Factors associated with breast self-examination among Malaysian women teachers

Abstract
The purpose of this study was to examine factors related to breast self-examination (BSE) among teachers in Selangor, Malaysia. A cross-sectional study was conducted among 425 female teachers in 20 randomly selected secondary schools. A self-administered questionnaire based on the health belief model was randomly selected secondary schools. A self-administered questionnaire based on the health belief model was used, including sociodemographic background and knowledge, beliefs and practices about breast cancer and BSE. Only 19% of the women performed BSE on a regular basis. Higher knowledge about breast cancer, greater confidence in performing BSE and regular visits to a physician were significant predictors for practising BSE. To promote BSE practice among Malaysian women, tailored health education and health promotion programmes should be developed based on a specific understanding of women's health beliefs.



509
Factors associated with breast self-examination
among Malaysian women teachers
P. Parsa,
1
M. Kandiah
2
and N. Parsa
3
ABSTRACT The purpose of this study was to examine factors related to breast self-examination (BSE) among
teachers in Selangor, Malaysia. A cross-sectional study was conducted among 425 female teachers in 20
randomly selected secondary schools. A self-administered questionnaire based on the health belief model was
used, including sociodemographic background and knowledge, beliefs and practices about breast cancer and
BSE. Only 19% of the women performed BSE on a regular basis. Higher knowledge about breast cancer, greater
confidence in performing BSE and regular visits to a physician were significant predictors for practising BSE. To
promote BSE practice among Malaysian women, tailored health education and health promotion programmes
should be developed based on a specific understanding of women’s health beliefs.
1
Child and Maternal Health Research Centre and Health Science Research Centre, Department of Maternal and Child Health, Hamedan University
of Medicine and Health Sciences, Hamedan, Islamic Republic of Iran (Correspondence to P. Parsa: pparsa2003@yahoo.com).
2
Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences;
3
Department of Psychology, Faculty of Human Ecology,
Universiti Putra Malaysia, Serdang, Malaysia.
Received: 12/07/09; accepted: 29/10/09
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
Facteurs associés à l’auto-examen des seins chez des enseignantes malaisiennes
RÉSUMÉ La présente étude avait pour objectif de rechercher les facteurs liés à l’auto-examen des seins chez des
enseignantes de l’État de Selangor (Malaisie). Une étude transversale a été conduite auprès de 425 enseignantes
travaillant dans vingt établissements d’enseignement secondaire sélectionnés aléatoirement. Un auto-
questionnaire reposant sur un modèle de croyances relatives à la santé a été utilisé, couvrant les informations
sociodémographiques des répondantes, leurs connaissances et croyances au sujet du cancer du sein et de l’auto-
examen des seins et leurs pratiques en la matière. Seules 19 % des femmes pratiquaient l’auto-examen des seins
de manière régulière. Une meilleure connaissance du cancer du sein, une confiance élevée dans la pratique de
l’auto-examen des seins et des visites régulières chez un médecin étaient des facteurs prédictifs importants pour
la pratique de cet auto-examen. Afin de promouvoir l’auto-examen des seins chez les femmes malaisiennes,
des programmes sur mesure d’éducation sanitaire et de promotion de la santé doivent être élaborés en tenant
compte des croyances des femmes en matière de santé.
EMHJ •  Vol. 17  No. 6  •  2011
Eastern Mediterranean Health Journal
La Revue de Santé de la Méditerranée orientale
510
Introduction
According to a recent report of the 
Malaysian cancer registry, 1 out every 
19 Malaysian women has a chance of 
geing breast cancer in her lifetime, and 
more than 4000 new cases of breast
cancer are diagnosed every year. Breast 
cancer is currently the most common 
female cancer in Malaysia, account-
ingfor 30.4% ofall cancers diagnosed 
among women [1]. Early detection and 
eective treatment areimportant to 
reduce morbidity and mortality due to 
breast cancer. Breast self-examination 
(BSE), mammography  and  clinical
breast examinationare believed to be 
appropriate and eective methodsof 
ensuring early detection of breast can-
cer.Although the eectivenessof BSE 
as abreastcancerscreeningmethod 
is controversial [2–4], the American
Cancer Society [2] and the Ministry 
in HealthofMalaysia[5]encourage 
women to be aware of how their breasts 
look and feel so they will be able to rec-
ognize any changes and report them 
promptly to their clinicians.
Despite the eectiveness of breast 
cancer screening behaviours in reduc-
ing mortality, research ndings indicate 
that screening rates remain low. In stud-
iesofcommunity samplesofdiverse 
groups of women in the United States of 
America (USA), the rates for performing 
monthly BSE ranged from 29% to 63% 
[6,7]. Similarndingswere reported 
instudies in Canada[8], Taiwan [9], 
Jordan [10] and Turkey [11]. e na-
tional health morbidity survey showed 
that 34% of women above age 20 years 
performedBSEbut thefrequencyof 
performance was not studied [12].
