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Self Breast Examination: A Tool for Early Diagnosis of Breast Cancer

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Abstract

Breast cancer is a global health concern and a leading cause of morbidity and mortality among women. It has been identified as a major public health problem in both developed and developing nations because of its high incidence-prevalence, over-burdened health system and direct medical expenditure. Studies have shown that in most of the developing nations breast cancer is diagnosed in advanced stages of the disease when compared with developed nations and thus has a poor outcome and high fatality rate. This paper aims to check the effectiveness of breast self-examination in early detection of the breast cancer. In addition, it plans to consider all the factors which hampers with the uptake of the technique and what all could be planned to improve the current scenario. An extensive search of all materials related to the topic was made using library sources including Pubmed, Medline and google scholar searches. Keywords used in the search include breast self-examination, barriers in breast self- examination and breast cancer. Breast self-examination (BSE) has been identified as the only realistic approach in early detection of breast cancer in developing nations. A wide knowledge-application gap has been observed across the globe between the knowledge and the actual practice of BSE. Multiple socio-demographic factors, myths, cultural beliefs, lack of accessibility to the health care services have been identified as the reasons for the poor uptake of BSE. Considering the potential of BSE, there is an immense need for a public health education program to inculcate the practice of breast self-examination among women to minimize the fear, denial, myths and misconceptions. This requires a sustained political commitment and further studies to recognize the perceived barriers which are interfering with the uptake of BSE so that the greatest challenge of late presentation can be curbed and the chances of survival improved.
American Journal of Public Health Research, 2013, Vol. 1, No. 6, 135-139
Available online at http://pubs.sciepub.com/ajphr/1/6/2
© Science and Education Publishing
DOI:10.12691/ajphr-1-6-2
Self Breast Examination: A Tool for Early Diagnosis of
Breast Cancer
Saurabh RamBihariLal Shrivastava*, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
Department of Community Medicine, Shri Sathya Sai Medical College & Research Institute, Kancheepuram, India
*Corresponding author: drshrishri2008@gmail.com
Received June 14, 2013; Revised June 20, 2013; Accepted June 22, 2013
Abstract Breast cancer is a global health concern and a leading cause of morbidity and mortality among women.
It has been identified as a major public health problem in both developed and developing nations because of its high
incidence-prevalence, over-burdened health system and direct medical expenditure. Studies have shown that in most
of the developing nations breast cancer is diagnosed in advanced stages of the disease when compared with
developed nations and thus has a poor outcome and high fatality rate. This paper aims to check the effectiveness of
breast self-examination in early detection of the breast cancer. In addition, it plans to consider all the factors which
hampers with the uptake of the technique and what all could be planned to improve the current scenario. An
extensive search of all materials related to the topic was made using library sources including Pubmed, Medline and
google scholar searches. Keywords used in the search include breast self-examination, barriers in breast self-
examination and breast cancer. Breast self-examination (BSE) has been identified as the only realistic approach in
early detection of breast cancer in developing nations. A wide knowledge-application gap has been observed across
the globe between the knowledge and the actual practice of BSE. Multiple socio-demographic factors, myths,
cultural beliefs, lack of accessibility to the health care services have been identified as the reasons for the poor
uptake of BSE. Considering the potential of BSE, there is an immense need for a public health education program to
inculcate the practice of breast self-examination among women to minimize the fear, denial, myths and
misconceptions. This requires a sustained political commitment and further studies to recognize the perceived
barriers which are interfering with the uptake of BSE so that the greatest challenge of late presentation can be curbed
and the chances of survival improved.
Keywords: breast cancer, breast self-examination, risk factors, screening, awareness
1. Introduction
Breast cancer is a global health concern and a leading
cause of morbidity and mortality among women [1,2,3,4].
