Knowledge and practice regarding breast self

examination among women at Abu Adam Area

(Khartoum South Locality)

Submitted By

Hagir Gafaar Abu Baker Mohamed Ahmed

BSc in nursing (National Alribat University)

A dissertation Submitted in partial Fulfillment for the

Requirements of Degree of MSC in Nursing

In

Community health Nursing

College of Nursing

University of Bahri

Supervisor:

Dr. Manal Mohammed Elhassan

faculty of nursing science Elnaileen University

2018
 Knowledge and Practice Regarding Breast Self-
Examination among Women at Abu-Adam Area
(Khartoum South Locality 2018).

Submitted By.

Hagir Gafaar Abu Baker Mohamed Ahmed

BSc in nursing (National Alribat University)

Examination Committee

Name Position Signature

Dr. Widad Ibrahim Abdelgadir Examiner …………………………

Dr. Saeeda Alsadig Examiner …………………………

Dr. Faiza Sabri Examiner …………………………

Prof. Salim Gbril Ahmed Dean of Graduate College …………………………

Examination Date: 2018

 ‫اليآة‬

‫‪j‬‬
‫ﭧﭨ‬
‫ﭽ ﯚ ﯛ ﯜ ﯝ ﯞ ﯟ ﯠ ﯡ ﯢ ﯣﯤ‬
‫ﯨ ﯩ ﭼ‬ ‫ﯥ ﯦ ﯧ‬
‫صدق ال العظيم‬
‫سورة يس‪(81) :‬‬

‫‪I‬‬
 Dedication

To my mother

To my father

To my husband

To my Brothers and Sisters

To my children wishing to them

happy and successful life

II
 Acknowledgements
I would like to thank Dr. Manal Mohammed Elhassan for her highly
appreciable and valuable supervision and advice throughout the study.
Special thanks to all members of my family for their encouragement
throughout conduction of the thesis.
Finally, my deep appreciation goes to anyone who supported me in this
research until it reached its final steps.

III
 Abstract
Background: Breast self-examination is one of the screening methods
for early detection of breast cancer. It is a check-up women do to look for
changes or problems in the breast..
Objective: To study knowledge and practice regarding breast self
examination among women at Abu Adam Area (Khartoum South
Locality).
Methods: This is a descriptive cross sectional community based study.
The study was conducted at Abu Adam Area at Khartoum South during
the period From December 2017-May 2018. The study sample included
200 women. Data was collected using a questionnaire by direct interview
with the participants.
Results: Overall good knowledge on breast self examination was scored
by 52% of the women followed by moderate knowledge by 27% and poor
knowledge by 21%.
The most common correct practice was reported by 35% on the time of
starting breast self examination as soon as the female started
menstruation. Overall good practice on breast self examination was
reported by 28% of the women, moderate by 30.5% and poor by 41.5% .
Conclusion: Good knowledge and practice on breast self examination
was significantly associated with ages less than 40 years (P value < 0.05).

IV
 ‫‪Abstract in Arabic‬‬
‫الخلفية‪ :‬الفحص الذاتي للثدي هو أحد طرق الفحص للكشف المبكر عن سرطان الثدي‪ .‬من فحص‬
‫النساء القيام به للبحث عن التغييرات أو مشاكل في الثدي ‪..‬‬
‫الهدف‪ :‬دراسة المعرفة والممارسة المتعلقة بالفحص الذاتي للثدي لدى النساء في منطقة أبو آدم‬
‫)محلية الخرطوم الجنوبية(‪.‬‬
‫الطرق‪ :‬هذه هي الدراسة المجتمعية المنهجية الوصفية‪ .‬أجريت الدراسة في منطقة أبو آدم بجنوب‬
‫الخرطوم خللا الفترة من ديسمبر ‪ 2017‬إلى مايو ‪ .2018‬وشملت عينة الدراسة ‪ 200‬امرأة‪ .‬تم‬
‫جمع البيانات باستخدام استبيان عن طريق مقابلة مباشرة مع المشاركين‪.‬‬
‫النتائج‪ :‬سجلت ‪ ٪52‬من النساء معرفة جيدة في الفحص الذاتي للثدي ‪ ،‬تلتها معرفة معتدلة بنسبة‬
‫‪ ٪27‬ومعرفة ضعيفة بنسبة ‪.٪21‬‬
‫تم البلغا عن الممارسة الصحيحة الكثر شيوعا بنسبة ‪ ٪ 35‬في وقت بدء الفحص الذاتي للثدي‬
‫بمجرد أن تبدأ الناث الحيض‪ .‬وقد أفادت ‪ ٪28‬من النساء بالممارسة الجيدة في الفحص الذاتي‬
‫للثدي ‪ ،‬بنسبة معتدلة ‪ ٪30.5‬والفقراء بنسبة ‪.٪41.5‬‬
‫الخلصة‪ :‬ارتبطت معرفة وممارسة جيدة في الفحص الذاتي للثدي بشكل كبير مع العمار اقل‬
‫‪ 40‬عامما )‪.(P value <0.05‬‬

