Mujer con patología mamaria. ¿qué factores se asocian a la práctica de la autoexploración? / Profile of women with breast disease wich does self-exploration. Which are the factors associated with this practice?

Antecedentes. En las últimas décadas la lucha contra el cáncer de mama se ha centrado, básicamente, en el tratamiento y en la prevención secundaria (fundamentalmente la detección precoz). La autoexploración mamaria, aunque no se ha demostrado que reduzca la mortalidad, sí es importante respecto a los casos detectados por la propia mujer (se estima que un 90% del total) y principalmente en los cánceres de intervalo. Objetivos. Identificar entre mujeres con cáncer de mama, cuántas realizan la autoexploración y los factores asociados. Describir las características clínico-patológicas de los cánceres en las mujeres que sí realizan la autoexploración. Metodología. En mujeres diagnosticadas de cáncer de mama, en un hospital de la provincia de Cádiz, España, se reconstruye de manera retrospectiva la historia relacionada con el proceso del cáncer, es decir, sintomatología, factores psicosociales que determinan el contacto con el sistema sanitario, realización de prácticas preventivas (participación en el Programa de Detección Precoz del Cáncer de Mama –PDPCM–, autoexploración mamaria,...). Se realiza una descripción clínico-patológica del tumor: síntoma de presentación, tamaño tumoral, ganglios negativos, grado de diferenciación histológica. Resultados. Se estudiaron 149 mujeres con cáncer de mama, de las cuales el 52% realizaba autoexploración. Las mujeres que realizan autoexploración son más jóvenes (54,78 años frente a 65,63), están casadas (66,2%), se encuentran laboralmente activas y tienen un nivel de estudios mayor. La valoración de la aparición del primer síntoma como algo importante se correlaciona positivamente con aquellas mujeres que practican la autoexploración. En cuanto a otras prácticas preventivas, las que se autoexploran son también las que más acuden al programa de detección precoz (74,4% frente a 29,5% en las que no se autoexploran). En cuanto a las características clínico-patológicas del tumor en las mujeres que se autoexploran: el tamaño tumoral medio es de 2,5 cm; el 50,7% se halla bien diferenciado, y en un 59,1% de los casos los ganglios son negativos. Conclusiones. Las mujeres que se autoexploran son más jóvenes, tienen un nivel educativo mayor, están casadas, se encuentran laboralmente activas y suelen participar en otras prácticas preventivas. En ellas, los tumores diagnosticados presentan un menor tamaño, se diagnostican en estadios más precoces y por lo general presentan mejor grado de diferenciación(AU)

Background/Aims: In recent decades the fight against breast cancer has focused primarily on the treatment and secondary prevention (early detection mainly). In the case of breast self-examination, althought it has not been prove to reduce mortality, it is important in cases detected by women themselves (it is estimated 90% of total), mainly in the interval cancers. Objectives: To identify within women with breast cancer, how many do self-examination and identify associated factors. Describe the clinical and pathological features of cancers in women who do perform self-examination. Methodology: In women diagnosed with breast cancer during 2007 in a hospital in the province of Cadiz, Spain, is reconstructed in retrospect the story related the cancer process: symptoms, psychosocial factors that determine the contact with the health system, preventive practices (self-examination, mammography screening). A description of the pathological tumor: presenting symptom, tumor size, node negative, grade of differentiation… Results: We studied 149 women with breast cancer, from whom 52% did self-exploration. Women who performed self-examination were younger (54.78 years) against the women who did not (65.63 years), married (66.2%), active workers and have a higher educational level. The assessment of the first symptoms in these women as «important» is positively correlated with those women who practice self-examination. For other preventive practices, women who does self-examination are also the most actives in early detection programs (74.4% against 29.5% which didn’t do self-examination). For the pathologic characteristics of tumor in women who did self-examination: the tumor size was 2.5 cm, 50.7 / are well differentiated, and 59.1% of cases the nodes are negative. Conclusions: Women who does self-examination are younger, have higher educational level, are married, are active workers and are often involved in other preventive practices. On them, the tumors diagnosed have a smaller size, are diagnosed at earlier stages and usually present better degree of differentiation(AU)

Psychosocial mediators of a nurse intervention to increase skin self-examination in patients at high risk for melanoma.

This prospective study examines psychosocial mediators of an efficacious skin self-examination (SSE) intervention that includes provision of a whole-body digital photography book depicting the entire skin surface. Individuals (n = 100) with established risk factors for melanoma were recruited from the Memorial Sloan-Kettering Cancer Center Pigmented Lesion Clinic during their initial dermatologist visit and were randomized to receive a photobook immediately (n = 49) or 4 months after intervention delivery (n = 51). Potential mediators included self-efficacy and response efficacy drawn from Social Cognitive Theory, melanoma worry, and SSE anxiety drawn from Self-Regulation Theory, and skin cancer knowledge, and skin awareness. Only self-efficacy was a significant mediator, accounting for 8% of the total effect of photobook enhancement on SSE adherence at 4 months.

Barriers identified by Swedish school nurses in giving information about testicular cancer and testicular self-examination to adolescent males.

The purpose of this study was to investigate to what extent school nurses in Sweden inform adolescent men about testicular cancer (TC) and testicular self-examination (TSE). A questionnaire was completed by 129 school nurses from 29 randomly selected municipalities. All respondents were women, with a mean age of 42 years. The results showed that about 6% of the school nurses had provided information on TC and 9% on TSE; however, the majority was open to presenting such information. The major reason reported for not providing this guidance was insufficient knowledge about the subject. The nurses who had given information were knowledgeable about both TC and TSE and more often informed young men about TC and TSE, whereas those who had only received information about TC were not as likely to provide information about TC or TSE. The results of this study highlight the need to educate school nurses about TC and TSE so they can include this information in their health teaching to adolescent males.

