Perform Breast Self-examination Research Articles

Adherence to recommendations for clinical follow-up after benign breast biopsy.

Women who undergo a benign breast biopsy are at elevated risk for the subsequent development of breast cancer (BC). Therefore, appropriate clinical follow-up of a benign breast biopsy is important. The present study examines the extent and correlates of nonadherence with follow-up recommendations after a benign breast biopsy. Women (n = 114) who had undergone a benign breast biopsy completed an initial telephone interview within 50 days of their biopsy (mean = 21 days). Additional telephone interviews were completed at 4 and 8 months post-biopsy. Measures of BC risk perception, general and BC-specific distress, BC-related attitudes and beliefs, social support, optimism, and informational coping style were completed. Specific recommendations for clinical follow-up and evidence of actual follow-up were obtained from medical records. Of 103 women given a specific recommendation for clinical follow-up, 34% were classified as nonadherent with follow-up recommendations. Logistic regression analyses indicated that nonadherent women were characterized by younger age, recommendations for follow-up by clinical breast examination alone, greater confidence in their ability to perform breast self-examination properly, higher perceived personal risk for BC, and greater BC-specific distress. Despite the importance of appropriate clinical follow-up of a benign breast biopsy, about one-third of women did not adhere to recommended follow-up. Risk factors for nonadherence suggest potential avenues for interventions to enhance participation in appropriate clinical follow-up.

Breast Self-exams by Teenagers

Teaching breast self-care as breast changes occur in the adolescent girl can influence positive behaviors such as performing breast self-examinations and seeking regular professional breast examinations. Health promotion behaviors often are taught in high school, but little research has been performed on teaching breast health in a high school setting. Therefore, this descriptive study aimed to identify the beliefs, knowledge, and practices of breast self-examination in adolescent girls. A pre- and posttest design was used to determine whether a teaching program would change beliefs, knowledge, and practices of breast self-examination. The results of this study demonstrate that a one-time intervention can be successful in increasing breast self-examination practice and the knowledge of breast self-examination and cancer in adolescents. Before the intervention, approximately 66% of students said they never examined their breasts, and only 3% performed breast self-examination monthly. In 1 month after teaching, these percentages changed appreciably, with 32% of students reporting that they never practiced breast self-examination and 23% reporting that they practiced breast self-examination monthly.

Self-Efficacy and Rural Women's Performance of Breast and Cervical Cancer Detection Practices

Self-efficacy has become an important variable in multiple areas of human performance, including health behavior modification (Bandura, 1997). This study explores variables that lead to women's perceived self-efficacy in performing regular detection practices for breast and cervical cancer. A sample of southeastern U.S. farm women ( N = 206) completed surveys that assessed their perceived and actual knowledge of women's cancer detection practices, as well as their perceived social norms and perceived barriers related to obtaining these tests. Regression analyses of these data revealed that perceived peer norms and the barriers of time and embarrassment were significant predictors of women's confidence in their ability to follow through with cancer detection practices. Perceived knowledge and perceived family norms significantly predicted women's perceptions of difficulty associated with cancer detection practices as well as women's confidence in their skills to perform breast self-examination (BSE). Time was also a significant barrier to confidence in performing BSE. Implications for health communication campaigns are discussed.

Evoked fear and effects of appeals on attitudes to performing breast self-examination: an information-processing perspective.

The effect of fear arousal on attitude toward participating in early detection activities [i.e. breast self-examination (BSE)] was studied from an information-processing perspective. It was hypothesized that fear arousal motivates respondents to more argument-based processing of fear-relevant persuasive information. Respondents first read information about breast cancer in which fear was manipulated. After measuring fear arousal, respondents read a persuasive message about performing BSE. Analyses with reported fear, but not manipulated fear, found support for the hypothesis. Respondents who reported mild fear of breast cancer based their attitude toward BSE more on the arguments provided than respondents who reported low fear of breast cancer. This finding suggests that the use of fear arousal may be an efficient tool in health education practice. However, alternative interpretations are provided, in addition to the suggestion to be careful with using fear arousal in health education messages.

