Assessment of the Factors Associated with Breast Cancer Screening among Rural Women in Selected Villages, Mangalore

Miss. Raji Varughese¹, Mrs. Shambhavi²

¹MSc Nursing, Laxmi Memorial College of Nursing, A.J Towers, Balmatta, Mangalore- 575 002

²Assistant Professor, Department of Medical Surgical Nursing, Laxmi Memorial College of Nursing,

A.J Towers, Balmatta, Mangalore -575 002,

Corresponding Author Email: sominiv2010@gmail.com, shambhavi.shettigar@yahoo.com

ABSTRACT:

Background: Breast cancer is the most common cancer in women worldwide, with nearly 1.7 million new cases diagnosed in 2012.One potentially important strategy in reducing breast cancer mortality is the use of screening to achieve earlier detection of cancer. Recommended preventive techniques to reduce breast cancer mortality and morbidity include breast self-examination (BSE), clinical breast examination (CBE), and mammogram.

Objective: The purpose of the study is to assess the factors associated with breast cancer screening among rural women

Research design and approach: Non-experimental, explorative survey design approach

Setting: The study was conducted in villages of Bajpe , Mangalore

Sample size and technique: 100 rural women who were residing in the villages of Bajpe were selected by consecutive sampling technique

Instrument used: Data was collected using breast cancer screening questionnaire and checklist to assess the factors contributing to undergo/not undergo breast cancer screening.

Major findings: The finding of the study showed that socioeconomic and environmental factors such as affordable for screening (60%), peer or family support (75.56%), having health insurance (28.89%) and recommended by physician (48.89%) influenced the women for undergoing breast cancer screening and knowledge factors like lack of knowledge regarding screening (60%) and do not know where to seek for screening (61.81%) influenced the women not to undergo breast cancer screening

KEY WORDS: Breast cancer screening; breast cancer; factors associated with breast cancer screening.

INTRODUCTION:

“Good health is a duty to yourself, to your contemporaries, to your inheritors, to the progress of the world”~ Gwendolyn Brooks

Every year the Women’s International Day is celebrated inspiring the women of today to stride ahead in life. While women have made progress in most of the field still she tends to inexplicably neglect her own health¹. Breast cancer is the most common cancer in women worldwide, with nearly 1.7 million new cases diagnosed in 2012. Breast cancer is probably the most feared cancer in women because of its frequency and psychosocial impact. It affects the perception of sexuality and self-image to a degree greater than any other cancer². Medical advances have shown that one-third of all cancers are preventable and a further one third, if diagnosed sufficiently early, is potentially curable. This observation demands that cancer control should be of increasing priority in the healthcare programmes of developing countries. One potentially important strategy in reducing breast cancer mortality is the use of screening to achieve earlier detection of cancer. This is very important because an excellent prognosis is directly associated with the stage at which the tumour is detected and how localised the lesion is. Early diagnosis usually results in treatment before metastasis and signifies a better outcome of management³.

Screening for early detection and diagnosis of diseases and health conditions is an important public health principle. Recommended preventive techniques to reduce breast cancer mortality and morbidity include breast self-examination (BSE), clinical breast self-examination (CBE), and mammography. CBE and mammogram require hospital visit and specialised equipment and expertise whereas BSE is an inexpensive tool that can be carried out by women themselves.

NEED FOR THE STUDY:

Breast cancer accounts for 1/10^th of all deaths per year all over the world. Screening for early detection and diagnosis of diseases and health conditions is an important public health principle. With this present background this study is designed to provide necessary information regarding women’s status of undergoing breast cancer screening like breast self-examination (BSE), clinical breast self-examination (CBE), and mammogram and the factors contributing to undergoing/not undergoing breast cancer screening among rural women in Mangalore.

OBJECTIVES:

1. To identify the breast cancer screening status among rural women

2. To identify the factors contributing to undergo breast cancer screeningamong rural women

3. To identify the factors contributing not to undergo breast cancer screening among rural women

METHODOLOGY:

A non-experimental, explorative survey design was used survey to assess factors associated with breast cancer screening among rural women at Mangalore. The study was conducted in Bajpe at Mangalore. 100 rural women who were residing in the villages of Bajpe were selected by consecutive sampling technique.

Inclusion Criteria

· Any woman between 40 to 60 years of age residing in the rural areas of Bajpe, Mangalore.

· Women who were willing to participate in the study.

Description of the Tools

Four tools were used in data collection

Tool 1: Demographic proforma was prepared by the researcher consisted seven items; age, religion, educational status, occupation, marital status, number of children and the source of information regarding breast cancer screening.

Tool 2: Structured breast cancer screening status questionnaire had six items. The subjects were instructed to tick mark (ü) on the appropriate space provided.

