The Knowledge of Breast Cancer and the Practice of Breast Cancer

Screening (Breast Self Examination)

A Systematic Review

Diana Hardiyanti

, Desak Gede Agung Suprabawati

and Esti Yunitasari

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Departement of Oncology RSUD Dr. Soetomo Surabaya, Indonesia

Keywords: Breast Cancer Screening, Cancer Screening Knowledge, Practice Breast Self Examination.

Abstract : Breast cancer is the main dead cause because of woman cancer. Breast cancer screening, especially breast self

examination (BSE), can detect breast anomally, the sign and symptom of breast cancer. Detection in early

stadium is able to decrease the mortality. Through this systematic review, researchers will assess the

knowledge and practice of BSE on respondents. Search articles using PICOT in database; Ebscho, Science

Direct, Elseiver, Sage Journals, Scopus, ProQuest, Pub Med, limited to the last 5 years; 2013 to 2018 catched

10 international journals and have been reviewed with systematic review of those. From ten reviewed journals,

seven journals explain that the knowledge of breast cancer is quite low, but less than 50% do breast cancer

screening (BSE) appropriately. However less than 50% do the breast cancer screening (BSE) appropriately.

This systematic review, strongly, suggests that the giving of periodic health education is to increase the

awareness for doing breast cancer screening.

1 BACKGROUND

Breast cancer is the leading cause of death among all

cancer diseases experienced by women in Indonesia.

Cancer is one of the health problems all over the

world, one of the factors why breast cancer mortality

rate increases is because it is detected in the severe

stage (WHO, 2014). According to WHO (World

Health Organization) number of cancer patients all

over the world currently reaches 14 million cases,

with 8.2 miliions death each year (Pusat Data dan

Informasi Kementerian Kesehatan RI, 2015). WHO

also states there is a significant increase in breast

cancer cases, which are 1.7 million new cases each

year.

Cancer controlling effort can be conducted by

preventing actions (KEMENKES, 2015). primary

prevention is an action to minimize and eliminate risk

factors, conduct a routine physical exercise, weight

controlling, and healthy lifestyle (Segura, Fombella,

Lorenzo, Martín, & Lopez, 2014), Secondary

prevention : conducting an early detection, such as

Screening mammography, Magnetic resonance

imaging (MRI), clinical breast examination (CBE)

and breast self-examination (BSE). Breast Cancer

(BC) early detection gives an important role in

reducing morbidity and mortality rate (Ewaid,

Shanjar, & Mahdi, 2018). Meanwhile, tertiary

prevention are diagnostic and treatment action to

reduce complication (KEMENKES, 2015).

BSE specifically aims to increase the possibility

of finding changes in breast tissue, although BSE

alone is not sufficient to detect early BC, this action

can help women manage their health, recognize their

breasts condition and conduct health preventive

behavior (Erdem & Tokta, 2016). BSE has many

advantages because it can be conducted at no cost,

alone and anywhere (Reisi, Javadzade, & Sharifirad,

2013). Women whose diagnosis is late can be caused

by lack of awareness and low concern for health

(Hasan et al., 2015).

Although BSE is simple, easy and economical

screening method, many women do not conduct BSE

or do not apply BSE in appropriate way (Okolie,

2012). Qualitative research by H Taha, Al-Qutub, &

Nystrom (2012) the fear of finding signs and

symptoms in breast cancer such as breast lumps and

fear of being diagnosed with breast cancer is a barrier

for women to perform BSE or other screening

methods.

A research suggests women in Baghdad have poor

knowledge and practice about BC, 61.2% of

respondents are knowledge, and 41.8% say they do

not know BSE (Hasan et al., 2015). Other studies

250

Hardiyanti, D., Suprabawati, D. and Yunitasari, E.

The Knowledge of Breast Cancer and the Practice of Breast Cancer Screening (Breast Self Examination).

DOI: 10.5220/0008323402500256

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 250-256

ISBN: 978-989-758-336-0

claimed to have knowledge about health, not enough

to improve solitary behavior (Özdemir, 2014).

Through this systematic review, researcher wants

to know knowledge of breast cancer and BSE

practice in women.