Factors associated with the use of breast and cervical cancer screening services among Chinese women in Hong Kong

We conducted a cross-sectional survey using a self-administered questionnaire among attendees of a well women clinic in Hong Kong during June and July 1998. The study aimed to examine the factors associated with the past and future use of screening services among Chinese women in Hong Kong and their perception of service providers. Of the 430 respondents (64% response rate), 87% were aged 31–50 y, 85% married, 93% attained education to upper secondary school level, and 96% were non-smokers. Nearly all respondents (99%) reported having sexual experience and most of them (87%) had such experience with only one partner; 59% reported having a pap-smear test, 28% a mammogram and 44% a breast self-examination. Women who were health conscious (ate a lower fat diet and performed regular exercise) were more likely to have used the screening service (mammogram and pap-smear test) and performed breast self-examination. Staff manner, privacy and cost were the most common contributing factors for respondent's desire for future use of the screening service. Respondents showed a preference for doctors (70%) over nurses (30%), and females (80%) over males (20%) as their service providers. The findings suggest the need to disseminate appropriate information on screening services among the public to dispel misconceptions about the preference for doctors over nurses and females over males. Improving clinician– and other staff–patient communication would be important for breast and cervical screening programs in Hong Kong. Public Health (2001) 115, 212–217.

Factors associated with the use of breast and cervical cancer screening services among Chinese women in Hong Kong

We conducted a cross-sectional survey using a self-administered questionnaire among attendees of a well women clinic in Hong Kong during June and July 1998. The study aimed to examine the factors associated with the past and future use of screening services among Chinese women in Hong Kong and their perception of service providers. Of the 430 respondents (64% response rate), 87% were aged 31–50 y, 85% married, 93% attained education to upper secondary school level, and 96% were non-smokers. Nearly all respondents (99%) reported having sexual experience and most of them (87%) had such experience with only one partner; 59% reported having a pap-smear test, 28% a mammogram and 44% a breast self-examination. Women who were health conscious (ate a lower fat diet and performed regular exercise) were more likely to have used the screening service (mammogram and pap-smear test) and performed breast self-examination. Staff manner, privacy and cost were the most common contributing factors for respondent's desire for future use of the screening service. Respondents showed a preference for doctors (70%) over nurses (30%), and females (80%) over males (20%) as their service providers. The findings suggest the need to disseminate appropriate information on screening services among the public to dispel misconceptions about the preference for doctors over nurses and females over males. Improving clinician– and other staff–patient communication would be important for breast and cervical screening programs in Hong Kong. Public Health (2001) 115, 212–217.

U.S. Women Physicians' personal and clinical breast cancer screening practices.

Little is known about predictors of physicians' personal or clinical compliance with breast cancer screening recommendations. We explored this in 4501 respondents to the Women Physicians' Health Study, a questionnaire-based study of a representative sample of U.S. women M. D.s. Overall, 21% of women physicians performed breast self-examination (BSE) at least monthly, about two thirds had received a clinical breast examination (CBE) within the last year, and 85% had received one within the last 2 years. Of those <40 years old, 14% had received a mammogram in the past year, as had 42% of those 40-49 and 59% of those 50-70 years old. Being a primary care practitioners or obstetrician/gynecologist was a significant predictor of counseling or screening for CBE and mammography. Only 46% of all women physicians reported discussing or performing mammograms at least once a year for those >/=50-</=75 years old, and 53% reported doing so for CBE. Also associated with performing CBE was examining one's own breasts at least once a year. Associated with mammography were having had a mammogram oneself in the past year and having a personal history of breast cancer. Other parameters, including age, ethnicity, region, practice type, practice site, control of work environment, work hours, amount of general continuing medical education (CME), career satisfaction, general health status, other breast disorders, personally having a recent CBE, or family histories of breast cancer or any other breast disorder, were not multivariately significantly associated with our counseling frequency outcomes. Women physicians may be especially efficient targets for breast cancer screening education.

Vicarious and persuasive influences on efficacy expectations and intentions to perform breast self-examination

How should public health campaign messages be designed to reach young women about the importance of practicing breast self-examination throughout their lives? To answer this question, an experiment was conducted by testing the impact of symbolic modeling and persuasive efficacy information on self-efficacy beliefs and intentions to perform breast self-examination. The effects of these modes of efficacy induction on fear arousal and response-outcome expectations also were assessed. Overall, symbolic modeling engendered greater efficacy expectations and behavioral intentions than did persuasive efficacy information, which in turn exceeded the control condition. Hypothesized differences among conditions on fear arousal and response-outcome expectations were not obtained. Theoretical implications for designing and pretesting breast self-examination messages during the planning and programming phase of the public relations campaign-management process are discussed. Ron Anderson is associate professor of advertising and faculty coordinator of the Program in Public Relations at the University of Texas at Austin.

