Breast self-examination

Knowledge and awareness of breast cancer and breast self-examination among college-going female students in Delhi-NCR: a cross sectional study

Purpose

Breast cancer (BC) presents a major public health challenge world-over including India. While several risk-factors, early signs and symptoms of BC are known, the knowledge and awareness of this disease remains poor among the population. The present study aimed to determine the extent of knowledge and awareness of BC, its risk factors, early signs and symptoms and breast self-examination (BSE) practice as an early detection method among Indian college-going female students.

Design/methodology/approach

The authors conducted a cross-sectional survey at a University in Delhi-NCR. Data on socio-demographic, knowledge and awareness of BC including BSE was collected using a pretested questionnaire. Chi-square test and logistic regression analysis was performed. All tests were two-sided and significance was set at p < 0.05.

Findings

A total of 866 female students participated in the study with mean age of 22.32 (±0.146) years having mean body mass index (BMI) of 21.22 (±3.52). As high as 82.1% of the participants had heard of BC but while 74.8% thought early detection is possible, 70.7% believed BC cannot be prevented. Gene mutations (60.2%) were identified as a significant risk factor, while breast pain (61.4%) was commonly recognized as a sign of BC. Only 29.8% of students ever performed BSE. Increased odds of performing BSE (OR = 3.4) was found among students who recognized gene mutations as an important BC risk factor.

Research limitations/implications

Knowledge and awareness of BC including BSE among female college students were found to be below average. It is suggested that there is an urgent need for increasing BC awareness among young girls through workshops and mobile-health interventions.

Practical implications

This study provides new information on the level of knowledge and awareness of BC risk factors, sign and symptoms and self-examination practice among young college girls. Moreover, this study advocates the need for design and implementation of a sustainable digital health model for active population BC screening, which is not being done currently.

Social implications

BC is a highly aggressive disease, which is now one of the leading causes of morbidity and mortality in India and world over. Although the knowledge of BC risk factors and its signs and symptoms have increased, the awareness of these elements among the general population at large is low and/or missing, especially in India. Furthermore, as a consequence of unorganized screening programs in the country, majority of women are presenting young with locally advanced disease. Understanding the existing level of knowledge and educating school, college and University students of the pertinent factors and screening practices such as BSE could drastically help in improving the self-screening and/or clinical examination rates. This could potentially lead to early detection and improved prognosis, thus ameliorating disease burden.

Originality/value

This study is one of the few studies conducted in India among young female college students belonging to non-medical backgrounds, delineating the level of knowledge and awareness of BC risk factors and signs and symptoms along with practice of early detection method such as BSE. The study has a considerable sample size and provides valuable evidence for a need to implement programs incorporating digital health models for accelerating awareness and screening of young girls in both rural and urban settings.

Knowledge of breast cancer and breast self-examination practices and its barriers among university female students in Bangladesh: Findings from a cross-sectional study

Early diagnosis of breast cancer is the best approach towards its control that may result in alleviating related mortality and morbidity. This study aimed to evaluate knowledge about breast cancer and both practices and perceived barriers to breast self-examination among female university students in Bangladesh. A cross-sectional study was carried out with 400 female students of Jahangirnagar University, Bangladesh. Participants were sampled from female dormitories at the university from January to April 2020. Proportionate stratified random sampling was conducted to calculate the study sample from each dormitory. A validated semi-structured self-reported questionnaire was employed to collect data from participants during the survey periods. The questionnaire consisted of demographic variables, items about knowledge about breast cancer, breast self-examination practices and its barriers. We applied descriptive and inferential statistics and data were analyzed using the Statistical Package for the Social Sciences (SPSS). Participants were aged between 18–26 years and comprised university students of first year (20%), second year (24%), third year (22%), fourth year (21%) and Master’s (14%). 18% of them reported positive family history (mother, aunt, sister/cousin, grandmother) of breast cancer. The overall mean score of total knowledge items was 15 (SD = 3) out of 43, with an overall correct rate of 34%. The mean score of total knowledge items was significantly higher (p<0.001) among Master’s students and students with family members who have had breast cancer. Only one in five students (21%) ever practiced breast self-examination. The mean score of practice of breast self-examination was significantly higher (p<0.001) among participants who reported having family member of breast cancer. Total knowledge score about breast cancer and practice of breast self-examination were significantly correlated with each other (r = 0.54; p<0.001). About 33% participants reported ‘lack of knowledge’ as the main barrier to practicing breast self-examination followed by ‘I do not have the symptoms’ (22%), and ‘shyness/ uncomfortable feelings’ (17%). The study revealed low levels of knowledge about breast cancer and low breast self-examination practices. Our findings highlight the need to develop, implement and promote socially, culturally and demographically appropriate educational interventions programs aimed at breast cancer and breast self-examination awareness and practice in Bangladesh.

