Content uploaded by Abdus Salam
Author content
All content in this area was uploaded by Abdus Salam on Mar 09, 2016
Content may be subject to copyright.
© 2016 Roy Rillera Marzo and Abdus Salam. This is an open access article distributed under the terms of the Creative Commons Attribution License -
NonCommercial-ShareAlikeUnported License (http://creativecommons.org/licenses/by-nc-sa/3.0/).
Journal of Applied Pharmaceutical Science Vol. 6 (02), pp. 016-021, February, 2016
Available online at http://www.japsonline.com
DOI: 10.7324/JAPS.2016.60203
ISSN 2231-3354
Teachers’ Knowledge, Beliefs and Practices of Breast Self-Examination
in a City of Philippine: A Most Cost-Effective Tool for Early Detection
of Breast Cancer
Roy Rillera Marzo, Abdus Salam*
Department of Medical Education, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
ARTICLE INFO
ABSTRACT
Article history:
Received on: 31/10/2015
Revised on: 22/11/2015
Accepted on: 16/12/2015
Available online: 27/02/2016
Breast self-examination (BSE) is a most cost-effective screening-tool for early-detection of breast cancer. The
objective of this study was to investigate knowledge, beliefs and practices of BSE among teachers. It was a cross -
sectional questionnaire survey conducted in Philippine in 2009. A standardized questionnaire was administered
among 450 randomly selected different school-level teachers. Responses were 70% of which 50%, 42% and 8%
from elementary, secondary and tertiary school-level teachers respectively. Thirty percent teachers were 11-20
years experienced. BSE knowledge on frequency, starting age and techniques varied from 60%-70%. Only 25%
and 39% possessed accurate knowledge on BSE timing during regular and irregular menstruation and 45% knew
right position for BSE. Believed to do BSE confidently were only 33%, although 65% motivated. Majority
respondents were un-believable about breast cancer susceptibility. Of 73% BSE practiced respondents, only 17%
and 24% practiced at recommended interval and time. Main reasons for not practicing BSE did not know how to
do, report by 82% respondents. Participants’ knowledge, beliefs on BSE were good but practice was low.
Planned integrated-educational programs by policy-makers, health care-providers and mass-media are necessary
to promote BSE for early detection and management of breast cancer aimed to promote a healthy life.
Key words:
Breast, self-examination,
cost-effective-screening-tool,
knowledge, beliefs, practices.
INTRODUCTION
Breast cancer is the most prevalent cancer in women
worldwide (Adibi et al., 2015; Puri et al., 2009). It is estimated
that 31% of cancers among women are due to breast cancer and it
accounts 19% of deaths among women due to cancer (Jemal et
al., 2005). There are about 1.2 million breast cancer cases
worldwide and globally every 3 minutes a woman is diagnosed
with breast cancer amounting to 1 million annually (Parkin et al.,
2001). The incidence could go up by 50% i.e. 1.5 million by
2020 as reported by world cancer in 2008 (Parkin et al., 2005).
The three recommended screening methods for breast cancer are
breast self-examination (BSE), clinical breast examination
(CBE), and mammography. Among these methods,
mammography is the method of choice. However, owing to the
high cost, its use is limited in the developing world (Devi et al.,
.
* Corresponding Author
Abdus Salam, Medical Education Department, Faculty of Medicine,
Universiti Kebangsaan Malaysia (National University of Malaysia),
Kuala Lumpur, Malaysia. Email:abdussalam.dr@gmail.com
1998). Clinical breast examination performed by a physician is
also expensive. A combination of CBE and mammography is used
frequently, although most women worldwide are not able to
undergo regular CBE and mammography because of high expenses
and limited availability, especially in third world countries like
Philippines. Under these circumstances BSE is an appropriate,
convenient and cost effective method that can be done by every
woman themselves with little training (Rutledge et al., 2001). Most
of the early breast tumors are self-discovered and that the majority
of early self-discoveries are by BSE performers (Smith et al.,
1980). Breast cancer patient's retrospective self-reports showed
that there is a positive association between performance of the BSE
and early detection of breast cancer (Philip et al., 1986; Sharma et
al., 2013). The Canadian Cancer Society (CCS, 2005) and the
American Cancer Society (ACS, 2005) continue to advise all
women over 20 years old to perform regular BSE. By these means,
women become familiar with the normal appearance and feel of
their breasts and are better able to recognize changes and report
them to their doctor for further professional evaluation (Anderson
et al., 2003).
