The effect of self-breast examination training provided to women between 18 and 49 years of age and practice on the belief of breast health: A randomized controlled study

Raising awareness of alcohol as a modifiable risk factor for breast cancer: A randomized controlled trial comparing the efficacy of accessing an interactive website with a non-interactive website

Breast and cervical cancer are leading causes of cancer burden in Sub-Saharan Africa (SSA). We measured breast and cervical cancer symptom and risk factor awareness and lay beliefs in Uganda and South Africa (SA). Between August and December 2018 we conducted a cross-sectional survey of women ≥18 years in one urban and one rural site per country. Households were selected using systematic random sampling, then one woman per household randomly selected to participate. Data were collected by interviewers using electronic tablets customised with the locally validated African Women Awareness of Cancer (AWACAN) tool. This has unprompted questions (testing recall) followed by prompted questions (testing recognition) on risk factor, symptom awareness and lay beliefs for breast and cervical cancer. Mann Whitney and Kruskal Wallis tests were used to compare the association between socio-demographic variables and outcomes. Poisson regression with robust variance was conducted to identify independent socio-demographic predictors. Of the 1758 women interviewed, 90.8% had heard of breast and 89.4% of cervical cancer. 8.7% recalled at least one breast risk factor and 38.1% recalled at least one cervical cancer risk factor. 78.0% and 57.7% recalled at least one breast/cervical cancer symptom respectively. Recognition of risk factors and symptoms was higher than recall. Many women were unaware that HPV, HIV, and not being screened were cervical cancer risk factors (23.7%, 46.8%, 26.5% respectively). In SA, urban compared to rural women had significantly higher symptom and risk factor awareness for both cancers. In Uganda married women/living with a partner had higher awareness of breast cancer risk factors and cervical cancer symptoms compared to women not living with a partner. Women mentioned several lay beliefs (e.g. putting money in their bra as a breast cancer risk factor). We identified gaps in breast and cervical cancer symptom and risk factor awareness. Our results provide direction for locally targeted cancer awareness intervention programs and serve as a baseline measure against which to evaluate interventions in SSA.

Mammography for Older Women?

BackgroundBreast and cervical cancer are leading causes of cancer burden in Sub-Saharan Africa (SSA). We measured breast and cervical cancer symptom and risk factor awareness and lay beliefs in Uganda and South Africa (SA).MethodsBetween August and December 2018 we conducted a cross-sectional survey of women ≥18 years in one urban and one rural site per country. Households were selected using systematic random sampling, then one woman per household randomly selected to participate. Data were collected by interviewers using electronic tablets customised with the locally validated African Women Awareness of Cancer (AWACAN) tool. This has unprompted questions (testing recall) followed by prompted questions (testing recognition) on risk factor, symptom awareness and lay beliefs for breast and cervical cancer. Mann Whitney and Kruskal Wallis tests were used to compare the association between socio-demographic variables and outcomes. Poisson regression with robust variance was conducted to identify independent socio-demographic predictors.ResultsOf the 1758 women interviewed, 90.8% had heard of breast and 89.4% of cervical cancer. 8.7% recalled at least one breast risk factor and 38.1% recalled at least one cervical cancer risk factor. 78.0% and 57.7% recalled at least one breast/cervical cancer symptom respectively. Recognition of risk factors and symptoms was higher than recall. Many women were unaware that HPV, HIV, and not being screened were cervical cancer risk factors (23.7%, 46.8%, 26.5% respectively). In SA, urban compared to rural women had significantly higher symptom and risk factor awareness for both cancers. In Uganda married women/living with a partner had higher awareness of breast cancer risk factors and cervical cancer symptoms compared to women not living with a partner. Women mentioned several lay beliefs (e.g. putting money in their bra as a breast cancer risk factor).ConclusionWe identified gaps in breast and cervical cancer symptom and risk factor awareness. Our results provide direction for locally targeted cancer awareness intervention programs and serve as a baseline measure against which to evaluate interventions in SSA.