Tool 3: Checklist to assess the factors contributing to undergo breast cancer screening had 20 items. The participant was advised to make a tick (ü) mark in the appropriate space given as indicated by ‘Yes’ or ‘No’.

Tool 4: Checklist to assess the factors contributing not to undergo breast cancer screening had 15 items. The investigator advised to make a tick (ü) mark in the appropriate space given as indicated by ‘Yes’ or ‘No’.

Validity and Reliability:

The content validity of the tool was established in consultation with the research guide and seven nursing experts from the department of medical surgical nursing.

The coefficient of internal consistency of checklist to assess the factors contributing to undergo and not to undergo breast cancer screening was checked by using Kuder Richardson method (r=0.74 and r=0.70 respectively) and it was found reliable

Data Collection Procedures:

Permission was obtained from District Health Officer, Dakshina Kannada. Prior to establish questionnaire, consent was obtained from respondent and self-introduction was given to the rural women.

Planned for Data Analyses:

Descriptive statistics was used for analysis

RESULTS:

Table 2: Frequency and Percentage Distribution of Rural Women Based on Non-Modifiable Factors that Contributed to Undergo Breast Cancer Screening N=45

Sl. No. Non-modifiable factors	f	%
1. Women with first pregnancy after the age of 30 years	11	24.45
2. Women who attained menarche before the age of 12 years	4	8.89
3. Women who attained menopause after the age of 55 years	6	13.34
4. History of non-cancerous growth in breast	2	4.45
5. Nulliparous	9	20.00
6. Family history of breast cancer	2	4.45
7. Not breastfed for longer than one year	8	17.78

Table 3: Frequency and Percentage Distribution of Rural Women Based on Behavioural and Personal Factors that Contributed to Undergo Breast Cancer Screening N=45

Sl. No. Behavioural and personal factors	f	%
1. Consumption of tobacco for more than 10 years	-	-
2. Consumption of alcohol more than three drinks per week	-	-
3. Consumption of large amount of fatty food (milk, butter, meat, biscuits cakes)	11	24.44
4. Use of oral contraceptives for more than 10 years	-	-
5. Pain and swelling in the breast	4	8.89
6. Hormone replacement therapy for more than 10 years	-	-
7. Obesity	12	26.67
8. Consumption of diet low in vegetables and fruits	7	15.56

Data in the Table 3 shows behavioural and personal factors that influenced the women for undergoing the breast cancer screening. The factors included consuming large amount of fatty foods (24.44%), pain and swelling in the breast (8.89%), obesity (26.67%) and taking diet low in vegetables and fruits (15.56%).

Table 4: Frequency and Percentage Distribution of Rural Women Based on Socioeconomic and Environmental Factors that Contributed to Undergo Breast Cancer Screening N=45

Sl. No. Socioeconomic and environmental factors	f	%
1. Affordable for screening	27	60.00
2. Peer or family support	34	75.56
3. Recommendation by a spiritual leader	-	-
4. Having health insurance	13	28.89
5. Recommended by the physician	22	48.89

Data in Table 4 shows socioeconomic and environmental factors that influenced the women for undergoing the breast cancer screening, which included affordable for screening (60%), peer or family support (75.56%), having health insurance (28.89%), and recommended by physician (48.89%).

Section D: Description of Factors that Contributed not to Undergo Breast Cancer Screening

Table 5: Frequency and Percentage Distribution of Rural Women Based on Cognitive and Perceptual Factors that Contributed not to Undergo Breast Cancer Screening N=55

Sl. No. Cognitive and perceptual factors	f	%
1. Negligence	15	27.27
2. Fear of procedure	15	27.27
3. Fear of positive report	13	23.63
4. Fear of pain during screening	11	20.00
5. Fear of embracement during screening	13	23.63
6. Fear of radiation	8	14.55
7. Feeling healthy	49	89.10
8. Feeling ashamed to undergo screening in front of male doctor/physician	16	29.10

Data in the Table 5 shows cognitive and perceptual factors that influenced the women for not undergoing the breast cancer screening, namely, negligence (27.27%), fear of procedure (27.27%), fear of positive report (23.63%), fear of pain during screening (20%), fear of embracement during screening (23.63%), fear of radiation (14.55%), feeling healthy (89.10%), and feeling ashamed to undergo screening in front of male doctor/physician (29.10%).

Table 6: Frequency and Percentage Distribution of Rural Women Based on Socioeconomic and Environmental Factors that Contributed not to Undergo Breast Cancer Screening N=55

Sl. No. Socioeconomic and environmental factors	f	%
1. No time	24	43.63
2. Lack of money	8	14.54
3. Long waiting hours in hospital	18	32.73
4. Lack of family support	10	18.18
5. Lack of accessibility/hospital is far	14	25.45

Data in Table 6 shows the socioeconomic and environmental factors that influenced the women for not undergoing the breast cancer screening. Factors included no time (43.63%), lack of money (14.54%), long waiting hours in hospital (32.73%), lack of family support (18.18%), and lack of accessibility (25.45%).