Marzo and Salam / Journal of Applied Pharmaceutical Science 6 (02); 2016: 016-021 017
Women in Philippine are facing the highest risk of breast
cancer in Southeast Asia that continues to rise by as much as 5
percent annually. Statistics from Philippine Cancer Society in
2005 revealed that 25% of the female population in the country
was suffering from breast cancer. There is a 10% risk of getting
the disease to every Philippine-woman and some 6,360 breast
cancer patients die each year in the country, making it the leading
cause of death among Philippine women (Alegre and Ramo,
2007). Therefore, screening for early detection and diagnosis of
breast cancer is very important.
School teachers play an important and unique role in
health education by helping young people to develop healthy
practices including BSE. Through health education in school,
students are able to gain an understanding and appreciation of
healthy lifestyles that promote lifelong wellbeing. There are
various studies that breast cancer awareness profile at community
level is largely unrepresented. The objectives of this paper is to
address the knowledge, beliefs and practices of BSE among the
teachers in a city of Philippine aimed to plan future interventions
in this field.
MATERIALS AND METHODS
Study Design and Subjects
This was an observational cross-sectional study
conducted on BSE among the teachers of primary, secondary, and
tertiary schools from private and public settings in Baguio City,
Philippine. The study was carried out during the periods of August
and September 2009. Subjects were 450 teachers, selected
randomly from different levels of schools in Baguio City,
Philippine.
Instrument
The questionnaire was designed keeping consistency
with the relevant literatures (Budden, 1999; Odusanya and Tayo,
2001; Demirkiran et al., 2007) and then piloted. The questionnaire
was divided into four sections: socio-demographic, knowledge,
beliefs, and practices. Socio-demographic section included
information about participants’ age, sex, marital status, level of
teaching, years of teaching experience and family history of breast
cancer. Knowledge section included questions on BSE awareness
such as, who should perform BSE, when BSE should be started,
positioning and techniques used, frequency and timing of BSE in
relation to menstrual cycle. Beliefs section was determined using
‘Health Belief Model’ consisted of statements rated using a five-
point Likert scale ranging from 1 (strongly disagree) to 5 (strongly
agree). The belief statements were about: Perceived confidence
in performing BSE, motivation or stimulus to accept the process,
susceptibility and seriousness of the disease, BSE-benefits and
BSE-barrier (Champion and Scott, 1997; Champion, 1995;
Champion, 1993). The practice section included questions on
participants’ BSE practices such as: whether they had performed
BSE previously and, if so, the age at which they began to perform
BSE; the most important factor that caused them to perform BSE;
the frequency of performing BSE in the prior 12 months; the time
at which they performed BSE in relation to menstrual cycle; and
the positioning and techniques used. If participants did
not perform BSE, they were asked to provide reasons of not
perform. To investigate knowledge and practice questions
concerning BSE position, techniques, frequency and timing for
performing BSE, the following operational definitions were made.
Position The position of BSE was considered correct if the
participants performed BSE in both standing in front of the mirror
and supine positions. If answers were recorded as BSE performed
in only standing or supine position, they were considered
incorrect.
Technique
The correct answer regarding techniques for conducting
BSE was “inspection and palpation (by using the pads of the
middle three fingers of one hand without removing the fingers
from the breast, in circular motions),” If the answer was
one of either inspection or palpation, it was considered to be
incorrect.
Frequency
If the answer was once a month, it was considered to be
correct.
Timing for conducting breast self-examination
The correct answer was “within two days after the end of
the cycle” for those with regular menstrual periods and “on a
specific day every month” for those with irregular or no
menstruation.
Data Collection and Analysis
Data was collected by administering the questionnaire
among the participants through institutional head. Before
administering questionnaire, informed consent was obtained from
all participants and was told all information would be kept
confidential. After administration, the questionnaire was collected,
compiled and analyzed using SPSS. The results were then
expressed in terms of number and percentage distribution.