Breast self-examination practice and its determinants among women in Ethiopia: A systematic review and meta-analysis

BACKGROUND

The survival rate from breast cancer is lowest in African countries and the distribution of breast self-examination practice of and its determinants are not well investigated in Ethiopia. Therefore, this systematic review and meta-analysis was designed to determine the pooled prevalence of breast self-examination and its associated factors among women in Ethiopia.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for this systematic review and meta-analysis. The databases used were; PUBMED, Cochrane Library, Google Scholar, CINAHL, African Journals Online, Dimensions and Summon per country online databases. Search terms used were; breast self-examination, breast cancer screening, early detection of breast cancer and Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. The meta-analysis was conducted using STATA 15 software. The pooled meta-analysis was computed to present the pooled prevalence and relative risks (RRs) of the determinate factors with 95% confidence intervals (CIs).

RESULTS

We identified 2,637 studies, of which, 40 articles (with 17,820 participants) were eligible for inclusion in the final meta-analysis. The pooled estimate of breast self-examination in Ethiopia was 36.72% (95% CI: 29.90, 43.53). The regional distribution breast self-examination ranged from 21.2% (95% CI: 4.49, 37.91) in Tigray to 61.5% (95% CI: 53.98, 69.02) in Gambela region. The lowest prevalence of breast self-examination was observed among the general population (20.43% (95% CI: 14.13, 26.72)). Women who had non-formal educational status (OR = 0.4 (95% CI: 0.21, 0.77)), family history of breast cancer (OR = 2.04 (95% CI: 1.23, 3.39)), good knowledge of breast self-examination (OR = 4.8 (95% CI: 3.03, 7.6)) and favorable attitude toward breast self-examination (OR = 2.75, (95% CI: 1.66, 4.55)) were significantly associated with practice of breast self-examination.

CONCLUSIONS

Only a third of women in Ethiopia practiced breast examination despite WHO guidelines advocating for this practice among all women of reproductive age. Intervention programs should address the factors that are associated with breast self-examination. Population specific programs are needed to promote breast self-examination.

Structural equation modeling to detect predictors of breast self-examination behavior: Implications for intervention planning

AIM

Breast cancer is the most frequent malignant tumor among Chinese women. Breast self-examination (BSE) is a simple, effective method for early detection of screening and it is essential for the prevention and control of breast cancer. The aim of this study was to create a hypothetical model to determine the factors influencing women's BSE behavior in Eastern China.

METHODS

A survey was conducted using an online questionnaire and targeting 1200 women aged 18-70 years in Eastern China. Collected data were analyzed using ibm spss 25.0 and amos 24.0 software.

RESULTS

The final model showed a desirable fitness to sample data. A direct positive relationship exists between knowledge on risk factors and BSE. A direct positive association was found between positive attitudes and BSE, while negative attitudes have a direct negative impact on BSE. Objective factors not only had a significant direct impact on BSE, but also directly affected the positive attitudes. Positive attitudes play an intermediary role between objective factors and BSE.

CONCLUSION

Knowledge on risk factors about breast cancer, attitudes toward BSE and objective factors are new predictors which may influence BSE by using the structural equation modeling method.

Psychosocial predictors of breast self-examination behavior among female students: an application of the health belief model using logistic regression

BACKGROUND

Breast cancer is a life-threatening condition affecting women around the world. The early detection of breast lumps using a breast self-examination (BSE) is important for the prevention and control of this disease. The aim of this study was to examine BSE behavior and its predictive factors among female university students using the Health Belief Model (HBM).

