CONDUCT CAPABILITY EARLY DETECTION OF BREAST CANCER WITH BSE THE ABILITY OF EARLY DETECTION OF BREAST CANCER WITH BSE

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1 CONDUCT CAPABILITY EARLY DETECTION OF BREAST CANCER WITH BSE THE ABILITY OF EARLY DETECTION OF BREAST CANCER WITH BSE Siti Masitoh, Sri Mulyati Midwifery Major at Jakarta III Health Polytecnic ABSTRACT Breast cancer is the second leading cause of death after uterus cancer. In Indonesia, more than 80% of cases are found in advanced stage, so the treatment to get recovered is difficult to do. In the medical world, there are various ways to detect early abnormalities in the breast,one of them is early detection of breast cancer alone that more easily done, known as BSE. The aim of research to determine the effectiveness of health education through lecture and demonstration method in improving young women knowledge about breast cancer and BSE practice in young women in SMAN 8 Tangerang. The research method using quasi-experimental with intervention and control groups research design. Samples are girls student in SMAN 8 Tangerang taken by purposive sampling technique, about 35 samples of the intervention group and 35 samples of the control group. Data analysis using paired sample t test with an alpha <0.05. The results show differences in knowledge of girls student about breast cancer before and after health education, z count equal to (p value = 0.000), and there are differences in ability to perform early detection of breast cancer with BSE s pratice with t count of (p value = 0.000), It concluded that health education through lecture and demonstration BSE s practice effected to knowledge about breast cancer and ability to do BSE in girl student in SMAN 8 Tangerang., Keywords: Health Education, Knowledge of Breast Cancer, Breast Self-Exam Practice INTRODUCTION Breast cancer is known as the most frequently cancer which attacking women. Furthermore, tendency prevelence enhancement cannot be avoided. Death caused breast cancer is still high, especially in developing country, because of delayed in diagnosis, which also means delayed treatment (Bustan, 2007, p.155) Although there is no accurate data to calculate the frequency of breast cancer in Indonesia, the incident of all cancers estimated 180 per population, especially breast cancer is about 18 per population (Bustan, 2007, p.156). Breast cancer is the most common cancer in women around the world, especially in developing countries. Currently, breast cancer is the second cancer causing death in women after cervical cancer, and the most common cancer in women (Wiknjosastro, H. 2006) In 2005, WHO (World Health Organization) estimates that every year there are about 12 million people around the world suffer from cancer and 7.6 million among them are died, if not controlled, 26 million people estimated will suffer from cancer and 17 million died because of cancer in year Ironically, these incident will happen more faster in poor and developing countries (MOH, 2010). It is estimated that the incidence rate in Indonesia is 12/ women, while the United States is approximately 92/ women with a quite high mortality, that is 27 / 100,000 or 18% of deaths are found in women (Medicine, 2010). Every year, breast cancer patients reached 1.1 million women and this amount represents 10% of new cases of all cancers. With mortality rate about 410,000 every year and made it more than 1.6% as the causes of women death around the world. Breast cancer is an issue that is likely to increase in countries with unlimited resources where incident rates increasing by 5% each year (Ministry of Health, 2013).

