Early Detection and Screening for Breast Cancer.

OBJECTIVE: To review the history, current status, and future trends related to breast cancer screening. DATA SOURCES: Peer-reviewed articles, web sites, and textbooks. CONCLUSION: Breast cancer remains a complex, heterogeneous disease. Serial screening with mammography is the most effective method to detect early stage disease and decrease mortality. Although politics and economics may inhibit organized mammography screening programs in many countries, the judicious use of proficient clinical and self-breast examination can also identify small tumors leading to reduced morbidity. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses have exciting opportunities to lead, facilitate, and advocate for delivery of high-quality screening services targeting individuals and communities. A practical approach is needed to translate the complexities and controversies surrounding breast cancer screening into improved care outcomes.

Breast cancer screening practices among Hong Kong Chinese women.

BACKGROUND: Although the incidence rates of breast cancer have been increasing remarkably in Hong Kong over the last 2 decades, little is known on breast cancer screening practices among this group of women. OBJECTIVES: This study aimed to report breast cancer screening practices among Hong Kong Chinese women and to examine the relationship between (1) demographic factors and (2) the modified Chinese Breast Cancer Screening Beliefs Questionnaire (CBCSB) score and women's breast screening behaviors. METHODS: A descriptive and cross-sectional method was used. Both English and Chinese versions of the modified CBCSB were administered. Of 946 Hong Kong Chinese women older than 18 years and invited to participate in the study, 753 (79.6%) completed and returned the questionnaire. RESULTS: The majority of participants (70%-90%) had heard of breast self-examination (BSE), clinical breast examination (CBE), and mammograms. Only 33.3% performed a BSE monthly; 37.8% and 32.7% of women within the targeted age group had a CBE annually and had a mammogram every 2 years, respectively. Being married and part-time employment were positively associated with women who performed BSE as recommended. In terms of modified CBCSB score, women who had BSE, CBE, and mammogram as recommended had significantly higher scores on the subscale attitudes to health check-up. CONCLUSION: Attitudes toward health check-up was influential in compliance with breast cancer screening practices among Chinese-Australian women. IMPLICATIONS FOR PRACTICE: Effort should be focused on specific subgroups of Hong Kong Chinese women, to fully understand the barriers involved in participating in breast cancer screening practices.

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)

La autoexploración mamaria como principal técnica de prevención del cáncer de mama / Breast self-examination as main technique for breast cancer prevention

El cáncer de mama es la neoplasia más frecuente en la mujer. Como principal medida preventiva destaca la autoexploración mamaria, ya que casi el 95% de los tumores mamarios es detectado por la propia mujer a través de esta técnica. La enfermería constituye el grupo sanitario más relacionado con la enseñanza de las pautas adecuadas para realizar la técnica de forma correcta: práctica mensual, reconocimiento de anomalías en la mama, acudir al médico especialista ante posibles dudas de cambios en las mismas, etc(AU)

Breast cancer is the most common malignancy in women. Breast self-examination stands out as the main preventive measure, since almost 95% of breast tumours are detected by the woman herself through this technique. Nursing is the group most closely related to health education appropriate guidelines to perform the technique correctly: monthly technical realization, recognition of abnormalities in the breast, go to the doctor for possible doubt about changes in them, etc(AU)

Un bulto en la mama. Tú eliges cómo abordarlo / A lump in the breast

Las estadísticas parecen indicar que en algún momento de su vida, una de cada nueve mujeres deberá afrontar un cáncer de mama. La autora relata su manera personal de hacerle frente, compartiendo las preguntas y respuestas que ha ido hallando en este camino. Es autora del libro de igual título que su artículo(AU)

The statistics seem to indicate that at some point in their lives, one in nine women must face breast cancer. The author recounts his personal way of moving forward and sharing the questions and answers that have been found in this way. She is the author of the book with the same title that his article(AU)