Results Of 450 distributed questionnaires, 369 teachers returned
the filled in questionnaire, but 52 questionnaires were excluded
due to incomplete data. As such 317 questionnaires were analyzed
giving a response rate of 70%. Table-1 explored the socio-
demographic characteristics where mean age of the participants
was 40.77 with a range from 22-64 years. Among 317 teachers,
14% were male and 86% were female and most of the respondents
(72%) were married. Majority teachers (50%) were from
elementary level school, while 42% from high school and 8% from
018
Marzo and Salam / Journal of Applied Pharmaceutical Science 6 (02); 2016: 016-021
tertiary level schools. Thirty percent teachers possessed 11-20
years of teaching experiences. Somehow 77-87% teachers were
aware of BSE while 14% had history of breast cancer in their
families.
Table 1: Socio-demographic characteristics of respondents, n=317.
Socio-demographic
characteristics of study
participants
n
%
Age
<30
62
19.56
30-39
100
31.55
40-49
82
25.87
50-59
51
16.09
>60
22
6.94
Sex
Male
45
14.2
Female
272
85.8
Marital status
Single
67
21.1
Married
228
71.9
Separated
12
3.8
Widow
10
3.2
Level of school at teaching
Elementary level
158
49.8
High School level
133
42
College level
26
8.2
Teaching experience in years
0-5
74
23.3
6-10
72
22.7
11-20
94
29.7
>20
77
24.3
Family history of breast cancer
Yes
43
13.6
No
274
86.4
Heard about breast self-
examination
Yes
276
87.1
No
41
12.9
Any information about breast
self-examination
Yes
245
77.3
No
72
22.7
Table 2: Knowledge related to BSE among the teachers, n=317.
Knowledge related to BSE
Answered
correctly
n
%
Do both sex people should perform BSE?
172
54
Age at performance of BSE should be started
223
70
Frequency of performance of BSE
189
60
Time of BSE performance in women with regular
menstrual cycle (within two days after menstruation)
79
25
Time of BSE performance in women with irregular
menstrual cycle (at a specific day each month)
123
39
Position of BSE performance should done (standing
in front of a mirror and lying down)
143
45
Technique of BSE performance (inspection and
palpation)
221
70
Teachers’ knowledge on BSE as shown in Table-2
revealed that 54% of the participants knew both male and female
should perform BSE, 70% knew correct age to start BSE and 60%
knew that it should be done regularly at every month. However,
knowledge about BSE timing in relation to menstrual cycle is poor
(25-39%).
Furthermore, only 45% participants knew correct
position of BSE although 70% knew correct technique, that it
should be conducted by inspection and palpation. Teachers’
perceived beliefs towards BSE (Table-3) showed only 33% of the
teachers were confident in performing BSE correctly and 65%
were motivated to accept the process of BSE. Only a small
percentage (9%) of respondents believes that they were susceptible
to develop breast cancer. The table also revealed that 50%
participant perceived the benefit of BSE while two third of the
participants did not understand the seriousness of the disease.
Table-4 reflected that 73% participants practiced BSE. Of 232
practiced participants, 92% started BSE practices after the age of
19 and only 17% practiced BSE regularly with 10-12 times in the
past 12 months.
Among the 50% BSE practiced participants with correct
technique and 45% with correct position, only 24% participants
practiced BSE at the correct time relating to their menstrual cycles
(Table-5).
Table 3: Teachers’ perceived beliefs towards BSE and breast cancer, n=317.
Perceived beliefs
Disagree
Not sure
Agree
n
%
n
%
n
%
Confidence in ability to
perform BSE
89
28
122
39
106
33
Motivation to accept the BSE
process
28
9
83
26
206
65
Susceptibility to develop
breast cancer
196
61
97
30
29
9
Seriousness of breast cancer
95
30
119
38
103
32
BSE-benefits
32
10
128
40
157
50
BSE-barrier
191
60
90
29
36
11
Table 4: Distribution of participants BSE practice, n=317.
BSE practice
n
%
Practiced
232
73
Not practiced
85
27
Total
317
100
Table 5: Distribution of teachers’ BSE practiced performances, n=232.
BSE practiced performances
Practices
n
%
Age at BSE practice started
Before age 19
19
8
After age 19
213
92
Frequency of BSE practiced in the
past 12 months
1-3 times
143
62
4-6 times
49
21
10-12 times
40
17
Timing of BSE practiced in relation
to period of menstrual cycle
Correct
55
24
Incorrect
177
76
Positioning of BSE practiced
(Correct when done by standing in
front of a mirror and lying down)
Correct
104
45
Incorrect
128
55
Technique of BSE practiced
(Correct when done by use of
inspection and palpation
techniques)
Correct
115
50
Incorrect
117
50
Factors influencing practice of BSE and reasons of not
practicing BSE are shown in Table-6. Fear of breast cancer was
the most important factor that leads them to practice BSE (67%),
followed by training or learned from the school (62%),
recommendation by both physician and media influence 54%,
advice of a health worker (49%) and encouraged by a breast cancer
victim (47%).