Estrategias para la enseñanza del autoexamen del seno a mujeres en edad reproductiva

To develop an effective strategy to inform Mexican women between 12 and 47 years of age about breast cancer (BC) and train them to perform breast self-examination (BSE). Between April, 1996 and July, 1998, two different strategies to teach BSE were designed and evaluated in Cuernavaca, State of Morelos, Mexico. These strategies included teaching materials and were based on opinions of women participating in the first stage of this study. Both strategies consisted of the presentation of a leaflet and a video. The first strategy was delivered by a public health nurse in charge of leading the session. The second one was presented by a BC survivor. This second strategy included slides and silicon breast models. These two strategies were then compared to a third one, consisting of a primary care nurse handling out a leaflet and showing a video, based on Health Secretariat's guidelines. In total, 149 women were trained. They were randomly assigned to any one of these three strategies. The effectiveness of the teaching strategies was determined by assessing the changes in the women's knowledge of BC and BSE, as well as in their ability to identify the largest number of lumps on a natural size silicon breast, before and after training. Statistical analysis included Student's t test, variance analysis, McNemar's chi 2, Pearson's chi 2, and multiple linear regression. With all three strategies, there was an increase of approximately 30% in women's knowledge of BC and BSE as well as in their ability to detect lumps. Although at the beginning of the training only one out of every 20 women were able to identify more than three lumps in the silicon model, by the end between 3 and 4 of every 10 women were able to do this, with values of p < 0.05. Some factors determine women's learning of both BSE and information about BC as well as their ability to identify lumps. Teaching BSE with any of the strategies evaluated could be included in an integral program to educate Mexican women on breast cancer prevention and early detection. The appropriate and monthly practice of BSE is linked both to a decrease in the amount of time elapsing between the identification of suspect signs and the demand for medical care, such as requesting a clinical breast examination, which entails identifying small tumors when BC is present.

Austrian women's attitudes toward and knowledge of breast self-examination.

Education of women to perform breast self-examination is a main objective of cancer societies worldwide. By means of a questionnaire, 975 healthy women in an Austria-wide population-based cross-sectional study were asked about their knowledge of breast self-examination (BSE) and mammography, and their cancer histories. 92% of the women knew BSE but only 31% practiced it thoroughly. Women living in rural communities with a life companion and younger women were more likely to practice BSE. Women who had family histories of cancer, especially older women, performed BSE significantly more often. There was a trend towards increasing BSE with increasing personal perception of the risk of cancer, especially among older women. The study showed a positive association between BSE and screening mammography. Although knowledge of BSE is widespread, it is actually practiced by only one third of women. Older women but not young women carry out BSE significantly more often when they have family histories of cancer. Information campaigns should target specific groups and emphasize the effectiveness of properly done BSE.

Auto-exame das mamas entre estudantes de medicina

Objetivo: avaliar o nivel de conhecimento e pratica do auto-exame da mama entre os estudantes do curso medico e determinar possiveis fatores associados a esta pratica. Metodos: foi utilizado um questionario que continha informacoes sobre os alunos e o seu conhecimento a respeito do auto-exame, permitindo ainda, verificar entre as alunas a pratica do mesmo. Utilizaram-se os testes do qui quadrado e t de Student, quando aplicaveis, para verificar a associacao de alguns fatores com o auto-exame. Resultados: dos 348 questionarios respondidos, 55 (16%) pertenciam aos alunos do 5o ano (estudantes que haviam cursado a Disciplina de Ginecologia da Universidade Federal de Goias), 43% eram mulheres, 62% tinham familiares medicos e 17% apresentavam historia familiar de câncer de mama. Em relacao ao conhecimento do auto-exame, 95% conheciam o metodo. Das 149 estudantes, apenas 64% o praticavam. Os motivos para nao faze-lo eram: por ser muito jovem (24%), por nao acreditar que pudesse acontecer com ela (4%), por medo (9%) e por preguica (19%), sendo que 44% das alunas nao souberam explicar o motivo. Tanto o conhecimento quanto a pratica do auto-exame nao estiveram associados ao ano do curso medico, historia familiar de câncer de mama ou a presenca de familiar medico. Conclusao: o auto-exame e conhecido por praticamente todos os estudantes de medicina mesmo assim, um terco das estudantes nao o praticam. Com isso ressalta-se a importância do auto-exame no curso medico, a fim de que os alunos possam levar mais informacoes a populacao, nao limitando esta tarefa aos meios de comunicacao.

