Social Perceptions of Breast Cancer by Women Still Undergoing or Having Completed Therapy: a Qualitative Study.

BACKGROUND: Diagnosis and treatment of breast cancer is a crisis situation which effects women's lives physically, socially and spiritually. Investigating women's perceptions of this disease is crucially important for treatment decisions. We therefore determined social perceptions and interpretations of women diagnosed with breast cancer during therapy and in the post-treatment period. MATERIALS AND METHODS: In the study, focus group and in-depth interviews were made with women still undergoing or having completed breast cancer treatment. Some 25 women were included in the research. Content analysis was used in the analysis of the qualitative data obtained after the focus group and in-depth interviews. RESULTS: Some of the women demonstrated positive perceptions towards accepting the disease, whereas others had emotions such as rebellion and anger. The loss of a breast is important with different interpretations. CONCLUSIONS: Women's acceptance or rebellion against the disease varies within their social interpretations after the treatment, as at the stage of diagnosis/treatment. All stages of breast cancer negatively affect the social life of the affected individual as much as her body. Nurses assume crucial roles in coping with these negative effects. Thus, it is necessary to know, and sociologically interpret, what is indicated by the information on what the negative effects concerning the disease are and how they are interpreted.

Breast cancer risk and early diagnosis applications in Turkish women aged 50 and over.

BACKGROUND: The aim of the study was to determine breast cancer risk and early diagnosis applications in women aged ≥50. MATERIALS AND METHODS: This cross-sectional, descriptive field study focused on a population of 4,815 in Mansurog?lu with a 55.1% participation rate in screening. In the study, body mass index (BMI) was also evaluated in the calculation of breast cancer risk by the Breast Cancer Risk Assessment Tool (BCRA) (also called the "Gail Risk Assessment Tool") . The interviewers had a three-hour training provided by the researchers, during which interactive training methods were used and applications were supported with role-plays. RESULTS: The mean age of the women participating in the study was 60.1±8.80. Of these women, 57.3% were in the 50-59 age group, 71.7% were married, 57.3% were primary school graduates and 61.7% were housewives. Breast-cancer development rate was 7.4% in the women participating in the study. When they were evaluated according to their relationship with those with breast cancer, it was determined that 73.0% of them had first- degree relatives with breast cancer. According to the assessment based on the Gail method, the women's breast cancer development risk within the next 5 years was 17.6%, whereas their calculated lifetime risk was found to be as low as 0.2%. Statistically significant differences (P=0.000) were determined between performing BSE - CBE and socio-demographic factors. CONCLUSIONS: It was determined that 17.6% of the participants had breast cancer risk. There was no statistically significant difference between the women with and without breast cancer risk in terms of early diagnosis practices, which can be regarded as a remarkable finding. It was planned to provide training about the early diagnosis and treatment of breast cancer for people with high-risk scores, and to conduct population-based breast cancer screening programs.

Assessment of cervical cancer risk in women between 15 and 49 years of age: case of Izmir.

BACKGROUND: The aim of the study was to determine risk factors for cervical cancer for women in Izmir. METHODS: This cross-sectional, descriptive field covered a population of 4319 women of reproductive age (15-49) (household registration in the Mukhtar's office-2007). A total of 1,637 women were included in the sample given a four-part questionnaire through face-to-face interview by visiting the women in their homes in order to determine socio-demographic factors, obstetric history, genital hygiene and the use of family planning methods. In addition, during the data collection process, the women were given group training in order to raise awareness of cervical cancer. The number and percentage distributions of the data were calculated. RESULTS: While the average age of the women was 31.9±9.77 (Min: 15.00-Max: 49.00), education level of 43.4% of them was elementary school only. It was determined that 70.3% of the women experienced at least one pregnancy, 71.0% had vaginal delivery and 75.9% used a contraceptive method. In the study it was determined that among the cervical cancer related risks vaginal delivery, vaginal lavage and having three or more pregnancies had the highest rates, while having sexual intercourse before 16 years of age and having more than one sexual partner constituted lower rates. The rate of the women who stated not having a smear in the last three years was 82.4%. CONCLUSIONS: Considering the case in terms of having Pap smear test, women's awareness on the risk factors and early diagnosis of cervical cancer was found to be low. Due to this reason, awareness of women has to be raised through education.

