Breast Self-examination Skills Research Articles

A Survey on Breast Cancer Awareness Among Medical, Paramedical, and General Population in North India Using Self-Designed Questionnaire: a Prospective Study.

Breast cancer (BC) has become the most common cancer in urban women. Unfortunately, most women are not aware of BC symptoms/signs, prevention, and management. In resource-limited countries like India where we do not have structured screening/awareness programs, a majority of women present with locally advanced BC. The aim of our study is to identify the present status of awareness about BC prevention, early detection, symptoms, and management in urban and rural Indian women (medical, paramedical, and nonmedical) and to assess whether education and socioeconomic strata have any role in better awareness about BC or not. We did a prospective cross-sectional observation study among the medical, paramedical, and nonmedical women in the northern part of India. We designed a questionnaire keeping in mind the three domains about BC-knowledge (questions 1-25 include risk factors, genetics, lifestyle changes, hormones, associated cancers, and modes of presentation like lump, nipple/skin changes), breast self-examination (questions 25-37), and attitude to prevention and early detection (questions 38-44). We also asked how many do breast self-examination (BSE) and what they think are the three main factors responsible for late presentation and the three main ways to increase BC awareness. The Likert scale was used for objective assessment. We analyzed the whole data using SPSS software version 15. A total of 220 women out of 270 completed the questionnaire. Out of 220 women, 26.4% were medical, 20.9% paramedical, and 52.7% nonmedical. Most women were educated (82.7%) and married (65%). 59.5% women resided in urban areas and the rest (40.5%) were from rural areas. We found that there was relatively more knowledge in the medical group; however, the skills of BSE and attitude to prevention and early detection in all the three subgroups and among rural and urban women were suboptimal and not different significantly. The three main factors responsible for delayed presentation were shyness and not knowing BSE, ignorance about BC symptoms, and social stigma of cancer along with financial constraints. The three main ways to improve BC awareness suggested were to have more advertisements on television and social media, roadside campaigns and in colleges along with group discussions and debates, and at grassroots level to involve Anganwadi workers and nurses to create more awareness in villages. There was less breast cancer knowledge and awareness among the nonmedical women compared to those among the medical and paramedical, the skills of BSE and attitude to prevention and early detection were suboptimal in all the three groups. Rural or urban dwellings did not make much difference in BC knowledge, skills of BSE, and attitude to prevention. More awareness regarding breast cancer symptoms with early detection and BSE need to be addressed with more information dissemination via social media, campaigns, and involvement of paramedics and social workers.

The Effect of Peer Education upon Breast Self-Examination Behaviors and Self-Esteem among University Students.

The current study was semi-experimentally designed in order to identify the effect of peer education upon breast self-examination (BSE) behaviors and self-esteem among university students. The study was undertaken with 100 female students who studied at Erzincan University. Peer educators were recruited from the 4th year students. The data were collected with a questionnaire form, BSE skill form and Rosenberg Self-esteem Scale in two phases one month before and after the BSE peer education. For the data assessment; percentage distributions, frequency, mean, standard deviation and Simple T test were employed. The mean age of the participant students was 20.45±1.67 year and all of them were single. It was found that during the first data collection phase, only 16 % of the students performed BSE while during the final data collection phase, the rate of the students performing BSE rose to 77 %. During the first data collection phase, students received a mean score of 2.36±4.13 from BSE skill form while during the last data collection phase they had a mean score of 10.70±3.40 from BSE skill form. When the scores obtained from Rosenberg Self-esteem Scale by the students were examined, it was seen that they received a mean score of 1.20±1.34 during the first data collection phase while they had a mean score of 0.84±1.07 during the final data collection phase. Although short-term feedback was obtained, it was noted that students' BSE knowledge and skills increased considerably.