It has been identified as a major public health problem in
both developed and developing nations because of its high
incidence-prevalence, over-burdened health system and
added direct medical expenditure [5,6,7,8]. Trend analysis
of breast cancer indicates a rise by 50-100% in the
incidence of breast cancer in last 20 years [9]. Breast
cancer in men is uncommon, accounting for less than 1%
of all breast cancers but rise in incidence of male breast
cancer has also been demonstrated [10,11]. Breast cancer
can be distinguished from other cancers by the fact that it
occurs at a site which can be easily noticed and thus liable
for early detection & treatment [12]. The incidence,
mortality and survival rates for breast cancer vary across
the globe because of underlying differences in known risk
factors, availability of organized screening programs and
access to effective and affordable treatment modalities [1].
However, fatality rates tend to be higher in low-resource
countries [13,14].
Breast cancer associated morbidity and mortality can be
reduced through early detection by means of screening
programs [15], as it not only increases the chances for
successful treatment and cure of the disease [16,17], but
also improves chances of survival and lessens the need of
invasive treatment [18]. Ensuring availability of early
diagnostic & screening services and taking immediate
steps have been regarded as the two main strategies for
warranting improvement in the prognostic outcome
[19,20,21].
Studies have shown that in contrast to the developed
nations most of the developing nations have recorded a
poor outcome and high fatality rate owing to diagnosis of
the breast cancer in advanced stages [22,23,24,25,26,27,28].
In-fact, in a study done in India, five-year survival rate
was 56% among patients diagnosed with breast cancer at a
later stage in comparison to 85% for cases diagnosed early
[29]. Implementation of the preventive measures has been
acknowledged as the main tool in the fight against breast
cancer worldwide. Globally, breast self-examination
(BSE), clinical breast examination (CBE) and
mammography are the recommended screening test for
early detection of breast cancer. Due to lack of access to
diagnostic facilities, especially for women in low resource
settings, it is essential to empower them with BSE as a
primary modality for screening [28,30]. This review
article aims to review the effectiveness of breast self-
examination in early detection of the breast cancer. In
136 American Journal of Public Health Research
addition, it plans to consider all the factors which hampers
with the uptake of the technique and what all could be
planned to improve the current scenario.
2. Materials and Methods
An extensive search of all materials related to the topic
was made using library sources including Pubmed,
Medline, World Health Organization website and Google
scholar searches for one month. Relevant documents,
technical publications series, systematic reviews, research
articles focusing on practice of breast self-examination
published in the period 1980 2013 were included for the
review. The identified articles were then re-grouped into
different sections viz. risk factors and clinical features of
breast cancer; significance of breast self-examination;
practice of breast self-examination; impact of socio-
demographic factors on performance of breast self-
examination; role of nurses’ in advocating breast self-
examination; impediments in breast self-examination; and
implications for practice and research. Keywords used in
the search include breast self-examination, barriers in
breast self-examination and breast cancer.
3. Breast Cancer: Risk Factors and
Clinical Features
The etiology of breast cancer is multi-factorial and
studies have revealed significant interaction between
endogenous (hormonal / genetic) and exogenous (drugs /
radiation) factors [31]. Other factors like women’s age
[32,33]; parity [34]; practice of late initiation of
breastfeeding [34,35]; oral contraceptives & hormone
replacement therapy [31,33,36]; high dietary fat, excessive
alcohol consumption, positive family history [33]; age at
menarche, menopausal status, age at first live birth,
genetic mutations and benign breast disease have also
been cited [37,38,39,40]. With regards to symptoms of
breast cancer, bloody discharge from the nipple and
presence of lump in breast are well known [41].
4. Breast Self-examination: Background
Early diagnosis of breast cancer is of extreme
significance in improving the survival rates and quality of
life especially in low-income countries [42]. Although
awareness about breast cancer has long been advocated
across the world, unfortunately studies have revealed that
a major proportion of women are still not breast aware
[41,43]. As discussed earlier, techniques such as breast
self-examination (BSE), clinical breast examination (CBE)
and mammography have been advocated for bringing
about a marked reduction in breast cancer associated
morbidity and mortality [44,45,46,47,48]. As compared to
CBE and mammography which require hospital visit and
specialized equipment / technical expertise, BSE is helpful
in the regard that it is cost-free, simple, non-invasive
intervention carried out by women themselves [4,49,50].