In this study the health belief model 
[13–15] was used as the theoretical
framework to examine variables related 
to BSE use. In previous studies, perform-
ing  regularBSE  hasbeenassociated 
with health belief model variables such 
as perceived susceptibility to breast can-
cer, seriousness of breast cancer, benets 
andbarriers toscreening,condence 
and health motivation [1–11,14–18]. 
Socioeconomic status, level of educa-
tion, referral from a physician, knowl-
edge,healthinsurancecoverageand 
family history of breast cancer have also 
been associated with the practice of BSE 
[6,10,11,19,20].
e purpose of the current study
was to identify the rate of practising BSE 
and factors related to BSE screening
behaviour in a sample of well educated 
Malaysian women. Understanding Ma-
laysian women’s health beliefs related 
to breast cancer screeningbehaviours 
will help health care professionals to 
choose more eective health education 
programmes and potentially to increase 
women’s screening practices.
Methods
A cross-sectional study was carried out 
among female secondary-school teach-
ers inthestateofSelangor,Malaysia, 
between January and April 2006.
Sample
A multi-stage random sampling method 
was used to select the 20 secondary
schools. A total of 425 teachers met the 
inclusioncriteria and gave informed 
consent to participate in the study. e 
participants eligible for the study met the 
following criteria: age 23–56 years (age 
range of working female teachers cur-
rently in employment up to retirement), 
no history of breast cancer or any other 
cancers, not pregnant or breastfeeding. 
is study obtained approval from the 
Ministry of Education of Malaysia.
Data collection
A questionnaire was developed by the 
authors basedon an extensivereview 
of the literature. e questionnaire 
obtainedinformation onparticipants’ 
sociodemographic characteristics; can-
cer-related history; and knowledge, be-
liefs and behaviours concerning breast 
cancer and BSE. Sociodemographic 
variables included: age, current marital 
status, educationlevel, incomelevel, 
ethnicity, religion and health insurance 
coverage. Cancer-related questions 
included: having regular health check-
ups with a physician (yes/no), previous 
breast disease (yes/no) and family his-
tory of breast cancer (yes/no).
Breast cancer knowledge questions 
(yes/noresponse)included:having 
everheard/readaboutbreastcancer 
screening tests; sources of information; 
and 43 knowledge questions on inci-
dence (3 items), symptoms (7 items), 
risk factors of breast cancer (15 items) 
and screening tests (18 items). A score 
of 1 was given for a correct answer and 
0forincorrect.emaximumscore 
for knowledge was 43 (100%) and the 
minimum score was 0 (0%). More 
description ofthe development ofthe 
knowledge scale may be found in an-
other published paper [21].
e section about beliefs had 
42 questions that were self-reported
measures with 6 scales: susceptibility to 
breast cancer (5 items), seriousness of 
breast cancer (7 items), benets of BSE 
(6 items),barriers toperformingBSE 
(6 items), condence in their ability to 
perform BSE (11 items) and health mo-
tivation (7 items). All the items had 5 
response choices ranging from strongly 
disagree (1 point) to strongly agree (5 
points). All scales were positively related 
to screening behaviours, except for bar-
riers, which were negatively associated.
e reliability of the knowledge and 
beliefsubscalesrangedfrom0.73to 
0.91, indicating good levels of internal 
consistency [22]. Factor analysis with 
principal components was carried out 
toassess the construct validityof the 
scales and was found to be acceptable. 
A detailed description of the translation 
and adaptation of Champion’s health 
belief model scale can be found in an-
other published article [23].
BSE behaviour was measured by
self-reportedresponses  toquestions 
about: ever having carried out BSE; fre-
quency, technique, etc.; and reasons for 
reluctance to practise BSE.



511
e Malay version of the instrument 
was pretested on 30 female teachers to 
check the clarity of the items.
Analysis
e women were categorized into 2 
groups: those who reported that they 
performed BSE and those who did not. 
Independent t-test was used to deter-
mine dierences between the 2 groups. 
e chi-squared test was used to exam-
ine the association between categorical 
variables and BSE. A logistic regression 
analysis was conducted to identify the 
extent to which variables signicantly 
predicted BSE behaviour. In all tests, the 
level of signicance was set at P < 0.05.
Results
General characteristics of the
subjects
e mean age of respondents was 37.2 
(SD 7.2), range 23 to 56 years. Most 
of them were married, of Muslim reli-
gion and Malay ethnic origin. Nearly 
all of them had a university degree and 
around one-h had no medical insur-
ance. Most teachers had less than 20 
years teaching experience. Among the 
total sample a family history of breast 
cancer was recorded by 36 respondents 
(9%) and only 11 (3%) indicated that 
they had a personal history of breast 
disease (Table 1). 
