|Year : 2020 | Volume
| Issue : 1 | Page : 44-49
Knowledge, attitude, and practice of breast self-examination among women attending primary health care facility, Menoufia Governorate, Egypt
Mahmoud A Abo Salem, Howida A Al Shazly, Reda A Ibrahem, Zeinab A Kasemy, Shaimaa Yaihya Abd El-Roaf
Department of Public Health and Community Medicine, Faulty of Medicine, Menoufia University, Menoufia, Egypt
|Date of Submission||06-Jan-2016|
|Date of Decision||03-Feb-2016|
|Date of Acceptance||11-Feb-2016|
|Date of Web Publication||25-Mar-2020|
Shaimaa Yaihya Abd El-Roaf
Shebin El-Kom, Menoufia Governorate
Source of Support: None, Conflict of Interest: None
To evaluate the level of knowledge, attitude, and practice of breast self-examination (BSE) among female in childbearing period (18–49 years old) in Menoufia Governorate.
BSE is a process whereby women examine their breasts regularly to detect any abnormal swelling or lumps to seek prompt medical attention. Breast cancer is the most common form of cancer among females in developed and developing countries. The early detection of breast cancer is the most important and beneficial area of protective techniques and has been positively linked with decrease of mortality and morbidity owing to the illness.
Patients and methods
A cross-sectional study was conducted on women attending primary health care facilities in Menoufia Governorate, Egypt. A total of 271 women were included and subjected to predesigned questionnaire to assess their knowledge, attitude, and practice for BSE.
It was found that 79.7% respondents were aware of BSE. The mass media were the major sources of information (68.4%), whereas the health workers accounted for only 14%. The attitude of participants to health information on BSE was positive. Despite the positive attitude to BSE, its knowledge and practice were low (33.6 and 39.2% had unsatisfactory knowledge and bad practice, respectively). Women with higher level of education (P = 0.009) and those employed in professional jobs (P = 0.001) were significantly more knowledgeable about BSE.
Conclusion and recommendations
There was low level of knowledge about BSE. The attitude of participant was generally positive, but the rate of practicing BSE was low. We recommend the establishment of institutional framework and policy guidelines that will enhance adequate and urgent dissemination of information about breast cancer and BSE to all women in Menoufia.
Keywords: breast, knowledge, attitude, and practice, self-examination, women attending primary health care facility
|How to cite this article:|
Abo Salem MA, Al Shazly HA, Ibrahem RA, Kasemy ZA, Abd El-Roaf SY. Knowledge, attitude, and practice of breast self-examination among women attending primary health care facility, Menoufia Governorate, Egypt. Menoufia Med J 2020;33:44-9
|How to cite this URL:|
Abo Salem MA, Al Shazly HA, Ibrahem RA, Kasemy ZA, Abd El-Roaf SY. Knowledge, attitude, and practice of breast self-examination among women attending primary health care facility, Menoufia Governorate, Egypt. Menoufia Med J [serial online] 2020 [cited 2020 Mar 30];33:44-9. Available from: http://www.mmj.eg.net/text.asp?2020/33/1/44/281315
| Introduction|| |
Breast self-examination (BSE) is a process whereby women examine their breasts regularly to detect any abnormal swelling or lumps to seek prompt medical attention.
Breast cancer is the most common form of cancer among females in developed and developing countries. According to WHO report, there were ~519 000 women who die owing to breast cancer annually, and more new cases are found, which is estimated to be approximately one million women developing breast cancer each year.
The early detection of breast cancer is the most important and beneficial area of protection techniques and has been positively linked with decrease in mortality and morbidity owing to the illness.
Early detection and screening activities of breast cancer include BSE, clinical breast examination, and mammography. BSE is effective, cheap, and less painful; however, it is dependent on knowledge and attitude toward BSE practice among women.
Mammography is the most successful way of detecting breast cancer among women older than 50 years.
Mortality rates from breast cancer have decreased by 25–30% with early detection, improving quality of screening activities and enhancing treatment.
Breast cancer detection in the early stages has a higher chance of responding successfully to treatment.
However, it is found that Arabic women currently face a significant risk of high mortality rate from breast cancer owing to its late diagnosis, that is, in the advanced stages of the disease.
Breast cancer is the most common cancer among Egyptian women. According to Egypt National Cancer Institute, breast cancer represents 18.9% of all cancer cases (35.1% in women and 2.2% in men).
Incidence of breast cancer in Egypt is not different when compared with other countries, which represented 24 per 100 000, and mortality rate related to breast cancer is 9.3% of all cancers.