Studies conducted in developing countries have
established BSE as one of the most reasonable and
feasible approach in early detection of breast cancer
[51,52,53]. BSE not only familiarize women with the
appearance/feel of their breast but also aids in early
detection of breast cancer [30]. Some of the studies have
reported that BSE is highly effective in increasing sense of
ownership about health, healthcare seeking behavior,
encouraging adoption of preventive health behaviors and
creating awareness about breast cancer among women
[54,55]. Multiple studies have concluded that women,
who regularly perform breast self-examination present
with smaller neoplasm and rare involvement of axillary
lymph nodes [29,30,56,57,58,59]. On the other hand,
some researchers have seriously questioned the usefulness
of BSE [60,61], while others have revealed no added
benefits of BSE in improvement of survival rates [62,63].
5. Practice of Breast Self-examination
With the rising incidence of breast cancer and absence
of any uniform breast screening strategy in most of the
nations, it is important to assess the knowledge and
practice of BSE in various age groups. Irrespective of the
multiple benefits of BSE, various studies identified a wide
knowledge application gap with regards to BSE, the
practice of BSE remaining low and variable in different
nations like 54% in England [59]; varying from 19% to
43.2% in Nigeria [50,64], and varying from 0 to 52% in
India [29,65]. In a study done in Korea, 27% of students
were engaged in BSE which was higher than what was
observed in students (10.1%) from Nigeria [66,67].
Among the health-care providers, around 90.3% women
performed BSE in Sao Paulo [68]; while in Turkey 28%
of the nurses and 32% of physicians did not practice BSE
[69]. Similarly, in a cross-sectional study conducted in
Iran it was revealed that most of the female health care
workers (63-72%) did not practice BSE [70]. Studies done
with an aim to assess the knowledge about BSE among
men have shown low level of knowledge [71,72]. This
was mainly because most of the pamphlets and
information-education-counseling materials usually deals
only with women’s breast cancer related issues [71,72].
6. Impact of Socio-Demographic
Parameters on Breast Self-examination
Studies have indicated that major proportion of the
women are not aware of what they need to do to protect
themselves from breast cancer or even how to check
themselves [73,74]. Further it has been reported that older
age (>45 years) and married women were more likely to
practice BSE than others [54,75]. In a study done in
Turkey, significant association was observed between
breast cancer knowledge and practice of BSE [54]. In
addition, women with a positive family history of breast
cancer had a better knowledge as well as higher frequency
of BSE than those with a negative family history [74,76].
The importance of education in the adoption of BSE
practice has been reported repeatedly [75,77,78].
Simultaneously the positive impact of educational
interventions on BSE and breast cancer awareness have
also been emphasized [79,80].
American Journal of Public Health Research 137
7. Role of Nurses’ in Breast Self-
examination
Health care providers, educational institutions and
mass-media are the important resources in dissemination
of any public health related information to masses. The
nursing staff can play a pivotal role in educating women
through specially designed learning programs in the health
care setting, as well as, through community outreach
approaches that suit the social and cultural settings [81]. A
study done in Turkey emphasized that nurses’ opinion
about breast cancer screening programs was crucial in
developing breast cancer educational programs [78]. It has
been reported that nurses who own adequate knowledge
about breast cancer can definitely contribute towards early
detection of breast cancer [82,83]. It has been realized that
nurses have an indispensible role in teaching women in
the community and in influencing their behavior,
especially those working in the rural healthcare set-up [12].
8. Barriers to Breast Self-examination
Though breast self-examination is considered an
important tool in early detection of breast cancer, multiple
barriers have been identified viz. awareness about breast
cancer [52,54,77,84]; lack of time, shortage of self-
confidence, fear of possible detection of a mass and
feeling of awkwardness about breast handling [85]; health
related assumptions [86]; anxiety and forgetfulness
[29,87]; low socioeconomic status and poor access to
health care facilities [88]; negative socio-cultural
perception about breast cancer and strong belief in
traditional medicine[89], and lack of motivational support
from parents, spouse or friends [90].