Practice, intention to practice,
and sources of information
Although 90% of the participants 
reported that they had heard about 
BSE,only 230/425 (54%)hadever 
performed BSE. Ofthese 19% stated 
that they performed BSE onaregular 
monthly basis; others reported per-
forming BSE every 2–3 months (11%) 
or occasionally (25%). 
When asked about their intention 
to practise BSE in the coming year, 80% 
of themsaid that theywould consider 
examining themselvesregularly.e 
mostcommonreasonfornotdoing 
breast cancer screeningwas alackof 
knowledge, followed by belief that is was 
time-consuming or that BSE was not 
needed if one was in good health.
Magazines  and  television  pro-
grammes were identied as the main 
sources of information on breast cancer 
and BSE by 95% and 83% of the par-
ticipants, respectively. Printed materials 
(67%), friends (52%) and health profes-
sionals (46%) were mentioned as other 
sources of information on breast cancer 
and BSE.
Participants’ health beliefs and
knowledge on breast cancer
and screening
Averageresponses to the items on the 
6beliefscalesandthe4knowledge 
scales are summarized in Table 2. 
Signicant dierencesbetweenthose 
who performed BSE and those who did 
not were observed for the total knowl-
edge score (P< 0.01) as well as for the 
itemsofknowledgeaboutsymptoms 
of breast cancer (P< 0.01), risk factors 
of breast cancer (P< 0.01) and screen-
ing methods (P<0.01).erewere 
no signicant dierences between the 
2 groups for knowledge about breast 
cancer incidence (P = 0.290).
Concerning belief scores and per-
forming BSE, signicant dierences 
between groups were observed for total 
beliefs (P< 0.001). Women who per-
formed  BSEhadgreater  condence 
(P <  0.001)  and  health motivation
(P< 0.001) and lower barriers to per-
forming BSE (P< 0.001)thanthose 
who did not. ere were no signicant 
dierences between the 2 groups for be-
liefs about susceptibility to breast cancer 
(P= 0.204), seriousness (P= 0.355) and 
the benets of BSE (P = 0.068).
Factors associated with BSE
As shown in Table 1, signicant associa-
tions were identied between perform-
ing BSE and income level (P = 0.019) 
and having regular checkups withthe 
physician (P< 0.001). Family history of 
breast cancer, history of breast disease, 
marital status, menstruation  status,
age, education level, ethnicity, religion, 
teaching experience, health insurance, 
ever heard about breast cancerand 
perceived health status were not signi-
cantly related to performing BSE.
Table 3 shows the logistic regres-
sion model for predicting BSE per-
formance from the sociodemographic 
variables and the knowledge and belief 
scales. is model was a good model 
forprediction of BSE andit explained 
27% of the variance in BSE performance 
(Nagelkerke R
2
= 0.27, χ
2
= 82.49, df =  
24, P< 0.001). e logistic regression 
analysis identied 3 variables with sig-
nicant odds ratios (OR). Women who 
reported having regular check-ups with 
a physician were over 3 times more like-
ly to perform BSE than those who had 
not (OR = 3.64, 95% CI: 1.82–7.27). 
Women with greater knowledge about 
breastcancerand screeningmethods 
(OR =1.08, 95%CI:1.02–1.13) and 
condencein theirabilitytodo BSE 
(OR = 1.06, 95% CI: 1.00–1.12) were 
also more likely to perform BSE.
Women who had perceived good 
health status (OR = 4.34, 95% CI: 0.66–
28.33), a family history of breast cancer 
(OR = 2.49,95% CI: 0.92–6.71),ever 
undergone clinical breast examination 
(OR = 1.90,95% CI: 0.98–3.66),ever 
heard about BSE (OR = 1.88, 95% CI: 
0.21–16.78)and married (OR = 1.28, 
95% CI: 0.46–3.53) were somewhat 
more likely to perform BSEthan who 
had not. However, these factors reached 
the accepted level of signicance (P
<0.05). e  remaining belief scales 
(perceived susceptibility for breast can-
cer, seriousness of breast cancer, ben-
ets of BSE, barriers to BSE and health 
motivation) were also not signicant 
predictors for BSE performance.
