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ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 4  |  Page : 219-224

Knowledge, attitude and practice of breast self-examination among females in medical and non-medical colleges in Qassim University


Qassim College of Medicine, Qassim University, Buraydah, Saudi Arabia

Date of Web Publication26-Oct-2017

Correspondence Address:
Safiya K Ibnawadh
Qassim College of Medicine, Qassim University, Qassim - Almulyda North of Prince Nayef Airport, Qassim
Saudi Arabia
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DOI: 10.4103/jhs.JHS_137_16

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  Abstract 

Aims: The objective of this study was to investigate any difference between females in medical and non-medical colleges for (1) knowledge and attitude of breast self-examination (BSE) and (2) practice of BSE.
Subjects and Methods: A cross-sectional study was conducted in Qassim University during 2014-2015. Cluster random sample method was used. The sample size consisted of 365 females. A confidential and self-administered questionnaire was used to collect data.
Results: Age range of the study participants was from 18 to 55 years, with a mean of 20.3 years. Moreover, 11% of the subjects had positive family history of breast cancer. Regarding their knowledge levels about BSE, 95.8% of medical students had heard of BSE in comparison to 93.3% of non-medical students. Social media was the most commonly reported source of BSE information (50.14%). We found that 49.7% of medical students had carried out BSE previously in comparison to 35.71% of the non-medical students.
Conclusions: Both medical and non-medical students showed lack of knowledge in BSE and even though their attitude towards it was positive, medical students had a better attitude towards it. Moreover, regarding the practice, the percentage of medical students who perform BSE was higher than that of non-medical students.

Keywords: Breast self-examination, breast cancer, Qassim


How to cite this article:
Ibnawadh SK, Alawad MA, Alharbi SS, Alduawihi NA, Alkowiter FS, Alsalhy AE, Alzahrani AA, Alenizy LA. Knowledge, attitude and practice of breast self-examination among females in medical and non-medical colleges in Qassim University. J Health Spec 2017;5:219-24

How to cite this URL:
Ibnawadh SK, Alawad MA, Alharbi SS, Alduawihi NA, Alkowiter FS, Alsalhy AE, Alzahrani AA, Alenizy LA. Knowledge, attitude and practice of breast self-examination among females in medical and non-medical colleges in Qassim University. J Health Spec [serial online] 2017 [cited 2019 Aug 25];5:219-24. Available from: http://www.thejhs.org/text.asp?2017/5/4/219/217310


  Introduction Top


Breast self-examination (BSE) is a “procedure in which a woman inspects and examines her breasts and their accessory structures for evidence of change that could indicate an abnormal process. It is one of the three tests the American Cancer Society (ACS) recommends in order to help detect breast cancer in its earliest stages”.[1]

BSE was first tested among the members of the Martha Organization in Finland in 1970s, and, in 1992, a women's organization launched ProMama, an organization that promotes BSE training.[2] A study conducted by Thomas et al., in Shanghai, China with controversial results showed that breast cancer mortality rates were not different from the non-treatment control group. Rates of diagnosed cancer were much the same in the control and BSE instruction groups. Survival rates were statistically similar between the groups.[3] BSE was first advocated by the ACS and the National Cancer Institute. The ACS currently recommends that women, starting from their early 20s, “should be told about the benefits of BSE. The importance of promptly reporting any new breast symptoms to a health professional should be emphasised. Women who choose to do BSE should receive instructions and have their technique reviewed on the occasion of a periodic health examination. It is acceptable for women to choose not to do BSE or to do BSE irregularly. (ACS, 2010)”.[4],[5] According to a report about female breast cancer incidence in Saudi Arabia, between January and December 2010; Qassim was ranked second with a percentage of 32.8%.[6] In a randomized controlled trial designed to test the effectiveness of international screening programmes for breast cancer in Scandinavian countries, it was found that mortality had decreased by 31%.[7] Statistics indicate that 90% of breast lumps are discovered by women themselves.[8] The 5-year survival rates have reached up to 85% with early detection of abnormalities and breast lumps.[9] The less developed countries showed low survival rates and this can be explained by the lack of early detection as well as the lack of good facilities.[10] A research conducted to investigate the knowledge and practice of BSE among Saudi female nursing college students in Riyadh showed that 66% of the sample stated that they perform BSE,[11] and another one conducted among female medical students in Taif showed that the majority (89.2%) of the participants knew that BSE should be carried out every month while only 17% of these students stated that they do perform BSE regularly.[12] A research conducted among women in Qassim region showed that 18.7% of the participants reported that they perform BSE regularly; while 69.7% of participants had never heard of BSE.[13] To the best of our knowledge, there is no published data in Saudi Arabia on the differences between females in medical and non-medical colleges regarding their knowledge, attitude and practice of BSE. There is also little information regarding whether medical colleges affect students on their knowledge and practice of BSE or not.

