Dangers and unreliability of mammography: breast examination is a safe, effective, and practical alternative

Overdetection of Breast Cancer

Overdetection (often referred to as overdiagnosis) of cancer is the detection of disease, such as through a screening program, that would otherwise remain occult through an individual’s life. In the context of screening, this could occur for cancers that were slow growing or indolent, or simply because an unscreened individual would have died from some other cause before the cancer had surfaced clinically. The main harm associated with overdetection is the subsequent overdiagnosis and overtreatment of disease. In this article, the phenomenon is reviewed, the methods of estimation of overdetection are discussed and reasons for variability in such estimates are given, with emphasis on an analysis using Canadian data. Microsimulation modeling is used to illustrate the expected time course of cancer detection that gives rise to overdetection. While overdetection exists, the actual amount is likely to be much lower than the estimate used by the Canadian Task Force on Preventive Health Care. Furthermore, the issue is of greater significance in older rather than younger women due to competing causes of death. The particular challenge associated with in situ breast cancer is considered and possible approaches to avoiding overtreatment are suggested.

Measurement of the knowledge level about breast self-exam among the female employees of a university hospital, Turkey

OBJECTIVE

Periodic mammography, clinical breast examination and breast self-exam (BSE) facilitate getting a therapeutic response and improve disease prognosis, by leading to early diagnosis of the breast cancer.

METHODS

The study included a total of 618 women working in Çukurova University, Faculty of Medicine, as technician, secretary, staff, midwife and doctor. They answered a 22-items questionnaire consisting of questions about general knowledge, 8 of these were about BSE.

RESULTS

While it was statistically significant that the education was not correlated with the age of onset of BSE and timing of BSE, the education was significantly efficient in terms of knowing the aim of the BSE, its frequency, post-menopausal BSE time, nipple discharge properties in the case of breast cancer, diagnostic methods and the risks. While it was statistically significant that the profession was not related to age of onset of BSE and knowing the right day of the month on which BSE should be performed, the education was likely to be efficient in knowing the frequency, post-menopausal BSE time, aim of the BSE, nipple discharge properties in the case of breast cancer, diagnostic methods and the risks. When the percentage of giving right answers to the questions and educational background and professional groups were compared, it was seen that the difference of the number of right answers and professional groups was significant.

CONCLUSION

Based on our results, we concluded that the education about BSE is warranted in order to increase the likelihood of female healthcare personnel to diagnose breast cancer at an earlier stage, given their role in raising the awareness of the population.

Breast examination as a cost-effective screening tool in a clinical practice setting in Ibadan, Nigeria

Background: Breast cancer is a disease of public health importance. It results in high morbidity and mortality in women worldwide. The high morbidity and mortality from breast cancer can be decreased by measures targeted at early detection such as screening. Breast examination as a screening tool for breast cancer in developing countries is advocated in view of its costeffectiveness.Method: The article selection method was obtained from primary and secondary literature sources which included original research articles, case control studies, review articles, proceedings, transactions and textbooks. The authors cited a clinical audit and articles published between 1988 and 2011. The search strategy included the use of internet search engines. This review was part of a larger research and the study protocol was approved by the University of Ibadan/University College Hospital, Ibadan Institutional Review Board (UI/UCH IRB). Clinical trial registration number-NHREC/05/01/2008a.Results: Breast self-examination (BSE) and clinical breast examination (CBE) as screening tools for breast cancer were analysed in detail.Conclusion: Breast examination is a screening tool that is cost-effective and reliable and should be encouraged in resource-constrained countries. Given the high cost and expertise required for mammography, current efforts at screening for breast cancer in developing countries should rely more on a combination of BSE and CBE.

Applying ecological and evolutionary theory to cancer: a long and winding road

Since the mid 1970s, cancer has been described as a process of Darwinian evolution, with somatic cellular selection and evolution being the fundamental processes leading to malignancy and its many manifestations (neoangiogenesis, evasion of the immune system, metastasis, and resistance to therapies). Historically, little attention has been placed on applications of evolutionary biology to understanding and controlling neoplastic progression and to prevent therapeutic failures. This is now beginning to change, and there is a growing international interest in the interface between cancer and evolutionary biology. The objective of this introduction is first to describe the basic ideas and concepts linking evolutionary biology to cancer. We then present four major fronts where the evolutionary perspective is most developed, namely laboratory and clinical models, mathematical models, databases, and techniques and assays. Finally, we discuss several of the most promising challenges and future prospects in this interdisciplinary research direction in the war against cancer.

An application of an extended health belief model to the prediction of breast self-examination among women with a family history of breast cancer

OBJECTIVES

This study reports an application of the health belief model (HBM) to the prediction of breast self-examination (BSE) among women with a family history of breast cancer. The study also considered the influence of breast cancer worries and past behaviour.

METHODS

Eight hundred and thirty-three women completed questionnaires, based on the HBM, to assess their beliefs about breast cancer and BSE. Of these women, 567 were followed-up at 9 months when BSE frequency was assessed.

RESULTS

Discriminant function analysis was employed to discriminate among infrequent, appropriate and excessive BSE. Two functions were calculated which were predictive of group membership. The first function maximally discriminated between the infrequent BSE group and the other two groups, with infrequent selfexaminers reporting a greater number of self-efficacy and emotion barriers, fewer benefits and less frequent BSE at Time 1. The second function maximally discriminated between the excessive BSE group and the appropriate BSE group, with excessive selfexaminers reporting higher levels of breast cancer worries and perceived severity and fewer self-efficacy barriers.