Evaluation of the Effects of Breast Cancer Screening Training Based on the Systematic Comprehensive Health Education and Promotion Model on the Attitudes and Breast Self-examination Skills of Women

Background: Improvement of attitudes toward breast cancer positively affects the screening behaviors of women. Imagery has been shown to have a positive impact on the screening behaviors of women. Aim: This study aimed to investigate the effects of breast cancer screening training based on the systematic comprehensive health education and promotion (SHEP) model on the attitudes and breast self-examination skills of women. Method: This quasi-experimental study was conducted at two urban healthcare centers of Mashhad, Iran in 2015. Participants were 120 women covered by these health centers, who received training on breast cancer screening based on the SHEP model. Intervention consisted of evaluation (literature review, topic selection), implementation (developing instruments, educator training, training of participants), and assessment (pretest-posttest). Data were collected using researcher-made questionnaires of attitude and breast self-examination (BSE) checklists. Data analysis was performed in SPSS version 20 using independent t-test and Mann-Whitney U test. Results: In the intervention and control groups, 55 (91.7%) and 56 (93.3%) participants were married, respectively. Results of Mann-Whitney U test before intervention showed no significant differences between the groups regarding the mean scores of attitude and breast self-examination skills (P>0.05). After a four-week follow-up, independent t-test revealed a significant difference between the groups in terms of the mean score of attitude (P<0.001). Moreover, Mann-Whitney U test was indicative of a significant difference in the mean score of BSE between the experimental and control groups (P<0.001). Implications for Practice: Considering the feasibility and applicability of the SHEP model for different age ranges, breast screening training based on this educational model could enhance the attitudes and performance of women in this regard.

Effectiveness of a structured teaching programme on knowledge of breast cancer and skill of breast self-examination: a quasi- experimental study in rural women

Background: The women in rural area lacked knowledge regarding breast cancer and breast self-examination (BSE). The study was designed to investigate the effectiveness of structured teaching programme to enhance knowledge and asses the skill of BSE among mahila mandal women.Methods: Quasi experimental one group pre-test and post-test design with the aid of a questionnaire and interview schedule was conducted among 42 mahila mandal women from three villages under Mugalur Community health and training centre, Karnataka. The pre-test knowledge was assessed using structured interview schedule and BSE skill was assessed by an observation check list.Results: Out of 42 women, most of the participants gained knowledge about breast cancer and developed skill in doing BSE. The mean pre-test knowledge score (7.6±3.0) was less than the post-test knowledge score (24.9±2.7). The mean pre-test skill score (0.7±1.0) was also less than the post-test skill score (12.4±2.0). The paired t value between the pre-test and post-test knowledge and skill score was statistically significant at 0.001 level. No significant association was existed between the selected baseline variables age, education, income, marital status and years of experience in mahila mandal with pre-test knowledge and skill score of breast cancer and BSE.Conclusions: The study concluded that structured teaching programme was an effective strategy in improving the knowledge and skill of women regarding breast cancer and BSE.

The effectiveness of a nurse-delivered breast health promotion program on breast cancer screening behaviours in non-adherent Turkish women: A randomized controlled trial

Background Few studies have investigated breast health programs to promote rates of having a mammography, clinical breast examination and breast self-examination among non-adherent Turkish women. Objectives To determine the effectiveness of a breast health promotion program on mammography and clinical breast examination use, breast self-examination frequency and proficiency (breast self-examination skills and lump detection), breast health knowledge and health beliefs about breast cancer screening in a sample of Turkish women. Design Experimental (pretest–posttest control group). Setting A community-based setting in Istanbul, Turkey. Participants 190 Non-adherent women (intervention group = 97, control group = 93) aged 41 and older, residing in Istanbul, Turkey. Methods The intervention group ( n = 97) received a 120-min breast health promotion program based on health belief model including a breast health education, film, breast self-examination instruction, and a booklet, a calendar, a card designed specifically for the study. The control group ( n = 93) received general information except breast health. Data were collected before the program, immediately after the program, and at 3- and 6-month post-program. The outcome measures are the mammography, clinical breast examination, and breast self-examination frequency, breast self-examination proficiency, breast health knowledge, and health beliefs (perceived susceptibility to breast cancer, benefits to mammography and breast self-examination, barriers of mammography and breast self-examination, confidence in performing breast self-examination). Results The breast health promotion program significantly increased breast self-examination frequency and proficiency and breast health knowledge. No significant differences existed in mammography and clinical breast examination rates between the two groups at 6 months. The program was effective in increasing perceived susceptibility to breast cancer, perceived benefits of mammography and breast self-examination, and confidence of breast self-examination. No significant difference was found between the two groups for perceived barriers to mammography. Conclusions The breast health promotion program was effective in increasing breast self-examination frequency and proficiency in a sample of Turkish women. In addition, it appears to be useful in raising the knowledge of breast health, enhancing confidence in performing breast self-examination, and increasing most health belief levels.