9. Implications for Practice
There is an immense need for a public health education
program to inculcate the practice of breast self-
examination among women to minimize the fear, denial,
myths and misconceptions. The messages and
recommendations about breast cancer screening must be
clear and the recognized barriers should be taken into
consideration for maximization of the outcome. Every
effort has to be taken to encourage the practice of BSE not
only among women but also among men as there is visible
increase in the incidence of male breast cancer. Healthcare
professionals including grass root level health workers
have to play a significant role in educating the public
especially the high risk men & women. The involvement
of community, family especially parents and spouse
should be facilitated to maximize the understanding of
BSE. Non-governmental organizations can be roped in
rural areas for this initiative. Concurrently, family
physicians should be encouraged to raise awareness; offer
clear and specific instructions on practice of breast self-
examination and promote referral as well.
10. Implications for Research
It is essential to plan and conduct community-based
studies to find the knowledge, attitude and practices of
BSE among both women and men as it will aid in
identification of the perceived barriers. Further studies are
needed to explore what customized interventions could be
implemented to improve the uptake and practice of BSE
and other methods for early breast cancer detection.
Results derived from these studies will help the program
managers and healthcare professionals to modify /
emphasize / strengthen the existing strategies so that the
greatest challenge of late presentation can be curbed and
the chances of survival improved.
11. Conclusion
Breast self-examination has been identified as the only
feasible and reasonable approach in early detection of
breast cancer especially in developing nations.
Considering the substantial role that can be played by BSE
in low resource settings, there is an urgent need for
interventions to implement and reinforce BSE in the
existing cancer awareness and screening programs. Also,
to bridge the wide knowledge - application gap, health
education and awareness campaigns should be organized
to empower the public on the causes, risk factors and
prevention of breast cancer.
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... Therefore, enhancing the mobile application's visual appeal, usability, acceptance, and effectiveness is necessary. 11 Objectives Phase 1: Development of an evidence based self-assessment smartphone application: a. To develop evidence based relevant content for the development of a user-friendly self-assessment smartphone application for patients with OSMF. ...
... Then, with the assistance of professionals in the creation of electronic content, the materials will be created with modifying rules and converting lessons to electronic formats, images, animations, also audio and video clips will be included. 11 The resources will then be created using Android Studio, a software development environment for the Android platform, in the form of installable applications for mobile devices. ...
... The OSMF application will consist of two components: the OSMF self-assessment and the OSMF educational resources. 11 The participants' smart electronic devices will have the application downloaded, and it can be utilized online. Patients will also be trained by the researcher for the handling of the application. ...
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Background: Sushruta (600 B.C.) described a condition called "Vidari" linked with progressive narrowing of mouth, depigmentation of the oral mucosa, and pain on taking food, oral submucous fibrosis (OSMF). In 1952, Schwartz called this illness, which affected five Indian women existing in Kenya, "atrophica idiopathica mucosae oris." Pindborg and Sirsat coined the term "oral submucous fibrosis" in 1966, which is still in use today. With an overall Indian prevalence rate of between 0.2–0.5%, OSMF is primarily found in India and Southeast Asia, according to global estimations. Patients with OSMF need regular follow-ups and to maintain this follow-up it is not always possible for the patient to visit a dental clinic. Hence developing a smartphone-based application for the follow-up of OSMF will be of great value to the patients. The study aims to evaluate the effectiveness of a smartphone application on OSMF self-examination in the follow-up of patients. Methods: There will be three phases of the research. The first phase will be the development of a smartphone-based application for the follow-up of patients with OSMF. The second phase will be distribution and training the patients regarding the usage of the application and the third phase will be evaluating the effectiveness of the smartphone application in maintaining the follow-up of the patients. Expected results: The follow-up of patients with OSMF is expected to be better and feasible using a smartphone application as compared to regular Outpatient Department-based follow-up. Conclusions: Designing a mobile application for the ease of users presents difficulties since it must take accessibility into account, which influences how well the application is received by users. The goal of OSMF examination awareness facilitation and intervention is to raise public knowledge. Educational activities significantly contribute to the advancement of information, convictions, and OSMF screening practice. CTRI registration: CTRI/2023/06/054514 (registration pending)
... The Breast Cancer Care (BCC) survey states that 42% of NHS trusts do not have enough experienced specialists in breast cancer; it is the cause for the decreasing rate of survival of breast cancer patients [2], [3]. A study by the World Health Organization (WHO) says that, of all affected patients, only 8% are diagnosed, 6% have passed away, the remaining people are not diagnosed, and most of them are females [4], [5].The mortality rate of breast cancer reaches 627000 deaths while India amounts to 14.0% of total cases beginning at early thirties [6], [7]. ...