CONCLUSIONS

The results highlight the importance of focusing on excessive as well as infrequent BSE. Interventions designed to enhance women's confidence in their ability to perform BSE, coupled with attempts to reduce breast cancer worries, may encourage more appropriate and effective BSE.

Health beliefs related to breast self-examination in a sample of Turkish women

PURPOSE/OBJECTIVES

To examine health beliefs and sociodemographic and breast cancer-related variables influencing breast self-examination (BSE) practice.

DESIGN

Descriptive, cross-sectional.

SETTING

Two vocational training centers in Istanbul, Turkey.

SAMPLE

438 women were selected using a convenience sampling method. Participants had not had breast cancer and were not currently pregnant or breast-feeding. The mean age of participants was 33.51 years (range = 18-67).

METHODS

Willing participants were asked to complete a self-administered questionnaire and the Turkish version of Champion's Health Belief Model Scale. The sample was categorized into two groups: performers (i.e., women who performed BSE at least occasionally) and non-performers (i.e., women who had never performed BSE).

MAIN RESEARCH VARIABLES

Perceived susceptibility to and seriousness of breast cancer, perceived benefits of and barriers to BSE, confidence in the ability to perform BSE, health motivation, and frequency of BSE practice.

FINDINGS

Significant differences between performers and non-performers correlated to age, marital status, health insurance, regular gynecologic visits, and education about breast cancer and BSE. The mean scores of perceived benefits and confidence were noticeably higher in performers. Stepwise logistic regression analysis yielded three significant predictor variables.

CONCLUSIONS

Women who had more confidence in their ability to perform BSE, had health insurance, and were informed about breast cancer were more likely to practice BSE.

IMPLICATIONS FOR NURSING

Women in Turkey are at great risk for advanced breast cancer and metastatic spread because of their lack of knowledge. Nurses must provide information on breast cancer etiology, risks, prevention, and detection. To promote BSE practice among Turkish women, tailored health education and health promotion programs should be developed based on a specific understanding of women's health beliefs.

Productive power and the 'practices of the self' in contraceptive counselling

This paper explores an under-researched issue within the reproductive health of women - the discursive construction of self-examination instruction in sexual health clinics. The study utilises Foucault's work on 'productive power', the 'practices of the self' and discourse to map out how nurses instruct contraceptive-using women in self-care practices. Forty-nine consultations in sexual health clinics were tape recorded and analysed. The data reveal how nurses utilise the discourse of risk as a technique to reinforce and develop self-care practices - a concept congruent with the Greco-Roman concept of the cura sui, the philosophical notion that one must make oneself into the object of care. Nurses build upon the notion of risk by educating women about their reproductive anatomy and physiology utilising medical texts as tools. This provides a contemporary example of the mia chora: identified by Foucault as the incitement for the individual to develop a usable knowledge of the body. Lastly, nurses instruct women in the development of a self-care regimen - the epimeleia, the development of habitual body techniques. It is proposed that this process is congruent with the Aristotelian notion of habitus, the development of body knowledge, body techniques and self-care practices necessary to pursue health.

A prática do auto-exame das mamas em mulheres de uma comunidade universitária

Dados estatísticos atuais apontam para elevados índices de prevalência e mortalidade em mulheres acometidas pelo câncer de mama (INCA, 2004), o que poderia ser minimizado pela prática do auto-exame, visto que esta se caracteriza como elemento facilitador de diagnóstico precoce. Esta pesquisa teve como objetivo conhecer a prática do auto-exame das mamas em mulheres representantes da população da PUCRS. Para tanto foi utilizada uma abordagem mista (qualitativa e quantitativa), aplicando-se como instrumento um questionário semi-estruturado, em uma amostra de 215 mulheres. Os resultados mostraram que apenas 25% das mulheres pesquisadas referem adotar a prática do auto-exame das mamas periodicamente como cuidado preventivo. O estudo também evidenciou que todas essas mulheres reconhecem a importância desta prática, porém, muitas vezes não sabem ou não lembram de realizá-la, e outras vezes a praticam de maneira inadequada (com relação à freqüência).

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.

Breast self-examination web site of the institute of oncology Sremska Kamenica vs. breast self-examination web sites in English language and languages of former Yugoslavia

Breast self-examination web site of the Institute of Oncology Sremska Kamenica was designed in 2000 year and since then it has had about 490 visits, i.e. one visit by day approximately. The site was presented at the 6th Annual World Congress on the Internet in Medicine "Mednet 2001" in Udine, Italy, from November 29 to December 2, 2001. The next phase in our project is to improve its contents to increase its popularity. To achieve this we compared our site with similar sites in English language and languages of former Yugoslavia. The results of this comparison are presented in this paper. To find the sites in all languages we used search engine Google.com and following key words: "breast self-examination" (English language), "samopregled dojke" (Serbian and Croatian languages) "Samopregledovanje dojk" (Slovenian language) and "Samopregledot na dojkata" (Macedonian language). Some additional aspects of breast self-examination such as its validity as a screening tool and its influence on breast cancer mortality were also involved. Our aim was to emphasize the importance of further development of telemedicine services in general, and particularly the importance of primary care and early detection, including breast self-examination as integral parts of teleoncology services.