Discussion
e ndings of this study have shown 
that teachers in Malaysia had a low rate 
of practice of BSE (only 19% performed 
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Eastern Mediterranean Health Journal
La Revue de Santé de la Méditerranée orientale
512
Table 1 Factors associated with performing breast self-examination (BSE) among Malaysian woman teachers (n = 425)
Characteristic Performing BSE
(n = 230)
Not performing BSE
(n = 195)
χ
2
-test P-value
No. % No. %
Age (years)
20–30 42 17.8 38 19.3 5.190 0.158
31–40 116 51.1 89 45.3
41–50 64 28.0 53 27.6
> 51 8 3.1 15 7.8
Marital status
Married 207 90.0 171 87.7 0.571 0.450
Single 23 10.0 24 12.3
Educational status
Diploma 15 6.1 15 7.7 2.230 0.332
Degree 208 90.8 169 86.7
Postgraduate 7 3.1 11 5.6
Ethnicity
Malay 199 87.2 157 80.6 4.596 0.204
Indian 11 4.4 16 8.1
Chinese 20 8.3 22 11.3
Religion
Muslim 203 87.7 159 81.7 5.346 0.254
Buddhist 14 6.1 14 7.0
Hindu 8 3.5 15 7.5
Christian 5 2.2 7 3.8
Menstruation status
Premenopause 216 94.3 183 94.1 0.047 0.977
Postmenopause 14 5.7 12 6.0
Income level (RM)
Low (< 3000) 28 12.0 31 16.0 7.940 0.019
Moderate (3000–5000) 96 42.0 103 52.5
Good (> 5000) 106 46.0 61 31.5
Health insurance coverage
No 45 19.6 41 21.0 0.139 0.709
Yes 185 80.4 154 79.0
Having regular health check-ups with physician
Yes 66 28.7 30 15.4 10.693
No 164 71.3 165 84.6 0.001
Family history of breast cancer
Yes 22 9.6 14 7.2 0.775 0.379
No 208 90.4 181 92.8
Personal history of breast disease
Yes 7 3.0 4 2.2 0.319 0.573
No 223 97.0 191 97.8
Ever heard/ read about breast cancer and BSE
Yes 223 97.0 183 93.8 2.391 0.122
No 7 3.0 12 6.2
Perceived health status
Good 97 42.4 73 37.8 1.17 0.556
Satisfied 129 55.9 117 59.5
Poor 4 1.7 5 2.7
RM = Malaysian ringgit.



513
BSE  monthly).  Similarly, therate  of 
regular performance ofBSE among 
female teachers was reported to be 6% 
in the Islamic Republic of Iran [24], 7% 
in Jordan [10] and 11% in Egypt [25]. 
e higher rate of BSE performance in 
our study may be aributed to teach-
ers’ awareness about the risk of breast 
cancer in Malaysia and their exposure to 
media information about breast cancer 
andscreening methods. Most ofour 
educatedwomenhad heardorread 
about breast cancer but only a few per-
formed BSE monthly. Consistent with 
this, Rashidi and Rajarm reported that 
85% of women of Middle East origin 
had heard of breast cancer screening but 
74% had never performed BSE [26].
In the analysis of factors associated 
withperformingBSE,havingregular 
health  check-ups  with  a  physician
was signicantly associatedwith BSE 
performance. Several researchers have 
reported on the role of physicians and 
health care providers in educating and 
encouragingwomento carry out BSE 
[10,11,27,28]. Routinebreast checks 
by providers may help women to feel 
at ease and become more condent
about performing BSE, and may pro-
vide knowledge about its benets.
Women with higher levels of knowl-
edgeaboutbreastcancersymptoms 
and screening demonstrated higher per-
formance rates of BSE. is is consistent 
with previous ndings suggesting that 
knowledge of breast cancer screening is 
an important facilitator for breast cancer 
screening behaviours [6,29,30]. Know-
ing thesteps required,understanding 
the required frequency of BSE and be-
ingawareofthenormal  anatomyof 
their own breasts are issues that can 
be addressed by health personnel in 
assisting womentodo BSEregularly. 
Information provided by health profes-
sionals via the media about correct BSE 
techniques and other health education 
opportunitiesmayincreasewomen’s 
BSE practice [31].
Several factors based on the health 
belief model theory—greater con-
dence of women in their ability to 
perform BSE, higher health motivation 
and fewer barriers to BSE—were asso-
ciated with performingBSE. However, 
condence about performing BSE was 
the only factor that reached statistical 
signicance. Similarly Yarbrough et al. 
[32] and MacDonald et al. [33] found 
that the health belief model did not 
predict breast cancer screening behav-
iour. e low variance on the perceived 
belief scales among our subjects may ex-
plain why the other health belief model 
scalescouldnot predictbreast cancer 
screening behaviour. e signicant
associationbetweencondenceand 
BSE performance in the previous year 
isconsistent with the resultsofother 
studies [29,34,35].is highlightsthe 
importance of introducing educational 
programmesto increase condence 
and identifying barriers to BSE for Ma-
laysian women. Intervention strategies 
should focuson teaching women how 
to make BSE a monthly habit.
