Abstract
Objective: The study aim was to investigate the association between knowledge of breast cancer and practice of breast self-examination(BSE) and having clinical breast examination (CBE) in a crosssectional sample of 700 Malaysian secondary school teachers.Methodology: A two-stage sampling frame was used; a simple random sample of 10 out of 24 schools was selected and all teachers within those schools were invited to participate. The following data were collected using a self-administered questionnaire (i) sociodemographic data, (ii) five knowledge categories: general knowledge of breast cancer, signs and symptoms, risk factors, mammography, recommended frequency of BSE and CBE, and (iii) practiceof BSE andCBE.Results: The response rate was 74% (518/700). Level of exercise was associated with BSE (p=0.02) and CBE (p=0.01), with exercise twice a week showing the strongest association compared to never exercising, OR=2.71 (95% CI=1.38-5.33, p=0.004) for BSE, OR=2.40 (95% CI=1.27-4.55, p=0.007) for CBE. Self-report of having an annual medical check up was associated with BSE, OR=2.13, (95% CI=1.29- 3.52, p<001) and CBE, OR=2.41, (95% CI=1.57-3.70, p<001). Likelihood of practicing BSE improved with increasing total knowledge score (quartiles) in a dose dependent manner, Q2, OR =1.78 (95% CI0.97-3.27), Q3OR =1.89 (95% CI 1.06-3.36), Q4OR =2.2 (95% CI 1.15- 3.91, p=0.02) compared to the lowest quartile Q1 when adjusted forexerciseand annual checkup. Knowledge of symptoms and signs was associated with BSE practice, OR =1.25 (95% CI 1.06-1.48, p=0.009) and CBE, OR =1.3 (95% CI 1.08-1.57, p=0.005) having adjusted for exercise and annual checkup (BSE and CBE) and age and marital status (CBE). General knowledge was also positively associated with BSE, OR=1.39 (95% CI 1.07-1.81, p=0.01) after adjustment though not with CBE (p=0.41). Knowledge of mammography was inversely associated with BSE however the association was not statistically significant OR =0.77 (95% CI 0.56-1.05, p=0.10).Conclusion: Correct knowledge of symptoms and signs of breast cancer is the most important factor associated with BSE and CBE in Malaysian women after adjustment for other positive health behaviors. Knowledge of risk factors, mammography and recommended frequency of BSE and CBE were not associated with practice of BSE and CBE.
Highlights
Breast cancer is the most common type of cancer among women worldwide and represents 14% of total cancer deaths in females in 2008
Knowledge of symptoms and signs was associated with breast self-examination (BSE) practice, OR =1.25 and clinical breast examination (CBE), OR =1.3 having adjusted for exercise and annual checkup (BSE and CBE) and age and marital status (CBE)
Correct knowledge of symptoms and signs of breast cancer is the most important factor associated with BSE and CBE in Malaysian women after adjustment for other positive health behaviors
Summary
Breast cancer is the most common type of cancer among women worldwide and represents 14% of total cancer deaths in females in 2008. Breast cancer prevalence in developed countries is more than developing countries, the majority of breast cancer mortality (69%) occurs in developing countries It accounts for over one million of the estimated 10 million neoplasms diagnosed worldwide yearly. In Malaysia, the National Cancer Registry (NCR) 2003-2005 reported an age-standardized rate (ASR) of 47.3 per 100,000. The Penang Cancer Registry 2004-2008 reported an incidence of 48 per 100,000 [2]. The International Agency for Research in Cancer (GLOBOCAN) 2012 estimated the ASR of breast cancer in Malaysia as 38.7 per 100,000 with 5410 new cases in 2012 [3]
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