Sociodemographic aspects of consanguineous marriage in an urban slum of a metropolitan area in Izmir, Turkey.

BACKGROUND: Consanguineous marriage is a common practice in Turkey. Sociodemographic and cultural factors associated with it are still unclear. AIM: The purpose of this study was to investigate the association between sociodemographic and fertility factors and consanguineous marriages in an urban slum of a metropolitan area in Turkey. METHODS: This community-based case-control study was conducted in Bayrakli Municipality health centres. Of the 1243 married women, 85 consanguineously married were included in the case group. A control group in non-consanguineous marriages consisted of 85 women matched to cases according to age and neighbourhood. Information about the subjects' sociodemographic features, fertility history and opinions about consanguineous marriage was collected. RESULTS: Factors that were associated with consanguinity included; having a low level of education (OR = 2.7, CI = 1.1-6.7), a brief duration time in Izmir after migration (OR = 4.7, CI = 1.9-11.6) and consanguineous parents (OR = 3.8, CI = 1.5-9.7). Despite the increased numbers in fertility features and higher perinatal mortality for first cousin marriages, there was no significant difference in the mean numbers of pregnancies, births, stillbirths and living children. CONCLUSION: Time after migration and educational background of women were the main factors associated with consanguineous marriages. Public health interventions to reduce consanguineous marriage in urban areas should target socioeconomically disadvantaged populations in cities.

Translation and validation of the Breast-feeding Self-efficacy Scale into Turkish.

BACKGROUND: Recent research indicates that most mothers give up breast feeding their infants early in the postpartum period due to difficulties with breast feeding and the belief that they are inefficient at breast feeding. Using self-efficacy theory as a conceptual framework to measure breast-feeding confidence, a Turkish version of the Breast-feeding Self-Efficacy Scale (BSES) was developed and psychometrically tested among Turkish mothers. OBJECTIVE: To translate the BSES into Turkish and assess its psychometric properties among breast-feeding mothers. DESIGN: A methodological study to assess the reliability, validity and predictive value of the BSES. SETTING: Women were recruited from two mother and child health-care units in the Altindag district in Izmir, Turkey between 2006 and 2007, and followed up two months post partum. PARTICIPANTS: 165 Turkish-speaking women. METHODS: Following back-translation, questionnaires were completed in hospital and at home by postnatal women. The BSES was administrated at one, four and eight weeks post partum to determine the method of infant feeding. The interviews and home visits were conducted in mothers' own homes at a mutually convenient time. FINDINGS: The psychometric assessment method used to validate the original BSES (English version) was replicated with the translated Turkish version. The well-concordance coefficient of Kendall's W scale was 0.227, p<0.01 and the test-retest reliability coefficient was 0.45. The consistency of the scale in terms of temporal process was efficient (p = 0.00). Cronbach's alpha coefficient was 0.91 and 0.92 at one and four weeks post partum, respectively, and the reliability of the scale was found to be high (0.80 ≤ α<1.00). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The Turkish version of the BSES can be used to determine which mothers are at risk of giving up breast feeding early in the postpartum period, and the subjects they need to learn about breast feeding.

Midwives roles in women's improvement of protective behaviour against breast cancer whether they have a family history of cancer or not.