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Breast cancer is the most frequent type of cancer largely experienced by women currently, although it could happen to men also. It appears when abnormal breast tissue cells grow rapidly and form tumors. Mammogram is a technique that is employed by doctors to analyse the breast in the diagnosis of early cancer. These mammograms are classified into Benign and Malignant. This research addresses the variability and potential oversight in radiologists’ manual mammogram interpretations, aiming to enhance classification accuracy by combining Convolution Neural Networks (CNNs) and Vision Transformers (ViTs). CNN is a successful image classification that uses hierarchical feature extraction, ViTs capture the global context but require substantial data and computation. In this research, we have used CLAHE-enhanced mammogram images from Kaggle for training and applied a CNN+ViT model. We have also used a few pre-trained models such as DenseNet, Inception, SE Resnet, and XceptionNet for comparative analysis. The CNN+ViT model gave us an accuracy of 90.1% showing robust performance. Although XceptionNet achieved perfect accuracy, it may indicate overfitting.
... Therefore, early detection programs such as breast selfexamination, objective breast health checkups, and mammography can help minimize the morbidity and mortality associated with breast cancer (12). In Ethiopia, a National Cancer Control Plan was established in 2015 (9), with breast self-examination (BSE) being promoted as a crucial method for early detection to improve survival rates (13). The key components of BSE involve pictorial checkups and palpation of the breast, which have been shown to empower women to take control of their breast health (14,15). ...
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Background Breast cancer is the most common cancer among women globally, and early detection through breast self-examination can improve survival rates. However, this practice is limited in developing countries like Ethiopia. Objective This study aimed to assess the factors influencing knowledge and practices related to breast self-examination among female governmental school teachers in Gondar Town, Northwest Ethiopia. Methods A cross-sectional study was conducted from May 1 to 30, 2019, with 422 female teachers in Gondar metropolis governmental schools selected through simple random sampling. Data were collected using a self-administered questionnaire and analyzed using EPI INFO version 7 and SPSS version 20. Result A total of 415 female teachers participated in the study, with a response rate of 98.3%. The mean age of respondents was 38.64 years. Only 41.9% had good knowledge of breast self-examination, while 14.5% reported good practice. Factors associated with knowledge included secondary education, higher degrees, and exposure to information. Factors influencing practice included having a degree or higher education and prior experience with breast self-examination. Conclusion and recommendation The study revealed low levels of knowledge and practice of breast self-examination among female teachers. Educational level was significantly associated with both knowledge and practice. Recommendations include implementing health education campaigns, organizing events like breast cancer awareness days, and forming support groups in schools to promote awareness and encourage regular breast self-examination among female teachers in Ethiopia.
... However, given the limited availability of testing facilities, particularly in low-resource areas, it is imperative to educate them on BSE as the chief screening approach. 4 Performing BSE can play a valuable role in promptly identifying breast abnormalities, increasing the likelihood of successful treatment. It has also been associated with a reduction in mortality and morbidity. ...
