Factors Influencing Breast Cancer Screening Behavior among Iranian Women

Background: Early detection of breast cancer is of great importance to improve women’s health and to decreasethe cost related to cancer death. Therefore, recognition of variables related to breast cancer screening behaviorsis necessary. Objectives of this study were to identify the rates of breast self-examination (BSE) performance andmammography use in Iranian women, and to characterize the demographic and cognitive factors associated withtheir breast cancer screening behavior. Method: Data were collected from a convenience sample of 388 females,using an adapted version of Champion’s revised Health Belief Model Scale. Results: The results showed that7.5% of the participants performed BSE on a regular monthly basis, and among the women aged 40 and older,14.3% reported having had at least one mammography in their lifetime. Perceived self-efficacy and perceivedbarriers to BSE were significant predictors for BSE performance. For having mammography, health motivationwas the main predictor. Conclusion: Eliminating barriers and increasing perceived self-efficacy with an emphasisto make the women acquainted with BSE performance; as well as increasing health motivation of women andpersuading of physicians for clinical breast examination (CBE) performance with low cost and free access tom ammography, are important to promote BSE and mammography.     

Breast cancer screening knowledge, attitudes, and practices among Korean American women

PURPOSE/OBJECTIVES: To describe the knowledge and beliefs about breast cancer and breast cancer screening and practices of clinical breast examination (CBE) and mammography of Korean American women. DESIGN: Cross-sectional survey. SETTING: Two Korean churches in a mid-sized Southeastern U.S. city. SAMPLE: A convenience sample of 107 Korean women ages 40 and older. METHODS: Data were collected using Champion's Health Belief Model instrument (susceptibility, seriousness, benefits, and barriers) and the Breast Cancer Knowledge test through mailed questionnaires. MAIN RESEARCH VARIABLES: Knowledge and beliefs about breast cancer screening and practices of CBE and mammography. FINDINGS: The percentages of Korean American women who ever had a CBE and mammography were 67 and 58, respectively. Among the Health Belief Model variables, women who never had a CBE had significantly lower knowledge scores and higher perceived barriers to CBE than those who had. Women who never had a mammogram reported significantly higher perceived barriers to mammography. Logistic regression analyses demonstrated that husband's nationality, regular checkups, and encouragement from family members and physicians were significant predictors of CBE and mammography use. CONCLUSIONS: The frequency of breast cancer screening practices among Korean American women is below national objectives. IMPLICATIONS FOR NURSING PRACTICE: As healthcare professionals in a culturally diverse nation, nurses need to increase their awareness of cultural variations and provide culturally and linguistically appropriate breast health education. Additional studies with women from a variety of settings are needed to validate present study findings.     

Knowledge,Facilitators and Perceived Barriers for Early Detection of Breast Cancer among Elderly Turkish Women

This article deals with elderly Turkish women’s experiences with breast self examination, clinical breastexamination and mammography screening, as well as perceived barriers and facilitators in the theoreticalframework of the Health Belief Model and the Health Promotion Model. This is a qualitative study performed on46 elderly women aged 60-75 years. Data were collected with focus group interviews and analyzed systematicallywith qualitative analysis techniques to determine themes concerning knowledge and facilitators of and perceivedbarriers to early detection of breast cancer among elderly women. Barriers to screening were insufficientknowledge, fear, neglect/postponement, embarrassment/religious beliefs, inability to make an appointment, lackof a physician’s recommendation and health professionals’ attitudes. Facilitating factors were being informedabout screening, fear, awareness of cancer screening, familial history of breast cancer and social support, makingan appointment, health professionals’ communication and physicians’ recommendations. Public health nursesand health professionals from other health disciplines should be aware of elderly women’s need for knowledgeabout screening, understand elderly women’s fear and worries about their health and know barriers to andfacilitators of screening.     