Effects of Action Oriented Breast Self-examination(BSE) Education on Knowledge, Self-efficacy, and Performance Competence in Nursing Students

【Purpose: This study was undertaken to test effects of action oriented BSE education on knowledge, selfefficacy, and performance competence in nursing students. Methods: A non-equivalent pre-posttest of time serial quasi-experimental design was used to prevent diffusion of the experiment. Out of 53 nursing students selected by convenient sampling in the third grade at a nursing college, 27 students were randomly assigned to the control group and were first given a traditional lecture on BSE. For the experimental group of 26 students action oriented BSE education consisted of lectures, demonstrations with breast models, and BSE skill practice by micro teaching. Results: There was no significant difference in general and BSE-related characteristics between the two groups. Scores of the experimental group in knowledge, self-efficacy, and performance after the intervention were significantly higher than those of the control group. Conclusions: Results showed that action- oriented BSE education was effective in increasing knowledge, self-efficacy and performance competence in nursing students. Education for students should incorporate strategies reinforcing confidence by practicing actual BSE skills as well as acquiring knowledge of BSE, so that students can become competent and practical cancer prevention educators.】

Knowledge and Intentions of Ninth‐Grade Girls After a Breast Self‐Examination Program

Breast cancer ranks as the second-leading cause of death for women. Until recently the American Cancer Society advocated teaching breast self-examination (BSE) procedures. The Susan G. Komen Breast Cancer Foundation, active in the fight against breast cancer, continues to support educational efforts to teach breast self-examination skills to adolescent girls. Funded by the Komen Foundation, a BSE education program was developed and delivered by health educators at the Hult Health Education Center. The 50-minute program consisted of a PowerPoint slide presentation of breast cancer and BSE facts, and a video demonstration of proper BSE technique. Using a quasi-experimental design, the program was evaluated for changes in knowledge and intention to perform BSE. Ninth-grade girls at four public high schools (n = 255) in Peoria, Ill., were given a pretest to determine their knowledge about breast cancer and breast self-examination. A delayed posttest was administered between five to six weeks later (n = 211). Using the Kruskal-Wallis nonparametric test, girls who participated in the BSE education program (treatment group) recorded a significantly higher overall mean knowledge score than girls who did not participate (comparison group). Those who participated in the program retained that knowledge over a five- to six-week period. Analyses of variance revealed that more girls in the treatment group reported performing BSE in the past month as well as a higher intention to perform BSE in the future.

Breast cancer screening adherence in African-American women

African Americans suffer a disproportionate burden of illness. Afrocentric, community-based health education programs that create permanent health resources within the community offer a viable means to reduce morbidity and mortality. This feasibility study randomized African-American cosmetologists into two groups of peer health educators and trained them to pass along health information to their clients. Cosmetologists in one arm were trained to become actively involved peer health educators, whereas, in the other arm, they were trained to be informed generally about the information they were passing along to their clients. An African-American ancestral storyteller refined the cosmetologists' storytelling skills to facilitate inclusion of key health facts and their repetition to others. Cosmetologists and their clients reported high acceptance of the cosmetologists as peer health educators. Cosmetologists preferred the active involvement in health education over the more passive role and reported no negative consequences to their business. Reported adherence to screening guidelines exceeded the Year 2000 goals for mammograms. Although the reported awareness of and training for breast self examination (BSE) were high, neither the cosmetologists' nor their clients' initial BSE skills suggested that prior teaching had occurred to the point of mastery. Clients reported their willingness to share their health-promotion information with other women. Although difficulties recruiting and retaining women to this research study were reduced by this Afrocentric model, they were not resolved entirely. Overall, this health-promotion model offers considerable promise as a way to reach African-American women with health-promotion information, whereas the feasibility study identified design modifications that will be necessary prior to project expansion. Cancer 1998;83:1836-1839. © 1998 American Cancer Society.