2 METHODS

The article search used PICOT framework

(Population: Women, never experienced breast cancer,

Exposure: Breast Self Examination (BSE) knowledge

and practice Control: -, Outcome: breast cancer

knowledge level and early detection, Time: 2013-

2018). Based on keyword determination according to

the topic contained in PECOT framework and

completed with Boolean Logic method in database;

Ebscho, Science Direct, Elseiver, Sage Journals,

ProQuest, the publication was limited to the last 5

years, 2013 to 2018, and it was obtained 26 journals

and selected 10 International Journals for the review.

3 RESULTS

3.1 Study Design

This systematic review reviews 10 selected journal,

all journals are international journal. The used

research design is: 6 journals using a cross-sectional

study, 1 journal using RCT, 3 journals using quasy

experiment.

3.2 Charateristic of Participant

From 10 reviewed Journals it found that the number

of samples varied between 89-2363 respondents who

have the criteria of women, never detected breast

cancer before. The measuring instruments used in all

studies are questionnaire instruments related to

sociodemographic, characteristics of respondents,

knowledge of breast cancer, early detection of breast

cancer and BSE practice.

3.3 Sensityfity and Specifity

In a cross sectional study Kim, Lee, Min, & Min,

(2017) with 17 items of BSE knowledge, 16

behavioral items and 5 practice items show the

correct answer result of BSE knowledge is only

29.2%, while the correct practice only conducted by

5.93% of respondents. BSE's knowledge level is

positively correlated with BSE practice, so education

on BSE to improve BSE knowledge can improve BSE

practice.

The study of Sama et al., (2017) defines that

88.1% of respondents have heard about BC, but less

than half of respondents who ever knew BC, ever

heard about BSE, with the percentage of only 38.5%.

Although the respondents have an awareness of breast

cancer risk, the overall knowledge about BC and

routine BSE execution is poor. It is required a

campaign to increase knowledge and BC prevention

strategy to help reduce BC.

The study conducted by Omoyeni,

Oluwafeyikemi, Oladunni Irinoye, & Adenike (2014)

states 51% of respondents have medium knowledge

and only 25% who have the excellent knowledge

about BC(Breast Cancer). Majority of respondents

have a positive attitude about BSE, but only 10.7%

whose practice BSE regularly.

The study conducted by Ewaid et al., (2018) state

that 82% of respondents know about BSE, but only

24% from them whose practice BSE. In addition,

47% of respondents obtain BSE knowledge from the

internet and television sources. The awareness of BC

and BSE among respondents is poor, so it is required

a further health education program on BSE and BC

risk factors.

Table 1 : Journal characteristic.

Jurnal Populasi Intervensi Comparison Outcomes Time

Determination of

Breast Self-

Examination

Knowledge and

Breast Self-

Examination

Practices among

Women and Effects

of Education on

their Knowledge

(Özdemir 2014)

89 female

respondents

at a course

during April

2007

Aged 16-52

years

89 female respondents at a

course during April 2007

Age 16-52 Analyzed with

Wilcoxon test and Paired t test

Measured:

1. Knowledge before and

after education

2. Practice BSE before and

after e ducation

3. Educational effects

Knowledge

and practice

of BSE before

and after

education

The value of

breast cancer

alert knowledge

increased 1.42

mean, breast

cancer risk

increased 1.50

mean, BSE

practice did not

increase.

Data

collection

is done

during

April

The Knowledge of Breast Cancer and the Practice of Breast Cancer Screening (Breast Self Examination)

251

Jurnal Po

ulasi Intervensi Com

arison Outcomes Time

Relationship

between

Knowledge,

Attitude and

Practice of

Breast-Self

Examination

among Middle

and High School

Girls (Kim et al.,

2017)

412

respondents

, consisting

of 137

middle

school

respondents

, 725 high

schools.

The cross-sectional study

used a questionnaire.

Analyzed using t-test and

Spearman correlation

coefficien

Knowledge

BSE

The results

show that BSE

education for

middle and

upper girls is

needed to

increase the

chances of

early detection

of breast

cance

Data

collectio

n was

conducte

d during

7 to 23

Decemb

er 2016.