On the other hand, the most important reason for not
practicing BSE was not knowing how to perform it (82%),
followed by the absence of problems in the breast (67%), fear of
finding a mass (55%) and thinking it too difficult to perform BSE
(41%).
Marzo and Salam / Journal of Applied Pharmaceutical Science 6 (02); 2016: 016-021 019
DISCUSSION
The current study was an in-depth evaluation of
participants’ BSE knowledge, beliefs and practices. Thirty percent
respondents possessed teaching experience of 11-20 years, 24%
more than 20 years, 23% possessed 6-10 years of experiences in
teaching with 50% elementary level, 42% high school level and
8% in college level where married respondents were 72% (Table-
1). Study participants found to have a good knowledge in regard to
who should perform BSE, age to start BSE, frequency and
techniques of BSE. However, participants’ knowledge on timing
of performing BSE in relation to regular and irregular
menstruation and position of doing BSE was very low (Table-2).
Previous studies also showed that there is a lack of good
knowledge regarding timing of performing BSE and position to
perform BSE. In one study only 17% of participants correctly
identified the recommended time for BSE (Budden, 1999).
Agboola et al. (2009) showed that the correct timing of BSE in
women with regular and irregular menstrual cycle is below
average (Agboola et al., 2009). Only 13.7% of the respondents
know the correct timing to conduct the BSE (Yakubu et al., 2014).
However, Demirkiran et al.,(2007) showed that 81.5% of the
nurses and 45.1% of the teachers knew the correct timing which
was much higher than the other studies, but regarding the position,
they showed only 16% nurses and 9% teachers correctly answered
regarding position of BSE (Demirkiran et al., 2007). Regarding the
technique of BSE, our study revealed that teachers had good
knowledge while Demirkiran et al. (2007) reported that none of
the participants answered the question about technique for BSE
correctly.
A good number of participants (87%) heard about BSE in
our study, which represents that participants are well aware about
BSE. Study among staff nurses in Ebonyi State University
Teaching Hospital showed 92.9% of them were found to have
heard of BSE (Agwu et al., 2007), which is almost similar to our
findings. On the contrary, study in Saudi Arabia reported only
30.3% of the participants have heard about BSE (Montazeri et al.,
2008; Rizwan and Saadullah, 2009).
Regarding teachers’ belief on BSE, this present study
showed their perceived belief towards confidence in doing BSE
and belief on susceptibility and seriousness of the disease was
poor. However, half of the teachers agreed with its beneficial role
in the early diagnosis of breast cancer (Table-3). This is also
reflected in the practice performance rate of BSE where 73%
teachers found to have practiced BSE (Table-4). Earlier studies
have shown that women paid more importance to breast cancer
and believe BSE should be performed regularly; however, the
same subjects did not believe they were at risk for breast cancer
(Budden, 1999; Odusanya and Tayo, 2001).
This is similar to this present study where more than half
of the teachers (61%) did not think they were at susceptible to
develop breast cancer (Table-3). Jarvandi et al. (2002) found that
most teachers feel themselves at risk of developing breast
cancer that led them to perform BSE routinely (Jarvandi et al.,
2002). Demirkiran et al. (2007) reported that teachers have
positive attitudes towards BSE; they were convinced to its value
for early diagnosis of breast cancer and also noted that 42.5% were
self-confident about performing BSE while the present study
revealed only 33% teachers were confident in their ability to
perform BSE correctly.
In the present study, a very good number (92%) of
teachers start practicing BSE at younger ages, although their
frequency, timing and technique were poor (Table-5) compared to
their knowledge. This implies that they do not practice what they
know. In one study, about one third of practicing women
performed six or less times correctly out of 12 times in a year and
only 15.6% performed 11 times in a year, and none performed all
the times correctly (Al-Azmy et al., 2013). Another study on
female healthcare workers reported that more than 70% of the
subjects had the knowledge of BSE and also strongly believed in
its beneficial effects, but only 6% of them performed BSE
regularly (Haji-Mahmoodi et al., 2002).