Conocimiento y práctica del autoexamen de mamas por usuarias de la Unidad de Salud de la Familia / Knowledge and practice of the breast self examination by the users of the Family Health Unit / Conhecimento e prática do auto-exame das mamas por usuárias de Unidade de Saúde da Família / studo transversal com 116 usuárias, de 40 a 59 anos, de uma Unidade de Saúde da Família, no sudoeste baiano, a fim de avaliar o conhecimento e prática das mesmas acerca do auto-exame das mamas (AEM). Foi utilizado formulário estruturado, analisado pela regressão de Poisson. 75,9 % das mulheres relataram conhecer o AEM e 65,5%, praticá-lo; A razão de prevalência para o conhecimento do AEM foi 1,40 vezes maior entre as mulheres com mais escolaridade; 2,85 vezes maior entre as que conheciam o câncer de mama e 15% maior para as que acham importante descobrir cedo a doença. A prática mostrou-se maior entre as economicamente ativas; com mais de 2 filhos; não tabagistas; que freqüentam a unidade mais de 2 anos, que conhecem e acham importante descobrir o câncer de mama precocemente. Depreende-se que é preciso investir mais em atividades de educação para evitar agravos à saúde da mulher

Estudio transversal con 116 usuarios, de 40 a 59 años, de una Unidad de Salud de la Familia en el suroeste de Bahía, con el fin de evaluar el conocimiento y la práctica de las mismas sobre el autoexamen de mamas (AEM). Se utilizó formulario estructurado, analizado por regresión de Poisson. 75,9% de las mujeres reportaron conocer el AEM y el 65,5% lo practica. La razón de prevalencia para el conocimiento del AEM fue 1,40 veces mayor entre las mujeres con mayor escolaridad, 2,85 veces mayor entre las que conocían el cáncer de mama y más del 15% para aquellas que consideran que es importante detectar la enfermedad temprano. La práctica fue más alta entre la población económicamente activa, con más de 2 hijos, no fumadoras, que asisten a la unidad durante más de 2 años, que conocen y sienten importante detectar el cáncer de mama precozmente. De ello se desprende que es preciso invertir más en actividades de educación para prevenir riesgos para la salud de la mujer (AU)

Transversal study with 116 users, from 40 to 50 years old, of a Family Health Unit in the southwest of Bahia, in order to assess the knowledge and the practice of themselves about the breast self examination (BSE). A structured form was used, analyzed by Poisson regression , the 75.9% of the women reported on knowing the BSE and the 65.5% of the women put it into practice.the prevalence reason for knowing the BSE was 1.4 times higher among women with higher scolarship, 2.85 times higher among those who know the breast cancer and more than 15% for those who consider that it is important to detect the disease early. The practice was higher among the economical active population, with more than 2 children, non-smoking, who attend to the unit for more tan 2 years, who know and feel that detecting the breast cancer early is important. From that can be deduced that it is necessary to invest more in education activities to prevent risks for the health of the women (AU)

The nurse's role in self-breast examination education.

Do you feel comfortable with your own knowledge of self-breast examination enough to educate a patient? Assessing a patient's compliance of performing self-breast examinations should entail not only if she merely does the examination, but when she is doing them and how she is doing them. There is evidence-based practice that portrays the proper way to perform a self-breast examination. If you, as the primary nurse, are not educated on proper techniques of a self-breast examination, it is your responsibility to provide a resource to the patient that can properly demonstrate this. Women should be educated on the proper way to do a self-breast examination. The first steps should include the ideal time of month to perform the examination. This will allow women to know what is normal breast tissue and what is abnormal to aide in early detection of breast cancer. Utilizing the tools of self-breast examination, yearly mammograms and clinical breast examinations, together with consistency, are the best protection in detecting early breast cancers.

Sociodemographic characteristics of women who engage in early breast cancer diagnostic behaviors: the case of Turkish women working in a textile factory.

The purpose of this study was to assess behaviors and health beliefs concerning early diagnosis of breast cancer among women working in a textile factory in Turkey. The data were collected with tools designed by the researchers. The study population consisted of 167 women working in a textile factory in Izmir, Turkey. According to their responses, 23.4% of the women performed breast self-examinations and 12.6% received clinical breast examinations. Results indicated that 91.6% of the women had no education about breast cancer. Early methods of detecting breast cancer should be included in workplace education programs.