‫‪V‬‬
 Table of Contents

Contents Page No.

Dedication I
Acknowledgements II
Abstract III
Abstract in Arabic V
Table of Content VI
List of Tables VII
List of Figures VIII
List of Abbreviations IX
Chapter One
Introduction and Literature Review
1.1 Background 1
1.2 Statement of the problem 3
1.3 Justification 4
1.4 Objectives 5
1.5 Literature Review 6
1.5.1 Early warning signs and symptoms of breast cancer 6
1.5.2 Breast cancer self-examination 7
1.5.3 Practice or breast cancer self examination 8
1.5.4 Knowledge of breast cancer risk factors and screening 9
1.5.5 Screening methods for breast cancer 9
1.5.6 Previous studies 12
Chapter Two
Methodology
2.1 Study design 17
2.2 Study setting 17
2.3 Study population 17
2.4 Sample size 18
2.5 List of variables 18
2.6 Data collection methods 18
2.7 Statistical analysis 19
2.8 Ethical considerations 19
Chapter Three
Results
Results 20-27

VI
Contents Page No.
Chapter Four
Discussion, conclusion and recommendations
4.1 Discussion 28
4.2 Conclusion 30
4.3 Recommendations 31
References 32
Appendices -

VII
 List of Figures

No Table Page
1 Distribution of the women according to knowledge on early 22
warning signs and symptoms of breast cancer
2 Distribution of the women according to knowledge on 23
definition of breast self-examination
3 Distribution of the women according to items of breast self- 23
examination
4 Distribution of the women according to practice regarding 24
breast self examination
5 Distribution of the women according to correlation between 25
knowledge regarding breast self examination and age group
6 Distribution of the women according to correlation between 26
knowledge regarding breast self examination and educational
level
7 Distribution of the women according to correlation between 26
practice regarding breast self examination and age group
8 Distribution of the women according to correlation between 27
practice regarding breast self examination and educational
level

VIII
 List of Figures

No Figure Page
1 Distribution of the women according to age group 20
2 Distribution of the women according to marital status 20
3 Distribution of the women according to educational level 21
4 Distribution of the women according to occupation 21
5 Distribution of the women according to socioeconomic 22
status
6 Distribution of the women according to overall knowledge 24
7 Distribution of the women according to overall practice 25

IX
 List of Abbreviations

ACS: American Cancer Society

BSE: Breast self-examination
CBE: clinical breast examination
SPSS: Statistical Packages for Social Sciences
STDs: Sexually transmitted diseases
WHO: World Health Organization

X
 Chapter One
Introduction & Literature
Review
 Chapter One
Introduction & Literature Review

1.1 Background
Breast self-examination (BSE) is one of the screening methods for early
detection of breast cancer. It is a check-up women do to look for changes
or problems in the breast. BSE helps women to familiarise themselves
with how their breasts look and feel, so that they are able to detect any
changes and alert health professionals early. Adult women of all ages are
encouraged to perform BSE at least once a month. Premenopausal
women should do it on day 5 to day 7 of the menstrual cycle, (the first
day of menses is considered day 1) and once monthly for postmenopausal
women (Smeltzer & Bare 2004:1450, 1452).
Other screening methods available include mammography and clinical
breast examination (CBE). Mammography can detect a tumour before it
is clinically palpable (smaller than 1 cm). However, mammography has
limitations. For example, it has a false negative rate ranging between 5%
and 10%, and is largely not affordable. Clinical breast examination (CBE)
is performed by advanced practice nurses and other health care providers.
It is recommended that CBE be part of a periodic health assessment, at
least every 3 years for women in their 20s and 30s and every year for
asymptomatic women at least 40 years of age (ACS 2010:2).
Breast cancer has become a major health problem in females because of
its high incidence in recent years (Moodi, Mood, Sharifirad, Shahnaz &
Sharifzadeh 2011:316). Moreover, breast cancer is the second leading
cause of cancer-related deaths in women (Allen et al 2010:444). Late
presentation for treatment is a problem because little can be done in terms
of curative management. Disruption of life styles was inevitable when
patients have to make frequent visits for palliative management.

