Breast Self-Examination (BSE) among Greek Women living in the greater area of Athens

Transcription

1 Breast Self-Examination (BSE) among Greek Women living in the greater area of Athens Roupa Z 1., Sapountzi-Krepia D 2., Gourni M 1., Dimitriadou A 2., Faros E 3., Karyda E 4., Sotiropoulou P 5 1. Higher Technological Educational Institute of Athens 2. Higher Technological Educational Institute of Thessalonica 3. Regional Hospital of Larissa 4. Agios Savas Anticancer Hospital of Athens 5. Health Visitor Nurse Abstract: This paper contains the findings of a scientific research which was designed as a comparative one and its purpose was to compare the knowledge related to BSE of Greek breast cancer patients with that of women belonging to a control group. 260 breast cancer patients and a control group of 260 women coming from the general population were also selected. All the subjects live in the greater area of Athens, capital of Greece. A semi-structured questionnaire designed by the researchers was used as an instrument for data collection. Data were analysed with the SPSS/PC + software. The results of the survey are presented in the form of percentages, crosstabulations and as results of the Pearson chi-square test. Statistical significance was set at p=0.05 or less. A variable of knowledge score (KSc) consisting of eight questions was created. The KSc scores for the patients were slightly, but not significantly higher than the KSc scores for the control group. Regarding the answers to the individual knowledge questions women of the control group had a better level of knowledge regarding the age at which one should begin to perform BSE (P=0.000) and patients showed a better level of knowledge concerning the BSE technique (P=0.000) as well as the duration of BSE (P=0.000). In conclusion, the present study revealed the need for action to be taken in Greece, focusing on educational efforts related to BSE. Key words: Breast Self Examination, Knowledge, Breast cancer, Greek women population, breast cancer. ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 1 - of 6

2 Introduction Breast cancer is one the most common cancers among women worldwide 1-2, which can be detected early by mammography, clinical breast examination (CBE) and breast self-examination (BSE) 3,4. Although there is some evidence to suggest that breast self-examination (BSE) contributes to the early detection of breast cancer, the underused of this preventing behaviour continues to exist 5. However, it should also be stressed that the literature published on this subject has questioned whether BSE makes a truly positive contribution to the prevention of breast cancer 6,7. The effectiveness of Breast Self-Examination (BSE) in detecting breast cancer depends not only on frequency, but also on the accuracy with which BSE is performed. Therefore, health care professionals need to provide not only instruction to the general population but also follow-up to interested women The purpose of this study was to compare the knowledge of Greek breast cancer patients with that of women belonging to a control group related to BSE. Materials and methods The research was conducted from February to June of Patients were chosen from among the women with breast cancer who visited the outpatient clinics of the Agios Savas Anticancer Hospital of Athens, Greece for a follow-up. The sample consisted of 260 patients and a control group of 260 women from the general population, selected at random. Patients as well as women of the control group live in the greater area of Athens, capital of Greece. All potential subjects were informed about the research, and it was made clear to them that participation was voluntary, i.e. that they were being invited to participate. An especially designed twenty-one-item questionnaire containing closed and open-ended questions was used. Questions concentrated on the following areas: demographic and social characteristics of the sample, general perceptions of the usefulness of BSE and the method by which it is performed as well as questions regarding useful information pertaining to BSE. Using the nominal group process for 100% professional agreement, three researchers confirmed that the content validity. The questionnaire was also pre-tested by a pilot study. The questionnaire retained the anonymity of all participants. Before answering the questionnaire, all subjects, who participated voluntarily, were given instructions on how to fill it out, and the completed questionnaire was placed anonymously in a collection box. Data analyses were conducted using SPSS/PC + software. Inter-group comparisons were made using comparison of means and the Pearson chi-square test. The results of the survey are presented in the form of percentages, cross-tabulations and as results of the Pearson chi-square test. Statistical significance was set at p=0.05 or less. Results - Demographics The age of the participants was almost the same in both groups, ranging from 18 to 65 years, the mean age for the patients group being 56.2, and 57.6 for the control group. In terms of marital status, 75% of the patients group were married, 15% were single, 8% divorced and 2% widowed. Marital status in the control group was similar, with 80% of the women married, 15% single and 5% divorced. Subjects in the control group had a wide range of educational qualifications: 50% had an academic degree, 33% were high school graduates, 15% had completed primary education and 2% had no education. The educational level of the patients group was as follows: ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 2 - of 6

