise on their own breasts achieved higher scores than the other groups. Scores for Technique and Inspection are better maintained over time than are those for Observation and Palpation.

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.