Breast self-examination: knowledge and practice among nurses in United Arab Emirates.

This study was conducted to explore the knowledge and practice of nurses regarding breast self-examination (BSE) in the United Arab Emirates. Nurses working in different hospitals constituted the study population. A total of 154 nurses who had come to participate in the breast cancer awareness week programme were the participants. Approval of the Gulf Medical University ethics committee was obtained. A self-administered, pre-tested, structured, close ended questionnaire was used for data collection. Statistical analysis was performed using PASW 17. Age of the participants in this study ranged from 20 to 59 years, with a mean age of 24.1 years. 96.1% of the participants were aware of the ideal age to start BSE, while 87.7% respondents knew that women with regular menstruation should perform BSE monthly on a particular day, preferably on the fifth or seventh day after menstruation. With regard to BSE technique, 68.8% knew that both inspection and palpation were the ideal methods to detect any change in the breast. A high proportion, 84.4% of the respondents, reported performing BSE. Among those married, 87.0% and among single 78.3% were practicing BSE. The results point out that the nurses have a satisfactory knowledge regarding BSE and this is shown in their practice of BSE. Emphasis should be laid on BSE in undergraduate and postgraduate courses, especially for nurses, as they are mostly involved in patient care and education.

Supporting breast self-examination in female childhood cancer survivors: a secondary analysis of a behavioral intervention.

PURPOSE/OBJECTIVES: To identify intervention targets that will increase the frequency of breast self-examination (BSE) in female survivors of childhood cancer. DESIGN: Secondary data analysis of longitudinal clinical trial data. SETTING: Outpatient clinic in a children's research hospital. SAMPLE: 149 female survivors (aged 12-18 years) a median of 11 years after diagnosis of leukemia or lymphoma (59%) or solid tumor (41%). METHODS: Paired t tests, Wilcoxon signed rank tests, repeated measures analysis of variance, and analysis of covariance. MAIN RESEARCH VARIABLES: BSE frequency, health risk perceptions, motivation, and fears or worries. FINDINGS: Baseline BSE frequency was the strongest influence on follow-up BSE. Baseline and follow-up age and school grade influenced follow-up BSE. Other influential variables included motivation for behavior change, motivation to commit to health promotion, concern about appearance, and an interaction between the intervention and mother's highest grade level. When baseline BSE frequency and school grade were statistically controlled, diagnosis and significant interactions between grade level and the follow-up measures of the mother's education, general fears about cancer, fears about cancer returning, and perceptions of susceptibility to late treatment effects were significant influences on BSE after intervention. CONCLUSIONS: Survivors least likely to perform BSE are fearful about cancer and are not motivated to change health behaviors. IMPLICATIONS FOR NURSING: Nurses should explore survivors' fears about cancer and late treatment effects to address misconceptions, use modeling techniques with return demonstrations to ensure competency in BSE, and tailor risk information to each survivor's background (socio-economic status, age, development) and cognitive (disease and treatment knowledge, risks) and affective (fears) characteristics to increase BSE motivation.

The effect of training on the knowledge levels and beliefs regarding breast self-examination on women attending a public education centre.

The aim of this study was to evaluate the effect of subject training on the level of knowledge about breast self-examination (BSE) and breast cancer in women attending a public education centre. This research was structured according to pre-test-post test, one group research design principles. The study involved 91 course attendees at the Erzincan Public Education Centre (73.4%). The average age of study subjects was 21.4+/-5.4. Of the 91 participants in the study, 3.3% (n=3) had a family history of breast cancer and 5.5% (n=5) have had a lump in their breasts. In pre-test questions, the rate of correct answers was between 13.2% and 68.1%. After training, the rate of correct answers increased to between 79.1% and 96.7% and attendees demonstrated an increase in the accuracy of their beliefs about breast cancer (health risk, susceptibility). The perception of self-efficacy, an important variable in the process of behaviour change, is a necessary component of changing and maintaining the practice of BSE. The results of this work and others demonstrate that education administered by nurses can increase positive perceptions about BSE self-efficacy. Education in BSE is easily administered, requires no special tools, could lead to early diagnosis of breast cancer if performed regularly and should be taught to all women aged 20 years and above.