In Egypt, breast cancer is usually detected at late stages (around 60% of cases detected in the third stage of breast cancer), when treatment options are limited, and fatality rate is high, as breast cancer is a highly fatal disease, especially with late diagnosis; therefore, early detection of breast cancer leads to better outcome and prognosis of breast cancer.
BSE makes women more 'breast aware,' which in turn may lead to an earlier diagnosis of breast cancer.
As there is high prevalence of breast cancer among Egyptian women, BSE was found to detect breast cancer early hence improve prognosis, so this work was carried out to study knowledge, attitude, and practice about BSE among Egyptian women.
In this study, a trial was done to link between knowledge of breast cancer and BSE practice.
This study aimed to determine the level of knowledge, attitude, and practice of BSE among women in the childbearing period.
| Patients and Methods|| |
A cross-sectional study was conducted from December 2014 to December 2015, and the practical part was done from July 1, 2015 to August 31, 2015. Women attending primary health care facilities, Shebin El-Kom District, Menoufia Governorate, were the patients of this study.
Two health care facilities were chosen randomly: Kebly health center of Shebin El-Kom was randomly chosen as an urban center and El Batanon family health center was randomly chosen as a rural health center.
A total of 271 women, 18 years of age and older, were included in this study and subjected to predesigned questionnaire to assess the following.
- Sociodemographic data and clinical and gynecological history of the studied females
- Questions covering knowledge about BSE, which included 14 questions to assess the knowledge of women about BSE with total score of 14; the women were considered to have satisfactory knowledge when score was more than 7 and unsatisfactory knowledge when score was less than or equal to 7
- Questions covering attitude of women toward BSE, which included eight questions to assess the attitude of women toward BSE, with a total score of 8; the women were considered having a positive attitude when score was more than 4 and negative attitude when score was less than or equal to 4
- Questions about practicing BSE (absent and present) and about level of practice, which included 11 questions to assess the practice of women regarding BSE, with a total score of 11; the women were considered to have good practice when score was more than or equal to 6 and poor practice when score was less than 6.
The data were coded, tabulated, and analyzed using the Statistical Package for Social Sciences (SPSS, version 14; IBM Corp., Armonk, New York, USA). Qualitative data were expressed as numbers and percentages, and the χ2 test and Fisher's exact test were used to test the relationship between these variables. Spearman's correlation coefficient (r) was used to estimate correlation between age and attitude level. All these tests used the level of significance at 5%.
| Results|| |
Mean age of participants in this study was 31. 33 ± 8.80 years, 56.8% had rural residence, 80.1% were married, ~three fourth of them had secondary and high education, 72.7% were housewives, and 72.7% had enough income [Table 1].
It was found that 79.7% of the respondents had heard about BSE. The mass media were the major sources of information (68.4%), whereas the health workers accounted for only 14% of these sources [Figure 1] and [Figure 2].
|Figure 1: Correlation between attitude score and age of participant women.|
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|Figure 2: Sources of information about methods of breast self-examination.|
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Rate of ever practice BSE was 29.2% among the studied group, and only 32.9% of them were of regular and optimum frequency. Overall, 46.1% of those not practicing BSE recorded that the cause was lack of information about BSE [Table 2].
|Table 2: Rate of ever practicing breast self-examination and barriers against it|
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The attitude of participants toward BSE was generally positive (76.4%). Despite the positive attitude to BSE, its knowledge and practice were low (33.6 and 39.2% were of unsatisfactory knowledge and bad practice, respectively) [Table 3].
|Table 3: Knowledge, attitude, and practice of breast self-examination among the studied group|
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Attitude was positively correlated with age of the participants (P = 0.02) [Figure 3].
Women with higher level of education (χ2 = 11.46, P = 0.009) and those employed in professional jobs (χ2 = 13.83, P = 0.001) significantly had more knowledgeable and had good practice regarding breast cancer and BSE. Knowledge level improved with positive family history of breast cancer and past history of breast lesions. BSE practice improved among those with high income [Table 4].