1
Chemotherapy was strongly indicated in the late stages and patients was
subjected to serious adverse effects.
Breast self examination is a technique that all women can do examine to
their own breast. Thus it is a useful self care activity for all adult women.
Regular monthly breast self examination is an essential health
maintenance activity. Teaching skills of breast self examination can be
life saving and with regular breast self examination, malignancy may be
discovered at an earlier stage, which can save lives (Jebbin and Adotey
2014).
The breast health survey done revealed that about 80,000 new
cases of breast cancer are diagnosed every year out of which 30,000 of
them have the disease. As prevention is not usually possible, early
detection is the only option left. Early detection and treatment can
increase 17% of five years survival (Clark et al 2010).

2
1.2 Statement of the problem
Throughout history, the female breast has been regarded as a symbol of
beauty, sexuality and motherhood. Any actual or suspected disease or
injury affecting breast tends to reflect the prevailing societal view of the
breast. The threat of mutilation or loss of a breast may be devastating for
the women because of psychosocial, sexual and body image implications
significance associated with it.

3
1.3 Justification
Despite an increase in women literacy rate and knowledge about breast
cancer, there are certain barriers to practice breast self examination, like
worry about breast cancer, embrassment, lack of time, unpleasant of
procedure, lack of privacy, fear of discovering a lump and unfavorable
attitude towards breast self examination 4. There is lack of knowledge
and skills is a barrier to breast self examination practice. Therefore the
researcher feels that, women by allowing women to talk about breast
cancer, correcting their misconceptions and supplying accurate facts,
they can reduce associated fear, anxiety and create awareness. Women
may then seek earlier assessment, diagnosis and effective treatment. So
the researcher selected the study to assess knowledge and practices
regarding the breast self examination, breast cancer and its treatment
modalities, to provide a self instructional module to improve knowledge
of participants.

4
1.4 Objectives
1.4.1 General objective
To study knowledge and practice regarding breast self examination
among women at Abu Adam Area (Khartoum South Locality).

1.4.2 Specific objectives

1. To assess the level of knowledge women regarding breast self
examination among women.
2. To determine level of practice of women regarding breast self
examination among women
3. To find out the relationship between age, education, marital status,
income, occupation of women and the level of knowledge and
practice regarding breast self examination among women.

5
1.5 Literature Review
1.5.1 Early warning signs and symptoms of breast cancer
The clinical manifestations of breast cancer include a firm lump or
thickening in breast, usually painless, 50% located in upper outer
quadrant of the breast; enlargement of axillary or supraclavicular lymph
nodes, which may indicate metastasis; bloody, clear or serous
spontaneous nipple discharge; breast asymmetry; a change in the size or
shape of the breast or abnormal contours, and nipple retraction or
scaliness, especially in Paget’s disease (Nettina 2010:902). Late signs
include pain, which may be due to inflammation indicative of fibrocystic
breasts or a malignant tumour; ulceration; oedema caused by blockage of
lymphatic drainage, and orange peel skin (peau orange) resulting from
oedema seen in metastatic breast disease (Weber & Kelley 2014:406-
408).
According to the ACS (2014), the most common symptom is a new lump
or mass which is painless, hard with irregular edges which are likely to be
cancerous. Breast lumps can be tender, soft or rounded and can even be
painful. For this reason, it is important to have any new breast mass or
lump, or breast change checked by a health care professional experienced
in diagnosing breast disease or other possible signs of breast cancer.
These signs include swelling of all or part of a breast (even if no distinct
lump is felt); breast or nipple pain; skin irritation or dimpling; nipple
retraction; redness, scaliness or thickening of the nipple or breast skin,
and nipple discharge other than breast milk. Sometimes a breast cancer
can spread to lymph nodes under the arm or around the collar bone and
cause a lump or swelling there, even before the original tumour in the
breast tissue is large enough to be felt on palpation.
According to the World Health Organization (WHO) (2013) (in Ncube
2014:lifestyle 2), cancer claims more than 7,6 million people annually

6
and this ranks it as one of the leading causes of death globally. About
70% of all cancer deaths occur in low- to middle-income countries.
Deaths from cancer worldwide are projected to rise to over 13, 1 million
by 2030 (Ncube 2014:lifestyle 2).

