Teaching Breast Self-examination Research Articles

Breast self-examination education for BRCA mutation carriers by clinical nurse specialists.

Breast self-examination (BSE) may be beneficial for women with a BRCA1 or BRCA2 mutation. Therefore, these women are often advised to perform BSE. However, only 20% to 35% is performing BSE monthly, and proficiency levels are low. Recently diagnosed carriers are educated by a specially trained clinical nurse specialist (CNS) on how to perform BSE, as part of the yearly surveillance. Clinical nurse specialists are already commonly involved in breast cancer care. However, CNSs are not yet involved in the counseling of BRCA mutation carriers. The aim of this RCT was 2-fold: (1) to evaluate the feasibility of CNS-led BSE education (based on the Health Belief Model) as part of BRCA surveillance and (2) to evaluate the effects and feasibility of additional written information leaflets concerning BSE. Thirty-seven female BRCA1 or BRCA2 mutation carriers were randomized into the intervention or control group. Women in both groups were educated about BSE by a specially trained CNS during the yearly visit to the outpatient clinic. The intervention group received additional written BSE instructions. After 3 months, 29 patients filled out a questionnaire, covering demographic characteristics, BSE behavior, and patient satisfaction. The BSE frequencies did not significantly differ between both groups. A significant increase in the self-reported frequency of BSE after CNS-led education (P < .001) was shown. Before the education, the main reason for not performing BSE was that women had felt unable to perform BSE (42.9%). Patient satisfaction with the CNS-led education was high. CNS-led BSE education is feasible for the yearly breast surveillance of BRCA mutation carriers. In addition, a leaflet was shown to be useful as an additional source of information for patients. These results indicate that it is feasible to involve a CNS in the yearly surveillance of BRCA mutation carriers, which could be a solution for the continuous increased demand for care, while providing continuing high-quality care.

Health care professionals’ practices, perceptions, and awareness regarding breast self-examination.

14 Background: In 2009, the United States Preventive Services Task Force (USPSTF) published the revised guidelines for breast cancer screening which recommended against teaching breast self-examination (BSE).The objective of this study was to assess healthcare professionals' practices, perceptions and knowledge in BSE as well as their adherence to the newly revised USPSTF guideline for BSE. Methods: A cross-sectional survey study was carried out in five medical and gynecological practices affiliated with a large academic teaching hospital in western Massachusetts. The survey was sent to all attending- and resident-physicians, nurse practitioners (NPs), physician assistants (PAs), and registered nurses (RNs) working in these medical practices.The survey collected demographic data and inquired about practitioners’ awareness and perceptions of the 2009 USPSTF guidelines. Results: The survey completion rate was 50.7%. Fewer than half of respondents correctly identified the 2009 USPSTF guidelines recommendations for BSE (41.4%). However, among 35 respondents who stated they were aware of USPSTF guidelines, only 37.1% adhered to them. Overall, 70% (95% CI 61.3%, 79.1%) stated that they do teach patients to perform BSE. The most frequent reasons cited for teaching BSE were: “early detection of cancer” (48.0%), and to “empower women”, (37.0%). In univariable analyses, female practitioners were significantly more likely than male practitioners to report teaching BSE (OR 2.64, 95% CI 1.11, 6.29). Other characteristics which showed an association without reaching statistical significance were: ≥ 5 years of practice (OR 1.67, 95% CI 0.70, 3.98); non-physician practitioner (OR 3.5, 95% CI 0.82, 14.93); US Med School (OR 2.20, 95% CI 0.84, 5.75); ever detecting a lump in a patient (OR 2.95, 95% CI 0.80, 10.87), and belief that BSE reduces morbidity and mortality (OR 2.12, 95% CI 0.84, 5.37). Conclusions: Knowledge of, and adherence to, the 2009 USPSTF guidelines related to BSE are relatively low. Despite being aware of the guidelines, some health professionals still taught BSE. Greater efforts should be made to educate healthcare professionals about the 2009 USPSTF guidelines on BSE.

Effectiveness of online education in teaching breast self- examination.