Productive power and the 'practices of the self' in contraceptive counselling.

This paper explores an under-researched issue within the reproductive health of women - the discursive construction of self-examination instruction in sexual health clinics. The study utilises Foucault's work on 'productive power', the 'practices of the self' and discourse to map out how nurses instruct contraceptive-using women in self-care practices. Forty-nine consultations in sexual health clinics were tape recorded and analysed. The data reveal how nurses utilise the discourse of risk as a technique to reinforce and develop self-care practices - a concept congruent with the Greco-Roman concept of the cura sui, the philosophical notion that one must make oneself into the object of care. Nurses build upon the notion of risk by educating women about their reproductive anatomy and physiology utilising medical texts as tools. This provides a contemporary example of the mia chora: identified by Foucault as the incitement for the individual to develop a usable knowledge of the body. Lastly, nurses instruct women in the development of a self-care regimen - the epimeleia, the development of habitual body techniques. It is proposed that this process is congruent with the Aristotelian notion of habitus, the development of body knowledge, body techniques and self-care practices necessary to pursue health.

Ação interativa e orientação do auto-exame das mamas durante a consulta ginecológica de enfermagem

Diversas causas ameaçam o bem-estar feminino, desencadeadas por eventos sócioculturais, tecnológicos, profissionais e familiares, influenciando no surgimento dos mais variados tipos de cânceres e congêneres, com altas incidências de morbimortalidade. Através da ação interativa junto à cliente, o enfermeiro, poderá influenciar positivamente para a redução dessas cifras, incentivando mudanças de comportamentos, em particular, estimulando a adoção do hábito mensal do auto-exame das mamas (AEM). Propusemos-nos, então, a trabalhar com base na hipótese de que, a ação interativa estabelecida entre enfermeiro e cliente pode favorecer e possibilitar a comunicação persuasiva, sua validação e a transmissão de informações, de forma a despertar na cliente o interesse pela aprendizagem e o desejo de elucidação de dúvidas. Objetivamos descrever e interpretar os fatores que podem influenciar na ação interativa do processo de comunicação entre enfermeiro-cliente e compreender a forma como vem se processando, na prática da enfermagem a ação interativa entre enfermeiro-cliente. O estudo tem abordagem qualitativa, foi realizado no Instituto de Prevenção do Câncer do Ceará (IPCC) nos meses de maio, junho e julho de 2004. Os dados foram coletados durante os Relacionamentos Interativos (RIs) entre enfermeiros e clientes, nas consultas de enfermagem ginecológicas. O instrumento de coleta dos dados utilizado foi observação livre com o apoio do diário de campo e uso do gravador, conforme autorização obtida. As enfermeiras, sujeitos deste estudo, foram cognominadas com os nomes de Selene, Melanipe, Eleutera, Crissa e Electra....

The nurse's role in promoting breast awareness to women.

Breast awareness is now a recognised part of health promotion and has replaced previous guidance on breast self-examination for women. Since it was introduced in the early 1990s, along with the breast awareness five-point code, it has become a key element in the strategy to detect breast cancer at an early stage. Despite this, confusion about breast awareness persists, with women still wanting to know how to examine their breasts properly.

Breast self-examination and breast awareness: a literature review.