2 One of the developing country is Indonesia, has a similar problem which the cancer has not been a priority, several obstacles happen such as a lack of knowledge and comunity concern, socio-cultural barriers, health organizations not optimal as well as the lack of resources (Ministry of Health, 2013). Hospital Information System (SIRS) data of 2007 states that breast cancer ranks first for inpatient in all hospitals in Indonesia (16.85%), followed by cervical cancer (11.78%). The highest cancer that indonesian women suffered is breast cancer with the number of incident 26 per 100,000 women, followed by cervical cancer incident rate of 16 per 100,000 women (MOH, 2010). Based on the age group, CASE Malignant Breast Cancer Strikes Age 15 Years To Dan paled Many AT found reproductive age group Namely Age Years Singer BECAUSE THINGS IN the age of estrogen MORE Many INCREASED. (Ministry of Health, 2012). Based on the Decree of the Minister of Health of the Republic of Indonesia No. 796 / Menkes / SK / VII / 2010 CONCERNING Technical Guidelines for Control of Breast Cancer And Cancer Cervical stated that prayer One Form increase awareness ABOUT symptoms And Signs Breast cancer is granting educational ABOUT Breast Self- Examination (Yang The term is known WITH BSE) (MOH, 2010). According to reasearch s result from reasearch center (2004), prevalence of women in 30 years and over who knows BSE in urban areas only 14.2%, while in rural 3.1%, furthermore whom perform BSE in urban areas by 7.4%, while in rural only by 1.4% (MOH, 2004). The survey conducted by Jakarta Breast Health Foundation in 2009 showed 80% of people do not understand the importance of early breast examination. Only 11.5% who understand, added with fear of breast lifted up to requirment to pay the expensive treatment cost so many patients defer his return to the health service by prefer seek alternative treatments (MOH, 2010) Research s result conducted by Sulastri (2012), about the effect of health counseling using video in Breast Self Examination (BSE) to knowledge and attitudes changes of young women in SMAN 9 Balikpapan has knowledge increased before and after counseling. Preliminary studies conducted by researcher in the form of interviews at SMAN 8 Tangerang in 2016, has been found that 4 out of 10 girl students (40%) who know about BSE. Therefore, I am interested to do research about effectiveness of Health Education about BSE against Capability To Do BSE at Young Women in SMAN 8 Tangerang METHOD Type of research is a quasi experiment with design Two Group Pretest Posttest. This research was conducted through pre and post test to intervention group also the control group at the same time, where only the intervention group who received treatment. Bivariate analysis conducted by Kolmogorov Smirnov test if all the data showed normal distribution, so the analysis using the t test dependent / paired sample t test, but if the data is not normal distributed, then using the Wilcoxon test. Standard error defined 5% or 95% standard reliance (Notoatmodjo, 2010, p.191). RESULT AND DISCUSSION The results showed the average (mean) age of respondent intervention group was 15.7 years with standard deviation 0.490, while the control was 15.6 years with standard deviation Respondents are teenage girl students with the youngest is 15 and the oldest is 17 years is a healthy reproductive years (low risk) to develop breast cancer. This is appropriate with Manuaba (2010) that the healthy reproduction (20-35 years) age is safe for breast cancer while over 45 years of age is agitated age to develop breast cancer. Many changes hapenned in adolescence both physically, socially and spiritually. Initially, teenagers was difficult to accept but with increasing time and age also understanding which are owned, teenagers began to accept the changes. Teenagers acceptance towards taboo things began to open because as a new knowledge for them, but the acceptance tend to be introverted and shy. Many

3 changes happen in adolescents. Spesific in young women, there is change in breast as a common thing in teenagers (Widyastuti, 2009). Based on the research s result 47.1% of respondents exposed and 52.9% of respondents are not exposed to BSE. BSE exposure is very important in influencing the attitude of a person in decision making. Most respondents are not exposed to BSE, therefore students are lacking knowledge about BSE. In the group exposed to BSE will affect the level of knowledge in the early detection of breast cancer. In general, a person is exposed to BSE more easily have the capability for early detection of breast cancer. The process of changing attitudes and code of conduct someone or people of group as well effort to maturing people through the efforts of the teaching and training (MONE, 2008). Researcher s assumption is because of respondent still lack of awareness and caution on health, especially reproductive health. Source of information are 39 (55.7%) of respondents from the media, only 3 (4.3%) who receive information from health professionals, while others from parents, school and peers. The source of information is the first person or media to acquire knowledge especially those supporting the activities and existence. The source of information is not a reason for a (girl) student to have ability to doing an early detection of breast cancer. Although with the right source of information, a girl student don t necessarily have the capacity for early detection of breast cancer and can practice the correct BSE. Availability source of information and family/school support, so students can make early detection of breast cancer (Roesli, 2009). There are increasing number of young women who experience FAM (Fibro mammary adenomas). This matter requires more young women that should receive health education on breast self examination before age of 20 years because this period is often happen significant hormonal increasing (MOH, 2009). Most of respondents (75.7%) use the phone / laptop as their information media and only 24.3% use TV. Many myths said that breast cancer is more common in women over the age of 30 years, but now many adolescents aged women suffering from breast cancer. Girls must be vigilant/wary because until now the cause of that malignant disease is still unknown, there are several contributing factors, alcoholic beverages, foods with high fat and giving birth over 30 years (Ghofar, 2009, p.13). Based on researchers observations, more respondents seek information from sources and media that are used outside the medical world, for the reason that they are still shy to learn more about breast health and do not know the benefits of BSE. The Affection of Health Education to Knowledge and Practical of BSE The level of someone knowledge affected by education, because education is an effort to provide knowledge so there is behavioral changes to do BSE practice. The education level of knowledge effected knowledge on health and healthy behavior (Notoatmodjo, 2010). According to Dictionory of Education in Achmad Munib, et al (2004) states that education is the process of a person develop skills, attitudes and forms of behavior in the community where he lives, the social process is people exposed to selected and controlled environmental influences, so he can obtain or experience social skill development and the optimal individual ability Research s result about knowledge and BSE practice get average score of knowledge pre-test is in intervention group and control group is Results of knowledge average score before health education about breast cancer and BSE is more higher compare of intervention group. The results of knowledge t-test on pre test = -4,841 and p value 0,000 so the result of reasearch analysis conclusion can be taken that there is a knowledge differences between intevention group who not yet get health education with control group who didn t get health education about breast cancer dan BSE practice. This is suitable with Monika s reasearch (2010) about the effectiveness of health education on mother s knowledge and attitude on doing BSE that has less knowledge about 48.75%. According to researcher s observation during the pre-test, control group respondent more prepare in physically and