Although alarge proportion of the 
women in this study perceived breast 
cancer as a serious disease, most of them 
didnotperceivethemselves asbeing 
Table 2 Comparison of knowledge and belief scores with breast self-examination (BSE) performance among participants
(n = 425)
Variable Performing BSE
(n = 230)
Not performing BSE
(n = 195)
Range t-test P-value
Mean
score
SD Mean
score
SD
Knowledge
Incidence knowledge 1.98 0.84 1.80 0.87 1–3 2.197 0.290
Symptom knowledge 2.75 1.22 2.18 1.34 1–7 4.488 0.001
Risk factor knowledge 6.43 2.57 5.50 2.55 1–15 3.668 0.001
Screening knowledge 10.59 2.46 9.00 3.41 1–18 5.500 0.001
Total knowledge 21.77 5.18 18.55 6.28 1–43 5.702 0.001
Beliefs
Susceptibility to breast
cancer 2.39 0.75 2.29 0.84 1–5 1.270 0.204
Seriousness of breast cancer 3.46 0.70 3.39 0.77 1–5 0.926 0.355
Benefits of BSE 3.89 0.50 3.79 0.62 1–5 1.829 0.068
Barriers to BSE 3.66 0.63 3.87 0.56 1–5 3.423 0.001
Confidence in performing
BSE 3.49 0.46 3.21 0.53 1–5 5.758 0.001
Health motivation 3.98 0.50 3.77 0.51 1–5 4.103 0.001
Total beliefs 3.51 0.23 3.23 0.30 1–5 6.116 0.001
SD = standard deviation.
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Eastern Mediterranean Health Journal
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514
Table 3 Logistic regression analysis for factors related to performing breast self-examination (BSE) (n = 425)
Variable β-coefficient SE Wald P-value OR 95% CI
Marital status
Single 1
Married 0.244 0.520 0.221 0.638 1.28 0.46–3.53
Age (years)
20–30 1
31–40 0.55 0.370 0.022 0.883 1.06 0.51–2.18
41–50 –0.360 0.429 0.703 0.402 0.70 0.30–1.62
> 50 –1.177 0.809 2.129 0.145 0.31 0.06–1.50
Education
Diploma 1
Degree 0.310 0.515 0.364 0.546 1.36 0.50–3.74
Postgraduate –0.450 0.819 0.302 0.583 0.64 0.13–3.17
Income (RM)
< 3000 1
3000–5000 –0.123 0.402 0.093 0.760 0.88 0.40–1.95
> 5000 0.389 0.446 0.760 0.383 1.48 0.62–3.34
Insurance
No 1
Yes 0.105 0.314 0.112 0.738 1.11 0.60–2.06
Regular health checkups
No 1
Yes 1.291 0.354 13.325 0.001 3.64 1.82–7.27
Family history of breast cancer
No 1
Yes 0.912 0.506 3.249 0.071 2.49 0.92–6.71
Personal history of breast disease
No 1
Yes –0.156 0.849 0.034 0.854 0.86 0.16–4.52
Heard about BSE
No 1
Yes 0.626 1.119 0.313 0.576 1.87 0.21–16.8
Perceived health status
Poor 1
Good 1.467 0.958 2.346 0.126 4.34 0.66–28.3
Satisfied 1.522 0.946 2.587 0.108 4.58 0.72–29.3
Undergoing clinical breast examination
No 1
Yes 0.639 0.335 3.634 0.057 1.90 0.98–3.66
Sources of information
Others 1
Doctors 0.115 0.301 0.147 0.701 1.12 0.63–2.62
Knowledge and beliefs
Knowledge of breast
cancer & screening 0.073 0.026 8.240 0.004 1.08 1.02–1.13
Susceptibility to breast
cancer 0.054 0.034 2.522 0.112 1.06 0.99–1.13
Seriousness of breast
cancer 0.033 0.026 1.591 0.207 1.03 0.98–1.09
Benefits of BSE 0.003 0.048 0.003 0.955 1.01 0.88–1.07
Barriers to BSE –0.010 0.041 0.061 0.806 0.91 0.92–1.00
Confidence in BSE 0.061 0.028 4.804 0.028 1.06 1.00–1.12
Health motivation 0.043 0.043 1.036 0.309 1.04 0.96–1.14
SE = standard error; OR = odds ratio; CI = confidence interval;
RM = Malaysian ringgit.
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

515
susceptible. is could be due to a lack 
of education on breast cancer and breast 
cancer screening practices. Health care 
personnel can provide information about
the magnitude and risk factors of breast 
cancer through public health education 
programmes. We found no signicant 
relationship between women’s beliefs 
about the seriousness of breast cancer 
and BSE practice. Previous studies have 
shown variable results about the relation-
ship of perceived seriousness of breast 
cancer with BSE practices. While studies 
in the USA [30], Jordan [10] and Korea 
[29] suggested that screening increases 
with increasedperceivedseriousness of 
breast cancer, other studies in Turkey 
[11] and Hong Kong [36] found no as-
sociation betweenperceivedseriousness 
and BSE behaviors. Women need to be 
helped to avoid misconceptions about 
breast cancer and learn more about the 
benets of earlydetection methods and 
timely treatment of breast cancer.
e majority of women in this study 
hadpositivebeliefs about thebenets 
ofBSE.Severalstudies have reported 
a signicant positive relationship be-
tweenperceived benets of screening 
and BSE practice [11,15,37],whereas 
others have found no signicant eect 
[10,35]. is indicates a need for well-
designed awareness programmes that 
underline the benets of preventive care 
and early screening.