AIM: To explore the literature on breast self-examination and breast awareness. OBJECTIVES: To clarify the confusion surrounding breast awareness and breast self-examination. To critique the evidence for breast awareness as a health promotion tool. BACKGROUND: Over 41,000 women are diagnosed with breast cancer each year in the United Kingdom. Compared with other European countries, women in England have poor survival prospects, for breast cancer, due in part to advanced disease at first presentation. In the United Kingdom, women are encouraged to be breast aware from the age of 18. However, the evidence suggests that women do not engage in breast awareness and are frightened and confused about their role in breast health promotion. METHODOLOGY: Four databases were used: Medline, Ebsco including CINAHL and Sociological Abstracts and the Cochrane Database of Systematic Reviews. The search terms 'breast awareness' and 'breast self-examination' were used and combined with 'breast cancer', 'breast screening' and 'health promotion'. CONCLUSION: The evidence on breast self-examination is clear, there is no benefit to breast cancer mortality and results suggest that breast self-examination may do more harm than good. Breast awareness provides women with some acknowledgement of the part they can play in being empowered to fight breast disease, not in terms of statistics used for mortality but on the qualitative effects of reductions in morbidity. RELEVANCE TO CLINICAL PRACTICE: The Royal College of Nursing of The United Kingdom is actively encouraging all nurses to promote breast awareness along with clear guidelines for doing so. The United Kingdom National Health Service Cancer Plan: a plan for investment, a plan for reform, encourages preventive care, information giving, good communication as well as evidence-based practice. In breast care this can reduce confusion for women and encourage empowerment in breast health promotion.

Knowledge, attitudes, beliefs, and practices regarding breast and cervical cancer screening in selected ethnocultural groups in Northwestern Ontario.

PURPOSE/OBJECTIVES: To examine the knowledge, attitudes, beliefs, and practices regarding breast and cervical cancer screening in selected ethnocultural groups (i.e., Italian, Ukranian, Finnish, and the native population) in Northwestern Ontario, Canada. DESIGN: Descriptive, exploratory. SETTING: Rural and urban settings in Northwestern Ontario. SAMPLE: 105 women aged 40 and older who were residents of Northwestern Ontario and members of selected ethnic groups, including Italian, Ukranian, Finnish, Ojibwa, and Oji-Cree. METHODS: An interview guide was designed specifically for this study to gather information regarding knowledge, attitudes, beliefs, and practices about breast self-examination (BSE), clinical breast examination (CBE), mammography, and cervical cancer screening procedures. Data were obtained through face-to-face interviews (two or three hours) in English or the language spoken. Interviews in other languages were transcribed into English. FINDINGS: Ojibwa and Oji-Cree women were more likely than any other group to not have practiced BSE, to have refused CBE or mammogram, to not have been told how to perform BSE, to not have received written information about breast examination, and to be uncomfortable and fearful about cervical cancer screening procedures (33% refused internal examination as compared to 0-8% in the other ethnic groups). Four issues emerged from the findings: (a) using multimedia sources to inform women about screening programs, (b) educating women regarding breast and cervical cancer screening, (c) reminding women when they are due for screening, and (d) identifying that Pap tests are uncomfortable and frightening. CONCLUSIONS: Cultural beliefs, attitudes, and practices of marginal populations (e.g., native women) are important to consider when developing strategies to address barriers to effective breast and cervical screening. IMPLICATIONS FOR NURSING: Educational programs that are culturally sensitive to participants are imperative.

Teaching and breast self-examination: an insufficiency of instruction.

Client teaching is recognised as an essential component of nursing and midwifery care, and all clinical areas provide opportunities for informal client teaching. This qualitative study aimed to explore registered nurses' professional practices with regard to teaching breast self-examination (BSE), and to identify factors that influenced their participation or non-participation in teaching about breast health. Participants' views were obtained using individual semi-structured interviews. The data were analysed inductively, that is, without imposing structure from the interview questions. Findings revealed that participants' perspectives of BSE and breast health, the dual symbolism of breasts, and the time constraints of clinical practice, were significant factors that impacted on participants' personal BSE practices and on their level of participation in teaching BSE. The results indicate that that nurses and midwives do not view teaching breast health as part of their role in client interaction, particularly in an acute care setting. Although nursing literature identifies midwives and nurses as ideally placed to promote health promotion activities, the image of BSE as linked to breast cancer, the dominant illness oriented model of care and a task orientated culture in health care facilities do not facilitate this.