Registered Nurses' Breast Self-Examination Practice and Teaching to Female Clients

Many registered nurses (RNs) do not regularly perform breast self-examination (BSE), and even fewer routinely teach the procedure. The aim of this descriptive survey was to investigate registered nurses' BSE practice and teaching to female clients. A systematic random sample of 171 female Australian RNs aged 20 to 65 who worked in acute or long-term care areas was surveyed. A questionnaire I developed and mailed to participants was used to collect the data, and descriptive statistics were used in data analysis. Ninety-three percent of participants reported performing BSE in the preceding 12 months. However, less than half (46%) had performed BSE monthly, and the major reason cited for not performing monthly BSE was "forgetting" (57%). Most participants (81%) stated they did not include the teaching of BSE in their nursing care; the major reason identified was "it was not relevant to their work context" (86%). However, 77% indicated feeling confident in teaching BSE, and most (94%) would teach BSE if they had the opportunity. Furthermore, participants were found to be more likely to teach BSE if they performed monthly BSE, felt confident with their BSE teaching skills, and had completed other nursing courses. The implications of this study are that nurses' teaching to clients may be increased if more emphasis on BSE occurs in the workplace and in undergraduate and postgraduate courses. Also, the provision of BSE educational programs is necessary to increase nurses' knowledge, confidence, performance, and teaching of BSE.

“Preparing for patients”: Preparing tomorrows doctors

The purpose of this study was to examine factors predicting the practice of breast self-examination behaviour among Chinese women in Hong Kong using a cross-sectional survey research design. The Health Belief Model was used as the theoretical framework for the study to examine differences between breast self-examination practicers and non-practicers and among breast self-examination frequency groups. Data were collected from a convenience sample of 124 women using self-administrated questionnaires. Less than half of the sample practised breast self-examination and only 16% of the practicers performing breast self-examination monthly. There were differences between practicers vs. non-practicers and among breast self-examination frequency groups and some support of the predictive power of the Health Belief Model was found. Logistic regression showed that practicers perceived health as important, having fewer barriers and higher susceptibility to breast cancer. Discriminant function analysis revealed that barriers and children status were strong predictors of frequency of breast self-examination practice explaining 21.1% of the total variance in breast self-examination practice.

Factors associated with breast self-examination behaviour among Chinese women in Hong Kong

The purpose of this study was to examine factors predicting the practice of breast self-examination behaviour among Chinese women in Hong Kong using a cross-sectional survey research design. The Health Belief Model was used as the theoretical framework for the study to examine differences between breast self-examination practicers and non-practicers and among breast self-examination frequency groups. Data were collected from a convenience sample of 124 women using self-administrated questionnaires. Less than half of the sample practised breast self-examination and only 16% of the practicers performing breast self-examination monthly. There were differences between practicers vs. non-practicers and among breast self-examination frequency groups and some support of the predictive power of the Health Belief Model was found. Logistic regression showed that practicers perceived health as important, having fewer barriers and higher susceptibility to breast cancer. Discriminant function analysis revealed that barriers and children status were strong predictors of frequency of breast self-examination practice explaining 21.1% of the total variance in breast self-examination practice.

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.

Cosmetic saline breast implants: a survey of satisfaction, breast-feeding experience, cancer screening, and health.

Saline breast implants have been used for the past 30 years for cosmetic and reconstructive purposes. Data based on a large number of patients are needed to evaluate patient satisfaction, cancer screening practices, problems associated with breast-feeding, and health effects. We conducted a follow-up study of 292 cosmetic saline breast implant patients from Texas and Louisiana who consented to a telephone interview. Using a Likert scale, we measured the patients' degree of satisfaction with the implants. The results indicated that 80.5 percent were satisfied, 73.3 percent would recommend saline breast implants to others, and 65.1 percent felt that implants improved their quality of life. The extent of satisfaction was independent of the number of additional surgeries, age at implant, and follow-up time. Mammography use and breast self-examination were reported with high frequency in this survey. Ninety-one percent of study participants who were between 40 and 49 years of age at time of interview and 94 percent of those 50 or older reported having had at least one mammogram. Breast self-examination was practiced by 75 percent of the women, and 61 percent reported checking their breasts at least once a month. Of the 46 women who had children after augmentation, 28 reported breast-feeding and 8 (28.6 percent) reported having implant-related problems. The patients were asked to provide information regarding a series of conditions for which they sought medical attention. They reported: atypical rheumatoid syndrome (n = 1), Sjögren syndrome (n = 1), atypical autoimmune disorder (n = 1), and chronic fatigue syndrome (n = 2). Overall, women who elected to have saline breast implants were satisfied with their augmentations, had mammograms and performed breast self-examinations more often than nonaugmented women. A few had problems when breast-feeding that could be related to their implants. There were no reports of breast cancer, but five women reported autoimmune conditions.