Our study reported that only 17% teachers practiced BSE
10-12 times and 21% practiced 4-6 times in a year while 45% and
50% teachers practiced BSE with correct position and correct
technique (Table-5).
It is reported that the ratio of practicing BSE is low in
teachers (Jarvandi et al., 2002). Nurses presented a BSE practice
ratio between 72.1% and 93%, increasing with age (Chong et al.,
2002). Study showed that students at nursing and midwifery
schools start performing BSE at younger ages, but the percentages
of those performing BSE regularly and at the correct time in
relation to their menstrual cycle are very low with a ranged from
.
Table 6: showed distribution of factors influencing practice of BSE and reasons of not practicing BSE, n-317.
Factor influenced BSE practice, n=232
n
%
Reasons for not practiced BSE, n=85
n
%
Fear of breast cancer
156
67
Do not know how to perform BSE
70
82
Learned from the school
143
62
Having no problems in the breasts
57
67
Physician recommendation
126
54
Fear of finding a mass
47
55
Media influence
126
54
Thinking it is too difficult
35
41
Advice of a health worker
114
49
Lack of time
26
31
Encouraged by a breast cancer victim
108
47
Forgetting
25
29
Breast pain
62
27
Finding it unnecessary
24
28
Family history of breast cancer
38
16
Not knowing its importance
2
24
Peer support
32
14
Reluctance
12
14
Feeling of a mass
31
14
Shamefulness
7
8
Encouraged by a friend
26
11
Nipple discharge
16
7
020
Marzo and Salam / Journal of Applied Pharmaceutical Science 6 (02); 2016: 016-021
11% - 46% (Budden, 1999).
Women health is deeply linked with the health of others
(Tazhibi et al., 2014). One of the important finding in our study is
that, 82% respondents did not perform BSE due to not knowing
how to do BSE (Table-6). Previous studies also showed that the
most common reasons for not doing BSE is lack of knowledge
(Jarvandi, 2002). The world, especially the developing countries
are faced with a wide variety of health-related challenges
(Feyzabadi et al., 2015).
Cancer care has become a global health priority (Zisun
Kim et al., 2012) and breast cancer is the most common cancer
among women (Karimian et al., 2010). Medicine cannot cure all
diseases (Jafari et al., 2015) and it is evidenced that BSE benefits
women to detect any changes in their breasts as early as possible
(Doshi et al., 2012).
Education is the backbone of a nation; the world in which
we live today is comprised of diverse people where educators face
complex-tasks in educating (Salam et al., 2014). Planned
interventional education programs have been shown to provide a
positive impact on outcomes (Salam, 2010).
A planned and integrated breast self examination
educational campaign through collaboration among the policy
makers, health care providers and mass media will definitely
promote a sustainable culture of BSE knowledge, beliefs and
practices (Salaudeen et al., 2009). Therefore, policy makers and
health care professionals should give due importance on BSE as an
early and most cost effective tool for detection of breast cancer and
thereby to promote a healthy life.
CONCLUSIONS
Participants’ knowledge on BSE was found satisfactory
except for the timing of BSE in relation to menstruation and
position to perform BSE. Although participants were motivated to
perform BSE, they did not believe that they were susceptible to
breast diseases. A good number of participants started BSE
practices at the age of 19 years but their frequency and timing for
BSE was not satisfactory.
Their practice rate was low in spite of having very good
knowledge on technique. These data imply that teachers in Baguio
city in Philippine need more educational intervention on breast
cancer and its early detection particularly by BSE. By knowing
how to do thorough BSE, teachers and women in general will be
able to identify breast cancer at the initial stages. This in turn may
help to eventually decrease the number of premature breast cancer
deaths in developing countries such as Philippines.
Breast cancer and breast-self-examination awareness
campaign programs targeted at younger women are suggested to
remove fear and misperceptions on BSE and thereby improve
breast cancer prevention. Policymakers and healthcare
professionals should implement integrated breast cancer and BSE
awareness campaign to promote BSE as an early and cost-effective
breast cancer screening tool.
CONFLICT OF INTEREST
The authors declare that they have no conflict of
interests.
REFERENCES
Adibi A, Golshahi M, Sirus M, and Kazemi K. Breast cancer
screening: Evidence of the effect of adjunct ultrasound screening in
women with unilateral mammography-negative dense breasts. J Res Med
Sci, 2015; 20(3):228-232.