4 mentally because already prepared by the teacher, these are student s regular schedule and, comfortable and conducive school / classroom compare to intervention group condition that less prepared in physically and mentally because of school environment on construction so make it less convenient and conducive that could not be predicted by the researchers. According to Notoatmodjo (2003), the obtained information can be increase respondent knowledge because most of the knowledge obtained through the eyes (reading) and the ear (hearing). Good knowledge if the information obtained from competent sources that is health professionals like midwife, nurse or doctor. This study supports Meliono (2007) which states that knowledge can be influenced by education, media, and information exposure. Researcher s assumption about research result show the knowledge of BSE on girl student at SMAN 8 Tangerang were less. The gap level of knowledge about importance of BSE caused by lack of information that received by girl students and lack of awarness level of breast cancer. According Notoatmodjo (2007), education is a process. Therefore, the educational process has inputs and outputs. The output of the educational process is staff or graduates who have insight and comprehensive way of thinking. According to researchers, BSE health education has influence on the practice of early detection of breast cancer. Research s result about knowledge after health education earned an average score of post test in the intervention group and the control group was The results of the average score of knowledge after health education about breast cancer and BSE intervention group was higher than the control. While the t-test knowledge in post test = and p value of 0.000, the results of the analysis can be concluded that there is a change of knowledge between the intervention group that already received health education with control group who did not receive health education about breast cancer and BSE practice. Knowledge of health education is very important for a student, this happens because with a good knowledge about something, the students can understand and conceive about anything in particular in maintaining personal hygiene. This health knowledge including initial step is very important to know at an early stage tumors or lumps in the breast, so can reduce the death rate from cancer, values and positive attitude towards healthy living principles, and the ability of students carrying out BSE in their everyday lives. Health education is intended to enlighten and transform society toward a better state as aspired, an attempt to disseminate new things that people are interested to implement it in their daily life, an activity to educate people, giving them knowledge, information and new capabilities so that they can shape the attitudes and behavior of living according to what it should be (Notoadmojo, 2010). Researcher s observation about the knowledge and practice of BSE with health education so respondent will conceive, motivated to change her attitudes and behavior to be able to perform BSE routinely and regularly in everyday life that can detect breast cancer early. The results of this study support Hastuti research (2012), which shows there is a positiveand really significant relationship between training and BSE (Breast Self-Examination) with the ability to perform BSE in SMA Negeri 1 Sukoharjo in Central Java with sample 106 students. According to the World Health Organization World Health Organization (WHO) is the only effective way until now, by detection as early as possible for possibility of this disease, by doing Breast Self Examination (BSE). This action is particularly important because almost 85% of breast lumps are found by patients themselves. This examination should be done 7-10 days after menses, because breast conditions are soft and loose so that it easier to touch (Suryaningsih and Sukaca, 2009, p.155). Early detection is done mainly in the teens with increased of vigilance accompanied by an appropriate treatment is believed to reduce the number of deaths due to breast cancer (Bustan, 2007). Based on the results of the study after being given education and modules, also assistance to do direct practice of BSE,so intervention group respondents show increased ability to practice, seen from the