This research evaluated the effectiveness of an online education model in teaching breast self- examination to university staff and students. 1,679 women participated in a breast self-examination online training program. Breast self-examination knowledge evaluation forms developed by Maurer (1997) were used in the research and were evaluated on a 100 point scale. Paired t-test and McNemar's Test statistics were employed. The participants scored an average of 46.5 (14.0%) on knowledge on breast self-examination before training, but 77.4 (11.0%) one month after education and 76.7 (9.52%) after six months. There was a clear significant difference between these knowledge levels (p<0.05). Similarly, while the rate for systematic practice of breast self-examination among women was 30.8% before training it increased to 47.8% afterwards. Again the difference was significant (p<0.05). Online education is an effective method for teaching breast self-examination to women.

Effect of Direct Education on Breast Self Examination Awareness and Practice among Women in Bolu, Turkey

To evaluate breast self examination (BSE) practice and the effect of a training program conducted by healthcare professionals on BSE. Women were randomized into control and test groups with both groups completing a questionnaire and three independent interviews where their BSE practices were evaluated. In all, 39.5% of the participants were previously provided information on BSE by healthcare professionals while 25.8% had no knowledge of BSE prior to enrollment. Compared to those informed about BSE through other means such as television, radio, and the internet, the scores of the first, second, and third visits were higher (p<0.05) in individuals who received BSE education from healthcare professionals and hospitals. BSE training provided by healthcare professionals may increase early breast cancer diagnosis and treatment rates by improving BSE awareness and practice.

32 Practice Trends in Management of Breast Cancer in Developing Country-India

Methods and Materials used: 1. Lectures on the causes and prevention of breast cancer 2. Talks aimed at demystifying Breast Cancer as an incurable disease 3. Teaching of Breast Self-Examination 4. Education on the superstition associated with breast cancer 5. Pictures and Flyers showing breast screening for the guidance or attendees 6. Testimonies by Survivors; Question and Answers section 7. Clinical Breast Examination of attendees Results: Certainly, the number of patients presenting with late stage cancer is on the decline on account of education and the screening exercise mounted by Breast Care International (BCI). Attitudes of patients who would not visit health facilities for medical examination and treatment have changed following adequate conscientisation in the mind and attitudes of patients. Conclusion/implications: Women diagnosed with Breast Cancer are encouraged to visit hospitals for medical examination and treatment, since breast cancer is captured under the National Health Insurance Scheme. The myth and misconceptions surrounding Breast Cancer as an incurable disease are on the decline. More women voluntarily visit health facilities whenever they experience any disorder in their breasts. The need to train more nurses in Oncology is very demand driven.

The role of clinical breast examination and breast self-examination

The efficacy of screening by clinical breast examination (CBE) and/or breast self-examination (BSE) is reviewed using indirect evidence from randomized breast screening trials and that from observational studies. In countries where breast cancer is diagnosed at an advanced stage, screening by CBE with the teaching of BSE as an integral component will probably be effective in reducing breast cancer mortality. However, in technically advanced countries where adequate treatment is given, no screening modality is likely to be sufficiently beneficial to outweigh the harms of screening, especially false positives and over-diagnosis.

Physician knowledge of and adherence to the revised breast cancer screening guidelines by the United States Preventive Services Task Force

We sought to assess knowledge and adherence to the revised US Preventive Services Task Force breast cancer screening guidelines among gynecologic care providers. This was a cross-sectional descriptive study based on a survey conducted among gynecologic care providers. Forty providers completed the survey (80%). In response to the statement "The current recommended age to initiate breast cancer screening is … .," 48.7% of providers responded in accordance with revised guidelines. For the statement "Women between the age of 50 and 74 years old are recommended to have screening mammography," 46.2% of respondents answered in accordance. In response to the statement "The United States Preventative Services Task Force recommends teaching breast self-examination," 71.8% of providers responded in accordance. A total of 37 respondents (92.5%) stated that they were aware of the revised guidelines, but 17 (42.4%) stated that they were applicable to their patient population. Knowledge of the revised guidelines appeared to be relatively low in our provider sample.

Knowledge, Attitude, and Practice of Obstetric Nurses in Relation to Breast Cancer and Breast Self-examination.