Agboola AOJ, Deji-Agboola AM, Oritogun KS, Musa AA,
Oyebadejo TY, Ayoade BA. Knowledge, Attitude and Practice of Breast
Self-Examination in Female Health Workers in Olabisi Onabanjo
University Teaching Hospital, Sagamu, Nigeria. IMJ, 2009; 8 (1):5-10.
Agwu UM, Ajaero, EP, Ezenwelu CN, Agbo CJ, Ejikeme BN.
Knowledge, attitude and practice of breast self-examination among nurses
in Ebonyi State University Teaching Hospital, Abakaliki. Ebonyi Med J,
2007. 6:44-47.
Al-Azmy SF, Alkhabbaz A, Almutawa HA, Ismaiel AE,
Makboul G, El-Shazly MK. Practicing breast self-examination among
women attending primary health care in Kuwait. Alexandria J Medicine,
2013; 49:281-286.
Alegre A, Ramo LV. Breast Cancer Incidence Highest among
Filipinas in SEA. Northern Dispatch, 2007; VII(6).
American Cancer Society (ACS). Breast Cancer Facts &
Figures 2005–2006. American Cancer Society, 2005. Inc Atlanta.
Anderson BO, Braun S, Carlson RW, Gralow JR, Lagios MD,
Lehman C, Schwartsmann G, Vargas HI. Overview of breast health care
guidelines for countries with limited resources. Breast J, 2003; 9:S42-50.
doi: 10.1046/j.1524-4741.9.s2.3.x.
Budden L. Student nurses’ breast self-examination health
beliefs, attitudes, knowledge, and performance during the first year of a
preregistration degree program. Cancer Nursing, 1999; 22(6):430-437.
Canadian Cancer Society (CCS). National Cancer Institute of
Canada. Canadian Cancer Statistics, 2005. Toronto.
Champion VL, Scott CR. Reliability and validity of breast
cancer screening Belie Scales in African American women. Nursing
Research, 1997; 46:331-337. doi: 10.1097/00006199-199711000-00006.
Champion VL. Development of a benefits and barriers scale for
mammography utilization.
Cancer Nursing, 1995; 18:53-59.
Champion VL. Instrument refinement for breast cancer
screening behaviors. Nursing Research, 1993; 42:139-143.
Chong PN, Krishnan M, Hong CY, Swash TS. Knowledge and
practice of breast cancer screening amongst public health nurses in
Singapore. Singapore Med J, 2002; 43:509-516.
Demirkiran F, Balkaya NA, Memis S, Turk G, Ozvurmaz S,
Tuncyurek P. How do nurses and teachers perform breast
self-examination: Are they reliable sources of information? BMC Public
Health, 2007; 7:96.
Devi R, Singh MM, Kumar R, Walia I. An effective manual on
breast self-examination. World Health Forum, 1998; 19:388-389.
Doshi D, Reddy BS, Kulkarni S, Karunakar P. Breast Self-
examination: Knowledge, Attitude, and Practice among Female Dental
Students in Hyderabad City, India. Indian J Palliat Care, 2012; 18(1):68-
73. doi:10.4103/0973-1075.97476.
Feyzabadi VY, Emami M, Mehrolhassani MH. Health
information system in primary health care: The challenges and barriers
from local providers' perspective of an area in Iran. Int J Prev Med, 2015;
6:57. doi:10.4103/2008-7802.160056
Haji-Mahmoodi M, Montazeri A, Jarvandi S, Ebrahimi M,
Haghigat S, Harirchi I. Breast self-examination: knowledge, attitudes, and
practice among female health care in Tahran. Iran Breast J, 2002;8:222-25.
Jafari M, Rafiei H, Nassehi A, Soleimani F, Arab M,
Noormohammadi MR. Caring for dying patients: Attitude of nursing
students and effects of education. Indian J Palliat Care, 2015; 21:192-197.
Marzo and Salam / Journal of Applied Pharmaceutical Science 6 (02); 2016: 016-021 021
Jarvandi S, Montazeri A, Harirchi I, Kazemnejad A. Beliefs and
behaviours of Iranian teachers toward early detection of breast cancer and
breast self-examination. Public Health, 2002; 116:245-249. doi:
10.1038/sj.ph.1900854.
Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun
MJ. Cancer statistics 2006. CA. A Cancer J Clin, 2005; 56(2):106-130.
Karimian Z, Mehran N, Haddad Z. The Assessment of
Knowledge, Attitude and Behavior of Women in Qom Toward Breast
cancer Screening Methods 2009. Res J Med Sci, 2010; 4(3):116-118.
Montazeri A, Vahdaninia M, Harirchi I, Harirchi AM, Sajadian
A, Khaleghi F, Ebrahimi M, Haghighat S, and Jarvandi S. Breast cancer in
Iran: Need for greater women awareness of warning signs and effective
screening methods. Asia Pac Fam Med, 2008; 7(1):6.
Odusanya OO, Tayo OO. Breast cancer knowledge, attitudes
and practice among nurses in Lagos, Nigeria. Acta Oncologia, 2001;
40:844-848. doi: 10.1080/02841860152703472.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics,
2002. CA. Cancer J Clin, 2005; 55:74-108.
Parkin DM, Bray FI, Devesa SS. Cancer burden in the year
2000:the global picture. Eur J Cancer, 2001; 37(suppl. 8):S4-66.
Philip J, Harris WG, Flaherty C, Joslin CA. Clinical measures to
assess the practice and efficiency of breast self-examination. Cancer,
1986; 58:973-977.
Puri S, Mangat C, Bhatia V, Kalia M, Sehgal A, & Kaur A.
Awareness of Risk Factors and Aspects of Breast Cancer Among North
Indian Women. The Int J Health, 2008; 8(2).
Rizwan MM, Saadullah M. Lack of awareness about breast
cancer and its screening in developing countries. Indian J Cancer, 2009;
46:252-253.
Rutledge DN, Barsevick A, Knobf MT, Bookbinder M. Bresat
cancer detection: of women from Pennysylvania. Oncol Nurs Forum,
2001; 28(6):1032-1040.
Salam A, Akram A, Bujang SM, Yaman MN, Kamarudin MA,
Siraj HH, Mohamad N. Educational Environment in a Multicultural
Society to Meet the Challenges of Diversity. J App Pharm Sci, 2014; 4
(09): 110-113.
Salam A. Educational program for patients with type-1 diabetes
mellitus receiving free monthly supplies of insulin improves knowledge
and attitude, but not adherence. Int J Diab Dev Ctries, 2010; 30:105.
Salaudeen AG, Akandem TM, Musa OI. Practice of Breast Self-
examination among Young Adults in Tertiary Institutions in Ilorin, North
Central Nigeria. Res J Med Sci, 2009; 3(1):31-35.
Sharma PK, Ganguly E, Nagda D, Kamaraju T. Knowledge,
attitude and preventive practices of South Indian women towards breast
cancer. The Health Agenda, 2013; 1 (1):16-22
Smith EM, Francis AM, Polissar L. The effect of breast self-
exam practices and physician examinations on extent of disease at
diagnosis. Prev Med, 1980; 9:409-417.
doi: 10.1016/0091-7435(80)90235-2.
Tazhibi M, Dehkordi ZF, and Babazadeh S. Trends in breast
cancer incidence rates by age and tumor characteristics of women in the
city of Isfahan for the period 2001-2010: An application of join point
analysis. J Res Med Sci, 2014; 19(4):319-325.
Yakubu AA, Gadanya MA, Sheshe AA. Knowledge, attitude,
and practice of breast self-examination among female nurses in Aminu
Kano teaching hospital, Kano, Nigeria. Niger J Basic Clin Sci, 2014;
11:85-88. Zisun Kim, Sun Young Min, Chan Seok Yoon, Kyu-Won Jung,
Beom Seok Ko, Eunyoung Kang, Seok Jin Nam, Seokwon Lee, Min Hee
Hur, Korean Breast Cancer Society. The Basic Facts of Korean Breast
Cancer in 2012: Results from a Nationwide Survey and Breast Cancer
Registry Database. J Breast Cancer, 2015; 18(2):103-111.
doi:org/10.4048/jbc.2015.18.2.103.
How to cite this article:
Roy Rillera Marzo, Abdus Salam. Teachers’ Knowledge, Beliefs
and Practices of Breast Self-Examination in a City of Philippine: A
Most Cost-Effective Tool for Early Detection of Breast Cancer. J
App Pharm Sci, 2016; 6 (02): 016-021.