PURPOSE: The aim of the study was to determine roles of midwives in helping women improve behavior for protection against breast cancer and towards early diagnosis whether they have a family history of cancer or not. MATERIALS AND METHODS: The study was planned in order to evaluate the efficacy of education about the risk factors of breast cancer and primary and secondary protection (early diagnosis) measures given to the women between the ages of 20-49, literate, married and who had or did not have cancer cases in their families. It was carried out in the region of Çamkule Levent Kara Health Care Center between March 2006 and April 2007. RESULTS: Age, educational and economic status of the women with or without a cancer case in their families have been equivalent and a statistically significant difference has not been determined between both of the groups (p>0.05). The cancer risk perception of the women having a cancer case in their families (75.8%) was higher than in those without (62.8%) (p<0.005). Although they were also better informed about protection against cancer and early diagnosis, they do not participate to a greater extent in the practices of early diagnosis-scanning of breast cancer and they do not turn the information into attitude or behavior. CONCLUSION: The results of the study showed that midwives have significant responsibilities for directing all women towards protection against breast cancer and early diagnosis programs.

Prevalence of prostate cancer among men aged 40+ living in Osman Gazi health care district.

BACKGROUND: Prostate cancer is a risk for men aged 40+ even if it is rarely seen among men under the age of 50. It is asymptomatic disease in its early period and if the person does not have an enlarged prostate it will be overlooked without screening. Consequently, the only way to diagnose prostate cancer in its early period is to determine the serum PSA (prostate-specific antigen) level of men aged 40+ and to do a digital rectal examination (DRE). OBJECTIVE: The aim of this study is to determine the prevalence of prostate cancer among men aged 40+, to mention the significance of DRE and PSA by means of a training to be done with the aid of a booklet about early diagnosis, and to encourage men to consult a doctor and get the right treatment at the right time. METHODS: The research was a descriptive field study. carried out among 660 men aged 40+ out of 3,285 men who live in Osman Gazi Health Care District, connected with the Presidency of Training and Research Health Group of Bornova. This group was selected as the smallest sample size by the systematic sampling method within the frame of setting the prevalence of prostate cancer at 10%, the confidence interval as 95%, the standard error as 2%. A total of 264 men of the sample group (participation rate 40%) agreed to a survey of International Prostate Symptom Score (I-PSS) projected by the study, and underwent DRE and PSA with a blood sample. RESULTS: Increase in the serum PSA level (4 ng/mL<) was determined in 10 men. Nodules were detected in 3 men together with the increase in PSA. One further nodule was detected only in DRE one examination of 12 participants. In the light of these data, it was decided to conduct a biopsy on 25 people, who had an increase in PSE and/or whose abnormalities were detected during DRE, in company with TRUS, and prostate cancer was detected in the biopsies of 5 people (1.89%). CONCLUSIONS: It can be thought that before a decision is made on routinizing prostate cancer screening, it may be more suitable to make randomized controlled screening trials for prostate cancer.

The effects of an educational program on knowledge of breast cancer, early detection practices and health beliefs of nurses and midwives.

AIM: To determine the effectiveness of an educational program concerning knowledge of breast cancer, early detection practices and health beliefs of nurses and midwives. BACKGROUND: Educational programs play an important role in breast cancer preventive behaviour. DESIGN: The study was designed as an experimental post-test only, control group design. The educational program was applied only to the experimental group. The study group included 157,134 nurses and midwives respectively in the experimental and the control group. METHODS: Participants in the experimental group received an educational program on the breast cancer. One year after the educational program was delivered, data were collected from the two groups using a personal data form and the Turkish version of Champion's Health Belief Model Scale. Descriptive statistics, paired samples t-test, chi-square test and Fisher's exact test were conducted in the course of the data analyses. RESULTS: The mean total knowledge score was significantly higher in the experimental group than in the control group. The application percentage of mammography and clinical breast examination was higher in the experimental group. There were no significant differences between two groups in performing breast self-examination. The experimental group was significantly more likely to feel confident and motivated, and their total score on the health belief scale was much better than that of the control group. CONCLUSIONS: The results of this study showed that educational intervention had a positive impact on knowledge of breast cancer, on practices related to breast cancer, on early detection and on the health beliefs in the experimental group. RELEVANCE TO CLINICAL PRACTICE: The educational programs, including techniques to increase the motivation and skills for early detection of breast cancer, should be made widespread in nursing and midwifery. Health beliefs should be considered in planning educational programs about breast cancer. Interventions should be designed to enhance nurses' and midwives' confidence and motivation.