This study aims to determine obstetrics nurses knowledge, attitude, and practice about breast cancer and breast self-examination (BSE), and to contribute to the early detection of breast cancer during breastfeeding periods. For the survey, 163 individuals (obstetric nurses) were chosen by convenience sampling and agreed to participate in the study. Their knowledge, attitude, and practice about breast cancer and BSE. Knowledge and attitude averaged 70.45+/-10.90 (of 100) and 3.64+/-0.27 (of 5), respectively. While most nurses (99%) recognized the importance of BSE, only 58.9% experienced BSE. BSE practice level averaged 8.35+/-1.96 (of 12). Only 20.2% had recommended BSE to their clients. Practice level varied significantly for different marital status, breastfeeding experience, and education, while knowledge and attitude remained independent. Nurses who had experienced mammogram or breast ultrasonogram themselves scored higher in knowledge. Attitude was higher for nurses who received recommendation for BSE, performed BSE, received BSE education, or recommended BSE to clients. Practice level was higher for nurses who received BSE education or willing to perform BSE in future. Practice level had a positive correlation with attitude but no correlation to knowledge. Obstetric nurses need continuing education for practicing BSE. Practical BSE education can not only promote preventive behavior of nurses, but it can also improve the breast health management of obstetrical clients.

Updated recommendations for breast cancer screening

To describe the rationale behind the new recommendations for breast cancer screening issued by the U.S. Preventive Services Task Force (USPSTF). The USPSTF reviewed new summary evidence provided by the Oregon Evidence-based Practice Center and the Cancer Intervention Surveillance and Modeling Network about benefits and harms including radiation exposure and the likelihood of false-positive testing, unnecessary biopsies and treatments that may not impact overall breast cancer mortality. The USPSTF concluded maximal benefit in breast cancer mortality with least harms can be achieved with biennial mammography screening commenced at age 50 and continuing until age 74 years. A small additional benefit could be realized if screening starts at age 40 years. The USPSTF concluded that the decision to start biennial screening before age 50 years should be a personal one and take into account individual patient context, including an individual's values regarding specific benefits and harms. Evidence from large-scale randomized trials led the USPSTF to recommend against the teaching of breast self-examination. The USPSTF found insufficient evidence to recommend for or against performing clinical breast examination.

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.

Nursing clinical trial of breast self‐examination education in China

The aim of this study was to test community-based nursing education about breast self-examination to see whether self-examination frequency could be increased. Breast cancer rates in China are rising rapidly, especially in cities. The majority of Chinese women does not know about breast self-examination, and the Chinese health care system cannot provide mammograms for the millions of at-risk women throughout China. This study was a randomized clinical trial of nurse-provided, community-based teaching of breast self-examination in the urban and rural areas of Tianjin and urban and suburban areas of Shanghai. Women (n = 1510) never diagnosed with breast cancer and 40 years and older were randomized by community and stratified by urban vs. other residences. At baseline, 9% of the intervention and 6% of the control groups did breast self-examination at least every other month. After 12 months, 34% of the intervention, but only 11% of the control, group did breast self-examination that often (P < 0.001). There was a significant impact in urban, suburban and rural areas, and intervention effects were stronger than any of the other influences tested. The clinical trial showed a statistically significant increase in breast self-examination after the nursing education intervention. As no other breast cancer screening method is available in most of China, this method is best suited for the masses of people currently at risk in China.

The Comparison of Factors related to Performance of Breast Self-examination by Age Group in the Middle and Mature Aged Woman.

This study aims to identify differences in breast self-examination (BSE) performance and influencing factors between woman-groups under and over 45 years old. The subjects were 152 women aged from 35 to 65, who were recruited through convenient sampling in a metropolitan city. They were divided into two groups: under and over 45 years old. The data were collected using self-reporting questionnaires and analyzed by chi-square test, t-test, Pearson's correlation coefficient, and stepwise multiple regression. Experience of BSE education (chi-square=4.68, p=.030), BSE performance (chi-square=20.12, p<.001), confidence (t=-2.97, p=.003), and self-efficacy (t=-2.44, p=.016) were significantly higher in the group over 45 years (the older group) than the one under 45 years (the younger group). Self-efficacy (beta=.346, p=.004) and susceptibility (beta=.238, p=.002) were 17.6% of the variance in the younger group's BSE performance. On the other hand, significantly influencing factors on the older group's BSE performance were self-efficacy (beta=.500, p<.001) and BSE education (beta=.217, p<.001), which accounted for 25% of the variance in the BSE performance. We conclude that differentiated strategies of considering age should be established in nursing intervention to detect breast cancer early.