The purpose of this study is as follows: (1) Knowing the evaluation of the performance of the implementation of educational and training programs based on the analysis of interests and performance, so that the results of the review can provide input to the company about activities that must be improved (concentrate here), maintained (keep up good work), have low priority ( low priority ), and the possibility of excessive (possible overkill). (2) Know the level of influence of the implementation of existing education and training programs on employee work productivity. Based on the data processing results, it is known that the elements of the implementation of education and training programs that must be considered and improved are as follows: Training Materials, Non-Formal Education, Training Schedule, Instructor Friendliness, Training Variations, Training Methods, and Training Manuals. While the elements of the implementation of education and training programs that must be maintained are as follows: Formal Education, Instructor Expertise, Instructor Ability, Training Infrastructure Facilities, Training Curriculum, Training Evaluation. The implementation of education and training programs affects employee work productivity, and the implementation of training programs is more dominant. This is because the implementation of training programs is more often done and more applicable, although it still seems theoretical on the employee's work. Therefore, the proper education and training programs will impact increasing the productivity of their employees.

Breast cancer (BC) is a worldwide fatal cancer among females. Efforts fighting against this disease should start with females at younger ages. This study evaluated the effectiveness a BC educational program in promoting female university students' knowledge and attitudes towards BC and practices of breast self-examination (BSE). A pre- and post-test design was used in two phases; pre- and post-intervention phase. A 1-day educational program was conducted with theoretical and practical educational sessions. Participants were evaluated twice (before and 2weeks after the intervention) for the following variables: knowledge regarding BC warning signs, BC risk factors and knowledge in regard to BSE, in addition to their attitudes and practices of BSE. A total of 110 participants were randomized into either intervention (n = 64, 58.2%) or control group (n = 46, 41.8%). Analysis revealed that participants in both groups had relatively low level of knowledge, negative attitudes, and poor practice towards BC and BSE before attending the intervention. Analysis of the post test revealed that participants in the interventional group had significant improvement in knowledge, positive attitudes, and more practice of BSE compared to participants in the control group. The implementation of a BC awareness program had positive effects on the female university students' knowledge, attitudes, and practices regarding BC and BSE. Findings from this study strengthen and reinforce the importance of conducting such awareness programs for this young age group.

Purpose: Tamoxifen and raloxifene, are primary prevention strategies for women at high risk of breast cancer (Visvanathan, 2013). Recent advances in genetic studies of breast cancer risk have identified common susceptibility loci that explain 14% of familial risk for breast cancer in the general population (Michailidou, 2013). However, it is not known if these loci are risk factors for breast cancer among high-risk women treated with SERMs for breast cancer prevention. We hypothesized that the large risk reduction associated with SERMs, coupled with the fact that several breast cancer loci correlate with family history, may limit the contribution of these common genetic loci to breast cancer in this high risk population. We present the first report to evaluate 75 established breast cancer susceptibility loci, in the context of a polygenic risk score (PRS), as a risk factor for breast cancer among high risk women taking raloxifene and tamoxifen for breast cancer prevention. Methods: We conducted a matched case-control study of 594 cases (i.e., participants who developed breast cancer while on SERM therapy) and 1,171 matched controls selected from the 33,000 participants enrolled in the NSABP P-1 and P-2 breast cancer prevention trials. Genotypes of 75 single nucleotide polymorphisms (SNPs) were available from a genome-wide association study conducted at the RIKEN Center for Genomic Medicine. We formed a quantitative PRS from reported per-SNP odds ratios (OR) for the 75 susceptibility loci. Conditional logistic regression was used to examine the PRS as a risk factor for breast cancer and to assess whether the PRS and breast cancer association differed by treatment type, family history, or other clinical characteristics. Analyses also examined associations of PRS with invasive vs. in situ cancer and ER-positive vs. ER-negative cancer. Results: The PRS ranged from 3.98 to 7.74, and a one unit change in PRS was associated with a 42% increase in breast cancer (OR=1.42; 95% CI: 1.18-1.70; P = 0.0002). There was evidence of a stronger association of PRS with breast cancer among women with no first-degree family history (OR=1.62, 95% CI: 1.18-2.21) compared to those with a positive family history (OR=1.32, 95% CI: 1.06-1.66) (Pintx<0.05). The PRS also appeared a stronger risk factor for ER-positive (OR=1.59, 95% CI: 1.25-2.02, P < 0.0002) vs. ER-negative (OR=1.05, 95% CI: 0.68-1.62, P=0.84) breast cancer, although differences did not reach statistical significance (Pintx=0.10). PRS and breast cancer associations were similar across tamoxifen and raloxifene treatments, age at trial entry, 5-year predicted Gail model risk, hysterectomy status, BMI, presence of atypical hyperplasia and invasive vs. in situ cancer. Conclusion: A polygenic risk score composed of 75 loci was a risk factor for ER-positive breast cancer, especially in the absence of a first-degree family history of breast cancer. Further, the PRS associations with breast cancer were similar for women taking tamoxifen or raloxifene for prevention. These data suggest that common genetic variation adds information on risk of ER-positive breast cancer in a high-risk population receiving SERMs. Citation Format: Celine M Vachon, Daniel J Schaid, James N Ingle, Matthew P Goetz, Donald L Wickerham, Michiaki Kubo, Erin E Carlson, Soonmyung Paik, Norman Wolmark, Yusuke Nakamura, Liewei Wang, Richard M Weinshilboum, Fergus J Couch. The contribution of common genetic variation to breast cancer risk among women receiving tamoxifen or raloxifene within the National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1 and P-2 trials [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-10-03.