Health Beliefs and Breast Cancer Screening Behaviors among Iranian Female Health Workers

Background: Breast cancer is a serious health problem. Early detection is crucial for optimal treatment andreducing mortality. Objective: The aim of this study was to evaluate health beliefs concerning performance ofbreast self- examination (BSE) and mammography in a sample of Iranian female health workers. Materialsand Methods: This cross-sectional study was performed among 441 female health care workers (physicians=88,nurses=163, midwives=38, officers=68, and others=84) in 3 different health centers in Yazd, Iran. Data werecollected using a self administered questionnaire which included demographic characteristics and thenPersianversion of the Champion’s Health Belief Model Scale (CHBMS). Results: The mean age of the participants was34.7±13.7. It was found that 41.9% of the workers performed BSE in the past and 14.9% of them regularly,but only 10.6% of them had undergone a mammogram. Perceived barriers to BSE (F=6.351, P=0.021) andmammography (F=5.214, p=0.022) were significantly higher in officers than physicians, nurses or midwives.Perceived barriers were lower among those who had performed BSE and mammography, but not significant(p=0.34 and p=0.56, respectively). Furthermore, perceived susceptibility and perceived benefits of the workerswho had BSE and mammography were significantly higher than who did not (p<0.05). Perceived seriousness wasnot a significant variable in BSE and mammography (p=0.71 and p=0.43, respectively). Conclusions: The healthbeliefs of health workers concerning the perceived susceptibility of breast cancer and the perceived benefits BSEand mammography significantly impact their screening practices.     

Women's Breast Cancer Risk Perception and Attitudes Toward Screening Tests

This study's objective is to identify women's breast cancer risk perceptions and their attitudes and knowledge on screening tests. The cross-sectional research. Gulhane Military Medical Academy, Ankara, Turkey. The population of 188 females who applied for gynecological examination. The study employed a semistructured questionnaire form. Questions such as female's demographic data, attitudes based on screening tests of breast cancer, family history, perceived risk breast cancer, and questions with regard to patients’ fear of breast cancer were included in the survey. In this study, it is determined that the rates of the women, who conduct breast self-examination (BSE), clinical breast examination (CBE) and mammography at least once, are very low. The reason for not performing the BSE was declared with a rate of 50.8% as “Do not know how to perform.” Of the women 20.2% were fully acknowledged about BSE. Nearly half of the women perceived 50% or more risk of developing breast cancer, and this rate increases as they get older. The risk perception and educational status increased CBE and mammography rates and BSE knowledge positively, but because of insufficient BSE application abilities BSE rate cannot increase as expected. It is recommended that nurses put forward the initiatives in training programs to increase women's BSE abilities. In planning such an education program risk perception and information of women about breast cancer should be considered.     

Breast Cancer Knowledge,Perception and Breast Self- Examination Practices among Yemeni Women: an Application of the Health Belief Model

Background: The incidence of breast cancer is rapidly increasing in Yemen with recent indications of constituting one-third of female cancers. The main problem in Yemen remains very late presentation of breast cancer, most of which should have been easily recognisable. Since stage of disease at diagnosis is the most important prognostic variable, early diagnosis is an important option to be considered for control of breast cancer in low resourced settings like Yemen. In the present study, we aimed at describing breast cancer knowledge, perceptions and breast self-examination (BSE) practices among a sample of Yemeni women. Materials and Methods: This cross-sectional study covered 400 women attending four reproductive health centres in Aden, Yemen through face-to-face interview using a structured questionnaire during April - July 2014. We collected data on sociodemographic characteristics, knowledge about breast cancer, and screening practices as well as respondents' perceptions based on the five sub scales of the Health Belief Model (HBM): perceived susceptibility; perceived severity; perceived barriers; perceived benefits; and self-efficacy. The response format was a fivepoint Likert scale. Statistical Package for Social Sciences (SPSS 20) was used for statistical analysis. Statistical significance was set at pResults: The mean age of women was 26.5 (S.D=5.6) years. The majority (89.0%) had never ever performed any screening. Two-thirds of respondents had poor knowledge. Perceived BSE benefits and self-efficacy and lower BSE barriers perception were significant independent predictors of BSE practice. Conclusions: Poor knowledge and inadequate BSE practices are prevailing in Yemen. The need for implementing culturally sensitive targeted education measures is mandatory in the effort to improve early detection and reduce the burden of breast cancer.     