Lack of knowledge, no time for BSE, 
embarrassment, fear of cancer diagnosis 
and perception of low susceptibility to 
breast cancer were commonbarriers 
for performing BSE in the current study. 
us, further qualitative research is 
needed to identify barriers to BSE for 
Malaysian women.
Although a majority of the women 
in this study had high health motiva-
tion, thiswas nota predictor forBSE 
practice. According to previous studies 
using the health belief model, women 
whoaremore motivatedto promote 
their health are more likely to perform 
BSE [10,29,30]. Similar to our nding, 
Secginli and Nahcivan found no asso-
ciation between health motivation and 
BSE practice [11]. 
Our results contrasted with previ-
ousndingssuggestingthatyounger 
and  well-educatedwomenare  more 
likely to practice breast cancer screen-
ing [11,17]. Women’s family history of 
breast cancer was not a predictorfor 
performing BSE also contrasted with 
previousstudies [7,10,11].It could be 
related to the small sample size and the 
low rate of family history of breast can-
cer among women in this study.
ere were some limitations to this 
study. First, the participants were all
secondary  schoolteachersandwere 
therefore unlikely to represent all Ma-
laysian women and thisinuencesthe 
generalizability of the study results. 
Secondly, a self-administered question-
naire might lead to overestimationof 
cancerscreening practices and useof 
References
National cancer registry, Malaysia 2003.1. The second report.
Kuala Lumpur, Malaysia, Ministry of Health, 2003
Smith RA, Cokkinides V, Brawley OW. Cancer screening in 2.
the United States, 2009: a review of current American Cancer
Society guidelines and issues in cancer screening. CA: a Cancer
Journal for Clinicians, 2009, 59:27–41.
Franco EL, Duarte-Franco E, Rohan TE. Evidence-based policy 3.
recommendations on cancer screening and prevention. Can-
cer Detection and Prevention, 2002, 26:350–361.
Smith RA, Cokkinides V, Eyre HJ; American Cancer Society. 4.
American Cancer Society guidelines for the early detection
of cancer, 2003. CA: a Cancer Journal for Clinicians, 2003,
53:27–43.
Clinical practice guidelines for management of breast cancer5. .
Kuala Lumpur, Malaysia, Ministry of Health, 2002.
Phillips JM, Wilbur J. Adherence to breast cancer screening 6.
guidelines among African-American women of differing em-
ployment status. Cancer Nursing, 1995, 18:258–269.
Salazar MK. Breast self-examination beliefs: a descriptive 7.
study. Public Health Nursing (Boston, Mass.), 1994, 11:49–56.
Miedema BB, Tatemichi S. Breast and cervical cancer screen-8.
ing for women between 50 and 69 years of age: what prompts
women to screen? Women’s Health Issues, 2003, 13:180–184.
Lu ZJ. Effectiveness of breast self-examination nursing inter-9.
ventions for Taiwanese community target groups. Oncology
Nursing Forum, 1998, 25:1693–1701.
health care services by subjects, a nd-
ing  thatcouldreducethevalidity  of 
the study.irdly, the studyincluded 
a large numberof youngwomen.e 
inclusion of more women in the older 
age groups (particularly menopausal 
women), could yield a larger proportion 
of women who are currently practising 
BSE. Further research is recommended 
using a larger sample size with women 
of dierent ages, sociodemographic
groups and occupational backgrounds. 
Nevertheless, the ndings of this study 
could inuence the planning of specic 
screening interventions and strategies 
for Malaysian women.
Conclusions
efact thatmostbreast cancers are 
foundby  patientsthemselves[3,38] 
suggests that women should know 
about breast cancer symptoms and 
BSE techniques for early detection. In-
creased knowledge about breast cancer 
risk factors and screening methods can 
helpwomentochange their lifestyle 
risk factors, decrease modiable risk fac-
tors and actively practice breast cancer 
screening. e ndings of this study 
point to an urgent need to increase Ma-
laysianwomen’s awareness aboutthe 
value of BSE. e health belief model 
may be a useful framework for planning 
programmes for the early detectionof 
breast cancer in Malaysian women.
EMHJ •  Vol. 17  No. 6  •  2011
Eastern Mediterranean Health Journal
La Revue de Santé de la Méditerranée orientale
516
Petro-Nustus W, Mikhail BI. Factors associated with breast self-10.
examination among Jordanian women. Public Health Nursing
(Boston, Mass.), 2002, 19:263–271.