1.5.2 Breast cancer self-examination

Anderson et al (1998:1469) define breast self-examination (BSE) as “a
procedure done by a woman by examining her breasts and their accessory
structures for evidence of changes that could indicate a malignant
process”. BSE is usually performed one week to ten days after the first
day of the menstrual cycle, when the breasts are smallest and cyclic
nodularity is least apparent. BSE is encouraged during all phases of a
woman’s adult life. A woman who regularly and carefully performs BSE
is better able to detect small abnormalities than a woman who is
unfamiliar with her breasts (Anderson et al 1998:1469). Doing BSE
regularly is one way for women to know how their breasts normally look
and feel.
Weber and Kelly (2014:400) refer to BSE as an option for women,
starting in their 20s, to familiarise themselves with the appearance of their
breast tissue to be able to detect any changes. Women who choose to do
BSE should have their practice reviewed during their physical
examination by a health professional. BSE plays a minor role in finding
breast cancer. Some women feel comfortable doing BSE regularly
monthly after their menses whilst others are more comfortable looking
and feeling their breasts whilst showering or getting dressed (Weber &
Kelly 2014:400). Women who have had a breast lumpectomy,
augmentation, or breast reconstruction may also perform BSE. Some
women may still decide not to do BSE even with the knowledge of its
advantages and disadvantages.

7
1.5.3 Practice or breast cancer self examination
In a study on BSE among female secondary school teachers in a rural
community in Oyo state, Nigeria, Faronbi and Abolade (2012:111-115)
found that 82% of the respondents were aware of BSE. Of the
respondents, 55% indicated that their source of this information was mass
media and 25% indicated friends, while 54% had little, if any, knowledge
of BSE. In addition, the respondents who practised BSE did not know
what to look for, and many did not do so regularly. This indicated poor
knowledge of and attitude towards BSE practice among the respondents
(Faronbi & Abolade 2012:115).
In a study on the practice of BSE among 250 women in Malaysia, Al-
Naggar, Bobryshev and Al-Jashamy (2012:3829-3833) found that race,
marital status, residency, regular exercise, awareness about breast cancer,
and other socio-demographic characteristics significantly influenced the
practice of BSE among Malaysian women. Ghodsi & Hojjatolesmi,
(2012:2561-2565) did a survey on educational needs of breast cancer and
BSE in Iranian women and found that most of the participants had no
previous information about BSE. The study emphasised the need for
women to be equipped with information to keep their families healthy
and share the knowledge gained with family and friends.
Yavan, Akyüz, Tosun and Iyigun (2010:189-201) examined women’s
breast cancer risk perceptions and knowledge of and their attitudes to
screening tests in Gulhane Military Medical Academy, Ankara in Turkey.
The study found that few of the women performed BSE, or had CBE and
mammography at least once. The main reason given for not performing
BSE was that they did not know how to do it. Risk perception and
educational status increased CBE and mammography rates and BSE
knowledge positively, but because of insufficient BSE application the rate
of practice did not increase as expected (Yavan et al 2010:201).

8
1.5.4 Knowledge of breast cancer risk factors and screening
Semarya, Worknish, Mignote, Mesfin and Alemseged (2011:1-9)
conducted an assessment of knowledge of breast cancer and screening
methods among nurses in University Hospital in Addis Ababa, Ethiopia.
Semarya et al (2011:9) found that only 57, 8% of the participants were
knowledgeable about breast cancer and its screening methods and 42, 2%
had no knowledge thereof. The findings emphasised the need to improve
the nursing curriculum and introduce ongoing workplace training in the
area of breast cancer and screening methods.
In Jordan, cancer is the second leading cause of death. Madanat and
Merrill (2002:276-282) examined breast cancer risk-factor and screening
awareness among women nurses and teachers in Amman, Jordan.
Madanat and Merrill (2002) wished to determine two dimensions of
breast cancer awareness, namely knowledge of risk factors associated
with the disease, and knowledge of BSE and mammography. The study
found that of the respondents, the nurses were more aware than the
teachers of the importance of breast cancer screening and its techniques.
Profession, age and family history significantly influenced breast cancer
screening awareness.