3 2 % of the women were illiterate, 10% of the women had not completed primary education whereas 40% had, 10% were high school graduates and 38% polytechnic or university graduates. Perceptions, knowledge and practice concerning the regular performance of Breast Self Examination (BSE) In general terms, the majority (57%) of the patients and the majority (67%) of the women in the control group, stated that they greatly appreciated the BSE technique because it is a reliable method for early detection of breast cancer that they can perform by themselves. However, another 24% of the patients and 16% of the women in the control group believe a doctor's examination gives them a feeling of security and enhances the reliability of the examination. Nevertheless, the frequency with which BSE was practiced was limited in both groups. Only 34.6% of the patients and 30% of the control group stated that they carried out a regular BSE on a monthly basis. However, only about a quarter of the subjects in both groups, 23.84% of the patients and 26.15% of the women in control group, stated that they had all the appropriate knowledge to perform BSE correctly, while 38.07% of the patients and 37.3% of the women in the control group stated that they do not feel it is important to perform BSE on a monthly basis. For the purpose of examining the difference in knowledge in connection with how frequently BSE was performed in the two groups, a variable of knowledge score (KSc) consisting of eight questions was created. The KSc was calculated by taking into consideration the number of correct answers divided by the total number of corresponding questions. The scale for the KSc ranged from 0 to 8. The knowledge scores are shown in Table 1. Table 1. Knowledge scores for patients group and control group KSc Mean Value SD Patients Group 3.51 (2.43) Control Group 3.44 (2.27) The KSc scores for the patients were slightly, but not significantly higher than the KSc scores for the control group. The answers to the individual knowledge questions and comparisons between the two groups are illustrated in Table 2. As can be seen in Table 2, women of the control group had a better level of knowledge regarding the age at which one should begin to perform BSE (P=0.000). Patients showed a better level of knowledge concerning the BSE technique (P=0.000) as well as the duration of BSE (P=0.000). Discussion The main findings of the present study are the following: 1. The majority of the subjects in both groups acknowledged the usefulness and the convenience of BSE in the early detection of the breast cancer. 2. The majority of the subjects fail to perform BSE regularly. 3. A considerable percentage of the subjects in both groups have insufficient knowledge of BSE. The number of women who participated in the present study and who actually perform BSE monthly is less than what would be desirable in both groups. This is unfortunate, since BSE is crucial for the early detection of breast cancers. However, it must also be stressed that studies in 16 European countries have shown that very few women perform BSE regularly 18. ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 3 - of 6

4 Table 2. Correct knowledge answers given by the patients and the control group, as well as comparisons Question Patients Group N % Control Group N % P Value Women should start performing BSE at the age of P = BSE should be performed every month, 7 days after the beginning of your period P = After menopause, BSE should be performed on the same day each month P = BSE is performed correctly when a vertical and a horizontal motion are applied to the breast by the palm or by two fingers of one hand P= One hand should be placed behind your head and a pillow placed under your shoulder on the side being examined while the other hand performs the BSE P = The duration of BSE should be at least 3 minutes for each breast P = The BSE technique includes the examination and palpation of both breasts P = The main reason for performing BSE is the early detection of possible breast tumors P- = The results revealed some statistically important differences among the correct answers given by the women in both groups (Table 1). In the light of these findings, it is important to underline that the percentages of women who gave correct answers was extremely low in both groups. Women in the control group were found to be better informed (Table 2) regarding one question only: the age at which BSE should begin (P=0.000). Although the patients were expected to have better knowledge than members of the control group, since following diagnosis they would have been provided with information about BSE, the findings revealed that patients were only better informed (Table 2) about the BSE technique (P=0.000) and the duration of BSE (P=0.000). Therefore, these findings indicate once again that ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 4 - of 6