The Effect of Education on the Early Diagnosis of Breast and Cervix Cancer on the Women’s Attitudes and Behaviors Regarding Participating in Screening Programs

The objective of this paper was to define the effect of education on the early diagnosis of breast and cervix cancer on the women?s attitudes and behaviors regarding participating in Cancer Early Diagnosis, Screening and Training Centers-CEDSTC screening programs. This semi-experimental study was completed with 342 women. The data were collected with forms “Champion’s Health Belief Model Scale Breast Cancer-HBMSBC” and “Health Belief Model Scale for Cervical Cancer and the Pap Smear Test-HBMSCCPST.” When the women’s health beliefs before and after 6 months of the education about the early diagnosis of breast and cervical cancers are considered, it is seen that the HBMSBC subscales health motivation, breast self-examination (BSE), and evasion to mammography (MMG) decreased and BSE self-efficacy and MMG benefit attitudes increased and HBMSCCPST subscales pap smear benefit attitudes increased and evasion to pap smear attitude decreased (p < 0.05). Six months after the education, 28.4% of the women had undergone MMG, 69.9% had performed BSE, and 33.6% had undergone a pap smear test. Education regarding early diagnosis of breast and cervix cancer was found to have positive effects on the health behaviors of the women related to BSE, MMG, and pap smear tests. The women require professional education program for increasing their attitudes and behaviors for CEDSTC screening programs. We suggest regularly providing education to increase participation in early screening programs.     

Do We Need to Maximise the Breast Cancer Screening Awareness?: Experience with an Endogamous Society with High Fertility

Background: In the State of Qatar, breast cancer has become the most common form of cancer amongwomen. The aim of this study was to explore knowledge, attitude and practice about breast cancer and toidentify potential barriers to screening procedures among women. Methods: This multistage sampling crosssectional survey in primary health care centers and the outpatient department of the Women’s Hospital in theState of Qatar targeted a representative sample of 1,200 Qatari women aged between 30 to 55 years of ageduring the period from December 2008 to April 2009. A total 1,002 subjects (83.5%) consented to participation.Face to face interviews were conducted with a designed questionnaire covering knowledge about breast cancer,attitudes and practices of breast cancer screening. Socio-demographic variables were included. Results: Themajority of Qatari women demonstrated an adequate knowledge about breast cancer, with a significant relationto education status. Almost three quarters were aware that breast cancer is the most common cancer in women.A good proportion knew that nipple retraction (81.2%) and discharge of blood (74.6%) are warning signs. Ofthe studied Qatari women, 24.9% identified breast self examination, 23.3% clinical breast examination (CBE)and 22.5% mammography as methods for detection of breast cancer. The frequently reported barriers amongthe Qatari women were asking any doctor/nurse how to perform breast self examination (57.3%), embarrassmentabout CBE (53.3%) and fear of mammography results (54.9%). Univariate and multivariate logistic regressionanalysis showed that family history, level of education, living in an urban area and having medical check-upswhen healthy were significant predictors for CBE and mammography. Conclusion: The study findings revealedthat although Qatari women had adequate general knowledge about breast cancer, the screening rates for BSE,CBE and mammography were low, these being performed most frequently by young Qatari women with ahigher level of education.     

Breast cancer early detection, health beliefs, and cancer worries in randomly selected women with and without a family history of breast cancer

BACKGROUND: Early detection practices (EDP) consist of clinical breast examination (CBE) and mammography. Breast self-examination (BSE) is no longer generally recommended, but many women still perform it. AIMS: To compare EDP, health beliefs, and cancer worries in women with and without a family history of breast cancer in a population-based sample. METHODS: 489 women aged 21-60 were randomly sampled from the entire Jewish female population of Israel; 61 (12.5%) had a family history of breast cancer. Participants answered questionnaires by phone, including demographic details, EDP performance, health beliefs, and cancer worries. RESULTS: Rates of CBE were similar in women with and without a family history (p>0.05). For women over 40, rates of undergoing mammography screening were similar (p>0.05), but regular attendance was reported more by women with a family history (p<0.05). More women under 40 with a family history of breast cancer attended mammography (p<0.05), but only about 14% had ever undertaken mammography screening and 27% had ever undertaken CBE. More than 50% of the women had performed BSE, while significantly more women with a family history reported its over-performance (p<0.01). Women with a family history reported higher perceived susceptibility (p<0.01), higher cancer worries (p<0.05), and fewer barriers to mammography (p<0.05). According to logistic regression analysis, higher odds of EDP were significantly related to perceiving fewer barriers and having higher cancer worries. A positive family history was related to higher odds of women undergoing mammography. Perceived susceptibility was significantly related to higher odds of BSE only. Over-performance of BSE was significantly related to having a positive family history, higher susceptibility, and higher cancer worries. CONCLUSIONS: (1) A high rate of women did not undergo CBE or mammography screening. Women under 40 with a family history of breast cancer who have never undergone CBE or mammography merit special attention. (2) The change in guidelines on BSE necessitates further study of its over-performance in relation to cancer worries. (3) Interventions are needed to promote attendance for CBE and mammography in younger women with a positive family history.     