: This article provides the position of the American Council on Science and Health regarding how breast cancer is defined and classified; the magnitude of the public health problem of breast cancer among women; the implications of variation in incidence of breast cancer internationally and with migration; access to health care as a factor in slight differences in incidence and mortality rates among African-American and white women; and the evidence concerning various proposed human-breast-cancer risk factors. The article classifies risk factors as either established, speculated, or unsupported on the basis of available evidence. Specific genes have been identified that may explain as much as 5–10% of new breast cancer cases. Inherited predispositions may be characterized by family history of breast or ovarian cancer, young age at diagnosis, breast cancer diagnosed in both breasts, and male breast cancer. Benign breast disease (BBD), particularly the subtypes of BBD involving atypical hyperplasia, and exposure early in life to ionizing radiation is an established risk factor for breast cancer. Several reproductive characteristics are established as risk factors for breast cancer: early age at menarche, first full-term pregnancy after age 35 years of late age, and late age of menopause. Obesity and low physical activity are established as risk factors for breast cancer and are modifiable. Speculated risk factors for breast cancer that are gaining scientific support include nulliparity, oral contraceptive use, and postmenopausal estrogen replacement therapy. Speculated risk factors for which there is conflicting or preliminary support include not breast feeding, postmenopausal estrogen/progestogen replacement therapy, prescribed diethylstilbestrol, low consumption of phytoestrogens, specific dietary practices, alcohol consumption, not using nonsteroidal antinflammatory drugs, abortion, and breast augmentation. Unsupported risk factors include higher than average consumption of phytoestrogens, premenopausal obesity, electromagnetic fields, and low-dose ionizing radiation after 40 years of age. There is only limited support for xenoestrogens and large breast size as risk factors for breast cancer.

Patient's self-efficacy in disease management and foot care is considered as an important indicator in controlling the complications of diabetes. This study was aimed to determine the effect of three-month training programme on foot care and self-efficacy of patients with diabetic foot ulcers. A quasi-experimental study was conducted on 60 patients with diabetic foot ulcers in Jiroft Imam Khomeini hospital from January 2016 to May 2016. These patients were randomly divided into intervention and control groups (30 patients in each group). The research instrument was a questionnaire on demographic data, self-efficacy questions for patients with diabetes and a researcher made questionnaire of diabetic foot care. Training programmes for foot ulcers care and prevention of new ulcers formation and other aspects of the disease were implemented during three months in the test group. Data were analysed using descriptive and analytic statistical tests (Mann-Whitney U, paired t-test and Pearson correlation coefficient) by SPSS version 18.0 software. The results showed statistically significant difference (p<0.001) in the score of self-efficacy between intervention group (182.25) and control group (93.56), and the foot care score was 47.43 in the intervention group and 30.18 in control group after the intervention. The average scores of self-efficacy and foot ulcers care significantly increased in the intervention group after training programme (p<0.001). The results showed that the implementation of training programme has been able to increase the self-efficacy of patients and the rate of their foot ulcers care and the prevention of new ulcers and effectively reduce the complications in diabetic patients.

