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.     

Factors Associated with a Lack of Knowledge of Performing Breast Self-Examination and Unawareness of Cervical Cancer Screening Services: Evidence from the 2015 Egypt Health Issues Survey

Background: The incidence of breast and cervical cancers is growing rapidly among Egyptian women. In this context, we assessed the prevalence of, and factors associated with the lack of knowledge among Egyptian females of performing breast self–examination (BSE) and unawareness of cervical smear cancer screening services. Methods: Secondary data analysis was performed on a representative population-based sample of 7,518 Egyptian females aged 15–59 years from the 2015 Egypt Health Issues Survey (EHIS). Crude and adjusted odds ratios (aOR) were used to explore the relationship between sociodemographic variables and having a lack of knowledge of performing BSE or unaware of cervical smear cancer screening service amongst 6,572 and 6,942 Egyptian females aged 21–59 years, respectively. Results: Mean age of females was 36.9 years with 62% aged between 21–39 years. The proportion of women with a lack of knowledge of performing BSE or who were unaware of cervical smear cancer screening service was 87.4% and 92.3%, respectively. After adjusting for potential confounding of sociodemographic and obstetric characteristics, young women aged 21–29 years (P<0.001), primary education or below (P<0.001), residing in rural areas (aOR, 1.37 and 1.48, P=0.001), accessing different media outlets "not at all or less than once a week" (aOR, 2.81 and 1.46, P≤0.05), were associated with a greater likelihood of being with lack knowledge of performing BSE or being unaware of cervical smear cancer screening services. Conclusions: In a country burdened with breast and cervical cancers, the majority of Egyptian women have a lack of knowledge on how to perform BSE or were unaware of the available cervical smear cancer screening services. Robust health campaigns are warranted to raise public knowledge of the method of BSE and of cervical smear cancer screening services, especially amongst females aged less than 30 years, with low levels of education, or those living in rural areas.     

Awareness of Cervical Cancer Risk Factors and Screening Behaviour among Nurses in a Rural Region of Turkey

The demographic characteristics of nurses and knowledge on risk factors of cervical cancer, as well asawareness of symptoms and attitudes in terms of screening programmers such as Pap smear, were assessed in across-sectional survey of nurses working in public Health Cabins and Family Health Centers in the rural area ofIzmir, located in the western region of Turkey. Of the nurses who participated in the research, 69.1% (67) saidthat they had talked about cancer and cancer prevention with their families or friends; 60.8% (59) believed thattheir occupation was important for cancer prevention; 11.3% of the nurses had a history of cancer in theirfamilies; and 63.9% (62) thought that their knowledge about cervical cancer was adequate. There were nosignificant differences between knowledge or attitudes about cervical cancer risk factors or symptoms andscreening methods regarding age, marital status, years of experience (p>0.05). However, there was a statisticallysignificant relationship between having received a pap test and having a history of cancer in their family (p<0.05).In conclusion, this study has shown that most nurses knew about the Pap smear test as a cervical cancer screeningmethods. However, there were no significant differences between knowledge or attitudes about cervical cancerrisk factors or symptoms and screening methods regarding age, marital status, years of experience.     

Knowledge and practices on breast and cervical cancer screening methods among female health care workers: a Sri Lankan experience

Breast and cervical cancer are the most common causes of cancer mortality among women worldwide, but they are largely preventable. There are limited data on knowledge and practices on screening methods of breast and cervical cancers among female health care workers in Sri Lanka, in spite of having an organized screening programme islandwide. A cross-sectional survey was conducted among 219 female health care workers including public health midwives (68.9%) selected from 6 districts in Sri Lanka using convenient sampling methods. A self-administered questionnaire was used as a pre-test in a capacity building training programme to collect the data. The mean (SD) duration of work experience of the respondents was 12 years and 52.5% were aged over 35 years. Most (76.7%) were married, and a family history of cancer was reported by 24.2%. Over 98% knew about self breast examination. Even though 84.1% practiced it, only 47.9% practiced it on a monthly basis. Clinical breast examination and mammography were known by 94.1% and 64.3% respectively. Only 19.2% had undergone a clinical breast examination within one year and 3.6% had ever undergone a mamography. Only 76.3% knew that a Pap smear detects precancerous stage of cervical cancer. Among 169 married workers, 73.4% had never had a Pap smear and only 17.2% had got it done within the preceding 5 years. Among the reasons for not doing a pap smear within 5 years, 47.0% believed it as not necessary, 17.3% due to fear/dislike, 23.2% as not having symptoms, 3% had not known about it and 3% not known about availability of services. The study findings suggest that the knowledge and practices on breast and cervical cancer screening methods among female health care workers need to be improved. Considering the role that health care workers play in communicating health behaviors to the general public, strengthening health education interventions for this group of females is essential.     