5 Greek women, be they part of the general population or patients, require more information about breast cancer and BSE. Furthermore, only a relatively low percentage of the women in both groups were aware of the day of the menstrual cycle on which BSE should be performed, as well as of the reasons why BSE is important. About a quarter of the subjects in both groups stated that they did not have the appropriate knowledge to perform BSE, while a considerable percentage of the subjects in both groups stated that they do not feel it is important to perform BSE regularly. It must be stressed that low levels of knowledge related to BSE and indifference to performing BSE are a continual feature of behavior in Greek women, since earlier research carried out on a Greek population showed similar results Nevertheless, the effectiveness of Breast Self- Examination (BSE) is related to frequency and accuracy in performing BSE, and therefore systematic information campaigns and health education programs must be provided for the female population In conclusion, the present study revealed the need for action to be taken in Greece, focusing on educational efforts in connection with the variables related to compliance with early breast cancer detection behaviour and the willingness to perform BSE regularly. References 1. Persson K, Johansson I, Ek AC.Breast self-examination among Swedish women: a survey of frequency, knowledge, and attitudes. J Cancer Educ 1995 ;10(3): Wu ZH., Black SA., Macrides KS., Prevalence and associated factors of cancer screening: why are so many older Mexican American women never screened?prev Med. 2001; 33(4): Κurtz ME, Given B, Given CW and Kurtz JC., Relationships of barriers and facilitators to breast selfexamination, mammography, and clinical breast examination in a worksite population. Cancer Nurs. 1993; 16(4): Benedict S, Goon G, Hoomani J, Holder P. Breast cancer detection by daughters of women with breast cancer. Cancer Pract 1997;5(4): De Grasse CE, O'Connor AM, Perrault DJ, Aitken SE, Joanisse S. Changes in women's breast cancer screening practices, knowledge, and attitudes in Ottawa-Carleton since Can J Public Health 1996; 87(5): Larkin M., Breast self examination does more harm than good, says task force, Lancet, 2001, 357(9274), Schabas R, Colonna J. To BSE or not to BSE? That is the question. Can J Public Health. 1992; 83(5): Brailey LJ. Effects of health teaching in the workplace on women's knowledge, beliefs, and practices regarding breast self-examination. Res Nurs Health 1986; 9(3): Roche M, Gosnell DJ. Evaluation of a hospital teaching program for breast self-examination. Patient Educ Couns 1989; 13(1): Nzarubara RG Control of breast cancer using health education. : East Afr Med J 199; 76(12): Chie WC, Cheng KW, Fu CH, Yen LL.A study on women's practice of breast self-examination in Taiwan. Prev Med 1993; 22(3): Drakshyani Devi K, Venkata Ramaiah P. Teacher's knowledge and practice of breast self examination. Indian J Med Sci 1994; 48(12): Persson K, Ek AC, Svensson PG. Factors affecting women to practise breast self-examination. Scand J Caring Sci 1997;11(4): Adderley-Kelly B, Green PM. Breast cancer education, self-efficacy, and screening in older African American women. J Natl Black Nurses Assoc 1997; 9(1): Clarke VA, Savage SA. Breast self-examination training: a brief review. Cancer Nurs 1999; 22(4): Clark JK, Sauter M, Kotecki JE. Adolescent girls' knowledge of and attitudes toward breast self- ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 5 - of 6

6 examination: evaluating an outreach education program. J Cancer Educ 2000; 15(4): Ludwick R, Gaczkowski T. Breast self-exams by teenagers: outcome of a teaching program. Cancer Nurs 2001; 24(4): Wardle J, Steptoe A, Smith H, Groll-Knapp E, Koller M, Smith D, Brodziak A. Breast self-examination: attitudes and practices among young women in Europe. Eur J Cancer Prev 1995; 4(1): Kavga-Paltoglou A.Greece: knowledge of breast selfexamination. Nurs Times 1990; 86(37): Tsamandouraki K, Alamanos Y, Tountas Y. Knowledge of and attitudes towards family planning and early detection of breast and cervical cancer in two female populations in Greece. Soz Praventivmed 1992;37(3): Corresponding author: Dr Zoe Roupa Aigosthenon 86 Galatsi Athens Tel / Fax: ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 6 - of 6