METHODS

This investigation was a cross-sectional survey carried out with 334 female students at Urmia University of Medical Sciences in the northwest of Iran. To collect the necessary data, researchers applied a valid and reliable three-part questionnaire. The data were analyzed using descriptive statistics and a chi-square test, in addition to multivariate logistic regression statistics in SPSS software version 16.0 (SPSS Inc., Chicago, IL, USA).

RESULTS

The results indicated that 82 of the 334 participants (24.6%) reported practicing BSEs. Multivariate logistic regression analyses showed that high perceived severity [OR = 2.38, 95% CI = (1.02-5.54)], high perceived benefits [OR = 1.94, 95% CI = (1.09-3.46)], and high perceived self-efficacy [OR = 13.15, 95% CI = (3.64-47.51)] were better predictors of BSE behavior (P < 0.05) than low perceived severity, benefits, and self-efficacy. The findings also showed that a high level of knowledge compared to a low level of knowledge [OR = 5.51, 95% CI = (1.79-16.86)] and academic undergraduate and graduate degrees compared to doctoral degrees [OR = 2.90, 95% CI = (1.42-5.92)] of the participants were predictors of BSE performance (P < 0.05).

CONCLUSIONS

The study revealed that the HBM constructs are able to predict BSE behavior. Among these constructs, self-efficacy was the most important predictor of the behavior. Interventions based on the constructs of perceived self-efficacy, benefits, and severity are recommended for increasing women's regular screening for breast cancer.

Using the health belief model to predict breast self examination among Saudi women

Background

In the Kingdom of Saudi Arabia, breast cancer (BC) usually presents at advanced stages and more frequently in young pre-menopausal women in comparison to western countries. There is controversy surrounding the efficacy of breast self examination (BSE) for early detection of BC in countries where other methods are available. This study aims to explore the perception towards breast cancer and towards BSE among Saudi women, using the Health Belief Model (HBM).

Methods

A convenient sample of adult Saudi female employees, working at King Abdulaziz Medical City, Riyadh, Saudi Arabia (n = 225), and their non-working adult female family members (n = 208), were subjected to the Arabic version of revised Champion’s Health Belief Model Scale (CHBMS) and the Arabic version of Breast Cancer Awareness Measure (CAM), to assess their knowledge and attitude on BC respectively. Percentage mean score (PMS) for each HBM domain was calculated. Significant predictors of BSE practice were identified using logistic regression analysis and significance was considered at p < 0.05.

Results

The majority of women heard about BSE (91.2 %), only 41.6 % reported ever practicing BSE and 21 % performed it regularly. Reported reasons for not doing BSE were: not knowing how to examine their breast (54.9 %), or untrusting themselves able to do it (24.5 %). Women were less knowledgeable about BC in general, its risk factors, warning signs, nature and screening measures (PMS:54.2 %, 44.5 %, 61.4 %, 53.2 %, 57.6 % respectively). They reported low scores of; perceived susceptibility, seriousness, confidence and barriers (PMS: 44.8 %, 55.6 %, 56.5 % & 41.7 % respectively), and high scores of perceived benefits and motivation (PMS: 73 % & 73.2 % respectively) to perform BSE. Significant predictors of  BSE performance were: levels of perceived barriers (p = 0.046) and perceived confidence (p = 0.001) to BSE, overall knowledge on BC (p < 0.001), work status (p = 0.032) and family history of BC (p = 0.011).

Conclusions

Saudi women had poor knowledge on BC, reported negative attitude towards BSE and their practice was poor. Working women and those with family history of BC, higher perceived confidence and lower perceived barriers on HBM, and those with high level of knowledge on BC were more likely to perform BSE. Breast awareness as an alternative to BSE needs further investigations. HBM was shown as a valid tool to predict BSE practice among Saudi women.