Home visits to

improve breast

health knowledge

and screening

practices in a less

privileged area

in Jordan (Taha

et al., 2014)

2363

women as

respondents

. Aged 20-

79 years.

Measurement of

knowledge about breast

screening of BSE and

mammography before

education of home visits by

local community.

Post test knowledge and

practice of breast health

Analysis using chi-square

and Fisher's

exact test.

BSE and

mammograp

examination

respondents

who

received free

mamorafi

vouchers

and who did

not get

mammograp

Average

Knowledge

Outcomes

increased

significantly

(p <0.001)

Pretest 11.4

Posttest 15.7

(maximum

score 16).

Increase of

BSE practice

visit and

mammograph

y on

respondents

who get

vouchers, only

2 respondents

who came

mamografi

without

voucher.

The data

was

collected

during

January

Septemb

er 2011.

up 6

months

after

first

month

visit.

Awareness of

breast cancer and

breast self-

examination

among female

undergraduate

students in a

higher teachers

training college

in Cameroon

(Sama et al.,

2017)

345

responden

mahasiswi

Higher

Teachers

Training

College

(HTTC)

Bambili,

University

of Bamenda

in the

Cross-sectional study to

measure:

1. Socio-demographic

characteristics

2. Knowledge of breast

cancer

3. Breast self-examination

Less than half

of respondents

who had

known about

breast cancer

and BSE

performed

BSE practices

(38.5%)

38.7% think

breast cancer

can be

40/5000

Data

collectio

n is

taken

April 11,

2016

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

252

Jurnal Po

ulasi Intervensi Com

arison Outcomes Time

Northwest

Region of

Cameroon..

changed by

traditional

treatment.

Knowledge of

breast cancer

and BSE is

sufficient,

BSE practice

is low

Assessment of

the Knowledge

and Practice of

Breast Self

Examination

among Female

Cleaners in

Obafemi

Awolowo

University Ile Ife,

Nigeria

(Omoyeni et al.,

2014)

Populasi

468

female

cleaners in

the

Institution,

sampel 30%

(140

responden)

Cross-sectional study to

measure:

1. Knowledge of breast

cancer and BSE

2. Attitudes about breast

cancer and BSE

1. 3. How respondents

practice BSE

This

study

was

conducte

d for 48

hours.

Knowledge and

practice of breast

self-examination

among sample of

women in

Shatra/Dhi-

Qar/Iraq (Ewaid,

Shanjar and

Mahdi, 2018)

n: 200

respondents

teachers

122

students

33 workers

Consecutive

sampling

technique

Using a closed

questionnaire in Arabic

questionnaires to collect

data developed by

researchers and based on

literature review.

The questionnaire contains

questions about features,

knowledge, and socio-

demographic practices

toward breast BC and BSE.

Pengetahuan

responden

dalam

penelitian ini

tentang BC

rendah,

Praktik BSE

sangat rendah

dan

diperlukan

banyak usaha

untuk

mengajarkan

teknik BSE

tepat.

January

and

March

2017

Knowledge,

attitudes, and

practice of breast

self‑examination

among female

health workers in

Isfahan, Iran

(Reisi, Javadzade

and Sharifirad,

2013)

N = 119

(total

female

healthcare

providers of

Isfahan

working in

healthcare

centers at

the time of

our study).

cross‑sectio

nal

descriptive

stud

cross-sectional descriptive

study was

respondents questioned 42

questionnaires

272/5000

Average

knowledge

- Symptoms of

BC (71.57%)

- Risk factors

(77.15%)

- BSE

(87.64%)

- Good

knowledge

doing BSE

way 79,8%

BSE Practice

The Knowledge of Breast Cancer and the Practice of Breast Cancer Screening (Breast Self Examination)