This study aims to explore the level of BSE knowledge among females in medical and non-medical colleges at Qassim University, in addition to, their attitude towards the practice of BSE. Information regarding such a study population is important as they form an important part of the Saudi community.


  Subjects and Methods Top


A cross-sectional study was conducted in Qassim University during 2014-2015 to assess the knowledge, attitude and practice of BSE. The study population included all female medical and non-medical students at Qassim University. A cluster random sample method was used where the total size of the population (n = 365) was sampled. The sample was selected from different colleges and it included both students as well as employees. The sample size was calculated according to the following established formula for determination of sample size:[14]



where, n = the minimum sample size, z = constant (1.96). We assumed a prevalence of 39% on the basis of a previous study [13]; P = 0.39 and q = 1 − p = 0.61. The minimum calculated sample size to achieve a precision of ±5% with a 95% confidence interval (CI) was 365. The sample size was increased by 15%, totalling 420 females for nonresponse. The response rate was 87% and some of the sections of the questionnaire did not reach the total sample size (n = 365).

Participation was on a voluntary basis. Anonymity and confidentiality of the responses were assured. Students who refused to complete the questionnaire in the process of the study were excluded.

Data were collected by a self-administered pre-tested close-ended questionnaire.

The questionnaire contained the following sections:

  • Personal and sociodemographic data such as age, educational level and marital status
  • Family history of breast cancer
  • Questions about BSE knowledge. We included questions about whether they know BSE and the meaning of it and the resources they learnt it from. We also asked details about the age and time at which BSE must be performed
  • Questions about their attitude regarding BSE. We asked whether they believe in its efficacy. We also asked about the reasons behind not doing it or doing it
  • Questions about their BSE practice. We asked the participants whether they perform BSE or not. We also asked about the correct way of performing BSE and the abnormalities that should be considered serious.


Ethical procedure

The study was approved by the Regional Research Ethics Committee, registered at National Committee of Bio and Medical Ethics (Registration No. H-04-Q-001). In addition, a written permission was obtained from the institution in which the study was conducted (Qassim University).

Statistical analysis

All the responses were entered into a designed analysis sheet and the analysis was carried out by Statistical Package for Social Sciences software (SPSS), Version 21.0, (SPSS Inc., Chicago, IL, USA). Descriptive statistics with cross-tabulations were performed. The Chi-squared test was used to examine the association between variables. The level of significance was set at 5% using the two-sided test.


  Results Top


[Table 1] demonstrates the sociodemographic data of the total sample of this survey. Age range of the study participants was from 18 to 55 years, with a mean of 20.3 years [Chart 1].
Table 1: Sociodemographic data of participants

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[Table 2] shows the distribution of participants according to their BSE knowledge levels. Nearly 95.8% of the medical students had heard of BSE in comparison to 93.3% of non-medical students (P = 0.372). Social media was the most commonly reported source of BSE information; where 52.04% of the non-medical students and 47.9% of the medical students learnt about BSE. This was followed by television, then family and friends [see [Chart 2] for the percentages in detail]. Almost 24.38% of the participants learnt the importance of BSE from the previously mentioned sources, 3.01% of the participants learnt about the correct time, 2.74% of the participants learnt about the correct method and the majority (63.84%) learnt all of the above-mentioned categories through these sources (P = 0.084). Nearly 67.45% of the medical students got the right answer on the meaning of BSE in comparison to 63.7% of the non-medical students (P = 0.0). Almost 99.4% of medical students think that BSE helps in the early detection of breast abnormalities in comparison to 98.98% of non-medical students (P = 0.651) [Table 2]. The majority of medical students (31.5%) believed that the age of starting to perform BSE should be from 25-34 in comparison to 25.12% of non-medical students (P = 0.427). Nearly 70.83% of the medical students got the right answer in the question “how often should BSE be carried out” which is monthly in comparison to 63.1% of the non-medical students (P = 0.323). Moreover, 42.6% of the medical students got the right answer regarding the specific time BSE should be performed, which is “5 days after regular menstruation”, in comparison to 27.2% of the non-medical students; however, the majority of them did not know the right answer [48.52% of medical students and 62.3% of the non-medical students (P = 0.008)]. Majority of the medical students (38.1%) opined that mammogram after the age of 40 years should be carried out annually in comparison to 25.6% of the non-medical students, while the majority of non-medical students (29.2%) felt that it should be carried out monthly in comparison to 23.2% of medical students who felt vice versa (P = 0.000).
Table 2: Knowledge of breast self-examination