Efficacy of a training course given by midwives concerning cervical cancer risk factors and prevention.

BACKGROUND: Cervical cancer is the second most common cancer type seen among women in most countries and an important cause of mortality. Although it is a preventable disease, most women living in developing countries cannot reach effective screening programs. It is essential that appropriate education about cervical cancer is provided. OBJECTIVE: This experimental field study was performed with the aim of evaluating the efficacy of training given to women about cervical cancer risk factors and primary and secondary prevention precautions. METHODS: The research focused on women between 25 and 29 years of age, literate, married and having social security. The study was conducted in the district of Evka 4 Health Care Center between the dates of April to August 2005. The women were given survey forms and questionnaires in order to determine their socio-demographic features and knowledge level about cervical cancer in the course of home visits. They were trained and given a manual at the data collection stage. At a second visit, carried out three months later, the trained women were again evaluated for their knowledge level about cervical cancer, risk factors and whether they had undergone a Pap smear test. RESULTS: Together with the difference between pre-/post-training mean information scores related to women's cervical cancer risk factors, the difference between the women's having a Pap smear test in the pre-/post-training period was found statistically significant. Only 16.3% of the women stated that they had a Pap smear test in the post-training period. CONCLUSIONS: It was determined that the women were in need of knowledge about risk factors related to cervical cancer, prevention from and early diagnosis of cervical cancer, but there was no significant increase in the rate of having a Pap smear test despite the increase in the knowledge level with the training given.

Health beliefs and breast self-examination in a sample of Turkish women academicians in a university.

OBJECTIVE: The purpose of this study was to evaluate health beliefs and BSE behavior of female academicians in a Turkish university. METHODS: This descriptive study was conducted at various faculties located in Ege University, Izmir, Turkey, in 2005. The sample consisted of 224 female academicians. Data were collected using a self-administered questionnaire and the Turkish version of Champion's Health Belief Model Scales (HBM). Descriptive statistics, t-test and Mann Whitney u analysis were conducted. RESULTS: The percentage of participants who regularly performed BSE was 27.7 %. Benefits and health motivation related to BSE ranked either first or second, along with confidence. Perceived barriers to BSE had the lowest item mean subscale score in academicians. Single academicians perceived susceptibility and seriousness higher than their married counterparts. Family history of breast cancer of participants affected their health beliefs subscale. CONCLUSIONS: BSE performance among participants was more likely in women academicians who exhibited higher confidence and those who perceived fewer barriers related to BSE performance, complying with the conceptual structure of the HBM. Therefore, it is recommended that in order to increase the rates of regular breast cancer screening, mass health protective programs based on the HBM should be executed for women.

Why do men refuse prostate cancer screening? Demographic analysis in Turkey.

Prostate cancer is one of the most common cancers in men, with a high incidence rates in Turkey. However, the early detection and diagnosis rates are considerably lower among Turkish men as compared with their counterparts in Western countries. This fact reflects a lack of awareness and fear of prostate cancer as well as low prevention activities. To reduce the disparities in prostate cancer survival, there is a great need to increase men's participation in screening programs. The present study was performed to assess why men do not seek screening or participate in screening programs, focusing on the demographics of men refusing a free screening program for prostate cancer.

Comparison of mediterranean, Western and Japanese diets and some recommendations.

During the past thousands of years, food systems, and thus human diets, have been and are shaped by climate, terrain, seasons, location, culture, and technology. In this context, many types of diet patterns have emerged. Nowadays, numerous epidemiological studies are being conducted in many countries in order to find relationships between empirically identified dietary factors and the occurrence of illnesses. Today, some dietary patterns are described as healthy eating models while others are generally qualified as unhealthy.

Eating habits, knowledge about cancer prevention and the HPLP scale in Turkish adolescents.