BackgroundAdmission of preterm infants in the neonatal intensive care unit limits the mother’s interaction with their infants, delaying accepting and playing the motherhood role. Besides, mothers of preterm infants have low self-esteem due to their infants' condition. Accordingly, the present study explored the effect of implementing the training program on maternal role adaptation and self-esteem of mothers of preterm infants admitted to the neonatal intensive care unit.MethodsThis study employed a quasi-experimental design with two groups. The participants were 80 mothers of preterm infants. The participants were selected using convenience sampling and simply randomly assigned to the intervention and control groups. The instruments included a demographic information questionnaire, the Rosenberg Self-Esteem Scale, and the Maternal Role Adaptation Scale. The participants in the intervention group attended the training program, while the control group did not receive any intervention. The questionnaires were completed by the two groups before and 2 weeks after the intervention. The collected data were analyzed using SPSS software version 21, a significance level of 0.05.ResultsThe maternal role adaptation scores before the intervention in the control and intervention groups were 134.222 ± 11.84 and 138.800 ± 12.42, respectively, showing no statistically significant difference (P = 0.096). The corresponding scores after the intervention for the control and intervention groups were 139.17 ± 12.46 and 154.05 ± 8.57, showing a significant intergroup difference (P < 0.001). Similarly, the pre-intervention self-esteem scores in the control and intervention groups were 30.30 ± 3.79 and 30.95 ± 8.61, showing no statistically significant difference between the two groups (P = 0.664). Besides, the post-intervention self-esteem scores in the control and intervention groups were 31.52 ± 3.42 and 36.001 ± 7.74, respectively, indicating a statistically significant difference between the two groups (P < 0.001).ConclusionGiven the insight from this study, implementing training programs is a suitable solution for improving maternal role adaptation and increasing mothers' self-esteem. Furthermore, nurses’ training packages can help the mother accept the maternal role more quickly and improve the mother's self-esteem for better care of the baby.Trial registration The registration number for this study was obtained from Kerman University of Medical Sciences, and the number of the grant was 98000150.

BACKGROUND AND OBJECTIVES:Despite its relatively low incidence in Saudi Arabia, breast cancer has been the most common cancer among Saudi females for the past 12 consecutive years. The objective of this study was to report the results of the first national public breast cancer screening program in Saudi Arabia.METHODS:Women 40 years of age or older underwent breast cancer screening. Mammograms were scored using the Breast Imaging-Reporting and Data System (BI-RADS). Correlations between imaging findings, risk factors and pathological findings were analyzed.RESULTS:Between September 2007 and April 2008, 1215 women were enrolled. The median age was 45 years, and median body mass index was 31.6 kg/m2. Sixteen cases of cancer were diagnosed. No cancer was diagnosed in 942 women with R1/R2 scores, and only 1 case of cancer was diagnosed in 228 women with R0/R3 scores. However, among 26 women with R4/R5 scores, 50% had malignant disease and 35% had benign lesions. No correlation was found between known risk factors and imaging score or cancer diagnosis.CONCLUSIONS:Public acceptance of the breast cancer screening program was encouraging. Longitudinal follow-up will help in better determining the risk factors relevant to our patient population.

The objectives of this study are as follows: To determine the level of influence of the implementation of existing education and training programs on employee productivity. Based on the data processing results, it is known that the elements of the implementation of education and training programs that must be considered and improved are as follows: Training Materials, Non-Formal Education, Training Schedules, Instructor Friendly, Training Variations, Training Methods, and Training Manual Books. Meanwhile, the elements of implementing education and training programs that must be maintained are as follows: Formal Education, Instructor Skills, Instructor Ability, Training Facilities, Training Curriculum, Training Evaluation. The implementation of education and training programs affects employee work productivity, and the implementation of training programs is more dominant. This is because the implementation of training programs is carried out more often and is more applicable even though it still seems theoretical on employees' work. Therefore, the right education and training program will impact increasing the productivity of its employees.

In western countries, female breast cancer is a major cause of death. Many risk factors for breast cancer have been identified, but the magnitude of the risks is clearly different between high and low risk areas. In this hospital-based case-control study we evaluated risk factors for female breast cancer in 158 women with breast cancer and 131 controls. Cases presented a later age at first birth and a lower median number of pregnancies. The risk of breast cancer increased with increasing age at first birth, particularly for women with lower parity. After controlling for other variables the risk significantly decreased with abortion history (OR = 0.5, 95% CI: 0.3-0.7) and oral contraception (OR = 0.5, 95% CI: 0.3-0.9). Premenopausal and postmenopausal women presented different risk factors. Among premenopausal cases the risk was lower for parous women (OR = 0.1, 95% CI: 0.0-0.7) and higher for those with a positive family history (OR = 4.5, 95% CI: 1.3-16). Compared to controls, postmenopausal cases only presented a significantly lower rate of abortions (OR = 0.2, 95% CI: 0.1-0.4). The present study shows that these women can be regarded as belonging to an intermediate risk population.