1.5.5 Screening methods for breast cancer

1.5.5.1 Clinical breast examination (CBE)
Clinical breast examination (CBE) is an alternative screening option, but
its effectiveness in reducing breast cancer mortality is not known. CBE is
performed by advanced practice nurses and other health care providers.
The ACS (2010) recommends that CBE be part of a periodic health
assessment, at least every 3 years for women in their 20s and 30s and
every year for asymptomatic women at least 40 years of age. This offers a
chance for women and their doctors or nurses to discuss changes in their

9
breasts, early detection testing. Women should be given information
about the benefits and limitations of CBE and BSE (ACS 2010). The
chance of breast cancer occurring is very low for women in their 20s and
gradually increases with age.
Sankaranarayanan et al (2011:1476-1480) conducted a study in Kerala,
India to evaluate whether three rounds of triennial CBE could reduce the
incident rate of advanced disease incidence and breast cancer mortality. A
cluster randomised controlled trial was initiated in January 2006 to
evaluate the effectiveness of CBE in reducing breast cancer mortality
compared with no screening in Trivandrum district, Kerala, India. The
study found substantially higher numbers of early-stage breast cancers in
the intervention (CBE screening) group compared with the control group
(no CBE screening). A major limitation of the study, however, was that
only interim outcomes were reported, and the mortality data was not
available.

1.5.5.2 Mammography
Mammography is a breast imaging technique that has been shown to
reduce breast cancer mortality rates. It can detect non-palpable lesions
and assist in diagnosing palpable masses. Two views are taken for each
breast: when the breast is mechanically compressed from top to bottom
(cranio-caudal view) and side to side (mediolateral oblique view)
(Smeltzer & Bare 2004:1452). Mammography can detect a breast tumour
before it becomes clinically palpable (smaller than 1 cm) but it has
limitations: the false negatives range between 5% and 10%. Younger
women or women on hormonal therapy may have dense breast tissue
making it more difficult to detect lesions with mammography (Smeltzer
& Bare 2004:1452).

10
Doctors who question the value of mammograms say that while they do
save lives, for each breast cancer death prevented, three to four women
are over-diagnosed meaning that a mammogram:
Finds a suspicious area that would eventually have been diagnosed as
cancer by other means, without any effect on prognosis.
Finds a suspicious area that never would have affected a woman’s health
if it hadn’t been found or treated.
This shows that a mammogram can have false positive results when it
shows an abnormal area that resembles cancer. The suspicious area will
require follow up with more than one doctor, extra tests, e.g. biopsy.
These pose psychological, physical and economic costs that come with a
false positive. The conclusion is that mammography could potentially
miss more than 75% of breast cancers in women in their 40s thereby
eliminating most of the survival benefit from screening mammography
(Joe 2014:1)
According to the ACS (2014) guidelines for the early detection of
breast cancer:
Women aged 40 years and older should have a mammogram yearly and
should continue doing so regardless of whether they are in good health.
Current evidence supporting mammograms shows that they offer
substantial benefits for women in their 40s of detecting breast cancer
early.
Women in their 20s and 30s should have a CBE by a health professional
every three years.
Starting at the age of 40, women should have CBE by a health
professional yearly.

11
1.5.5.3 Magnetic resonance imaging (MRI)
MRI is more sensitive than mammograms and also has a higher false-
positive rate when it finds something that turns out not to be cancer. This
then leads to unnecessary biopsies and other tests which predispose
women to anxiety and worry (ACS 2010). For most women at high risk,
screening with MRI and mammograms should begin at the age of 30
years and continue as long as a woman is in good health. There is no
evidence at present that MRI is an effective screening tool for women at
average risk (ACS 2010).