Knowledge, attitude and practice of breast self-examination among female university students from 24 low, middle income and emerging economy countries

The aim of this study was to investigate the knowledge, attitude and practice of Breast Self-Examination (BSE) among female university students from 24 low, middle income and emerging economy countries. Using anonymous questionnaires, data were collected from 10,810 female undergraduate university students aged 16- 30 (mean age 20.7, SD=2.9) from 25 universities in 24 countries across Asia, Africa and the Americas. Overall, 50.4% of the female students indicated that they knew how to conduct BSE. Among all women, 59.3% had never practiced BSE in the past 12 months, 21.3% 1-2 times, 10.3% 3-10 times, and 9.1% monthly. The proportion of monthly BSE was above 20% in Nigeria and Laos and below 2% in Bangladesh, India, Singapore, Russia, and South Africa. Logistic regression found that BSE importance or positive attitude was highly associated with BSE practice. BSE practices were found to be inadequate and efforts should be made to develop programmes that can increase knowledge related to breast cancer as well as the practice of breast self-examination.

Practice of breast self-examination among women in Malaysia

OBJECTIVES

The objective of this study was to examine the practice and associated factors of breast self- examination (BSE) among Malaysian women.

METHODS

For this cross-sectional study 250 women were selected by a simple random sampling technique. The questionnaire was consisted of three parts: socio-demographic characteristics, knowledge about BSE, and practice of BSE. Obtained data was analyzed using SPSS version 13. T-test and ANOVA test were used to explore the relation between socio-demographic characteristics and the practice of BSE.

RESULTS

About 32% of the participants reported that they have had family history of cancer and about 20% of the participants reported that they have had family history of breast cancer. The majority of the participants (88.8%) have heard about breast cancer and 78.4% of the participants have heard about BSE. Race, marital status, residency, regular exercise, awareness about breast cancer, belief that breast cancer can be detected early, belief that early detection improves the chance of survival, family history of cancer, family history of breast cancer, awareness about BSE, and belief that BSE is necessary, significantly influenced the practice of BSE among women. Practice of BSE on monthly basis was found to be 47.2% among the study participants.

CONCLUSION

The socio-demographic characteristics significantly influence the practice of BSA among women in Malaysia. The findings of this study might not only influence the planning of specific screening interventions and strategies in Malaysia but might also be important for the relevant international communities, interested in the peculiarities of BSE incidence in different countries.

Differences in illness-related knowledge of breast cancer patients according to their involvement in self-help groups

OBJECTIVE. There is little evidence of the gain in illness-related knowledge obtained in breast cancer self-help groups. This paper seeks to explore whether participants in self-help groups know more about breast cancer than non-participants and to examine the level of knowledge of leaders of self-help groups in comparison to the other two groups. METHODS. A sample of 727 women affected by breast cancer was interviewed with a self-administered questionnaire assessing knowledge on disease, prevention, and aftercare. The interviewing took place during three different surveys conducted between 2005 and 2009. The data of the second and third survey were used in order to create a larger data base and to include self-help group leaders. RESULTS. Participants in self-help groups knew significantly more than non-participants, although only in the subtests lymph edema and breast-examination. Leaders of support groups scored highest in all subtests. Involvement in a support group was most decisive for respondents' knowledge, but other factors such as age, education, and medical history also had effects. CONCLUSION. Self-help groups provide a considerable potential for acquiring illness-related knowledge. As the participation rate in German breast cancer self-help groups is still quite low, it seems reasonable to generate more interest in this kind of support.

Awareness of breast cancer risk factors and practice of breast self examination among high school students in Turkey

Background

Young breast cancer patients have a lower rate of survival than old breast cancer patients due to being diagnosed at advanced stages. Breast self-examination makes women more "breast aware", which in turn may lead to an earlier diagnosis of breast cancer. The purpose of this study was to investigate knowledge and practice of breast self-examination and to determine knowledge of risk factors for breast cancer among high school students.

Methods

This is a descriptive and cross-sectional study. It was conducted in a high school in Manisa, Turkey. The study sample included 718 female high school students. A socio-demographic characteristics data form, knowledge of breast self examination and risk factors for breast cancer form and breast self examination practice form were used to collect data.