Health Promotion Lifestyle and Cancer Screening Behaviors: A Survey among Academician Women

Breast self examination (BSE), screening mammography and Pap smear screening can significantly reducemortality from breast and cervical cancer. In an effort to understand the factors that influence BSE,mammography, and Pap smear behavior of woman academicians, we here explored the relation between healthpromotion life-style and women’s cancer screening practice. A total of 750 woman academicians working in auniversity were enrolled, 350 of them responding to the survey. The study instruments used were the HealthPromotion Life-Style Profile (HPLP) scale and a questionnaire of demographic data. There was a significantrelationship between age-group, marital status, presence of cancer in the family, history of cervical erosion anddoing BSE, having mammography and a Pap smear. Additionally, both the general mean and nearly all domainsof HPLP were significantly related to BSE, mammography, and Pap smear behavior. This study demonstratedstrong relationships between breast and cervical cancer screening behavior and health promoting lifestyle inthis subgroup of women, making an important contribution to understanding the factors influencing women’shealth behavior.     

Knowledge,Attitude and Practice of the Pap Smear as aScreening Procedure Among Nurses in a Tertiary Hospital inNorth Eastern India

Background: Cancer of the uterine cervix is one of the most common cancers among women worldwide.Industrialized countries have dramatically reduced the incidence of mortality from cervical carcinoma in the last50 years through aggressive screening programs utilizing pelvic examinations and Papanicolaou (Pap) smearsbut it still remains a major problem in the developing world. Objectives: This study was performed to determineknowledge, attitude and practice of Pap smear as a screening procedure among nurses in a tertiary hospitalin north eastern India. Material and Methods: This cross sectional study was carried out with a questionnairesurvey covering the socio demographic factors, knowledge, attitude and practices about Pap smear screeningamong 224 nurses in Regional Institute of Medical Sciences, Imphal, Manipur, India during December 2011.Results: Two hundred and twenty one participants (98.6%) had heard about cervical carcinoma but 18.3%lacked adequate knowledge regarding risk factors. Knowledge about the Pap smear was adequate in 88.8% ofthe respondents. Out of these, only 11.6% had Pap smear at least once previously. The most common reasons fornon-participation in screening were lack of any symptoms (58.4%), lack of counselling (42.8%), physician doesnot request (29.9%) and fear of vaginal examination (20.5%). Conclusion: Although knowledge of Pap smear asa screening procedure for cervical cancer is high, practice is still low. The nurses who should be responsible foropportunistic screening of women they care for are not keen on getting screened themselves. If we can improvethe practice of Pap smear screening in such experts, they should be able to readily provide appropriate andaccurate information and motivate the general population to join screening programs.     

Evaluation of Anal Cytology in Women with History of Abnormal Pap Smear,Cervical Intraepithelial Neoplasia,Cervical Cancer and High Risk HPV for Anogenital Dysplasia

Background: Anal cancer is uncommon. Although uncommon, the incidence of anal cancer has increased amongthe general population of the United States and other countries over the past 30 years. We evaluated anal cytology inwomen with the history of abnormal pap smear, cervical intraepithelial neoplasia, cervical cancer and high risk HPVfor anogenital dysplasia. Methods: In this cross-sectional study, 153 patients over the age of 21 years, referred to ImamHossein Hospital in 1395-1396 who were being monitored due to abnormal pap smear, cervical cancer, CIN and highrisk HPV, were evaluated with anal cytology for anogenital dysplasia. Results: 153 patients were enrolled in fourmain groups. Among those with a history of abnormal pap smear (39 patients), only 25% of the patients with HSILhad abnormal anal pap smear, and the rest of them had negative anal smear. Among those with a history of CIN (61patients), patients with CIN III, 30.8% had abnormal anal smear, while the rest had a negative anal smear. Among thosewith a high risk of HPV (23 patients), 50% of the patients with concurrent positive HPV 16 and 18 had anal abnormalsmear. Patients with a history of cervical cancer (30 patients) who had radiotherapy with or without surgery showed anegative anal smear. The ratio of anal SIL positive of individuals with a sexual partner was only 1.9%, while this ratiowas 27.3% for those with more than one partner and this difference was statistically significant (P <0.0001). 15.4%of smokers had positive anal SIL test result, while, only 2.9% non-smokers had the same result, and this differencewas statistically significant (P = 0.03). 20% of the patients who had anal intercourse showed a positive anal SIL scoreresult, compared to 1% for those who did not. This difference was statistically significant (P <0.0001). Conclusion:Among people with a history of abnormal cervical pap smear, CIN, cervical cancer and high-risk HPV during the last6 months, abnormal anal tests are most commonly seen in patients who had risk factors such as anal sex, cigarette,multi partner etc. with high grade interepithelial squamous cervix such as HSIL, CIN III, HPV 16 and 18; more studiesin larger sample size are needed to have the better conclusion.     

