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A STUDY TO “ASSESS THE KNOWLEDGE AND PRACTICES ON BREAST SELF EXAMINATION, BREAST CANCER AND ITS TREATMENT MODALITIES AMONG ADULT WOMEN, AGE BETWEEN
25-55 YEARS” AT MADHUGIRI TALUK, TUMKUR
DIST, IN A VIEW TO DEVELOP A SELF
INSTRUCTIONAL MODULE.
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DESSERTATION
Ms. USHA.H.
OBSTETRICS AND GYNAECOLOGICAL NURSING
MADHUGIRI SRI RAGHAVENDRA COLLEGE OF NURSING
MADHUGIRI – 572132 TUMKUR DISTRICT
1. / NAME OF THE CANDIDATEAND ADDRESS / Ms. USHA.H.
M.Sc., Nursing 1st Year
Madhugiri Sri.Raghavendra College of Nursing , Shankar Matt Road,
Raghavendra Extension,
Madhugiri- 572132, Tumkur district.
2. / NAME OF THE INSTITUTION / Madhugiri Sri.Raghavendra College Of Nursing, Madhugiri.
3. / COURSE OF STUDY AND
SUBJECTS / M.Sc., NURSING 1st Year
Obstetrics and Gynaecological Nursing
4. / DATE OF ADMISSION TO
COURSE / 30-10-2009.
5. / TITLE OF THE TOPIC / A study to assess the knowledge and practices on breast self examination, breast cancer and its treatment modalities among adult women, age between 25-55 years at Madhugiri Taluk, Tumkur Dist, in a view to develop a self instructional module.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
6. BRIEF RESUME OF INTENDED WORK:
INTRODUCTION:
“ Attitude is a little thing that makes a big difference”
- Winston Churchill
Breast Cancer is the most common malignancy in women in United States. Breast Cancer is a leading cancer among the women worldwide, with more than 5,40,000 new cases each year. Over 40% of these cases are in the developing countries8. The lifetime risk of women for developing Breast cancer was 9.5% among whites and 6.9% among blacks in the United States6. Mean age of occurrence of breast cancer is about 42 years in India as compared to 53 years in white women of the United States of America12. There is rapid increase in the incidence between the age 35 to 50 years and secondary rise in frequency after 65 years of age1.
Patients diagnosed with localized Breast cancer with no axillary node involvement have a five year survival rate of 98%. Conversely, only 6% of patients diagnosed with advanced stage breast cancer with metastases to distant sites will survive five years or more21. Breast cancer is the second leading cause for the death in worldwide and fifth most common cancer in India. According to the population based tumor registry cell of the Indian council of Medical Research in New Delhi, breast cancer constitutes about 12% of all cancers detected in Delhi and about 24% of all cancer in women5.
Survival from breast cancer decreases rapidly with increasing stage of disease. Typical population based figures for five year relative survival are 86%, 58%, 46% and 12% for stage I, II, III and IV respectively. There is considerable potential for reducing population mortality from breast cancer by a systematic approach to improving the stage at presentation by early detection3. Professional organizations recommended monthly breast self examination and every month women should get her breast examined by a trained health care provider every three years, up to the age of 40 years and annually there after. It is not practiced in the developing countries, due to ignorance of people and lack of trained health manpower18. Examination of the breast has been advocated for many years as the first screening modalities for detection of the breast cancer. A World health organization expert committee has also recommended breast self examination for the early detection of the breast cancer18.
The extent of the surgical intervention is determined by the clinical presentation and by the possibility of resecting the tumor with clean margins. The goal is to preserve the breast, because there is no evidence that a mastectomy is more beneficial than a lumpectomy plus radiation therapy. However because of size or the multifocal or multicentric extent of disease, a mastectomy may be necessary to provide adequate tumor removal20.
Common signs and symptoms of breast cancer include a lump in the breast that feel distinctly different from other breast tissue or that does not go away, swelling and thickening of the breast tissue, dimpling or pulling of the skin on the breast which may then resemble the skin of an orange, any change in the breast shape or contour, nipple discharge, retraction and scaliness of the nipple, pain or tenderness of the breast and swollen bumps or puss-filled sores. If the women find out these characteristics to be reported to the health care providers for the prompt treatment30.