Implementation Intentions and the Theory of Planned Behavior.

This study concerns the implications of Peter Gollwitzer's concept of implementation intentions for Icek Ajzen's theory of planned behavior. Attitude, subjective norm, perceived behavioral control, and intentions were assessed before an intervention that required subjects to make implementation intentions concerning when and where they would perform breast self-examination during the next month. Behavior was assessed by self-report 1 month later. Results supported Gollwitzer's contention that goal intentions that have been supplemented by implementation intentions concerning where and when the behavior is to be performed are more likely to be enacted. Evidence suggested that implementation intentions were effective because they provided a mechanism that facilitated the retrieval of intentions in memory. Implementation intentions also reduced the capacity of past behavior to predict future behavior, suggesting that implementation intentions mimic the effect of habit in human action. Implications for applications of models of attitude-behavior relations are outlined.

Perception of breast cancer risk and psychological distress in women attending a surveillance program

Women at high risk of developing breast cancer who attend surveillance programs (SP) overestimate their risk and are highly anxious; those who are anxious are less likely to perform breast self-examination (BSE). We attempted to determine if counseling by a breast surgeon could increase women's accuracy of risk perception and hence decrease their anxiety and increase their likelihood of performing BSE. We also tested the efficacy of a series of four informative newsletters in reducing anxiety. All 145 women who scheduled an initial appointment during one year for our SP were asked to participate; 94 women completed a self-report questionnaire containing validated instruments before their first SP visit. Of these, 41 women were randomly selected to receive the newsletter. Women were mailed follow-up questionnaires at 2 and 4 months after their initial visit. Of the sample, 76% overestimated their risk of developing breast cancer by at least doubling their actual risk as measured with empiric risk tables. Their psychological distress was between 0.5 to 1 standard deviation above normative scores. Being older and having greater confidence in the ability to perform BSE were the only variables that predicted performance of BSE. A follow-up assessment performed 4 months after the initial visit showed a significant improvement in the accuracy of perception of risk (p < 0.01) and a reduction of cancer anxiety (p < 0.05), but no significant change in performance of BSE. The newsletters produced no significant effect. Women attending a breast surveillance program showed a significant improvement in their ability to estimate the risk of developing breast cancer and a reduction in their anxiety after counseling, but no significant change in performance of BSE. The possibility that improvement in risk perception and reduction of cancer anxiety can lead to greater adherence to screening behaviors needs to be tested with a larger number of women and over a longer time period.

Knowledge, attitudes, and patterns of cancer screening: a self-report among foreign born Hispanic women utilizing rural migrant health clinics.

Hispanics are the fastest growing minority in the United States and are currently Washington state's largest minority, with the highest growth rates found in the rural agricultural areas of eastern Washington state. Because breast and cervical cancer mortality rates are higher in Hispanics than other U.S. women, subgroups of Hispanic women with the lowest cancer screening utilization rates need to be identified and targeted for cancer control intervention to most effectively reduce late-stage cancer diagnoses and mortality. A study was conducted at six migrant health clinics located throughout eastern Washington state to discern age-specific proportions for utilization of mammography, breast self-examination, and Pap smears among Hispanic migrants to the United States. Knowledge and attitudes regarding these procedures also were assessed and face-to-face interviews were completed with 512 women. Among women 20 years or older, 15 percent had never heard of a Pap smear, only 78 percent had ever received a Pap smear, and only 44 percent had received a Pap smear within the prior year. In all, 73 percent of the women had been taught breast self-examination, 62 percent performed breast self-examination, and 41 percent had performed a breast self-examination in the prior month. Among women 40 years or older, only 38 percent had never heard of a mammogram, 38 percent had ever received a mammogram, and only 30 percent had received a mammogram in the prior two years. Cost was reported as a major barrier for screening in this population. Additionally, a substantial proportion of the women perceived Pap smears and mammography as unnecessary or diagnostic procedures, rather than preventive health measures.

Breast cancer worry and screening: some prospective data.

Breast cancer concerns were measured among 353 women, ages 40-75, from North Dakota. One year later, participants were recontacted and asked about their screening behavior during the previous year. Greater concern about breast cancer, even the highest level of concern, was related to a higher likelihood that women performed breast self-examination, had a mammography screening, and had a clinical breast examination. These data do not support the idea that worry inhibits action; instead, they suggest that nonpathological worry motivates self-protective behavior.