1.5.6 Previous studies

A descriptive study was conducted to assess the knowledge of
breast self-exams (BSE) via pre-tests and post-tests in older African-
African women (> 60) at an initial session (time 1), and then again at a
follow-up session (time 2) two months later. A sample of 57 older
African-American women living in inner city apartment buildings
participated in the study. there were significant differences between pre-
test time 1 and post-test time 1 (p = .000) and pre-test time 2 and post-test
time 2 (p = .000). In addition, a significant difference was detected
between pre-test time 1 and pre-test time 2 (p = .039). Additionally, a
content analysis revealed what factors would influence older African-
American women to continue to perform BSE in the future. Providing
BSE education to older African-American women may be useful in
decreasing mortality rates for breast cancer.14
The study conducted on knowledge, attitudes, regarding breast
cancer detection practices. It was found that out of 57 south Asian
women, 12% of the participants practiced breast self examination
monthly. 49% had undergone at least one clinical breast examination
during their lives and 47% had never had a mammogram. The majority

12
(54%) of women have lack of knowledge about breast cancer. while 21%
of the women said detecting cancer early was important only 5% reported
that cancer could be cured.15
The study conducted on adolescent girls’ knowledge and attitudes
towards breast self examination by using quasi experimental method.
They selected sample from schools participating in an education program
provided by a regional health education canter. The sample consisted of
137 adolescent girls. Findings suggest that a one-hour lesson can improve
knowledge and attitudes of adolescent girls with respect to breast self
examination and early cancer detection.16
The study conducted a descriptive survey to determine health
beliefs, attitudes, knowledge and performance over the first year of a
registered nursing degree program towards breast self examination. The
convenience sample consisted of female students ages 40 years or
younger who were surveyed at the beginning (n = 105) and end (n = 71)
of the first year of the course. Approximately one-third of students
reported performing breast self examination monthly. There is no
statistically significant differences were found between students pre-test
and post-test breast self examination variables.17
A study was conducted on attitudes, knowledge and practice of
breast self-examination (BSE) in Port Harcourt, Nigeria. : A written
questionnaire was distributed to 200 women from different walks of life
in Port Harcourt to assess their attitudes to, knowledge and practice of
BSE. Their responses were then collated and analyzed. Ninety-eight
percent of the respondents had formal education, majority having
obtained tertiary education. Eighty-five point five percent of them had
heard of BSE but 39.0% practised BSE only occasionally, while 24.0%
did not practise it at all. Among 76 health workers who participated in the
study, 60.0% of doctors and 53.7% of nurses practised BSE only

13
occasionally. Only one doctor could describe how to perform BSE
correctly. The news media, nurses and physicians were the commonest
sources of information on BSE. Most women in Port Harcourt, though
aware of BSE and its usefulness never practise it. Those who care to
practise it are ignorant of how to correctly do it. There is need for a
vigorous health education programme on this subject for our women. It is
hoped that this will help to reduce the morbidity and mortality associated
with carcinoma of the breast.18
The study conducted a survey to identify and describe self
examination knowledge and practices of women. The sample consisted of
65 female whose ages ranged between 17 and 45 years. fewer than half
(44%) of these participants indicated that they would classify their breast
self examination as regular, only 27% of the participants indicated that
they had examined their breast from 9 to 12 months in the previous 12
months, which would normally be considered regular breast self
examination.19
The pre-experimental study was conducted to assess the
effectiveness of planned teaching programme regarding breast self
examination among 50 post graduate students in padmavati Mahila
university at Tirupati. Most of the students were in the age group of 24-26
years and Hindus. They were studying in various disciplines i.e. m.sc.
(22%), journalism (16%), biochemistry (18%) M.A Telugu (14%), M.A
English (14%), and others MBA, BC (16%). pre-test and post test data
was collected by self administered questionnaire. there was significant
(p<0.01) gain in knowledge of postgraduate students after planned
teaching programme. pre-test mean score was 12.38 (25.26%) while the
post test mean score was 39.78 (81.78%).20
A cross sectional study was conducted on attitudes and knowledge
of breast self-examination among Austrian women's in Australia. , 975

14
healthy women in an Austria-wide population were asked about their
knowledge of breast self-examination (BS) and mammography, and their
cancer histories.92% of the women knew BSE but only 31% practiced it
thoroughly. Women living in rural communities with a life companion
and younger women were more likely to practice BSE. Women who had
family histories of cancer, especially older women, performed BSE
significantly more often. There was a trend towards increasing BSE with
increasing personal perception of the risk of cancer, especially among
older women. The study showed a positive association between BSE and
screening mammography. Although knowledge of BSE is widespread, it
is actually practiced by only one third of women. Older women but not
young women carry out BSE significantly more often when they have
family histories of cancer. Information campaigns should target specific
groups and emphasize the effectiveness of properly done BSE. 21
A study was conducted on knowledge of secondary-school female
students on breast cancer and breast self-examination in Jeddah, Saudi
Arabia. A self-administered questionnaire was given to 6380 female
secondary-school students (mean age = 18.1 years) in Jeddah to identify
their knowledge of breast cancer and attitude towards breast self-
examination (BSE). Knowledge of risk factors and presentation was very
low. Over 80% of students failed to answer 50% of the questions
correctly. A higher knowledge level was associated with older age,
marriage and having children. Also students who had undergone
mammography, had been exposed to breast surgery or had a positive
family history of breast cancer showed significantly higher knowledge
levels. Only 39.6% reported ever hearing of BSE and only 14.4% and
7.1% respectively knew the correct frequency and timing. However,
82.4% had a positive attitude towards learning B.22