Knowledge and Practices Related to Screening for Breast Cancer among Women in Delhi,India

Background: Breast cancer is a major public health problem globally. The ongoing epidemiological, socio-cultural and demographic transition by accentuating the associated risk factors has disproportionately increased the incidence of breast cancer cases and resulting mortality in developing countries like India. Early diagnosis with rapid initiation of treatment reduces breast cancer mortality. Therefore awareness of breast cancer risk and a willingness to undergo screening are essential. The objective of the present study was to assess the knowledge and practices relating to screening for breast cancer among women in Delhi. Methods: Data were obtained from 222 adult women using a pretested self-administered questionnaire. Results: Rates for knowledge of known risk factors of breast cancer were: family history of breast cancer, 59.5%; smoking, 57.7%; old age, 56.3%; lack of physical exercise, 51.9%; lack of breastfeeding, 48.2%; late menopause, 37.4%; and early menarche, 34.7%. Women who were aged < 30 and those who were unmarried registered significantly higher knowledge scores (p ≤ 0.01). Breast self-examination (BSE) was regularly practiced at-least once a month by 41.4% of the participants. Some 48% knew mammography has a role in the early detection of breast cancer. Since almost three-fourths of the participants believed BSE could help in early diagnosis of breast cancer, which is not supported by evidence, future studies should explore the consequences of promoting BSE at the potential expense of screening mammography. Conclusion: Our findings highlight the need for awareness generation among adult women regarding risk factors and methods for early detection of breast cancer.     

Knowledge of Risk Factors & Early Detection Methods and Practices towards Breast Cancer among Nurses in Indira Gandhi Medical College,Shimla, Himachal Pradesh,India

Background: Breast cancer is an increasing health problem in India. Screening for early detection should leadto a reduction in mortality from the disease. It is known that motivation by nurses influences uptake of screeningmethods by women. This study aimed to investigate knowledge of breast cancer risk factors & early detectionmethods and the practice of screening among nurses in Indira Gandhi Medical College, Shimla, Himachal Pradesh.Materials and Methods: A cross-sectional study was conducted using a self-administered questionnaire to assessthe knowledge of breast cancer risk factors, early detection methods and practice of screening methods among457 nurses working in a Indira Gandhi Medical College, Shimla-H.P. Chi square test, Data was analysed usingSPSS version 16. Test of significance used was chi square test. Results: The response rate of the study was 94.9%.The average knowledge of risk factors about breast cancer of the entire population is 49%. 10.5% of nurses hadpoor knowledge, 25.2% of the nurses had good knowledge, 45% had very good knowledge and 16.3% of thenurses had excellent knowledge about risk factors of breast cancer and early detection methods. The knowledgelevel was significantly higher among BSC nurses than nurses with Diploma. 54% of participants in this studyreportedly practice BSE at least once every year. Less than one-third reported that they had CBE within thepast one year. 7% ever had mammogram before this study. Conclusions: Results from this study suggest thefrequent continuing medical education programmes on breast cancer at institutional level is desirable.     