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Regarding the participants' attitude towards BSE, 98.2% of the medical students felt that BSE is necessary in comparison to 96.4% of the non-medical students (P = 0.295). Nearly 97.04% of the medical students believed in BSE's role in the early detection of breast cancer in comparison to 96.43% of the non-medical students (P = 0.743). Almost 49.7% of the medical students had carried out BSE previously in comparison to 35.71% of the non-medical students, while medical students who had not carried out BSE previously had a percentage of 50.3% in comparison to 64.29% of the non-medical students (P = 0.003) [Chart 3]. The majority of the medical students (30.2%) believed that the reason behind performing BSE is to examine their breasts regularly in comparison to 28.9% of the non-medical students (P = 0.032). Majority of the medical students (61.1%) opined that the reason behind not performing BSE was because they do not have any symptoms in comparison to 53.2% of the non-medical students (P = 0.011). Nearly 98.8% of the medical students felt that BSE is useful in comparison to 98.5% of the non-medical students (P = 0.776).



Regarding BSE practice, when the participants were asked about the last time they performed BSE, 25.4% of the medical students reported they had done it less than a month ago, in comparison to 8.7% of the non-medical students [Chart 4]. Majority of the students, both in the medical (38.67%) and non-medical (61.33%) colleges, answered that they did not perform BSE previously. Regarding performing BSE after menopause, 41.1% of the medical students answered that it should be carried out monthly whereas 28.2% of the non-medical students felt that it should be performed yearly. There were 16.1% from the medical students that did not know when BSE should be carried out in comparison to the non-medical students (14.9%). Medical students who did BSE by themselves were 77.8% in comparison to 65.4% of the non-medical students. Almost 3.1% of the medical students answered that they did it with the help of a friend or their mothers in comparison to 4.2% of the non-medical students. Nearly 19.1% of the medical students answered that they performed it through the help of a doctor or nurse in comparison to 39.4% of the non-medical students. When participants asked about the places where they perform BSE, the majority of the medical students answered in front of mirror (68.7%) in comparison to 53.3% of the non-medical students, while the medical students who did it while lying in bed were 9.8% in comparison to 19.2% of the non-medical students. Medical students who performed it in bathroom were 15.3% in comparison to 19.2% of the non-medical students while the remaining medical (6.13%) and non-medical students (8.2%) answered that they did it in other places. Regarding the area which should be examined, 3.5% of medical students answered that the area to be the nipple in comparison to 6.7% of non-medical students, while 19.5% of the medical students answered breast only in comparison to 7.2% of the non-medical students. Nearly 5.4% of the medical students answered that breast tail should be examined in comparison to 7.2% of the non-medical students, while the majority of medical (66.7%) and non-medical (49.2%) students answered that they should examine the whole breast. However, the remaining students from both colleges (medical and non-medical), 22.8% answered that they did not know. Nearly 60.1% of the medical students followed the circular method in BSE in comparison to 53.8% of the non-medical students, while 10.1% of the medical students followed the radial method in comparison to 7.7% of the non-medical students. Almost 6% of the medical students followed the linear method in comparison to 4.1% of the non-medical students. However, the remaining students from both the colleges answered that they did not know (29.4%). Nearly 13.6% of the medical students answered that performing BSE is painful in comparison to 17.9% of the non-medical students, while 86.4% of the medical students answered that it was non-painful in comparison to 82.1% of the non-medical students. [Table 3] shows what respondents should look for during BSE along with their response towards the abnormality.
Table 3: Knowledge of Breast cancer presenting symptoms and their attitude towards detecting abnormalities

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  Discussion Top


We predicted that the level of knowledge and practice of BSE among medical students would be better than the non-medical students and we predicted a positive attitude towards BSE from both the two groups. In this study, both medical and non-medical students showed lack of knowledge in BSE and even though their attitude (medical and non-medical students) towards it was positive, medical students had a better attitude towards it. Moreover, regarding the practice, the percentage of medical students who perform BSE was higher than that of non-medical students. Thus, our hypothesis was supported.