BACKGROUND: Nutritional status and healthy lifestyle are important factors not only in cancer etiology but also for prevention efforts. A good nutritional status contributes to a healthy life with high economic, social and cultural level. Unhealthy eating habits are part of risky behavior seen from adolescence. The present study was therefore carried out to determine eating habits, level of knowledge about cancer prevention and behavior of a group of adolescents. METHODS: Data were collected using questionnaire covering eating habits and knowledge of adolescents on prevention from cancer, and special scale (HPLP) to determine the related behavior. Three hundred sixty six of 390 students volunteered for study. RESULTS: Eating habits and the level of cancer prevention knowledge were similar for both genders, except for the exercise issue. The mean total points of adolescents in the Health Promotion Behavior and Subscales was 113,63. While spiritual growth had the highest score in HPLP subscale, exercise had a minimal score. Exercise was the only HPLP subscale with a statistically significant difference between male and female genders. CONCLUSIONS: Although they have some information, the adolescents surveyed did not have preventive skills relative to their practical life. In general in order to ensure cancer prevention and a healthy life style social, cultural and sportive activities should be encouraged and educational programmes supporting these goals should be designed and applied for all stages of life, starting in early childhood.

Breast cancer awareness and practice of breast self examination among primary health care nurses: influencing factors and effects of an in-service education.

AIM: The purposes of this study were to identify the level of breast cancer and breast self examination practice knowledge of primary health nurses and the factors influencing breast cancer and breast self examination knowledge as well as to investigate the frequency of breast self examination practice of primary health nurses and influencing factors and to evaluate the effects of an in-service training program about breast cancer and breast self examination practice for primary health nurses. BACKGROUND: An increased awareness among nurses about breast cancer prevention would most likely result in a higher number of better educated women about breast cancer and also motivate adherence to screening recommendations. DESIGN AND METHODS: A pre-test and post-test design was implemented to evaluate the effectiveness of a Breast Cancer and Breast Self Examination Education Program for primary health nurses. The program was instructed to 192 of the 215 primary health nurses by two nurse trainers. Pre- and post-tests made available a quantitative evaluation of the level of improvement in breast cancer and breast self-examination knowledge. RESULTS: Mean of total breast cancer knowledge score of primary health nurses prior to the program was 58.51 SD 15.63 whereas, it increased to 75.96 SD 9.53, revealing a statistically significant escalation (p < 0.0001). A significant increase was detected in the number of primary health nurses practising breast self examination as a result of the significant improvement in the mean of self breast self examination practice knowledge score which rose evidently from 71.09 SD 19.31 to 85.02 SD 12.92 (p < 0.0001). CONCLUSION: The in-service education program improved the knowledge about breast cancer and practice of breast self examination in trained primary health nurses. The program model, which involved trained primary health nurse also represented an efficient use of the resources. RELEVANCE TO CLINICAL PRACTICE: It is important that primary health nurses have adequate breast cancer knowledge and practice of breast self examination to contribute effectively to primary health care. Findings of this study can be used to guide the planning efforts on continuous education of primary health nurses about breast cancer and breast self examination issues.

Breast cancer risk assessment and risk perception on nurses and midwives in Bornova Health District in Turkey.

Risk perception is a significant component of awareness of breast cancer risks. It can be helpful to reduce deaths of breast cancer via increasing awareness risk level. This study aimed to discuss the level of perceived and calculated breast cancer risk and to provide data on the practice of breast self-examination and use of mammography among 215 nurses and midwives working in the 23 primary healthcare centers in Turkey. Participants were asked to assess their personal lifetime breast cancer risk by a 4-item Likert scale ("no risk," "usual," "moderate," and "strong" risk), which determined "perceived breast cancer risk." Gail model was used to assess the "calculated breast cancer risk," which was calculated by the tool provided by the National Cancer Institute, version 7. Perceived and calculated risk levels were compared. The relation between sociodemographic and risk factors with "perceived risk" was examined. In addition, the influence of perceived risk on breast cancer screening practice was also assessed. The level of perceived risk of nurses and midwives was higher than that of calculated risk. Considering the fact that participants were healthcare professionals, the use of breast self-examination and mammography practices as a preventive behavior by nurses and midwives was lower than expected. Implications are discussed with regard to breast cancer risk and preventive behavior.