|Table 4: Relationship between sociodemographic criteria of the studied group and their knowledge, attitude, and practice towards breast self-examination|
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| Discussion|| |
According to the results of this work, it was found that 79.7% of respondents had heard/read about BSE, and this is consistent with the results of Akel et al., who estimated the knowledge and practice of Jordanian women toward breast cancer and BSE and found that 67% of the sample population had heard/read about BSE. Similar results were found by Gwarzo et al., who estimated the knowledge and practice of BSE among 221 women students aged 16–28 years old and found that 87.7% of respondents had heard about BSE. However, it was different from that of Karayurt et al., who performed their study in a high school in Manisa, Turkey. The study sample included 718 high school female students. They found that more than half of the students (62.1%) reported that they had not heard about BSE. In this work, mass media was reported as the major sources of information (68.4%), whereas the health workers accounted only 14% of the sources of knowledge. This was in line with the results of Akel et al. who found that the main source of information about BSE was obtained from mass media such as TV/radio and printed media (58%), followed by Health Care Staff in Comprehensive Health Centers (29%). Moreover, similar results were obtained from Karayurt et al. who found that media was identified as the main source of information on breast cancer by 48.6% of the participants. Moreover, this result was concordant with that of Legesse and Gedif, who did a study on 845 women in Northern Ethiopia to assess knowledge of breast cancer and its prevention, and they found that media was the major source of information (59.1%). This can be attributed to widespread and attraction of mass media, which makes it a valuable source of knowledge not only in health-related topics but also social and political issues.
Participants' level of knowledge in the current study was generally unsatisfactory (66.7% had unsatisfactory knowledge). This could be attributed to shortage of health educational program performed in the primary health clinics as well as poor awareness related to the value of health. This is in concordance with the findings of Seif and Aziz, who conducted their study on 122 working females; they found that only 11% of the total sample had satisfactory knowledge about BSE. Elshamy and Shoma studied 133 female nurses aged 30–48 years old working in different health care settings in Mansoura University Hospitals to study knowledge and practice of breast cancer screening and found that the knowledge about early detection of breast cancer was limited. In the same context, Marinho et al. found that only 7.4% from a total sample of 663 women selected from multiple health centers had adequate knowledge about BSE. Moreover, Khalil found that only 23.5% from a total sample of 217 women selected from two health centers in Menoufia Governorate had adequate knowledge about BSE. These results disagreed with Reisi et al., who found that the knowledge about breast cancer and doing BSE was good (79.8%) when they performed their study on 119 female health workers in Isfahan (Iran).
In this study, the level of knowledge was higher among women with moderate and high education. This is in agreement with Seif and Aziz, who found a positive correlation between level of education and knowledge about BSE. Moreover, it was consistent with Farahat et al., who documented the same result. On the contrary, other demographic variables including age, residence, and marital status were not significantly related to knowledge score, but this was different compared with Khalil and Seif and Aziz, who found that the urban resident womenhad significantly higher knowledge score, and also contradictory to Akel et al., who found that the highest knowledge level about BSE was found in married women (79.7%).
The current work reported that female occupation had a significantly influence on knowledge regarding breast cancer and BSE. This result was supported by Okobia et al., who found that education and employment significantly influenced knowledge of breast cancer and BSE.
The findings of this study which demonstrated that attitude of participants toward BSE was mainly positive (76.4%) were consistent with the results of Reisi et al. who found that 72.4% of their participants also had positive attitudes. This was opposed by Farahat et al., who found that the participants' attitude toward BSE was only 37.8%. This difference can be explained, as in recent years, there has been a marked increase in rate and detection of different types of cancer, which reflected on the attitude of participants toward this problem.
In this study, it was found that women with high education and high level jobs had significantly higher attitude score. This was consistent with the results of Reisi et al. who found a significant relationship between the attitudes and the university degree of education. Similar results were noticed by Farahat et al., who found that the attitude toward BSE was significantly affected by level of education. Opposite results were documented by Persson et al., who looked at the relationship between different sociodemographic criteria and BSE attitude and practice among their participants and found no relation between level of education and attitude toward BSE.
This study found that the rate of practicing BSE was 29.2% among the studied participants and only 32.9% of them were of regular and optimum frequency. The cause of not practicing BSE was lack of information about BSE in 46.1% of participants. This was consistent with Karayurt et al. who found that the percentage of the students who performed BSE regularly every month was 6.7%, and the most common reasons for not doing BSE were not knowing how to perform BSE (98.5%). Moreover, this finding was in agreement with Farahat et al., who found that only 16.1% were actually practicing it. This is owing to the lack of knowledge about BSE, and only 20% of practicing participants were of regular and optimum frequency. Moreover, this study was in agreement with Elshamy and Shoma, as only 18.8% of the nurses practiced BSE on a monthly basis. Akel et al. also found that ~48% were practicing breast self-examination, and Desoukya and Tahaa found that none of the participants had ever practiced BSE. On the contrary, Sorenson et al. found that despite the high proportion of their sampled women who knew about BSE and believed it to be effective, a relatively low proportion actually practiced it routinely and with appropriate technique.
This study documented that the practice of participants toward BSE was mainly poor (60.8%). This was consistent with the results of Reisi et al. and also with Sorenson et al., who found that a relatively low proportion that actually practiced it routinely and did it with the appropriate technique.