Beliefs and Behaviors of Breast Cancer Screening in Women Referring to Health Care Centers in Northwest Iran According to the Champion Health Belief Model Scale

Background: Breast cancer is the most common cancer in women. All ages are susceptible and more than90% of the patients can be cured with early diagnosis. Breast self-examination (BSE) and mammography can beuseful for this aim. In this study we examined the components of the Champion health belief model to identifyif they could predict the intentions of women to perform such screening. Materials and Methods: A total of380 women aged 30 and above who had referred to health-care centers were assessed for use of breast cancerscreening over the past year with a modified health belief model questionnaire. Logistic regression was appliedto identify leading independent predictors. Results: In this study 27% of the women performed BSE in thelast year but only 6.8% of them used mammography as a way of screening. There were significant differencesregarding all components of the model except for perceived severity between women that underwent BSE. overthe past year and those that did not. Findings were similar for mammography. Regression analysis revealedthat intentions to perform BSE were predicted by perceived self-efficacy and perceived barriers to BSE whileintentions to perform mammography were predicted by perceived barriers. Conclusions: This study indicatedthat self-efficacy can support performance of BSE while perceived barriers are important for not performingboth BSE and mammography. Thus we must educate women to increase their self-efficacy and decrease theirperceived barriers.     

Comparison of Two Different Educational Methods for Teachers’ Mammography Based on the Health Belief Model

Background: Breast cancer is the most common cancer in women. One way to decrease the burden ofthis cancer is early detection through mammography. This study compared the effectiveness of two differenteducational methods for teachers’ uptake of mammography based on the Health Belief Model. Materials andMethods: The current study was a randomised trial of 120 teachers over 40 years old in two groups receivingmultimedia or group education, both based on the Health Belief Model. Participants completed questionnairesbefore, immediately and three months after educational intervention. Mammography was evaluated beforeand after educational intervention. Results: The participants in the two groups were demographically similar.Comparison showed no difference noted in the scores of knowledge, perceived barriers, susceptibility, andseverity constructs between two groups (p > 0.05). Health motivation and benefit were perceived to be higher inthe group education compared to the multimedia group. There was a significant difference in mammographybetween two groups after the intervention (p= 0.003). Conclusions: Planning and implementation of educationalprogram based on the Health Belief Model can raise knowledge and increase participation in mammographyespecially with group education.     

Predictors of breast cancer screening behavior in women with a strong family history of the disease

This study applied the self-regulation model to examine cognitive and emotional predictors of screening in unaffected women with a strong family history of breast cancer. 748 unaffected female members of an Australian registry of multiple-case breast cancer families formed the sample. Participants completed a baseline psychosocial questionnaire and a screening questionnaire 3 years later. Multinomial logistic regression was employed to determine predictors of under- and over-screening according to national guidelines. At follow-up 16% of women under-screened and 10% over-screened with mammography; 55% under-screened with clinical breast examination (CBE); and 9% over-screened with breast self-examination (BSE). Of the women found screening according to guidelines for mammography 72% reported ever having received specific recommendations for mammography screening from a health professional. Compared to appropriate screeners, under-screeners on mammography were less likely to have received a screening recommendation (as were under-screeners on CBE), were younger and reported lower perceived breast cancer risk, but were at higher relative risk (RR) of breast cancer and were more likely to report elevated depression. Over-screeners on mammography were more likely to be younger and have a lower RR of breast cancer. Over-screeners on BSE reported elevated cancer-specific anxiety, were less likely to be university educated and more likely to have received a recommendation for BSE. Under- and over-screening is common in women with a strong family history of breast cancer. Evaluation of interventions targeting perceived risk of breast cancer, anxiety and depression are needed to ensure women obtain accurate advice from relevant specialists and enact screening recommendations.     