Breast self-examination proficiency in older women: measuring the efficacy of video self-instruction kits.

Older women represent the highest risk group for breast cancer but do not use screening at recommended frequencies. Age-sensitive screening programs addressing the developmental issues, unique value systems, and problems of access for all older women are critically needed. Television is an ideal medium for reaching isolated older women with health information and educational programs. This research explored the efficacy of using video self-instruction kits to increase breast self-examination (BSE) proficiency and knowledge about breast cancer among a sample of 62 women > 60 years of age. Participants were given breast health kits containing an instructional video, printed educational materials, a miniature lump model, and BSE skill checks. Before using the kits and 30 days later they were tested on measures of BSE proficiency and knowledge about breast cancer. Results indicate that the self-instruction programs had significant and positive impacts on the two BSE proficiency measures: skill demonstrations (t = 7.32, p < 0.0001) and lump detection using a simulation model (t = 4.23, p < 0.0001). Knowledge about breast cancer scores also improved from pretest to posttest. Implications for cancer nurses and direct outcomes from the research including newly designed instructional media materials are discussed.

Breast Self-Examination Proficiency: Attitudinal, Demographic, and Behavioral Characteristics

Despite public efforts to promote breast self-examination (BSE), few data exist that identify the skill level that women possess after formal BSE training. This investigation assessed BSE skill deterioration and identified critical factors that may contribute to BSE proficiency level. Data were collected on 57 women who voluntarily participated in a free BSE training program. The subjects completed a 68-item questionnaire and returned for a 30-min reevaluation of self-modeling BSE and examination of a breast model. Proficiency scores were obtained as they related to a woman's weeks posttraining, psychosocial, attitudinal, and behavior profile, and knowledge of breast cancer and BSE. A woman's BSE proficiency level deteriorates after initial training (r = −0.353, p = 0.004). Educational level (r = 0.253, p = 0.029) and age (r = −0.4094, p = 0.001) were significantly related to level of BSE proficiency. Approximately 17 weeks was determined as a critical time period posttraining for skill deterioration. Self-reported data collected from the questionnaire that had been used in previous studies to determine BSE proficiency were inaccurate in predicting observed BSE proficiency. Women should be taught proficiency of BSE by self-modeling and one-on-one training, and they should be reevaluated at 3-4 months. Special emphasis should be directed at offering BSE training to older women, women less educated, and those women at higher risk for developing breast cancer. Self-reported data appear to be unreliable in predicting a women's BSE proficiency. To address the true effect of BSE on cancer morbidity and mortality, an observed evaluation of a women's BSE proficiency should be defined and reevaluated at critical time periods posttraining.

Training and Maintenance of Breast Self-examination Skills

Maintenance of breast self-examination (BSE) skills is crucial to the effectiveness of self-exams in early detection of breast tumors. Although researchers have developed an effective technology for training in these skills, the actual maintenance of such skills remains questionable. The objective of this study was to evaluate the effects of reassessment (and retraining) on maintenance of BSE skills. Twenty-nine women (ages 25-64 years) were trained to complete BSE using the MammaCare training program. Experimental subjects were required to demonstrate their skills at a two-month reassessment and received retraining if their skills had declined below set standards. Measures of proficiency were obtained by requiring all subjects to examine breast models at pretraining, posttraining, and two follow-ups (four months and one year). Lump detection rates were significantly higher in the experimental group at both follow-ups. The control group showed a significant decrease in lump detection rates between posttraining and each follow-up. Results suggest that, after training, periodic reassessment (and retraining) could prevent significant deterioration of BSE skills.

Breast Self-Examination Skill and Frequency: A Review

Abstract For breast self-examination (BSE) to reach its potential as a screening method, it must be performed skillfully and regularly. In this review, we discuss both measurement and intervention issues relevant to BSE skill and adherence, including: (a) appropriate criteria for determining BSE skill, (b) training approaches for generalizing BSE skill, (c) potential problems with self-reported BSE frequency, and (d) interventions for encouraging long-term BSE frequency. Recommendations for future research on the specific topic areas are made.

