MODULE 1. Interprofessional working in early detection of breast cancer
7.1. Education offered by health care professionals
Breast self examination (BSE)
Breast self-examination is one of the methods that may have an affect on early detection of breast cancer. It does not replace mammography, but it raises self-awareness and should be performed regularly. BSE has been recommended by healthcare professionals for over 70 years and the first programs supporting it started in Europe around 1950. Despite its long history, studies have shown, that women do not perform BSE monthly. (Funke – Krause-Bergmann – Pabst – Nave 2008)
It is very important that patients are taught to perform BSE correctly. This could be done when the patient is having a clinical breast examination (CBE) performed by the professional, who at the same time is teaching the procedure to the patient. Women have found both videos and booklets useful, but still value face to face session with a health care professional. (Funke Et al. 2008) Studies have shown that nurse´s willingness to recommend BSE to their clients depends significantly on how confident they are of performing it them- |
selves. Every healthcare professional should be trained to perform and give guidance on BSE, as it is an effective and low cost procedure, which is easily done during a standard appointment. (Ceber – Turk – Ciceklioglu 2009)
BSE should be part of women´s monthly routine starting from the age of 20. CBI should be conducted once in every three years until the age of 39 and yearly after that. Teaching methods regarding BSE vary as well. The most common methods are booklets, videos and different simulations, such as silicone breasts with implanted fake tumors. Recommendations on the age of beginning regular routine mammography varies from 40 to 60 depending on each country´s own health program. (Akpınar – Baykan – Naçar – Gün – Çetinkaya 2011) This education video can be found on NHS web pages. It is a very good example of effective and practical knowledge passed on from professionals to customers. |
Awareness, Accessibility, Availability, Approachability
Everything begins with the health professional´s knowledge level and attitude towards breast cancer screening. If they do not find these things important, they will not educate their patients well enough. On the other hand, when health professionals choose to play an active role in the community, they have a very good opportunity to have an influence on women´s knowledge and participation regarding breast cancer screening. Studies have shown that biggest reasons for not performing BSE are neglect and not caring. Other reasons are not believing that they would get cancer and that they are afraid of what they may find. (Akpınar – Baykan – Naçar – Gün – Çetinkaya 2011)
Breast cancer awareness leads to active breast cancer screening, which helps with early detection of breast cancer. This has an effect on the cancer patients’ survival rate, because when cancer has been detected, it is more |
likely to be operable and treatable. Knowledge of this circle helps to raise awareness and spreads the word about the importance of screening among women. (Shieh – Chen – Tsai – Kuo – Tsai – Lu 2012)
It is important to identify the patients, who need more support and knowledge about screening. Studies have shown that married women tend to take better care of themselves according to the screening, BSE and CBE rates. It is seen that both the support from their husband as well as a better economic status have an influence on their participation. One possible channel to inform women is social media. It is nowadays the most powerful way to get information through to big target groups. (Kotepui – Piwkham – Chupeerach – Duangmano 2014) |
Risk factors and women´s awareness of them
Studies have shown that among women, the most known risk factors for breast cancer are family history, increased age and the use of oral hormone contraceptives or hormone therapy. Other risk factors, such as early menarche (<12 years), late menopause (> 55 years) or high breast tissue density are not as widely known, though being proven by various studies. (Lacovara – Ray 2007)
About 75% of the women who participated in studies about breast cancer awareness in Thailand and Germany had good or fair knowledge about breast cancer risk factors. The rest of the participants had poor knowledge. (Kotepui – Piwkham – Chupeerach – Duangmano 2014) This shows that it is important to try and provide knowledge about early detection of breast cancer and breast cancer screening programs. Women are more likely to attend mammography appointment, if there is a close friend or a member of the family who has had breast cancer. (Manjer – Emilsson – Zackrisson 2015) This is due to them having more knowledge of breast cancer than those whose close ones has been saved from it. |
Those women who perceive they have a high risk of developing cancer are less likely to have a positive attitude towards breast cancer information. This may be due to the fear of getting cancer themselves. On the other hand, women who gave high importance to cancer risk factors in a study, were more likely to react positively to cancer information. (Sanz-Barbero – Prieto – Cambas 2015)
Breast cancer risk assessment tools cannot identify if a patient will develop breast cancer or not. However, they can provide a relative risk compared to the general population. A risk assessment tool uses mathematical methods while comparing patients answers to the general population. (Lacovara – Ray 2007) |