15
 A study was conducted on knowledge and attitudes of breast self
examination in a group of women in shiraz, southern Iran.. The median
(interquartile range (iqr)) age of participants was 38.5 (14) years. of the
300 studied women, 283 (94.3%) were married; 160 (53.3%) performed
bse—9 (5.6%) of whom did BSE using a correct method and at an
appropriate time. of 140 non-performers, 74 (52.9%) did not know how to
do BSE; the remaining women did not do BSE for fear of being found
positive for cancer or did not care about it. those who performed BSE
learned it from medical personnel (n = 72, 49.4%), their relatives, and TV,
radio, books, journals and pamphlets. of those who performed BSE, 9
(5.6%) found an abnormal examination; 6 (3.8%) were found positive
after further evaluation. the likelihood of performing BSE was not
associated with educational level, marital status, age of participant, or
how the participant learned about BSE : considering that 46.7% of
participants did not perform BSE and that almost all of those who did
perform BSE did it incorrectly and taking into account that a lack of
knowledge on how to perform BSE was the main reason why most non-
performers did not examine themselves establishing educational
programmes to teach women at risk may help in the early diagnosis of
breast cancer. 23

16
Chapter Two
Methodology
 Chapter Two
Methodology

2.1 Study design

This is a descriptive cross sectional community based study.

2.2 Study Setting:

The study was conducted in Abu Adam Area at Khartoum South Loclaity.
Khartoum is the capital city of Sudan and the capital of Khartoum (state),
located at the confluence of the White Nile in the Blue Nile (Al-Muqrin),
forming the Nile River together. Its the headquarters of the President of
Sudan and the Politics of Sudan, and the presidency of the various central
ministries, and the leadership of the Sudanese Armed Forces and foreign
diplomatic missions from embassies and consulates, the headquarters of
some Arab and African regional organizations and most of the political
institutions of the State. Which is the heart of Africa for the airlines, for
the passage of airlines that cut the North Africa of the continent towards
its Southern Africaand those that pass through the West Africa and East
Africa of the continent. The city has many public and private universities
and colleges, various educational institutions, corporate heads, national
banks and branches of foreign companies.

2.3 Study population

Women at reproductive age the study area.

2.3.1 Inclusion criteria

Acceptance to participate in the study.

2.3.2 Exclusive criteria

17
 1. patients refuse to participate.
2. patients below 20 years.

2.4 Sample size

The study size was consisted women at reproductive age in the study area
(total coverage). Time-frame sample size was taken for specified study
period.
N = ( Z)2 Pq / ( d)2.
N= sample size;
Z= statistically certainly;
P= prevalence = 50% = 0.5
d = the degree of accuracy desired = 0.05;
Z=1.96;
q=1-P = 1-0.5 = 0.5
N = (1.96)2*0.5*0.5/(0.05)2 ;
N = (3.8416*0.25)*0.0025
= 0.9604/0.0025= 200
Hence the sample size was 200 women.

2.5 List of variables

Age, education, marital status, occupation, economic status, knowledge
about meaning of breast cancer, self examination, etc and practice
regarding breast self examination.

2.6 Data collection methods

A structured questionnaire was designed and used to fulfill the objectives
of the study.

18
2.7 Statistical analysis
Data was processed using Statistical Packages for Social Sciences (SPSS)
version 23.0. Frequency and percentages as well as mean values and
stranded deviation of the correct answers and practices were calculated.

2.8 Ethical consideration:

 Approval from University.
 Approval from locality authorities.
 Official litters.
 Consent form to every participant.