Training Breast Self-Examination: A Research Review and Critique

Despite an increase in knowledge about breast cancer, a relatively low percentage of women practice breast self-examination (BSE) regularly and competently. This article reviews the BSE literature with a focus on training of BSE components, discrimination training, and the effectiveness of training procedures. Methodological issues such as the absence of control groups, lack of criteria for termination of training and reliance on self-reports of BSE frequency are identified weaknesses of BSE training studies. A theoretical analysis of BSE highlights potential difficulties in maintaining regular practice of BSE. Recommendations regarding training of proficient BSE skills and promoting regular practice of BSE are offered, and suggestions for further refinement of BSE training and directions for future research are discussed. Promising avenues of research in BSE training technology include discrimination training (on real or simulated breast tissue) together with computerized assessment of skill proficiency.

Practice and effectiveness of breast self examination: A selective review of the literature (1977-1989)

From a review of the literature on studies on breast self examination (BSE), it is evident that BSE functions as an effective preventive health behavior. Only 19% to 40% of women practice BSE on a monthly basis, and there is no strong evidence that women who practice monthly BSE perform the procedure correctly. Confidence in BSE performance, prior BSE instruction, and finding some way to remember to do BSE were the factors most positively associated with frequent BSE practice. Women need to be given the facts about breast cancer and information about early detection methods and also need to be taught BSE in such a way that they feel confident in their BSE skills. The most effective way to teach BSE is to teach the woman on her own breasts. Since BSE is a skill, an accurate assessment of the learners' BSE techniques is necessary to adequately evaluate BSE teaching methods.

Changes in breast self-examination behavior achieved by 89,835 participants in the canadian national breast screening study

Breast self-examination (BSE) behavior was analyzed in 89,835 participants in the National Breast Screening Study (NBSS) of whom 64,619 were eligible for annual rescreening and 25,216 were followed by mail after a single screen exam. Among those eligible for rescreening, BSE competence scores based on seven BSE criteria significantly improved over time and correlated directly with reported BSE frequencies. Among all participants, the proportion reporting BSE frequencies of greater than or equal to 12/year increased over time from approximately 20% on entry to 50% to 64% at final screen. Similarly, reports of zero frequency diminished from 50% to 10% to 15%. Variables such as educational status, age (fifth versus sixth decades), eligibility for mammography, smoking history, and ethnic origin had negligible or no influence on BSE competence. However, women with first-degree relatives with breast cancer had significantly higher BSE scores. NBSS experience suggests that most women who enter screening programs will upgrade their BSE skills if subjected to brief episodes of repeated BSE instruction.

Breast Self-Examination among College Women: Predictors for Cancer Control

Monthly breast self-examination (BSE) to aid in the early diagnosis of breast cancer is advocated for all adult women, but regular and competent practice is unusual. Our purpose was to explore the associations between young women's reported cancer history, BSE training, demographic variables (predictors), self-reported frequency of BSE, BSE skill level, breast lump detection ability, confidence, and anxiety (outcome variables). A general health history questionnaire was administered to 73 female university students, faculty, and staff. BSE skill and detection ability were measured by observation; confidence and anxiety ratings were obtained by interview. BSE frequency was predicted by employment status and cyclically enlarged breasts, while BSE skill was related to professional BSE training and the length of that training plus bra size. Surprisingly, BSE training was not found to be associated with self-reported BSE frequency. These analyses suggest that BSE training may result in more complete BSE (although well below acceptable standards) performed by women who are moderately confident and sensitive to the risk of breast cancer--but not in more frequent BSE.

Training Breast Self-Examination to Competence: Assessment of an Educational Program

The purpose of this study was to examine the effects of behavioral rehearsal training on breast self-examination (BSE) skills, confidence and anxiety levels. Fifty-one university women participated as the training group, 22 women served as the no-training comparison group. Pre- and post-training measures were obtained for each group. BSE skill was measured by direct observation and symptom detection ability was measured through breast model examination. Confidence and anxiety were measured by interview using a 6-point scale. The training group received thorough group instruction and individual BSE practice with feedback.The experimental group obtained a pre-test mean of 28% correctly performed BSE steps, which increased following training to 92% (P < 0.001). The control group showed essentially no change. BSE confidence increased and breast cancer anxiety decreased significantly in the experimental group, while the control group showed essentially no change. These results suggest that behavioral BSE train...