Breast self-examination: defining a cohort still in need

Background The value of breast self-examination (BSE) to detect early breast cancer is controversial. Methods Within an institutional review board–approved prospective study, 147 high-risk women were enrolled from 2004 to 2007. Yearly clinical examination, BSE teaching, and mammography were performed simultaneously followed by interval breast magnetic resonance imaging (MRI). Women underwent additional BSE teaching at 6 months. Women reporting a mass on BSE underwent clinical evaluation. Results Fourteen breast cancers were detected in 12 women. BSE detected 6/14 breast cancers versus 6/14 detected by MRI and 2/14 by mammography. Of 24 masses detected by BSE, 6/24 were malignant. The sensitivity, specificity, and predictive value of BSE to detect breast cancer were 58.3%, 87.4%, and 29.2%, respectively. The sensitivity, specificity, and predictive value of a Breast Image Reporting and Data System (BI-RADS) score of ≥4 on MRI were 66.7%, 88.9%, and 34.8%, respectively. Conclusions BSE detects new breast cancers in high-risk women undergoing screening mammogram, CBE, and yearly breast MRI.

Teaching breast self-examination through pantomime: a unique approach to community outreach.

Cancer educators should pursue strategies to improve African American women's adherence to breast cancer screening. Successful educational approaches consider the cultural context and belief systems of African Americans. Storytelling provides a forum in which women teach one another through personal testimony. The Witness Project of St. Louis created an innovative approach to storytelling, pantomime, which is visually effective in conveying the story of how to perform breast self-examination (BSE). Pantomime offers a powerful message of the importance of regular BSE.

A Brief Intervention Designed to Increase Breast Cancer Self-Screening

To assess the efficacy of an intervention designed to increase appropriate use of breast self-examination (BSE). Two-armed randomized clinical trial of cancer-control interventions in women that compared a BSE intervention program to a dietary intervention, which served as the control group. The study was conducted at a large health maintenance organization in Portland, Oregon. Participants were 616 female members of the health maintenance organization who were aged 40 to 70 years. The intervention consisted of a 30- to 45-minute individual counseling session that featured BSE instruction, training and practice with silicone models, identification of barriers to BSE, and problem-solving. This intervention was followed by two brief follow-up telephone calls. The study outcome measure was self-reported BSE practice, which included duration, frequency, and specific elements of exam. The study had a 90% response rate. At the 1-year follow-up, chi2 analyses showed that significantly more individuals in the BSE intervention (59%) reported adequate BSE performance compared with those in the control group (12.2%; p < .001). This brief intervention was successful in encouraging women to perform adequate BSEs. Although the role of the BSE in patient care remains controversial, these results show that even brief intervention programs can be effective at encouraging self-screening for cancer. This intervention could easily be modified to target other screening practices (e.g., skin or testicular cancer screening) that are associated with reduced cancer morbidity and mortality.

A Different Approach to Breast Self-Examination Education

Breast cancer is a common cancer among women, and early detection is important for breast cancer mortality and morbidity. The aim of this study was to determine the effects of daughters teaching their mothers about breast self-examination (BSE) and its health beliefs. In the study's first stage, 168 university students were trained by the School of Health students about BSE through group training methods. Then, these trained university students were asked to train their mothers about BSE. Data were collected before the training and then again after the training (1 month later). The study instruments included questionnaire forms and the Champion Health Belief Model Scale. The results were analyzed using paired- and unpaired-sample t test, analysis of variance, bivariate correlation analysis, and stepwise multiple regression analysis. The results show that women's knowledge level increased 2-fold after training, and the knowledge level difference between pretraining and post-training was significant (P = .000). The mothers' background information (hear-read) and BSE practice (P = .006 and .006, respectively) before the training process were found to be significant predictors of sociodemographic and other variables influencing the mothers' knowledge levels. The training increased the perceived benefit (P = .032) and confidence (P = .000) significantly. It was found that there was a negative but significant correlation between perceived barriers and BSE knowledge after the education (P = .019). It was found that mothers' knowledge level about BSE was higher after the education. Furthermore, perceived barriers decreased while other subscales increased. Education from daughter to mother can be used as a BSE training approach to increase women's knowledge about BSE.