PurposeThis study aimed to evaluate the preliminary effectiveness of an educational intervention using a web-app to improve knowledge of breast cancer risk factors and symptoms and adherence to healthy eating and physical activity among women without breast cancer diagnosis in Asturias (Spain).MethodsA pragmatic randomized pilot trial was conducted to evaluate the impact of a web-app-based intervention for women without breast cancer diagnosis. Women in the intervention group participated in a 6-month intervention web-app based on the Behaviour Change Wheel Model. The web-app includes information about breast cancer risk factors, early detection, physical activity and diet.ResultsTwo hundred and eighty-fifth women aged 25–50 were invited to join the study. Two hundred and twenty-four were randomly assigned to either the intervention group (IG = 134) or control group (CG = 90) according to their place of residence. Adherence among women in the IG increased significantly from pre- to post-intervention for eight of the 12 healthy behaviors and for the identification of six risk factors and six symptoms compared to women in the CG and, among whom adherence only increased for two behaviors, the identification of one risk factor and 0 symptoms. The intervention significantly improved the mean number of risk factors + 1.06 (p < 0.001) and symptoms + 1.18 (p < 0.001) identified by women in the IG.ConclusionsThe preliminary results of this study suggest that an educational intervention using a web-app and based on the Behaviour Change Wheel model could be useful to improve knowledge of breast cancer risk factors and symptoms and to improve adherence to a healthy diet and physical activity in women without a previous breast cancer diagnosis.

INTRODUCTION: Breast cancer represents a serious public health problem worldwide, for its high incidence, morbidity, mortality, especially among women. It’s a multifactorial disease and the role of obesity in the etiology of breast cancer is found mainly in postmenopausal women in whom the increase in body weight and changes in fat distribution are common. MATERIALS AND METHODS: It is a multi-institutional case-control study. We studied 703 women, 268 of these were the case group and 435 represented the control group for subsequent evaluation of selected risk factors in one year from August 2009 to 2010. Data collection was performed by applying a protocol and an informed consent approved by the ethics committee of Federal University of Alagoas. All patients were weighed and measured for height and waist and hip circumferences. Data were entered and analyzed by Epi-Info 3.5.1. Windows version. Statistical tests were: Chi-square test, Bartlett s test, ANOVA and Mann-Whitney/Wilcoxon (Kruskal-Wallis test for two groups). RESULTS: The mean age of women with cancer was 52.40 years. of the 325 (46.2%) patients who were in menopause 157 (48.3%) were carriers of breast cancer and 168 (51.7%) were healthy. Among the 378 (58.3%) in premenopausal patients, 111 (29.4%) belonged to the case group and 267 (70.6%) to the control group. (OD: 2.2479, 95% CI, 1.6481 to 3.066). The body mass index (BMI) didn’t show any significant relationship between cases and controls (p = 0.9713). The waist-hip ratio (WHR) showed an average of 0.9295 in the case patients and average less than 0.8714 in the control patients (p = 0.0000). DISCUSSION: The incidence of breast cancer increases rapidly with age. The average age of the patients with breast cancer was 52.40 years. Among controls the mean age was 46.78 years. The results showed BMI of postmenopausal women with an average of 26.15 kg/m2 and an average of 25.65 kg/m2 in women in reproductive age (p = 0.0136). The excessive body weight is associated with increased risk of breast cancer in postmenopausal women. In contrast, excess weight does not seem to be associated or even often associated with a lower risk of cancer in premenopausal women. In our study we observed no statistically significant difference in BMI between cases and controls (p = 0.9887), which agrees with other results already described in the literature. It is noteworthy that the incidence of obesity and/or breast cancer in the populations studied may have influenced the results. The mean WHR found among all patients was 0.89. The mean WHR in patients with breast cancer was higher (0.92) compared to controls (0.87) (p: 0.000). The combination of higher ratio circumference and WHR with the incidence of breast cancer portrayed in this study agrees with the studies conducted to investigate this same variable as a risk factor for breast cancer. Considering menopausal status, patients in reproductive age had resulted in a mean waist-hip ratio of 0.87 and an average of 0.91 menopausal (P: 0.000). Significant result and it also represents what is found in other studies. CONCLUSION: For menopausal status, it was found that to be in menopause was a risk factor for breast cancer. The BMI did not show statistical significance for cancer and waist-hip ratio had its association with proven cases of cancer.