Results

The female high school students had insufficient knowledge about breast self-examination and a low percentage of students reported that they had performed breast self examination monthly. The most common reason for not doing breast self- examination was "not knowing how to perform breast self-examination" (98.5%). Most of the students had little knowledge of the risk factors for breast cancer. The most widely known risk factor by the students was personal history of breast cancer (68.7%). There was a significant relation between breast self-examination practice and age, school grade, knowledge about breast cancer and knowledge about breast self- examination.

Conclusion

There is a need to increase knowledge of adolescent females about the risks of breast cancer and benefits of early detection. In fact, health care professionals can develop effective breast health care programs and help young women to acquire good health habits.

The effect of training on the knowledge levels and beliefs regarding breast self-examination on women attending a public education centre

The aim of this study was to evaluate the effect of subject training on the level of knowledge about breast self-examination (BSE) and breast cancer in women attending a public education centre. This research was structured according to pre-test-post test, one group research design principles. The study involved 91 course attendees at the Erzincan Public Education Centre (73.4%). The average age of study subjects was 21.4+/-5.4. Of the 91 participants in the study, 3.3% (n=3) had a family history of breast cancer and 5.5% (n=5) have had a lump in their breasts. In pre-test questions, the rate of correct answers was between 13.2% and 68.1%. After training, the rate of correct answers increased to between 79.1% and 96.7% and attendees demonstrated an increase in the accuracy of their beliefs about breast cancer (health risk, susceptibility). The perception of self-efficacy, an important variable in the process of behaviour change, is a necessary component of changing and maintaining the practice of BSE. The results of this work and others demonstrate that education administered by nurses can increase positive perceptions about BSE self-efficacy. Education in BSE is easily administered, requires no special tools, could lead to early diagnosis of breast cancer if performed regularly and should be taught to all women aged 20 years and above.

Breast self-examination practices among women from six ethnic groups and the influence of cancer worry

Diverse samples of women (N = 1364) from Brooklyn, New York, were interviewed regarding their breast cancer screening practices. Of interest here is the relation between cancer worry and adherence to breast self-examination (BSE) guidelines among the six ethnic groups identified--European American, African American, Haitian, Dominican and English-speaking Caribbean women. There was a significant difference in cancer worry by ethnicity. Logistic regression analysis indicated that education, cancer worry, and perceived efficacy of BSE significantly predicted adherence. Furthermore, there were significant differences among women of African descent in BSE adherence and cancer worry. These differences reflect the emerging need for researchers to empirically and methodically investigate ethnic and cultural factors, as well as emotions and affect in preventive health behaviors.

Breast self-examination: longitudinal predictors of intention and subsequent behaviour

This study analysed in a longitudinal design the relationship between past breast self-examination (BSE) behaviour, determinants, intention and future BSE behaviour in a population of adult Dutch women. Past behaviour and psychosocial determinants were assessed at T1, followed 6 weeks later (T2) with the assessment of the intention to perform BSE monthly. Half a year after the first measurement the current BSE behaviour was assessed by means of a telephone survey (T3) (total end response 78%, n=364). The questionnaires included BSE behaviour, intention, attitude (pros and cons of BSE, anticipated regret, moral obligation), social influence (support, modelling) and self-efficacy. Other background variables assessed were past BSE behaviour, and demographics. Although 81% of the women stated that they performed BSE, only 41% of the women performed BSE correctly. Women who performed BSE correctly differed from women who did not on all psychosocial determinants assessed a half year earlier, with the exception of anticipated regret. Stepwise multiple regression analyses showed that the psychosocial determinants explained 51% of the variance in intention to perform BSE, assessed 6 weeks later; past behaviour accounted for 2% of extra explained variance. Logistic regression analyses showed that past behaviour, the psychosocial determinants and intention were significant predictors of correct BSE behaviour a half year later (Nagelkerke's total explained variance was 47%). It was concluded that misperceptions of correct BSE behaviour was highly prevalent. Both the psychosocial determinants as well as past behaviour were important predictors of intention to perform BSE and subsequent BSE behaviour.

A multimedia interactive education system for prostate cancer patients: development and preliminary evaluation

Background

A cancer diagnosis is highly distressing. Yet, to make informed treatment choices patients have to learn complicated disease and treatment information that is often fraught with medical and statistical terminology. Thus, patients need accurate and easy-to-understand information.