Secginli S, Nahcivan NO. Factors associated with breast cancer 11.
screening behaviours in a sample of Turkish women: a ques-
tionnaire survey. International Journal of Nursing Studies, 2006,
43:161–171.
Narimah A. Breast examination. In: Public Health Institute, 12.
Ministry of Health. Report of the second national health and
morbidity survey conference. Kuala Lumpur, Ministry of Health,
1997:145–148.
Rosenstock IM. Why people use health services. 13. Milbank Me-
morial Fund Quarterly, 1995, 44:94–127.
Champion VL. Instrument refinement for breast cancer screen-14.
ing behaviors. Nursing Research, 1993, 42:139–143.
Champion VL, Scott CR. Reliability and validity of breast cancer 15.
screening belief scales in African American women. Nursing
Research, 1997, 46:331–337.
Pisani P, Bray F, Parkin DM. Estimates of the world-wide preva-16.
lence of cancer for 25 sites in the adult population. Interna-
tional Journal of Cancer, 2002, 97:72–81.
Hoeman SP, Ku YL, Ohl DR. Health beliefs and early detection 17.
among Chinese women. Western Journal of Nursing Research,
1996, 18:518–533.
Straughan PT, Seow A. Attitudes as barriers in breast screening: 18.
a prospective study among Singapore women. Social Science &
Medicine, 2000, 51:1695–1703.
Juon HS, Seo YJ, Kim MT. Breast and cervical cancer screening 19.
among Korean American elderly women. European Journal of
Oncology Nursing, 2002, 6:228–235.
Legg JS, Fauber TL, Ozcan YA. The influence of previous breast 20.
cancer upon mammography utilization. Women’s Health Is-
sues, 2003, 13:62–67.
Parsa P et al. Knowledge and behaviors on breast cancer 21.
screening among female teachers in Selangor, Malaysia. Asian
Pacific Cancer Prevention Journal, 2008, 9:271–278.
Nunnally J, ed. 22. Psychometric theory. New York, McGraw-Hill,
1967.
Parsa P et al. Reliability and validity of Champion’s Health Be-23.
lief Model Scale for breast cancer screening among Malaysian
women. Singapore Medical Journal, 2008, 49:897–903.
Jarvandi S et al. Beliefs and behaviours of Iranian teachers 24.
toward early detection of breast cancer and breast self-exami-
nation. Public Health, 2002, 116:245–249.
Yanni-Seif N, Aziz M. Effect of breast self examination training 25.
program on knowledge, attitude and practices of a group of
working women. Journal of the Egyptian National Cancer Insti-
tute, 2000, 12:105–115.
Rashidi A, Rajaram SS. Middle Eastern Asian Islamic women 26.
and breast self-examination. Needs assessment. Cancer Nurs-
ing, 2000, 23:64–70.
Ajayi IO, Adebamowo CA. Knowledge, belief, attitudes to-27.
wards breast cancer in Southwestern Nigeria. Cancer Strategy,
1999, 1:20–24.
Aliabadi-Wahle S. Training in clinical breast examination as 28.
part of a general surgery core curriculum. Journal of Cancer
Education, 2000, 15:10–13.
Han Y, Williams RD, Harrison RA. Breast cancer screening 29.
knowledge, attitudes, and practices among Korean American
women. Oncology Nursing Forum, 2000, 27:1585–1591.
Champion VL, Menon U. Predicting mammography and breast 30.
elf-examination in African American women. Cancer Nursing,
1997, 20(5):315–322.
Kalichman SC, Williams E, Nachimson D. Randomized com-31.
munity trial of a breast self-examination skills-building inter-
vention for inner-city African-American women. Journal of the
American Medical Women’s Association, 2000, 55:47–50.
Yabroff KR, Mandelblatt JS. Interventions targeted toward 32.
patients to increase mammography use. Cancer Epidemiology,
Biomarkers & Prevention, 1999, 8:749–757.
McDonald PA et al. Perceptions and knowledge of breast 33.
cancer among African-American women residing in public
housing. Ethnicity & Disease, 1999, 9:81–93.
Erblich J, Bovbjerg DH, Valdimarsdottir HB. Psychological dis-34.
tress, health beliefs, and frequency of breast self-examination.
Journal of Behavioral Medicine, 2000, 23:277–292.
Smiley MR et al. Comparison of Florida Hispanic and non-35.
Hispanic Caucasian women in their health beliefs related to
breast cancer and health locus of control. Oncology Nursing
Forum, 2000, 27:975–984.
Fung SY. Factors associated with breast self-examination be-36.
haviour among Chinese women in Hong Kong. Patient Educa-
tion and Counseling, 1998, 33:233–243.