Comparison of Three Methods of Teaching Women How to Perform Breast Self-Examination

This paper presents results from an experimental study designed to evaluate the relative effectiveness of three methods of teaching women how to do breast self-examination (BSE). Frequency of BSE, confidence in examination performance, proficiency of BSE technique, and lump detection performance were the main outcome variables assessed. The three training methods compared in this study were provision of a pamphlet describing how to do BSE, having women view a videotape depicting proper performance of BSE, and having women practice doing BSE on a life-like breast model. Results showed that passive methods of BSE instruction such as the use of pamphlets or films were of little value in helping women develop the tactile skills necessary for proficient BSE. Three months after training, it was found that lump detection performance, as measured on silicone breast models, was significantly higher among those women who had been given an opportunity to practice doing the breast examination on a breast model with corrective feedback given by a BSE instructor. The opportunity to practice doing the examination with corrective feedback on performance appears to be a critical variable in the acquisition of BSE skill.

Determining Validity of Measuring the Quality of Breast Self-Examination

A study was undertaken among college women to validate written self-report of breast self-examination (BSE) technique by comparing it to demonstrations given to a trained observer. Nineteen steps within the three BSE positions were used as the norm for a competent BSE performance. The written self-report survey of BSE skill performance was then validated by comparing ratings obtained through such a self-report mechanism to ratings by trained observers. Findings indicated that the written report of BSE competency.underestimated the quality of the actual demonstration. Results of this study have demonstrated that self-report is highly correlated with observed performance (r = .62) and that the form of this relationship is consistent across the various levels of demonstrated performance skills. These findings strongly suggest that the self-report can be used as a good surrogate measurefor actual performance, as long as comparisons are made to the range of the self-reported and not to the ideal score.

Teaching Breast Self‐Examination in the High School

We are all familiar with the statistic that one in 1'5 women will develop breast cancer sometime in her life. Many women's worry about the possibility of breast cancer has become actualized. At present about 95% of breast cancer is detected by the woman herself; however, these discoveries occur so late that 60% of those lesions have already spread resulting in a less than favorable prognosis. Upon closer questioning many women acknowledged that the lump was found by a boyfriend or husband. A Gallup survey found that three out of four women who had heard about breast self-examination did not practice it. These women identified their own ignorance of the technique as their reason for inaction.' To reduce the risk of breast cancer women need increased skills and knowledge to do effective breast self-examination. Effective breast self-examination skills are vital for early detection of breast cancer. Once women know how to do monthly breast self-examinations they find it reassuring t o discover they are indeed healthy. Reaching women to teach them these skills, however, is difficult. A community project was undertaken to incorporate breast self-examination into the curriculum of two high schools in a suburban community. The authors decided to direct their efforts to the high school population because they seemed to be the ideal population for learning these skills. First, they are easily accessible. Second, research has found that good health habits are best established at an early age.* t 3 Learning this skill early is important because breast cancer can, though rarely, occur in the high school population. Another benefit is that high school students might share this information with older female family members who are at higher risk. In the authors' experience in teaching breast self-examination it seems the younger generation is more comfortable with touching their own bodies and is more easily influenced to practice breast self-examination. Incorporating breast self-examination in the high school curriculum along with other health teaching might have the long range effect of reducing the barriers of fear, ignorance and embarrassment sometimes accompanying this practice. For these reasons the authors firmly believe that the high school population should be exposed t o breast self-examination knowledge. Those who are in the education and health fields are faced with a two-pronged challenge. Women need t o learn breast examination skills, yet at the same time they need help to reduce the barriers toward practicing what they have learned. The Wayne County branch of the American Cancer Society found that the public health nurses were the most viable teachers and the high school p o p ulation, the most appropriate population. In the 1974-1975 school year they began a project to teach breast self-examination to tenth-grade females in Detroit. They chose this grade because of the large number of dropouts in the eleventh grade. They accomplished this task by teaching the breast self-examination content t o the public health nurses whose services are utilized by the schools in Detroit. The public health nurses enjoyed teaching this and also reported adult behavior on the part of the students. This program continued in the 19751976 school year. However, as of this writing this program has not yet been evaluated. Thus, we implemented a project in a local high school.