Objective

To introduce the development and preliminary evaluation through focus groups of a novel highly-interactive multimedia-education software program for patients diagnosed with localized prostate cancer.

Methods

The prostate interactive education system uses the metaphor of rooms in a virtual health center (ie, reception area, a library, physician offices, group meeting room) to organize information. Text information contained in the library is tailored to a person's information-seeking preference (ie, high versus low information seeker). We conducted a preliminary evaluation through 5 separate focus groups with prostate cancer survivors (N = 18) and their spouses (N = 15).

Results

Focus group results point to the timeliness and high acceptability of the software among the target audience. Results also underscore the importance of a guide or tutor who assists in navigating the program and who responds to queries to facilitate information retrieval.

Conclusions

Focus groups have established the validity of our approach and point to new directions to further enhance the user interface.

Cost-effectiveness of a systematic training programme in breast self-examination

Breast self-examination (BSE) appears to be an effective method for earlier detection of breast cancer. The provision of specialized training programmes in BSE may increase the awareness of breast cancer as well as improve the practice of BSE. This study assessed the cost-effectiveness of a BSE programme that a Danish health authority is considering implementing. A model was developed that related the cost of training (of a specified target group) to the anticipated effects of the training. These anticipated effects included increased knowledge of BSE, more routine use of BSE, fewer cases diagnosed with breast cancer where the tumour is larger than 20 mm and fewer cases where the cancer has spread to lymph nodes. The model was calibrated with data synthesized from the literature, own survey data and local expert guess. In the baseline scenario, the incremental cost per person with better knowledge of BSE was estimated to be 106 euro (2002 price level), the cost per person who begins to undertake BSE to be 180 euro, and the cost per person who correctly applies the technique to be 142 euro. The cost per avoided cancer with spreading to lymph nodes was estimated to be 15 410 euro and the cost of avoiding a cancer tumour larger than 20 mm to be 16 318 euro. Sensitivity analysis showed that these cost-effectiveness ratios varied with different assumptions for the effects of BSE training.

Early detection of cancer: knowledge and behavior among Dutch adults

This paper reports on knowledge and behavior among Dutch adults (n = 1530) regarding early detection of cancer (passive detection, active detection and help-seeking behavior). Written questionnaires assessed knowledge of detection methods and cancer symptoms, symptom recognition, detection behaviors, and help-seeking behaviors. Respondents did not have much general knowledge of detection methods and cancer symptoms, but recognized most cancer symptoms. More women than men paid attention to cancer symptoms. For most symptoms, medical help would be sought within the appropriate time by the majority of the respondents. Principal component analyses revealed relations between symptoms pertaining to the 'interior' body and those pertaining to the 'exterior' body. Correlations between symptom recognition, detection behavior and help-seeking behavior were low. Differences in demographic groups and differences in knowledge and behavior require adaptation of future health education on early detection of cancer to different groups.

Validation of a questionnaire to evaluate the attitude towards primary prevention advice from the European code against cancer

Educative interventions to promote primary prevention of cancer (PPC) should be based on psychosocial models and be tailored to attitude. Attitude is a difficult variable to measure. The aim of this study was to draw up a questionnaire to evaluate the attitude to PPC of relatives of patients affected by cancer. An interview of 48 patients, who answered open questions, allowed 67 items to be drawn up. Three hundred and fifty-five people answered the self-administered questionnaire of 67 items (69 of them did it twice, with an interval of 2 weeks). The factorial analysis revealed five factors that explain the 36% total and the 115% common estimated variance. The Cronbach's alpha oscillated between 0.80 and 0.93. The intraclass correlation coefficient was 0.7721 (95% CI (confidence interval) 0.6311-0.8592, P<0.0001). The analysis based on Samejima's model ordered the items according to their discriminating power and the difficulty/ease with which people agree with the most preventive option. The average scores obtained in both surveys of 69 people did not show significant statistical differences (P=0.195). The definitive questionnaire obtained has 63 items that measure attitude to PPC behaviour in a reliable and stable way.