Bazargan M et al. Mammography screening and breast self 37.
examination among minority women in public housing
projects: the impact of physician recommendation. Cel-
lular and molecular biology (Noisy-le-Grand, France), 2003,
49(8):1213–1218.
Aspinall V. An effectiveness way to reduce mortality. Screen-38.
ing for malignant breast disease. Professional Nurse (London,
England), 1991, 6:283–287.
    • "The mean knowledge score of BSE is higher among respondents who performed BSE compared to those who did not. This is consistent with previous finding suggesting that knowledge of breast self-examination is an important facilitator for breast self-examination practice (Parsa et al., 2011). According to Gok et al. (2009) knowledge of BSE is one of the factors effects on performing BSE, those who had the higher knowledge of BSE more likely to practice BSE. "
    Full-text · Dataset · Dec 2015 · Asian Pacific journal of cancer prevention: APJCP
    • "The mean knowledge score of BSE is higher among respondents who performed BSE compared to those who did not. This is consistent with previous finding suggesting that knowledge of breast self-examination is an important facilitator for breast self-examination practice (Parsa et al., 2011). According to Gok et al. (2009) knowledge of BSE is one of the factors effects on performing BSE, those who had the higher knowledge of BSE more likely to practice BSE. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: In Malaysia, breast cancer is the first cancer among females regardness of race. Aim: The purpose of this study was to identify the knowledge and BSE practice among undergraduate female students at four public universities in Klang Valley, Malaysia. Materials and Methods: This cross-sectional study was conducted among 820 undergraduate female students using a self-administered questionnaire covering socio-demographic data, knowledge of breast cancer and BSE practice. Results: The mean age of the respondents was 21.7±1.2 years. The majority of them were single (96.8%), Malay (91.9%) and 16.5% of respondents had a family history of breast cancer. This study showed low level of knowledge on breast cancer and breast self-examination among participants. Only 19.6% participants were performing BSE regularly. Knowledge of breast self-examination was significantly associated with BSE practice (p=0.00). Also, there were significant associations between performing BSE with age, marital status and being trained by a doctor for doing BSE (p<0.05). Conclusions: Our findings showed that the rate of BSE practice and knowledge of breast cancer is inadequate among young Malaysian females. A public health education program is essential to improve breast cancer prevention among this group.
    Full-text · Article · Oct 2015
    • "between overall body image satisfaction and women's breast health behaviours among various populations. Several articles also pointed out other barriers such as women having lower coping skills to deal with abnormal results, higher anticipated pain during procedure, fear and anxiety of radiation, side-effects and x-rays (Abdullah et al., 2011; Al-Dubai et al., 2011; Kanaga et al., 2011; Parsa et al., 2011; Al-Dubai et al., 2012; Dahlui et al., 2012; Farid et al., 2014). Although procedural cost was listed as one of the common barriers to seeking screening tests thus leading to late diagnosis, this may only be applicable to those who are poor and those living in rural areas (Subramanian et al., 2013). "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Breast cancer is the most common cancer and the leading cause of cancer mortality among women of all ethnic and age groups in Malaysia. Delay in seeking help for breast cancer symptoms is preventable and by identifying possible factors for delayed diagnosis, patient prognosis and survival rates could be improved. Objectives: This narrative review aimed to understand and evaluate the level of in-depth breast cancer knowledge in terms of clinical breast examination and breast self-examination, and other important aspects such as side-effects and risk factors in Malaysian females. Since Malaysia is multicultural, this review assessed social perceptions, cultural beliefs and help-seeking behaviour in respect to breast cancer among different ethnic groups, since these may impinge on efforts to ‘avoid’ the disease. Materials and Methods: A comprehensive literature search of seven databases was performed from December 2015 to January 2015. Screening of relevant published journals was also undertaken to identify available information related to the knowledge, perception and help-seeking behaviour of Malaysian women in relation to breast cancer. Results: A total of 42 articles were appraised and included in this review. Generally, women in Malaysia had good awareness of breast cancer and its screening tools, particularly breast self-examination, but only superficial in-depth knowledge about the disease. Women in rural areas had lower levels of knowledge than those in urban areas. It was also shown that books, magazines, brochures and television were among the most common sources of breast cancer information. Delay in presentation was attributed mainly to a negative social perception of the disease, poverty, cultural and religion practices, and a strong influence of complementary and alternative medicine, rather than a lack of knowledge. Conclusions: This review highlighted the need for an intensive and in-depth breast cancer education campaigns using media and community health programmes, even with the existing good awareness of breast cancer. This is essential in order to avoid misconceptions and to frame the correct mind-set about breast cancer among women in Malaysia. Socio-cultural differences and religious practices should be taken into account by health care professionals when advising on breast cancer. Women need to be aware of the risk factors and symptoms of breast cancer so that early diagnosis can take place and the chances of survival improved
    Full-text · Article · Aug 2015
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