253

Jurnal Po

ulasi Intervensi Com

arison Outcomes Time

- 39.50%

routine

perform BSE

- 9.2% do 7-

11 times a

year

- 34.50%

between 1-6

times a year

- - 12.6%

did not do

BSE

Knowledge,

Attitudes, and

Behaviors about

Breast Self-

Examination and

Mammography

among Female

Primary

Healthcare

Workers in

DiyarbakJr,

Turkey (Erdem

and Tokta, 2016)

n= 369

female

primary

healthcare

workers

(PHW),

cross-

sectional

study

Responden mengisi

kuesioner yang berisi

sociodemographic

characteristics, knowledge

about BSE, and actual

practice of BSE

In the comparison of the

subgroups of those

multiple groups which are

statistically significant,

Mann-

Whitney ܷ was conducted

and the Bonferroni revision

was

done.The Spearman rank

correlation was employed

between

two scores. According to

statistical analyses ܲ < 0.05

considered significant.

knowledge in

BSE is good,

92.6% had

done BSE,

But only

30.1% do BSE

routine every

month after

the menstrual

period.

No significant

HW has an

awareness of

the advantages

of doing

routine BSE.

In this study,

HW that has

good

knowledge,

has significant

BSE practices.

15-30

Januari

2015

Result of the study conducted by Reisi et al.,

(2013) indicates majority of respondents already have

a good knowledge of BC and BSE (79.8%), and

(72.45%) have a positive attitude, but only (39.5%) of

respondents whose practice BSE routinely. It is

required a further study to determine early detection

service usage factor in women.

The study Erdem & Tokta (2016) states that there

is a significant relationship between respondents who

have good BSE knowledge and conduct BSE practice

(ܲ= 0.001), but knowledge level of clinical BC is still

poor. A BSE adequate knowledge is not reflected in

BSE behavior and practice. The option to conduct

breast self-examination should be conducted on the

respondent..

The study conducted Morse, Maegga, Joseph, &

Miesfeldt (2014) defines (98.2%) of respondents

know about BC, (30%) know about BC risk factors.

In addition, (56%) are aware of the need for BSE

practice, (40%) do not conduct BSE Practice, yet only

(0.9%) of respondents conduct BSE regularly. This

study states woman in Tanzania have lack awareness

of breast examination.

The study conducted Hasan et al., (2015) states

that (61.2%) respondents have poor knowledge, only

(30.3%) whose conduct BSE practice, (40.8%) state

they do not know the way of BSE Practice.

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A research of Özdemir (2014) states majority of

respondents (68.5%) know about BSE. The young

respondents do not know how to practice BSE and

cancer risk factors awareness. Respondents

experience increased BC and BSE knowledge

increasing after health education intervention.

The average Knowledge Outcome study of Hana

Taha et al., (2014) increases significantly (p <0,001)

Pretest 11,4, Posttest 15,7 (maximum score 16).

Increase of BSE practice visit and mammography on

respondents who get vouchers, only 2 respondents

who come in mammography without voucher.

4 DISCUSSION

BSE is recommended to be conducted by women

since the age of 20, although there is no study stating

that BSE directly reduces mortality (Segura et al.,

2014), by conducting a routine BSE, women can

know the condition of their normal breast and also

experience and aware if there is a change in their

breasts. It should also note that, changes in the breasts

do not always indicate presence of breast cancer

(ACS, 2015).

Respondents who are reluctant to perform early

examination because they feel they have a healthy

lifestyle, no family has breast cancer, feel busy

enough to even forget (Daliana et al., 2014). In

addition, the lack of knowledge about BC and BSE is

significant with the lack of BSE practice performed

(Hasan et al., 2015).

Good knowledge of BC and BSE, should be

followed by a woman's awareness to care for her

health and BC precautions (Morse et al., 2014)

All reviewed journals state the need for health

education, to improve BC and BSE knowledge, to

raise awareness of BSE practices across women,

ranging from student, teacher, general public, to

health worker.

5 CONCLUSIONS

The systematic outcomes of this review, described

from 10 journals analyzed, 7 journals indicate the

respondent's knowledge about breast cancer

(symptoms, risk factors, prevention and treatment)

and early detection especially BSE is quite low,

followed by low BSE practice by respondents. The

other 3 journals mentioned that respondents have

good knowledge and experience knowledge

improvement after health education, but there is no

improvement in BSE practice.

Routine health promotion needs to be done,

through various media to increase knowledge and

raise awareness for early detection of health

problems.

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