Patient adherence to skin self-examination. effect of nurse intervention with photographs.

BACKGROUND: Results from a single case-control study suggest that skin self-examination (SSE) has the potential to reduce mortality from melanoma by 63%. Despite these encouraging results, SSE rates are low. Few prospective studies of interventions to increase SSE in high-risk cohorts have been performed. The purpose of this study was to assess the impact of a brief nurse-delivered intervention using digital photographs on patients' adherence to performing SSE. DESIGN SETTING/PARTICIPANTS: Patients at high risk for melanoma skin cancer (five or more dysplastic nevi) (N=100) were recruited from the outpatient Pigmented Lesion Clinic at Memorial Sloan-Kettering Cancer Center. All participants had baseline whole-body digital photography as part of their clinical evaluation. INTERVENTION: Patients were randomized: Group A (n =49) received a teaching intervention (physician and nurse education module) with a photo book (personal whole-body photographs compiled in the form of a booklet, with nurse instruction on how to use the photographs); and Group B (n =51) received the teaching intervention only without a photo book. MAIN OUTCOMES/MEASURES: Self-administered questionnaires were provided at three intervals: baseline, post-teaching intervention, and at the 4-month post-baseline visit. To assess adherence with SSE, patients were asked, "How many times in the past 4 months did you (or someone else) usually, thoroughly examine your skin?" RESULTS: In Group A (teaching intervention with photo book), 10.2% of the patients at baseline reported skin examination three or more times during the past 4 months, while 61.2% reported skin examination three or more times at the 4-month follow-up (p =0.039 for paired comparison). In Group B (teaching intervention only), nearly 20% of the patients at baseline reported skin examination three or more times during the past 4 months, while 37% reported skin examination three or more times at the 4-month follow-up (p =0.63). The increase in reported skin examination was compared between the two groups (>51% v >17.6%, p =0.001). CONCLUSIONS: The results suggest that a brief nurse-delivered intervention is effective at increasing patient adherence with SSE. Utilizing digital photographs as an adjunct to screening appeared to increase patient adherence to performing SSE.

A pilot study using nurse education as an intervention to increase skin self-examination for melanoma.

BACKGROUND: A pilot study of an intervention using nurse education for skin self-examination (SSE) was conducted in order to determine specific factors that would be important for the design of a larger intervention. METHODS: Seventy-five subjects completed a pretest, a posttest, a thorough skin examination by a dermatologist, and an educational session by a nurse. RESULTS: Results showed that the subjects increased the frequency of SSE to a predetermined optimal frequency of once every one to two months. Increases in optimal SSE were associated with increases in knowledge about melanoma (p = 0.006). CONCLUSIONS: Before intensive campaigns are launched to improve SSE, models incorporating theories of behavioral change should be tested.

Metodos diagnosticos utilizados en la patologia mamaria. Estructura del subprograma nacional de cancer de mama / Diagnostic methods used for the breast diseases. Structured of tha National Subprogram of Breast Cancer

Se presentan los diferentes metodos de diagnostico utilizados en el pesquisaje de cancer mamario : examen clinico de las mamas, el autoexamen de mamas (AEM) y la mamografia; hacemos una explicacion detallada de la indicacion de esta ultima con sintomas latentes, en lesiones no palpables y casos asintomaticos, asi como ventajas de este metodo. Se explica la estructura del Subprograma de diagnostico Prec-Clinico y Precoz de cancer mamario y exponemos datos sobre la situacion del cancer de mama en el pais. Hacemos alusion del objetivo de la encuesta y estructura del carro movil, donde va implicito el manejo de las distintas clasificaciones: bajo, mediano, alto muy alto, riesgo. En este trabajo se describe la labor de desarrollo y apoyo al programa por parte del equipode salud en especial por el personal de Enfermeria y promotora de salud (BS)

Métodos diagnósticos utilizados en la patología mamaria. Estructura del subprograma nacional de cancer de mama / Diagnostic methods used for the breast diseases. Structured of tha National Subprogram of Breast Cancer

Se presentan los diferentes métodos de diagnóstico utilizados en el pesquisaje de cáncer mamario : examen clínico de las mamas, el autoexamen de mamas (AEM) y la mamografía; hacemos una explicación detallada de la indicación de esta última con síntomas latentes, en lesiones no palpables y casos asintomáticos, así como ventajas de este método. Se explica la estructura del Subprograma de diagnóstico Prec-Clinico y Precoz de cáncer mamario y exponemos datos sobre la situación del cáncer de mama en el país. Hacemos alusión del objetivo de la encuesta y estructura del carro móvil, donde va implícito el manejo de las distintas clasificaciones: bajo, mediano, alto muy alto, riesgo. En este trabajo se describe la labor de desarrollo y apoyo al programa por parte del equipode salud en especial por el personal de Enfermería y promotora de salud (BS)

[Self-examination of the breast: the identification of the knowledge, attitudes, habits and practices (KAHP) required for working out the educational proposals]. / Auto exame de mama: identificação dos conhecimentos, atitudes, habilidades e práticas (CAHP) requeridos para elaboração de propostas educativas.

The authors use the Precede Health Education Model for making social, epidemiology, educational and behavioral diagnosis for breast cancer. It helps self-exam made monthly by women from Vargem Grande Paulista--Basic Health Unit--São Paulo.