Social psychological correlates of paying attention to cancer symptoms and seeking medical help

Social psychological correlates of two main aspects of the process of cancer detection, viz. passive detection (i.e., paying attention to cancer symptoms) and help-seeking intention, were studied among a-symptomatic Dutch adults. Two written questionnaires, with a six-week interval, identified correlates of both variables, using a determinant model based on the theory of planned behavior. Knowledge, advantages, self-efficacy, being female and being more highly educated were associated with passive detection. Knowledge, advantages, moral obligation, anticipated regret, social norm, and self-efficacy were correlated with the intention to seek help. We suggest that educational programs need to address the two variables separately and also need to tailor their content to the various social psychological correlates of these two aspects.

Beliefs and behaviours of Iranian teachers toward early detection of breast cancer and breast self-examination

A descriptive study was carried out to explore the beliefs and behaviours of Iranian teachers toward breast cancer and breast self-examination (BSE). A 10% random sample of 8000 teachers working in four central regions of Tehran was selected. Data on beliefs and behaviours regarding breast cancer and BSE were collected by means of a structured questionnaire. In all, 578 women participated in the study. The mean age of the respondents was 37.3 y (s.d.=8.8), and most were married (83%). The majority of the respondents believed that 'Like every other woman I am at risk of breast cancer' (67%) and that 'Family history of breast cancer is a risk factor for breast cancer' (59%). However, only 6% of them reported that they are performing BSE on a regular basis. The most common reasons for not doing BSE and not going for clinical examination were lack of knowledge and the belief that it was not necessary (34 and 36%, respectively). Doing BSE was more frequent in married (P<0.00001), and older (P<0.00001) women. Except for those with a positive family history of breast cancer, there was no association between breast cancer beliefs and almost all other variables studied. The findings suggest that although the majority of Iranian teachers seem to be quite knowledgeable about breast cancer, they need more education on breast cancer and BSE. Since teachers' beliefs and behaviours may have an impact on young females, planning training courses for this group of women is essential.

Health behaviour, risk awareness and emotional well-being in students from Eastern Europe and Western Europe

Life expectancy and other indices of health have deteriorated markedly in the former socialist countries of Eastern Europe over recent decades. The possible roles of lifestyles, knowledge about health and behaviour, emotional wellbeing and perceptions of control were assessed in a cross-sectional survey of young adults of similar educational status in Eastern and Western Europe. As part of the European Health and Behaviour Survey, data were collected in 1989-1991 from 4170 university students aged 18-30 years from Austria, Belgium, the Federal Republic of Germany, the Netherlands and Switzerland, and from 2293 students from the German Democratic Republic, Hungary and Poland. Measures were obtained of health behaviours, awareness of the role of lifestyle factors in health, depression, social support, health locus of control, and the value placed on health. After adjustment for age and sex, East European students had less healthy lifestyles than Western Europeans according to a composite index of 11 health behaviours, with significant differences for seven activities: regular exercise, drinking alcohol, avoiding dietary fat, eating fibre, adding salt to food, wearing a seat-belt, and using sunscreen protection. East European students were less likely to be aware of the relationship between lifestyle factors (smoking, exercise, fat and salt consumption) and cardiovascular disease risk. In addition, they were more depressed (adjusted odds of elevated scores on the Beck Depression Inventory of 2.46, 95% C.I. 1.95-3.09), reported lower social support, and had higher beliefs in the "chance" and "powerful others" locus of control. Internal locus of control levels did not differ across regions, and Eastern Europeans placed a higher valuation on their health. Unhealthy lifestyles associated with lack of information about health and behaviour, greater beliefs in uncontrollable influences, and diminished emotional well-being, may contribute to poor health status in Eastern Europe.

Breast self-examination and cervical (Pap) smear test: attitudes and self-reported practices among South African women

This study investigated the attitudes and practices of breast self-examination and cervical (Pap) smear test among South African women. The sample included 150 Black and 150 White women chosen by systematic random sampling from telephone directories. The Black women were within the age range of 18 to 80 years (M age 38.9 yr., SD = 4.7), and the White women were within the age range of 19 to 91 years (M age 41.8 yr., SD = 3.5). Analysis indicated that 97.1% of the White women and 44.9% of the Black women said that they know how to examine their breasts. Of those women, significantly more Black (56.1%) than White (8.9%) women examined with the recommended frequency of more than 10 times a year. Of the Black women 60.5% and 8.4% of White women had never had a cervical smear test. Logistic regression analysis indicated that attitudes were an independent predictor for these two tests.