... The only way to avoid late diagnosis is to prevent it. Thus, breast cancer can be diagnosed early through breast self-examination, clinical breast examination and mammography [6]. This is what prompted us to conduct this research in order to study the knowledge, attitudes, practices and factors associated with breast cancer early screening among women in the Municipality of Abomey-Calavi with the aim of guiding health policy makers to regularly and consciously institute mass screening and awareness campaign days for the early diagnosis of breast cancer in Benin. ...
... Early identification and prompt treatment are the most effective interventions for BC management, according to the World Cancer Report 2020 (5). Because breast cancer is frequently discovered in advanced stages in underdeveloped nations, attempts to identify it early may help to shorten the time between diagnosis and treatment, increasing the likelihood of survival and curing the disease as well as making it easier and more affordable to treat (6).In low-income nations compared to high-income countries, early detection of breast cancer by breast self-examination (BSE) is crucial for improving breast cancer outcomes and survival (7).There is an urgent need for interventions to implement and strengthen BSE in the current cancer awareness and screening programs, given the significant role that BSE may play in low-resource settings (8). ...
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Background Globally and in India, breast cancer is a prevalent malignancy. India saw 178,361 new cases and 90,000 deaths in 2020. Timely detection is vital, highlighting the importance of Breast Self-Examination (BSE), especially in low-income settings. Strengthening BSE in awareness and screening efforts is urgent. Despite awareness, practical application lags due to women’s reluctance. Effective execution demands partnerships, a multi-sectoral strategy, and training grassroots workers. Objective To address these challenges, the present study aims to strengthen the breast cancer screening program using BSE strategy and adopting a referral mechanism for the diagnosis and treatment of suspect cases. Methods A community-based study occurred in specific districts of Rajasthan (2017–2022), enhancing breast cancer screening for women aged 30–65. It involved healthcare providers and local women, utilizing tools like the MT-DM-GP6620 Breast Inspection Model, educational booklets, and semi-structured schedules. The strategy encompassed knowledge assessment, capacity building for healthcare providers, BSE training, increasing women’s breast cancer awareness, suspect case referrals, and phone-based follow-up. Results Our study encompassed 157,225 women aged 30–65 in Jodhpur, Jalore, and Pali districts. Initial breast self-examination (BSE) awareness was below 1%. BSE training reached 218,978 women using booklets and demonstrations, with 72% aged 30–65 and the rest 15–30. Follow-ups reinforced BSE, leading to 745 identified suspect breast cancer cases, mostly due to painless lumps (332 cases). Capacity-building workshops involving 824 medical and paramedical staff strengthened early breast cancer detection in Jodhpur and Jalore, in collaboration with the district health department. Conclusion The study model’s success suggests its applicability in other Rajasthan districts, Indian states, and global breast cancer prevention programs. While positive outcomes were evident, challenges related to culture, cost, and benefits warrant consideration. The approach prioritized early detection through community engagement, reducing patient and government burdens. Community involvement and healthcare engagement were pivotal, with breast self-examination proving effective for enhancing awareness and early detection. Promoting BSE education can significantly enhance breast cancer awareness and early detection.
... BSE consists of two basic steps tactile and visual examination of the breast [6]. As compared to clinical breast examination and mammography which require hospital visit, specialized equipment and technical expertise whereas BSE is helpful in the regard that it is cost-free, simple, non-invasive intervention carried out by women themselves [7,8]. Johns Hopkins Medical centre states, Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular BSE is very important to prevent breast cancer [9]. ...
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Background: Breast self-examination is one of the cheapest breast cancer screening tools. This is important to initiate early breast cancer detection by them.
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Breast cancer is the most common cause of death among women worldwide. Breast self-exam (BSE) is considered an important public health procedure; primary prevention should be given the highest priority in the fight against cancer. Pre-experimental one group pre-test post-test research design was adopted. The knowledge score of ANM 1st year Students in post-test shows majority i.e., 95.8 percent acquired above average knowledge while, 4.2 percent had average knowledge and none of them had below average knowledge. The calculated value of paired t-test is 25.846 is greater than the tabulated value of paired t-test with 69 degree of freedom i.e.2. It shows that the VATM was effective.