Table 7: Frequency and Percentage Distribution of Rural Women Based on Knowledge Factors that Contributed not to Undergo Breast Cancer Screening N=55

Sl. No. Knowledge factors	f	%
1. Lack of knowledge on breast cancer screening tests	33	60.00
2. Do not know where to seek for screening	34	61.81

Data in Table 7 shows the knowledge factors that prevented the women undergoing the breast cancer screening. Factors included lack of knowledge regarding screening and do not know where to seek for screening influenced 60% and 61.81% of rural women respectively.

DISCUSSION:

This study reveals that the highest percentage (39%) of women got information regarding breast cancer screening from media and highest percentage (46%) of women were in the age group of 40-45 years. The results were supported with a cross sectional study conducted in Saudi Arabia among female teachers to assess the knowledge, attitude and practices of breast cancer screening .The study findings revealed that printed media is the most common source of information and most participants belongs to 4^th decade age group⁴.

The present study revealed that knowledge factor is the most influencing factor (mean percentage 60.90%) which prevented the women to undergo breast cancer screening. The result were supported with a cross sectional study conducted to determine the level of knowledge regarding breast cancer and to increase awareness about breast cancer screening practices among a group of women in a tertiary care hospital in Mumbai ,India revealed that knowledge factor is the main barrier to undergo screening⁵. The result were also supported with the study conducted to assess the current knowledge, attitudes and practices of women on breast cancer and mammography at Mulago hospital ,Uganda revealed that main barrier to do mammography was lack of information⁶.

IMPLICATION:

Nursing Education:

Curriculum should give importance to improve nurse’s knowledge and skill in BSE. Nurses should have thorough knowledge regarding the breast cancer prevention and breast cancer screening tests so that they can impart this knowledge to the community and motivate them to practice in their life.

Nursing Practice:

The nurses working in wards and clinics can play a significant role in giving advice and motivation regarding breast cancer screening. The nurses should be knowledgeable and should maintain good interpersonal relationship and include family members in all the health education programmes.

Nursing Administration:

Communication through media can play a very important role in disbursing information to the public with preparation of simple messages in newspapers, pamphlets, magazines and television in local language which will help in dispelling the myths and propagating the importance of breast cancer screening.

Nursing Research:

Nursing practice needs to be based on scientific knowledge. Nurses have to gather information regarding facts, ethical issues and myths about factors associated with breast cancer screening.

RECOMMENDATIONS:

· A similar study can be undertaken on a larger sample in the community area.

· A similar study can be undertaken among different samples like teachers above 40 years in schools, colleges or any institution.

· A study can be conducted to assess the knowledge of women in the community on prevention of breast cancer.

· A camp or teaching programme can be conducted in rural community by healthcare professionals to give awareness to the people on breast cancer screening

CONCLUSION:

The study finding suggests that insufficient knowledge of breast cancer screening negatively influenced the woman’s breast cancer screening behaviour. This also emphasises the need to educate the women regarding early detection of breast cancer by undergoing breast cancer screening tests.

REFERENCES:

1. Agarwal N, Suneja A. Female breast gynaecologist viewpoint (FOGSI). New Delhi: Jaypee Brothers Publication; 2000.

2. Smeltzer CS, Bare GB. Brunner and Suddarth’s textbook of medical surgical nursing.10^th ed. Philadelphia: Lippincott Williams and Wilkins Publication; 2004.

3. The World Health Report 1997 - Conquering suffering, enriching humanity. [online]. Available from: URL:www.who.int/whr/1997/en/

4. Khadiga F, Abdurrahman, Mohaimeed A. A cross-sectional study to assess the knowledge, attitudes, and practices surrounding breast cancer and screening in female teachers of Buraidah, Saudi Arabia. Interior Journal of Health Sciences 2007; 1(1):61–7.

5. Ahuja S, Chakrabarti N. To determine the level of knowledge regarding breast cancer and to increase awareness about breast cancer screening practices among a group of women in a tertiary care hospital in Mumbai, India. The Internet Journal of Public Health 2009; 1(1).

6. Elsie KM, Gonzaga MA, Francis B, Michael KG, Rebecca N, Rosemary BK, Zeridah M. Current knowledge, attitudes and practices of women on breast cancer and mammography at Mulago Hospital, Uganda. The Pan African Medical Journal 2010; 5(3):9.

Received on 27.03.2015 Modified on 24.04.2015

Int. J. Nur. Edu. and Research 3(2): April-June, 2015; Page 218-223