6.1. NEED FOR STUDY:
“My cancer scare changed my life. I’m grateful for every new,
healthy day I have. It has helped me prioritize my life”
- Olivia Newton-John
Breast self examination is a technique that all women can do examine to their own breast. Thus it is a useful self care activity for all adult women. Regular monthly breast self examination is an essential health maintenance activity. Teaching skills of breast self examination can be life saving and with regular breast self examination, malignancy may be discovered at an earlier stage, which can save lives18.
A set of limitations has been negatively related to breast self examination practice such as lack of confidence in one’s examination, fear of an abnormality, forgetting and lack of time. Therefore instruction in breast self examination can be used to increase the frequency and thoroughness of practice18. The breast health survey done revealed that about 80,000 new cases of breast cancer are diagnosed every year out of which 30,000 of them have the disease. As prevention is not usually possible, early detection is the only option left. Early detection and treatment can increase 17% of five years survival16.
Throughout history, the female breast has been regarded as a symbol of beauty, sexuality and motherhood. Any actual or suspected disease or injury affecting breast tends to reflect the prevailing societal view of the breast. The threat of mutilation or loss of a breast may be devastating for the women because of psychosocial, sexual and body image implications significance associated with it2. In absence of an enact etiological agent for breast cancer, the most appropriate way of controlling it, will be early detection and treatment. Mammography is the method of choice but its use is limited due to high cost and unavailability7. Breast self examination is an ideal, safe, effective and cost free method which can be done by every women at her leisure time with little training. Breast self examination helps women to find their breast cancer early10.
Despite an increase in women literacy rate and knowledge about breast cancer, there are certain barriers to practice breast self examination, like worry about breast cancer, embrassment, lack of time, unpleasant of procedure, lack of privacy, fear of discovering a lump and unfavorable attitude towards breast self examination4.
The researcher feels that lack of knowledge and skills is a barrier to breast self examination practice. Therefore the researcher feels that, women by allowing women to talk about breast cancer, correcting their misconceptions and supplying accurate facts, they can reduce associated fear, anxiety and create awareness. Women may then seek earlier assessment, diagnosis and effective treatment 16. So the researcher selected the study to assess knowledge and practices regarding the breast self examination, breast cancer and its treatment modalities, to provide a self instructional module to improve knowledge of participants.
6.2.REVIEW OF LITERATURE:
6.2.1 A study was conducted to investigate the relationship between the
performance of breast self examination. The sample size of 694 (69.4%) women,
aged 25-80 were selected with the questionnaire. The step-wise logistic regression
analysis shows that, for the whole sample as well as for the interview group, age
was the only significant predictor of breast self examination. The study was
concluded that the importance of younger women performing the examination is
stressed. Due to nurses being strategically located in a wide range of geographical
locations, allowing them to meet women in different settings, they are a good
choice for motivating women to practice breast self examination9.
6.2.2 A study was conducted to develop an effective strategy to inform
Mexican women between 12 and 47 years of age about breast cancer and train
them to perform breast self examination. The sample size of 149 women were
selected randomly to assess the strategies. The results shows with strategies, there
was an increase of approximately 30% in women's knowledge of breast cancer
and breast self examination as well as in their ability to detect lumps. The study
was concluded with appropriate and monthly practice of breast self examination11.
6.2.3 A study was conducted to identify the beliefs, knowledge, and practices of
breast self examination in adolescent girls. The sample size of 350 teenagers were
selected for descriptive study to determine whether a teaching program would
change believes knowledge and practices of breast self examination. The results
shows that a one-time intervention can be successful in increasing breast self
examination practice and the knowledge of breast self-examination and cancer in
adolescents. The study was concluded that in 1 month after teaching, these
percentages changed appreciably, with 32% of students reporting that they never
practiced breast self examination and 23% reporting that they practiced breast
self examination monthly13.