Determining the Awareness of and Compliance with Breast Cancer Screening among Turkish Residential Women

Background: Breast cancer is the leading cause of cancer-related deaths in women. Despite being associatedwith high morbidity and mortality, breast cancer is a disease that can be diagnosed and treated early. Materialsand Methods: In this cross-sectional study of 321 women, data were collected by Questionnaire, Breast CancerRisk Assessment Form and Champion’s Health Belief Model Scale. Mann-Whitney U, Kruskal-Wallis, Chisquaredtests and logistic regression were used in the statistical analysis. Results: It was found that only 2.2%of women have high and very high risk levels of breast cancer risk. There is a positive correlation between earlydiagnosis techniques and Health Belief Model Sub-Dimension scores which are sensibility, health motivation,BSE (Breast self-examination) self-efficient perception and negative correlation between mammography barrierscore and BSE barrier score (p 0.05). When factors for not having BSE were examined, it was determined thatthe women who do not have information about breast cancer and the women who smoke have a higher risk ofnot having BSE. Conclusions: It is important to determine health beliefs and breast cancer risk levels of womento increase the frequency of early diagnosis. Women’s health beliefs are thought to be a good guide for planninghealth education programs for nurses working in this area.     

Health belief model and practice of breast self-examination and breast cancer screening in Iranian women

Objective

The objective of this study is to determine the role of different health belief model components in practice of breast cancer screening among Iranian women.

Subjects and methods

A cross-sectional study of 500 women aged 18–65 years was conducted in an urban population under the coverage of a health therapeutic system in Babol, northern Iran in 2012. Demographic data and data regarding practice of breast self-examination (BSE), breast clinical examination (BCE), and mammography were collected by interview, and a standard health belief model questionnaire was used to assess women’s attitudes in six different domains based on a Likert scale that ranked from 1 to 5. The average score of each item for each domain was calculated. The Wilcoxon rank test and a multiple logistic regression model were used to estimate the odds ratio of each domain for performing breast cancer screening (BSE, BCE, and mammography).

Results

The mean age of the women was 31.2 (9.4) years. Overall, the average scores in domains of perceived benefit, self-efficacy, and health motivation were significantly higher among those who performed BSE and BCE, but not for mammography. For the domains of perception of susceptibility, seriousness, and barriers, no significant differences were observed. Higher scores on the scales of perceived benefits, perceived confidence/self-efficacy, and health motivation showed significant positive association with performing BSE [adjusted OR (95 % confidence interval [CI]) 1.73 (1.11, 2.72), 4.01 (2.39, 6.73), and 2.01 (1.30, 3.08), respectively] and BCE [adjusted OR (95 % CI) 1.65 (1.0, 2.95), 2.33 (1.39, 3.91), and 1.58 (1.0, 2.53), respectively], but not for performing mammography. For perceived susceptibility, perceived seriousness, and barriers, no significant association was observed.

Conclusions

Positive attitudes toward perceived benefits, perceived confidence/self-efficacy, and health motivation have a strong association with performing BSE and BCE. The impact of health belief model subscales on breast cancer screening may vary with respect to culture and values.     

Knowledge,Attitudes and Practices Regarding Breast Cancer amongst Lebanese Females in Beirut

Objectives: Regular screening for breast cancer is associated with better survival, but compliance with guidelinesdepends on good knowledge and attitudes. This study aimed to assess the level of breast cancer knowledge, attitudesand screening practices in Lebanese females, and identify their socio-demographic determinants as well as barriers tomammography use. Methods: This cross-sectional study was conducted with 371 Lebanese females residing in Beirutaged 18-65 with no history of breast cancer. The questionnaire applied was adapted from Stager and Champion.The overall knowledge score was determined with sections on general knowledge, curability, symptoms, and screening;the overall attitude score concerned attitudes towards breast cancer, screening, and barriers; and the overall practicesscore was for breast self examination (BSE), clinical breast examination (CBE) and mammography. Bivariate andmultivariate analyses of socioeconomic determinants were performed for each score. Results: The mean knowledgescore was 55.5±17.1% and that for attitudes was 71.9±8.3%. For self-examination, mammography and clinicalexamination practices, individual means were 45.7±42.3%, 77.9±36.5% and 29.1±45.5%, respectively. Knowledge,attitudes and practices correlated positively with each other (p<0.0001). The highest average was the knowledgeof symptoms (72.8±24.7%), and the lowest that of curability (49.6±25.7%). Most frequent barriers to mammographywere fear of learning bad news, pain, costs, and staff unpleasantness. Higher education was associated with betterknowledge (p=0.002) and smoking with lower levels (p=0.003). Older age (p=0.002), higher education (p=0.02),and taking exercise (p=0.02) were associated with better attitudes. Higher education (p=0.02) and having children(p=0.003) were associated with better practices. Conclusion: More emphasis should be placed on educating femaleson the curability of breast cancer and specific targeting of the barriers identified.