Regarding participants' knowledge of BSE, 97.04% of the medical students and 96.43% of the non-medical students in our study felt that early detection can improve survival. This finding is consistent with a previous study conducted among female patients attending primary healthcare centres of Qassim region, where 86% of the subjects felt the same.[13]

In this study, medical students obtained their first information from social media (47.9%), followed by TV/radio (36.6%). The least important source of information for the medical students was the newspaper (5.3%). The non-medical students also obtained their first information from social media (52.4%) followed by TV/radio (36.2%), and the percentage for the newspaper was 9.7%. Observations about the first source of information were reported in Awka, Anambra State, Nigeria where 38.8% of the respondents also stated that social media was their first source of information.[15] and on the basis of this data we suggest utilizing social media more frequently to improve awareness among the community.

In this study, 42.6% of the medical students knew about the proper time of BSE and 23.2% knew about the frequency of BSE whereas 27.2% of the non-medical students knew about the proper time of BSE and 29.2% knew about the frequency of BSE. A study in Pakistan showed that only 13.5% knew about the proper time of BSE, and 21.8% knew about the frequency of BSE.[16] A study from Angola showed similar results where more than 50% of medical and non-medical students did not know the best time to perform BSE.[17]

Regarding the attitude, more than half (58.08%) of the respondents had never carried out a BSE previously, the percentage of medical and non-medical students' percentage was 50.30% and 64.29%, respectively, while 42.19% had practiced BSE, the percentage of medical and non-medical students was 49.7% and 35.7%, respectively. This proportion is not that high when compared with the studies carried out in Nigeria, where 45.2% having never carried out BSE, while 54.8% having practiced BSE.[15]

Regarding the practice of BSE in our study, 16.4% of the respondents performed BSE within the last month, the majority of them were in the medical field. A high level of practice was also reported by a similar study in Saudi Arabia where 66% of the nursing students reported performing BSE.[11]

In our study, 15.6% of the respondents who were aware about the abnormalities of breast were not high compared with other similar study conducted in Saudi Arabia, Qassim (23%)[13] and very low compared to a study in Tehran (57%)[18] and Egypt (81.6%)[19] in which the respondents mentioned breast lump as the first change.

One of the limitations of this study is that most of the participants are in their 1st year of college which may not give accurate results about their medical knowledge. Further studies should aim at different levels and colleges to get more accurate results.


  Conclusion Top


We conclude that studying a healthcare major has a big impact on the knowledge and attitude of BSE and breast cancer screening. We suggest that campaigns be started to increase awareness about BSE and breast cancer screening for women. In adition, further researches are needed to identify the causes of inadequate knowledge of BSE and breast cancer screening among female students of Qassim University.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Thomas DB, Gao DL, Ray RM, Wang WW, Allison CJ, Chen FL, et al. Randomized trial of breast self-examination in Shanghai: Final results. J Natl Cancer Inst 2002;94: 1445-57.  Back to cited text no. 3
    
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Doshi D, Reddy BS. Breast Self-Examination: Knowledge, Attitude, and Practice among Female Dental Students in Hyderabad City, India; January-April, 2012. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401738.[Last accessed on 2014 Jul 17].  Back to cited text no. 10
    
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Dalal MN, Sahar HA, Al-Hanouf AA, Abrar AO, Eiman MA. Knowledge, attitude and practice of breast self-examination and breast cancer among female medical students in Taif, Saudi Arabia, Taif University. Open J Prev Med 2014; 4(2), 69-77.  Back to cited text no. 12
    
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Wang W. Clinical epidemiology. Basic Principles and Practical Applications. Vol. 101. Beijing: Higher Education Press; 2012.  Back to cited text no. 14
    
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Kayode FO, Akande TM, Osagbemi GK. Knowledge, attitude and practice of breast self-examination among female secondary school teachers in Ilorin, Nigeria. Eur J Sci Res 2005;10:2005.  Back to cited text no. 15
    
16.
Tazeem S, Khair UN. Knowledge and practice of breast self-examination among antenatal attendees presenting to a tertiary care hospital in Karachi, Pakistan. JUMDC 20132013; 4: 94-55.  Back to cited text no. 16
    
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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