6.2.4 A study was conducted to develop an educational booklet about breast
self examination and test its effectiveness on University Nursing Students
knowledge and practices. A sample size of 212 nursing students at the Faculty of
Nursing, Alexandria University, were selected by a self - administered
questionnaire. The result shows the general lack of knowledge and practices
related to breast self examination among nursing students, where poor total score
of knowledge and practices was obtained. The study was concluded by improving
the health behavior, especially breast self examination, among nursing students
is needed to help them assume their responsibility towards prevention14.
6.2.5 A study was conducted to assess knowledge, attitude, and practice of breast
self examination in health centers. The sample size of 663 women were selected
randomly for interview. In the data analysis, women's answers for knowledge,
attitude and practice regarding breast self examination. The results shows that
knowledge and practice of breast self examination were adequate in 7.4% and
58.1% of the women were have forgetfulness, was the main barrier for not
performing self-examination. The study was concluded by the women attending
the health centers sampled in this study had inadequate knowledge and
practice about breast self examination, but they had an adequate and favorable
attitude about it15.
6.2.6 A study was conducted to determine the knowledge, attitudes and practices
of women in Qassim region regarding breast self examination, and also to explore
their level of knowledge regarding breast cancer. The sample size of 300 females,
20-70 years of age, were selected by a 10 randomly selected primary health care
centers. The result shows the 70.7% of the participants were literate. Regarding
the knowledge of risk factors, 76% of the respondents had 3 or more correct
answers out of the total 7 questions. 26% of the respondents did not know the
presenting symptom of breast cancer. A study was concluded that the level of
awareness of the females of Qassim region regarding breast cancer and
breast self examination is not adequate17.
6.2.7 A study was conducted on knowledge, attitude and practice about breast
cancer among civil servants in Benin city, Nigeria. A sample size of 400 females
civil servants were selected by a structured questionnaire. The result shows 277
(72.0%) respondents had tertiary level of education. 312 (81.0%) respondents
knew correctly that breast lump is usually the first symptom of presentation of
breast cancer. 144 (37.5%) respondents knew that a positive family history of
breast cancer is a risk factor. The study was concluded with the level of
awareness about breast cancer among civil servants in Benin City is low19.
6.2.8 A study was conducted to assess knowledge, attitudes and practice
concerning early detection for breast cancer among Iranian health care providers.
The sample size of 318 Health Care Providers were selected by a stratified simple
random sampling and with given questionnaires. The result shows for six
knowledge questions, 71.8% participants had four or more correct responses,
80.5% agreed completely with women will accept the screening program if the
physicians advise it. 81.5% did not carry out breast examinations for the majority
of female outpatients and inpatients during last year. The study was concluded
with the Knowledge and attitudes are relatively appropriate, but practical measures
are not enough29.
6.2.9 A study was conducted to compare the clinical outcome of patients with
stage I breast cancer diagnosed during two time periods that differed with respect
to adjuvant systemic therapy. The sample size of 1407 women < 60 years of age,
who were diagnosed breast cancer stage I. The results shows that the most evident
reduction of distant recurrence risk was among hormone receptor-negative patients
and among patients with a high tumor s-phase fraction. The study was
concluded that the causes of the increase in distant recurrence free survival for
women with breast cancer stage I are complex22.
6.2.10 A study was conducted to describe the introduction, and trends in the use
of adjuvant systemic therapy for breast cancer in 2 of 6 public health regions in
Sweden. The sample size of 328 patients were selected on Population-based data
for the use of adjuvant therapy. The result shows the use of systemic treatment
was infrequent before the late 1980s, but increased during the 1990s. In 2005, the
proportion of operable breast cancer patients treated with adjuvant endocrine
therapy in the ages 40-59 was around 60 to 80%. The study was concluded that the
trends in, and levels of the use of adjuvant systemic therapy for breast cancer
varied over time in the two study regions, particularly for endocrine therapy23.
6.2.11 A study was conducted on breast cancer knowledge and screening
practices. The sample size of 1,000 women were selected by a self-administered
questionnaire. A result shows the response rate was 100%. The mean score was