The current work revealed that practicing women had sufficient level of knowledge about BSE. This was in agreement with Karayurt et al. who found that there was a significant relation between BSE practice and information about breast cancer and BSE. Moreover, Al-Azmy et al. found that practicing women had sufficient level of knowledge about BSE.
| Conclusion|| |
Awareness of BSE was high but the practice was low. Education appears to be the major determinant of level of knowledge among the study participants. We recommend the establishment of institutional framework and policy guidelines that will enhance adequate and urgent dissemination of information about breast cancer and BSE to all women in Menoufia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Parkin DM. Cancer in developing countries. Cancer Surv 1994; 19
World Health Orgnization. World Health Organization cancer. 2010. Available from: www.who.int/mediacentre/factsheets/fs297/en/
. [Last accessed on 2014 Nov 20].
Mele N, Archer J, Pusch BD. Access to breast cancer screening services for women with disabilities. J Obstetr Gynecol 2005; 34(A)
Mai V, Sullivan T, Chiarelli AM. Breast cancer screening program in Canada: successes and challenges. Salud Publica Mex 2009; 51
Bener A, El Ayoubi HR, Moore MA, Basha B, Joseph S, Chouchane L. Do we need to maximize the breast cancer screening awareness? Experience with an indigenous society with high fertility. Asian Pac J Cancer Prev 2009; 10
Bener A, Ayub H, Kakil R, Ibrahim W. Patterns of cancer incidence among the population of Qatar: a worldwide comparative study. Asian Pac J Cancer Prev 2008; 9
Omar S, Khaled H, Gaafar R, Zekry AR, Eissa S, El-Khatib O. Breast cancer in Egypt: a review of disease presentation and detection strategies. East Mediter Health J 2003; 9
Seif NY, Aziz MA. Effect of BSE training program on knowledge, attitudes and practice of a group of working women. J Egypt Nat Cancer Inst 2000; 12
Ibrahim EM, Zeeneldin AM, Sadeq BB. The present and the future of breast cancer burden in the Kingdom of Saudi Arabia. J Clin Oncol 2008; 26 (I5)
Karayurt Ö, Özmen D, Çetinkaya AÇ. Awareness of breast cancer risk factors and practice of breast self-examination among high school students in Turkey. 2008. Available from: www.biomedcentral.com.
[Last accessed on 2015 May 15].
Akel A, Mohammed R, Mohammed IT. Knowledge and practice of Jordanian women towards breast cancer and breast self-examination. JRMS 2006; 18
Gwarzo U, Sabitu K, Idris SH. Knowledge and practice of breast-self examination among female undergraduate students of Ahmadu Bello University Zaria, Northwestern Nigeria. Ann Afr Med 2009; 8
Legesse B, Gedif T. Knowledge on breast cancer and its prevention among women household heads in Northern Ethiopia. Open J Prev Med 2014; 4
Elshamy KF, Shoma AM. Knowledge and practice of breast cancer screening among Egyptian nurses. Afr J Haematol Oncol 2010; 1
Marinho LA, Cecatti JG, Osis MJ. Kowledge, attitude and practice of breast self-examination in health centers. Rev Saude Publica 2003; 37
Khalil LA. Acceptance of breast self-examination among females in urban and rural areas in Menofiya Governorate MS thesis, Menoufia university, Menoufia, Egypt; 2007. Available from: http://eulc.edu.eg/eulc_v5/libraries/start.aspx
. [Last accessed on 2018 May 22].
Reisi M, Javadzade SH, Sharifirad G. Knowledge, attitudes, and practice of breast self-examination among female health workers in Isfahan, Iran. J Educ Health Promot 2013; 2
Okobia MN, Bunker CH, Okonofua FE. Knowledge, attitudes, and practice of Nigerian women towards breast cancer. Across sectional study. World J Surg Oncol 2006; 4
Persson K, Svensson P, Ek A. Breast Self-Examination an analysis of self-reported practice. Jadv Nurs 1997; 25
Desoukya DE, Tahaa AA. Effects of a training program about breast cancer and breast self-examination among female students at Taif University. J Egypt Public Health 2014; 90
Sorenson J, Hertz A, Gudex C. Evaluation of a Danish Teaching Program in breast self-examination. Cancer Nur 2005; 28
Al-Azmy SF, Alkhabbaz A, Almutawa HA, Ismaiel AE, Makboul G, El-Shazly MK. Practicing breast self-examination among women attending primary health care in Kuwait. Alex J Med 2013; 49
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]