Prospective analysis of the long-term effect of teaching breast self-examination and breast awareness

Breast cancer is the most common cancer in women in the industrialized world and a leading cause of death. Breast self-examination (BSE) is one of the methods for an early detection of breast cancer. In the present study the effectiveness of a campaign promoting BSE and breast awareness was analysed. Seminars were conducted in 2003 in Lower Saxony, Germany by a female gynaecologist and a social pedagogue and included a lecture, an individual training in BSE in a separate room and a talk about the importance of regular BSEs. Questionnaires were handed out immediately after the seminar and were sent by post 1 year later. Attendance of the seminar resulted in a significantly higher percentage of monthly BSEs (21.4% before vs. 61.9% after the teaching). Furthermore, 92.1% of the women who did not perform a monthly BSE stated that at least they examined their breasts more frequently after attending the seminar. The data demonstrate that the seminars in BSE had profound effects on the compliance of women in carrying out BSE regularly and correctly, without influence of age or education.

Temporal trends in breast cancer presentation in the third world.

BackgroundThird world breast cancer is characterized by late presentation, occurrence at relatively young ages and dismal mortality. This poor outcome has encouraged patients to patronize quacks and alternative healers. Public control measures have targeted mainly public education and provision of screening facilities. Recent reports from the developed world indicate a high association with obesity, tobacco and alcohol, habits which though not currently very popular in the third world are nevertheless increasingly accepted.MethodsA prospective study initiated in 1985 for all breast cancer patients attending 4 hospitals located in the Eastern Nigeria heartland where the author practiced. On attendance to hospital detailed epidemiological data including social habits were collected from patients.ResultsReports from our first series [1987–97] showed some improvement in terms of earlier presentation compared to a historical control of earlier reports from the sub-region. Reports from the present study showed that this improvement has not been maintained probably as a result of diversion of public health campaign finances to HIV/AIDS. However there is an increasing mean age of presentation due to a higher representation of above 70 years age group and a significant reduction in parity. Alcohol intake and smoking have remained at low levels among the patients.ConclusionThere is need to take another look at cancer public health campaign mechanisms in the face of competing demands from HIV. Public control measures should include among others teaching of Breast Self Examination [BSE] to patients, Clinical Breast Examination [CBE] to health workers and opportunistic CBE to all patients. Strenuous efforts should be made to break the vicious cycle of late presentation, poor treatment outcome and reluctance of patients to present to health facilities because of poor outcome.

Audit of a radiographer/nurse-led family history breast cancer clinic

Following the publication of National Institute of Clinical Excellence (NICE) guidelines for familial breast cancer [1], we implemented nurse-led and radiographer-led family history clinics. These replaced a formerly ad hoc system of general practitioner mammogram requests and referrals to the surgical breast clinic. At the clinic, women were assessed as to their level of increased risk of breast cancer by a detailed family history. They were taught breast self-examination and were put onto appropriate mammography surveillance when indicated or were reassured and discharged. The majority of referrals were from general practitioners – 62% of women were found to be in the high (23%) and moderate (39%) risk categories. Thirty-eight per cent of patients were found to be at population risk (24%) or were inappropriate referrals. In conclusion: (1) nurse/radiographer-led family history clinics are effective and an efficient use of resources; (2) there is a high degree of client satisfaction; and (3) there are a significant number of referrals that were not indicated according to NICE guidelines, and action is required to address this issue.

The Effects of Breast Self-Exam Education on The Performance of Nursing and Midwifery Students: A 6-Month Follow-Up Study*

Background. Late detection of breast cancer is still a leading cause of morbidity among patients. We aimed to evaluate the efficacy of preplanned breast self-examination (BSE) training on nursing and midwifery students. Methods. A total of 74 first-year nursing and midwifery students were trained on BSE. Data were collected before and after BSE education by a modified questionnaire. Results. The BSE accuracy of the students was increased after education. Furthermore, positive attitude and behavior of the students toward BSE were improved. The students started to practice BSE with the right techniques and positions at the right time. The main reasons not to perform BSE were the lack of knowledge and motivation prior the education. Conclusions. BSE training is effective in nursing and midwifery students but should be repeated periodically for better efficacy. J Cancer Educ . 2007; 22:77–79.