Differences in Breast and Cervical Cancer Screening Rates in Jordan among Women from Different Socioeconomic Strata: Analysis of the 2012 Population-Based Household Survey

Background: The burden of breast and cervical cancer is changing over time in developing countries. Regularscreening is very important for early detection and treatment. In this study, we assessed inequalities in breastand cervical cancer screening rates in women according to household wealth status, and analyzed the potentialpredictors associated with a low cancer screening rate in Jordan. Materials and Methods: A nationwide populationbasedcross-sectional survey collected information on different variables at the national level. All ever-marriedwomen (the phrase is used throughout the text to refer to women who had ever married) aged 15–49 years wereincluded in the survey. Analysis of breast self-examination (BSE) and clinical breast examination (CBE) at leastonce in the previous year was carried out in 11,068 women, while lifetime Pap-smear testing was carried outin 8,333 women, aged 20-49 years. Results: Over 39% and 19% of ever-married Jordanian women reportedhaving undergone a breast examination during the previous year and Pap smear examination at least once intheir lifetime, respectively. The rate of BSE in the previous year was 31.5%, that of CBE in the previous yearwas 19.3%, and that of Pap smear examination at least once in life was 25.5%. The adjusted OR was higher forperforming BSE (aOR 1.22, 95% CI 1.04–1.43), undergoing CBE (aOR 1.31, 95% CI 1.08–1.60) and undergoingPap smear examination (aOR 2.38, 95% CI 1.92–2.93) among women in the highest wealth-index quintile ascompared to those in the lowest quintile. The concentration index was 0.11 for BSE, 0.01 for CBE, and 0.27for Pap smear examination. Women in their twenties, living in rural or the southern region of Jordan, with anelementary school education or less, who listened to the radio or read the newspaper not more than a few times ayear, and nulliparous women were less likely to undergo breast and cervical cancer screening. Conclusions: Therates of breast and cervical cancer screening are low in Jordan. Reducing the sociodemographic and economicinequalities in breast and cervical cancer screenings requires concerted outreach activities for women livingunder socially deprived conditions.     

Association of Knowledge,Attitude and Demographic Variables with Cervical Pap Smear Practice in Nepal

Background: Coverage of cervical pap smear test in Nepal is below general global values. One of the reasonsmay be that cervical cancer prevention policy of Nepal has ‘Visual Inspection of Cervix with Acetic Acid’ as theonly screening tool. The focus of present study was to find out association of demographic factors, knowledgeand attitude regarding cervical Pap smear test with its practice by women in Nepal. Materials and Methods:This cross sectional analytical observational study was conducted between February 1, 2013 and April 30, 2013.Participants were interviewed with the help of a structured questionnaire. Chi square and multivariate logisticregression tests were used to detect associations of variables with pap smear practice. Results: Chi square testshowed that practice was significantly associated with knowledge about pap smear test and cervical cancer,having favourable attitude towards the test, urban residency and 36-50 years age-group. Pap smear utilizationwas not associated with age-at-marriage, parity and age-at-first-child-birth. Multivariate logistic regressionshowed favorable attitude towards pap smear test as the only variable which significantly influenced pap smearpractice (p= 0.006, OR: 2.4). Conclusions: Pap smear coverage has been found to be 15.7% which is lower thanglobal average and that for developing countries. Health education programs which are effective not only inincreasing knowledge about cervical cancer and pap smear test but also effective in positively changing attitudetowards the test should be organized to increase pap smear coverage.     

Distribution of cervical and breast cancer risk factors in women and their screening behaviours

Breast cancer and cervical cancer are important causes of cancer‐related mortality in women all over the world. The present study was conducted in order to investigate the distribution of cervical and breast cancer risk factors in women and their knowledge and behaviours about cancer screening methods. The study is cross‐sectional in nature. It was conducted with the participation of 1,886 women in Turkey. Data were collected through a questionnaire. The knowledge and behaviours of women aged 40 and over about breast cancer or cervical cancer screening methods were investigated according to the education level; results showed that the rates of those who knew and did breast self‐examination were significantly lower in illiterate women. Besides, the rates of women who did breast self‐examination were significantly lower in those who were aged 40 and over, and the rates of those who had clinical breast examination and Pap smear test were significantly lower in women aged 39 and below (p < 0.01). This study identified the most notable breast and cervical cancer risk factors as low education levels, high number of deliveries, short breastfeeding period, obesity and low socio‐economic level. For this reason, public health policies should be developed to minimise these risk factors.     

Level of Awareness of Cervical and Breast Cancer Risk Factors and Safe Practices among College Teachers of Different States in India: Do Awareness Programmes Have an Impact on Adoption of Safe Practices?