Methods proven to work
Peer Education
In Turkey, they have studied the effectiveness of peer education in breast cancer screening and health beliefs. Peer trainers can be ordinary people, so no expertise is needed. This may help with gaining the trust and creating a comfortable learning environment among the target group. The idea is to educate selected peer trainers, who are suitable for teaching others. Then these trainers reach out for women and teach them what they have learned themselves. This method is based on ongoing teaching, which is happening in as comfortable way and place as possible. The aim is to get women to understand the importance of breast cancer screening and create a positive attitude towards it. It has proven to be effective though a low cost system. (Gözüm – Karayurt – Kav – Platin 2010) Teaching seminars There have been very promising studies on the effects of teaching seminars considering BSE. For example, in Germany, they arranged seminars that included both lectures about early detection of breast cancer, and a possibility for private one to one teaching of BSE. These seminars had a very positive effect on how often the participant´s performed BSE after the seminar compared to the situation before. |
The increase was significant, as before the seminar, only 21,4% of the participants did BSE monthly, but after 1 year of the seminar the percentage was 61,9. Though BSE cannot be considered as a vital part of early detection of breast cancer, it helps to develope women´s positive attitude towards screening and increases their knowledge of breast cancer and screening programs. (Funke – Krause-Bergmann – Pabst – Nave 2008)
BSE teaching with follow up calls A new method of teaching BSE was studied in China. They recruited 60 participants who attended a 1hr teaching seminar, where various materials, such as a lecture, a video, a conversation and check lists were used. Before the seminar, participants completed questionnaires focusing on their knowledge according to breast cancer and BSE. After the seminar, the participants received a breast health booklet including a 14 step BSE check list and a shower head BSE reminder card. Follow up phone calls were made one and three months after the seminar. They showed a significant improvement in general knowledge, attitude towards breast cancer and accuracy of BSE practice. During the phone calls, participants could ask questions in addition to their interview. (Ouyang – Hu 2015) |
Questions
1. Could we find an inspiring and interesting way to teach BSE to women? Could it be possible to make it less uncomfortable and more down to earth a subject, so that people would talk about it more and maybe even teach the principles to their uneducated friends? 2. How could we make sure that every woman knows about the screening programmes and her right to participate? Do we have sufficient funds to spread information widely enough? Could more responsibility about educating women be referred to the government instead of leaving it to health care professionals and would this work? |
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References
- Akpınar, Yeliz Yelen – Baykan, Zeynep – Naçar, Melis – Gün, İskender – Çetinkaya, Fevziye 2011. Knowledge, Attitude about Breast Cancer and Practice of Breast Cancer Screening among Female Health Care. Asian Pacific Journal of Cancer Prevention, Vol 12, 3063-3068
- Ceber, Esin – Turk, Meral – Ciceklioglu, Meltem. 2009. The effects of an educational program on knowledge of breast cancer, early detection practices and health beliefs of nurses and midwives. Journal of Clinical Nursing. Vol 19, pp 2363-2371
- Funke, L – Krause-Bergmann, B – Pabst, R – Nave, H 2008. Prospective analysis of the long-term effect of teaching breast self-examination and breast awareness. European Journal of Cancer Care 17, 371–376
- Gözüm, Sebahat – Karayurt, Özgul – Kav, Sultan – Platin, Nurgun 2010. Effectiveness of peer education for breast cancer screening and health beliefs in Eastern Turkey. Cancer Nursing, Vol.33/ No.3, 213-220
- Kotepui, Manas – Piwkham, Duangjai – Chupeerach, Chaowanee – Duangmano, Suwit 2014. Knowledge, attitudes and practice of breast cancer screening among female personnel of Walailak University. Health Expectations, 18, 3069–3078
- Lacovara, Jane E – Ray, Jessica 2007. Deciphering the diagnostic process of breast cancer. Medsurg Nursing, Vol.16/ No.6, 391-399
- Ouyang, Yan – Qiong – Hu, Xiaoyan 2015. The Effect of Breast Cancer Health Education On The Knowledge, Attitudes and Practise: A Community Health Center Catchment Area. Journal of Cancer Education 29, 375-381
- Manjer,Åsa Ritenius – Emilsson,Ulla Melin – Zackrisson, Sophia 2015. Non-attendance in mammography screening and women´s social network: a cohort study on the influence of family composition, social support, attitudes and cancer in close relations. World Journal of Surgical Oncology. Vol 13, 211-217
- Sanz-Barbero, Belén – Prieto, María Eugenia – Cambas, Naiara 2015. Factors associated with a positive attitude towards receiving cancer information: a population-based study in Spain. Health Expectations, 19, 288–298
- Shieh, S.H. – Chen, H.C. – Tsai, W.C. – Kuo, S.Y – Tsai, Y.F. – Lu, C.H. 2012. Impact of breast cancer patients’ awareness on attendance at screening. International Nursing Re-view 59, 353–361