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Low cancer awareness contributes to delay in presentation for cancer symptoms and may lead to delay in cancer diagnosis. The aim of this study was to review the evidence for the effectiveness of interventions to raise cancer awareness and promote early presentation in cancer to inform policy and future research. We searched bibliographic databases and reference lists for randomised controlled trials of interventions delivered to individuals, and controlled or uncontrolled studies of interventions delivered to communities. We found some evidence that interventions delivered to individuals modestly increase cancer awareness in the short term and insufficient evidence that they promote early presentation. We found limited evidence that public education campaigns reduce stage at presentation of breast cancer, malignant melanoma and retinoblastoma.
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Objective: To determine the knowledge of women on early diagnosis methods and risk factors for breast cancer (BC). Methodology: This descriptive study was conducted on all the women attending to the Eskisehir Municipality Women's Counseling and Solidarity Center in a province of western Turkey for any reasons between April 1, 2008 and April 1, 2010. The evaluation of knowledge was scored by a questionnaire formed using literature. The statistical analysis was carried out using Chi-square (x2), and student t test. A value of p<0.05 was considered statistically significant. Results: The average age of the participants was 47.21±10.46 years. The proportion of those with enough knowledge about BC was 48.7%. In younger ages, in those with higher education levels, in those living in nuclear family type, in those with higher family income level, in those smoking cigarette, in those receiving knowledge previously about BC, in those having positive family history and in those with a benign or malignant breast disease diagnosed previously, the knowledge about BC were higher (p<0.001, per one). Conclusion: According to the results of this study, breast self-examination, a simple and economical diagnostic tool which protects women's privacy, should be performed regularly and properly by women themselves.
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Each January, the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection, including guideline updates, emerging issues that are relevant to screening for cancer, and a summary of the most current data on cancer screening rates for US adults. In 2004, there were no updates to ACS guidelines. In this article, we summarize the current guidelines, discuss recent evidence and policy changes that have implications for cancer screening, and provide an update of the most recent data pertaining to participation rates in cancer screening by age, gender, and insurance status from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System.
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Study objective-The aim was to determine whether breast self examination leads to earlier diagnosis and whether this translates into a larger utilisation of conservative surgical procedures. Design-The study was a survey of a cohort of breast cancer patients diagnosed over the period September 1986-July 1988. Subjects-Participants were 1315 women enrolled in a clinical trial testing the effectiveness of two follow up regimens by 30 general hospitals throughout Italy. Measurements and main results-Overall, 511 patients (39%) reported some breast self examination practice, but only 109 (8%) did this regularly and in a way deemed correct by their physicians. Breast self examination practice was positively associated with patients' education and past history of benign breast disease and negatively with age. Self examiners were found to have a significantly greater chance of being diagnosed with a primary tumour coded as pT1 according to the 1982 TNM classification (odds ratio = 1.42, 95% CI = 1.13-1.79). This protective effect was mostly evident in the subgroup of optimal performers (odds ratio = 1.54, CI = 1.01-2.34). Nearly half the patients (319/655) eligible for conservative surgery still had an unnecessary radical procedure. Conclusions-Premorbid breast self examination seems to have a modest effect on the extent of disease at diagnosis. The still widespread use of radical surgery suggests that a careful reanalysis of priorities among possible public interventions is needed before launching massive educational campaigns targeted exclusively at consumers.
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This study presents the first population-based report on breast cancer in the Islamic Republic of Iran using data derived from a cancer registry. A retrospective study was conducted to find all new breast cancer cases in 5 provinces covered by the cancer registry during the 5-year period 1996-2000. There were 2421 cases recorded in the 5 registries. The age-standardized incidence rate (ASR) was 16.2 per 100 000 person-years. In contrast to more developed countries, the ASR of breast cancer was low, with the lowest rate seen in Ardabil province.