Background: Breast and cervical cancers are the most common causes of cancer mortality among womenin India, but actually they are largely preventable diseases. Although early detection is the only way to reducemorbidity and mortality, there are limited data on breast and cervical cancer knowledge, safe practices andattitudes of teachers in India. The purpose of this study is to assess the level of awareness and impact ofawareness programs in adoption of safe practices in prevention and early detection. Materials and Methods:This assessment was part of a pink chain campaign on cancer awareness. During cancer awareness events in2011 at various women colleges in different parts in India, a pre-test related to cervical cancer and breast cancerwas followed by an awareness program. Post-tests using the same questionnaire were conducted at the end of theinteractive session, at 6 months and 1 year. Results: A total of 156 out of 182 teachers participated in the study(overall response rate was 85.7 %). Mean age of the study population was 42.4 years (range- 28-59 yrs). Therewas a significant increase in level of knowledge regarding cervical and breast cancer at 6 months and this wassustained at 1 year. Adoption of breast self examination (BSE) was significantly more frequent in comparisonto CBE, mammography and the Pap test. Magazines and newspapers were sources for knowledge regardingscreening tests for breast cancer in more than 60% of teachers where as more than 75% were educated by doctorsregarding the Pap test. Post awareness at 6 months and 1 year, there was a significant change in alcohol andsmoking habits. Major reasons for not doing screening test were found to be ignorance (50%), lethargic attitude(44.8%) and lack of time (34.6%). Conclusions: Level of knowledge of breast cancer risk factors, symptomsand screening methods was high as compared to cervical cancer. There was a significant increase in level ofknowledge regarding cervical and breast cancer at 6 months and this was sustained at 1 year. Adoption of BSEwas significantly greater in comparison to CBE, mammography and the Pap test. To inculcate safe practices inlifestyle of people, awareness programmes such as pink chain campaign should be conducted more widely andfrequently.     

Relations between Breast and Cervical Cancer Prevention Behaviour of Female Students at a School of Health and their Healthy Life Style

Regular breast self-examination (BSE) and pap-smear tests are the two of the positive heath behaviors forimproving, promoting and protecting the health of adolescent girls. The present quasi-experimental researchwas carried out with the purpose of analyzing the relations between breast and cervical cancer preventionbehavior of female students at a School of Health and their health lifestyle. The research was conducted atÇanakkale Onsekiz Mart University School of Health between November 2008 and February 2009. A total of77 female students attending the first and second grades were included in the sample. Education pertinent to thematter was provided and evaluation was made three months later. A knowledge evaluation form for breast andgynecological examination, the Healthy Life-Style Behavior Scale (HPLP), was used in data collection. Numberpercentages, the McNemar Bowker test, the t test and the Mann Whitney U test were used in the evaluation.Despite the information they had received, not all of the students performed regular breast self-examination(BSE) prior to the education. For 24.7% (n=19) the reason for not ding regular BSE was their having no symptomsand for 29.9% (n=23) it was due to thinking that they would not have breast cancer. The reason for not havingpap smear test was a virgin status. Three months after the education, knowledge level scores of the studentsincreased approximately three and a half times (from 23.8±9.8) to 81.2±8.0). The rate of having regular BSE was88.3% after three months, however; there was no pap smear test probably due to the fact that it was a taboo.When the rate of having regular BSE three months after the education and HLPL scores were compared, thescores of those having it regularly and the scores of those not having it regularly were found to be close and nostatistically significant difference was detected (p>0.05). In conclusion, consultancy service units should beestablished to comprehend the barriers perceived by adolescent girls who do not have regular health screening,to make appropriate strategic planning in order to eradicate the hindrances in Muslim societies and to enhancethe motivation of youth with continuous education.     

Awareness of cervical cancer screening among nursing staff in a tertiary institution of rural India

Objective

To determine the baseline information about the knowledge of cervical cancer and explore attitude and practice of Pap smear screening among staff nurses.

Methods

A pretested structured self administered questionnaire based survey was done on 205 staff nurses working in Rural Institute of Medical Sciences & Research, Saifai, Etawah, containing mostly recognition and some recall type questions about demographics, knowledge about cervical cancer, its risk factors, screening techniques, attitudes towards cervical cancer screening and its practices.

Results

In this study, 74% knew that Pap smear is used for detection of cervical cancer, but only 59% knew that it can detect both cancerous as well as precancerous lesions of the cervix. Only 18% of the respondents knew about human papillomavirus vaccine. A 47% of respondents had never taken a Pap smear; 63% never referred patients for the screening. Most nurses (79%) thought that a speculum examination and Pap smear are procedures to be performed by the doctors. Among all the respondents, only 11% had ever undergone a Pap smear on themselves.

Conclusion

Despite knowledge of the gravity of cervical cancer and prevention by screening, attitudes and practices towards screening were negative.