Nutrition, lifestyle, and breast cancer risk among Turkish women.

Breast cancer is the most common malignancy in women, with more than 1 million cases occurring worldwide annually. Cancer is one of the leading causes of mortality in Turkey; deaths due to breast cancer constitute 24.1% of all carcinoma cases reported among women. We conducted a case-control study of Turkish women with and without breast cancer to investigate the relationships of selected lifestyle and nutritional risk factors with breast cancer risk. Factors were chosen based upon published associations with breast cancer. Subjects were women in Izmir, Turkey. Cases were 123 women with breast cancer registered with the Department of Oncology, Ege University Hospital, in February through July 2004. The control group included 120 randomly selected women without a breast cancer diagnosis, registered with the Evka-4 Health Care Center and having similar sociodemographic characteristics. Inclusion criteria for participation consisted of 40 yr of age and over and willingness to participate. Chi2 tests and t-tests were used to determine statistical differences between cases and controls based on selected variables. Logistic regression was used to find the association between selected risk factors and breast cancer occurrence. Cases had smoked for more years, their age of first pregnancy was higher, and breast cancer occurrence was more common in first-degree relatives such as mothers and sisters of cases compared with controls. Cases were found to have consumed higher amounts of vegetable oil in contrast to controls. These findings are consistent with similar studies conducted in both developed and developing countries.

Ethical issues for cancer screenings. Five countries--four types of cancer.

In recent years, medical ethics has become an undisputed part of medical studies. Many people believe that modern advances in medical technology--such as the development of dialysis machines, respirators, magnetic resonance imaging, and genetic testing and types of cancer screenings--have created the bioethical dilemmas that confront physicians in the 21st century. Debates over research and screening ethics have until recently revolved around two related questions: the voluntary, informed consent of subjects, and the appropriate relationship between risk and benefit to subjects in the experiment. Every patient has a right to full and accurate information about his or her medical condition. This legal principle arose primarily through court decisions concerning informed consent, but over time, physicians recognized that most patients prefer to learn the truth about their condition and use the information well. To screen is to search for disease in the absence of symptoms or, in other words, to attempt to find disease in someone not thought to have a disease. Examples of screening include routine mammography to detect breast cancer, routine Pap smears to detect cervical cancer and routine prostate specific antigen (PSA) testing to detect prostate cancer. Ethical principles to be followed in cancer screening programs are intended mainly to minimize unnecessary harm to the participating individuals. Numerous ethical questions can be raised about the practice of screening for disease. This paper reviews recommendation for cancer screening from five countries, examine them from an ethical perspective, and make conclusion from this analysis.

Ethical issues for cancer screening.

In recent years medical ethics has become an undisputed part of medical studies. Many people believe that modern advances in medical technology - such as the development of dialysis machines, respirators, magnetic resonance imaging and genetic testing and types of cancer screenings - have created bioethical dilemmas that confront physicians in the 21st century. Debates over research and screening ethics have until recently revolved around two related questions: the voluntary, informed consent of subjects, and the appropriate relationship between risk and benefit to subjects. Every patient has a right to full and accurate information about his or her medical condition. This legal principle arose primarily through court decisions concerning informed consent, but over time physicians recognized that most patients prefer to learn the truth about their condition and use the information well. To screen is to search for disease in the absence of symptoms or, in other words, to attempt to find disease in someone not thought to have a disease. Examples of screening include routine mammography to detect breast cancer, routine pap smears to detect cervical cancer, and routine Prostate Specific Antigen (PSA) testing to detect prostate cancer. Ethical principles to be followed in cancer screening programmes are intended mainly to minimize unnecessary harm for the participating individuals. Numerous ethical questions can be raised about the practice of screening for disease. Here, we examine four leading cancer killers worldwide and we review the screening of protocols of these cancer types and their possible ethics.