5 average value of pre-test = and post-test = The results of the initial value from BSE practice using the t test was obtained p value of means that there are significant differences. In the intervention group after the post-test, increased in statistical and empirical,is significantly improved with practicing BSE in appropriate and correct. In the control group increased from to in statistical and empirical is an increasing of average practice value, but not meaningful. Increasing of BSE practice value because of respondents received direct assistance from researchers, and helping from enumerators during the learning process. Knowledge gained by respondent about BSE will be practiced in everyday life so can detect early changes that occur in the breast before the breast cancer. In accordance with the theory Notoatmodjo (2012). The scientific method is a systematic way to gain knowledge more sistematic, logi and scientific. Then the method of inductive thinking to get conclusion, by conducting direct observations, make a note to all facts in relation to the object being observed. The material that provided for assisting in the module that can improve their knowledge and skills in line with the research respondents Saputri et al (2014) get a comparison score cadre knowledge using visual and audio lectures, audio visual with a mean (6.71) is greater than the lecture group (2. 80); (p = 0.000) so that the audio-visual and lectures are equally able to enhance the knowledge score on cadres. Discussion method with instructional media types leaflet effectively to improve learning outcomes biology subjects in class XI SMA Wedang, Demak. Researcher s observation after the girl student gets assistance BSE practice and its benefits, the girl student will be motivated and lead to a positive attitude to be practiced in daily life. CONCLUSION AND RECOMMENDATION Characteristics of respondents an average age is 15.7 years; most of the respondents (52.9%) not exposed to BSE information, respondent resource of information mostly (55.7%) from media; There is a difference in the average value of the knowledge and practice of BSE before and after treatment in the intervention group; There is no difference in the average value of the knowledge and practice of BSE before and after treatment in the control group; There was a significant effect of health education on the knowledge and practice BSE in the intervention group and the control group. The school collaborate with the nearest health center to improve UKS through adolescent reproductive health services, especially health education about breast cancer and BSE as required responders. REFERENCES Departemen Pendidikan Nasional RI. (2008). Kamus Besar Bahasa Indonesia Pusat Bahasa. Edisi keempat. Jakarta: Departemen Pendidikan Nasional RI Depkes RI. (2008). Profil Kesehatan Indonesia Jakarta : Depkes RI Monika. (2010). Efektivitas Penyuluhan Kesehatan Terhadap Pengetahuan dan Sikap Ibu dalam Melakukan Pemeriksaan Payudara Sendiri (SADARI) di Lingkungan Linggarjati Pematang siantar tahun 2010.Medan:USU Mubarak Promosi Kesehatan Sebuah Pengantar Proses Belajar Mengajar Dalam Pendidikan. Yogyakarta. Graha Ilmu. Notoadmojo,S. (2003). Pendidikan dan PrilakuKesehatan. Jakarta: Rineka Cipta. Notoatmodjo, S. (2007). Promosi Kesehatan dan Ilmu Perilaku. Jakarta:Rineka Cipta Prawirohardjo, S. (2009). Ilmu kandungan. Jakarta : Bina Pustaka. Rasjidi, I. (2009). Deteksi Dini Dan Pencegahan Kanker Pada Wanita. Jakarta: CV Sagung Seto.

6 Sulastri. (2012). Pengaruh Penyuluhan Kesehatan Menggunakan Video Dalam Pemeriksaan Payudara Sendiri (SADARI) Terhadap Perubahan Pengetahuan Dan Sikap Remaja Putri Di SMA 9 Balikpapan Tahun Jurnal Promosi Kesehatan Nusantara Indonesia. No.10. Edisi 10 Juli-Desember 2012.

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