A qualitative study on detecting cancer symptoms and seeking medical help; an application of Andersen's model of total patient delay

Patient delay is the interval between the day someone first becomes aware of an unexplained symptom and the day they seek medical consultation. This pre-diagnostic period is comprised of several stages which may involve delay on the part of the individual. This study investigated factors influencing the process of detecting cancer symptoms and consulting a general practitioner (GP). Twenty-three patients were interviewed about their experiences during this process. Among factors stimulating the process of detection and consultation were associating symptoms with cancer, and discussing symptoms with others. Being ashamed or embarrassed about the symptoms and attributing symptoms to common ailments were among the impeding factors. The findings of the present study suggest that future health education on early detection of cancer should focus on increasing knowledge and providing positive information about early detection of cancer. It is recommended that educational materials be disseminated to the general public via more channels, including non-medical channels.

Factors affecting women to practise breast self-examination

The aim of the study was to identify factors of decisive importance for women's motivation to perform breast self-examination (BSE), which could form the basis of an intervention programme. Interviews were conducted in 1994 with 48 women focusing on four different areas: 1) why the women examined did not examine their breasts, 2) the influence of their upbringing, 3) information or education previously received about the method of examination, and 4) other types of self-care. The findings were summarized under the following categories: feelings, experiences, and lifestyle. Anxiety/fear of discovering a lump and faith/trust in one's own ability to perform the examination were dominating factors influencing the practice or non-practice of BSE. However, there was a general need for knowledge, theoretical as well as practical, among the women studied. They also needed help to identify a strategy to enable them to remember to perform the examination. In order to make BSE a habit, education about BSE ought to be provided to girls at school. The important role of nurses in teaching women to examine their breasts themselves and in reminding them to perform the examination was emphasized.

Improving breast self-examination compliance: a Southwest Oncology Group randomized trial of three interventions

BACKGROUND

Only 20-40% of U.S. women conduct breast self-examination (BSE). This Southwest Oncology Group experimental study compared the impact of three interventions on BSE compliance.

METHODS

Subjects were randomly assigned to one of three arms: (1) physician message; (2) physician message and BSE class; or (3) physician message, BSE class, and reinforcement (phone and postcard). Compliance (frequency and accuracy) was measured by interview at intake and at 6 months and by phone contact at 1 year. Logistic and multiple regression were employed.

RESULTS

This analysis included 2,233 subjects from six institutions. At 1 year the percentages of women doing BSE were 59, 62, and 78% for Arms 1-3, respectively; gains over intake frequency (27% average) were significant within each arm (P < or = 0.0001). At both 6 months and 1 year the differences between Arm 1 and Arm 2 average accuracy scores and the differences between Arm 2 and Arm 3 in the percentage of women doing BSE were significant (P < or = 0.0001). Findings within institutions were consistent with the overall findings.

CONCLUSIONS

The addition of a BSE class increased accuracy over physician message alone; physician message, BSE class, and reinforcement gave the highest percentage of women doing BSE.

Testicular cancer: to screen or not to screen?

OBJECTIVES - To evaluate the evidence for and against routine testicular cancer screening by primary health care providers and patients (testicular self examination). SETTING - Low reported frequency of routine screening for testicular cancer attributed to poor knowledge of the disease and how to screen for it. METHODS - Literature based evaluation of the screening suitability of testicular cancer as a disease and palpation of the testis as the proposed screening test, and of the effectiveness of screening for testicular cancer. RESULTS - Testicular cancer is not a major public health problem. Its low prevalence makes routine screening cost ineffective. As a screening test for the disease, palpation has high sensitivity but its levels of specificity and positive predictive value are unacceptable. Palpation of the testes has not been shown to reduce mortality or morbidity. CONCLUSION - There is insufficient evidence to justify routine screening for testicular cancer by health care providers and patients. This lack of evidence may better explain the low reported levels of screening than can ignorance of the evidence available.