19
Chapter Three
Results
 Chapter Three
Results

Figure (1) Distribution of the women according to age group

Highest percentage of the women 56% in the age group 20-40 years and
20.5% aged less than 20 years (Figure 1). (n=200)

Figure (2) Distribution of the women according to marital status

The majority of the studied women 61.5% were married and 4% were
widowed (Figure 2). (n=200)

20
Figure (3) Distribution of the women according to educational level
Highest percentage of the women 35.5% had secondary level of
education and 13% had university education (Figure 3). (n=200)

Figure (4) Distribution of the women according to occupation

The majority of the women 58% were housewives and 7.5% were
students (Figure 4). (n=200)

21
 Figure (5) Distribution of the women according to socioeconomic
status
Most of the women 55% had medium socioeconomic level and 11.5%
had high economic level (Figure 5). (n=200)
Table (1) Distribution of the women according to knowledge on early
warning signs and symptoms of breast cancer (n=200)
Correct Incorrect
Signs N % N %
Breast lump that is fixed , not tender 109 54.5 91 45.5
Skin or nipple retraction 78 39.0 122 61.0
Nipple discharge in a non-lactating
woman 95 47.5 105 52.5
Enlarged lymph nodes in axillae 114 57.0 86 43.0
Small pimple on the breast 123 61.5 77 38.5

The most correct answer on the early warning signs of breast cancer was
mentioned by 61.5% of the women on the sign of small pimple on the
breast (table 1).

22
Table (2) Distribution of the women according to knowledge on
definition of breast self-examination (n=200)
Correct Incorrect
Definitions
N % N %
The assessment made on the breast by an individual to check for
64 32.0 136 68.0
breast lumps
On definition of breast self examination 32% of the women mentioned
that breast self examination is the assessment made on the breast by
individual to check fro breast lumps (table 2).
Table (3) Distribution of the women according to items of breast self-
examination (n=200)
Correct Incorrect
N % N %
What do woman inspect for during breast self-examination
Fluid coming from the nipple in a non-lactating mother 119 59.5 81 40.5
Shape and size of the breast 102 51.0 98 49.0
Skin for changes in the contour, any swelling and nipple appearance 89 44.5 111 55.5
What does a woman feel for when doing breast self- examination
Breast lump which may be painless or painful and fixed 126 63.0 74 37.0
Pimples on the breast 74 37.0 126 63.0
Enlarged lymph nodes in the axillae 93 46.5 107 53.5
When should a woman start doing breast self-examination
As soon as she starts menstruating 75 37.5 125 62.5
At the age of 20 years 62 31.0 138 69.0
At the age of 40 years 57 28.5 143 71.5
When she has been diagnosed
with breast cancer 43 21.5 157 78.5
How often should breast self-examination be performed
Monthly 1-7 days after menstruation 86 43.0 114 57.0
Once every 4th months 68 34.0 132 66.0
When one suspects something abnormal is developing in the breast 115 57.5 85 42.5
Highest knowledge score was reported on the feeling of breast lumps
which may be painless of painful and fixed which mentioned by 63% of
the studied women (table 3).

23
Figure (6) Distribution of the women according to overall knowledge
Overall good knowledge on breast self examination was scored by 52%
of the women followed by moderate knowledge by 27% and poor
knowledge by 21% (Figure 6) (n=200)
Table (4) Distribution of the women according to practice regarding
breast self examination (n=200)
Correct Incorrect
Practice N % N %
Monthly 1-7 days after
menstruation 65 32.5 135 67.5
Mammogram and health worker 41 20.5 159 79.5
Once yearly 61 30.5 139 69.5
After menstruation 43 21.5 157 78.5
As soon as I started menstruating 70 35.0 130 65.0

The most common correct practice was reported by 35% on the time of
starting breast self examination as soon as the female started menstruation
(table 4).

24
 Figure (7) Distribution of the women according to overall practice
Overall good practice on breast self examination was reported by 28% of
the women, moderate by 30.5% and poor by 41.5% (Figure 7). (n=200)
Table (5) Distribution of the women according to correlation between
knowledge regarding breast self examination and age group (n=200)
Knowledge
Age Good Moderate Poor Chi squire P value
< 20 years 25 6 10 24.12 0.002
20-40 years 70 39 3
> 40 years 9 9 29

Good knowledge on breast self examination was significantly associated

with ages less than 40 years (P value < 0.05) (Table 5).

25
Table (6) Distribution of the women according to correlation between
knowledge regarding breast self examination and educational level
(n=200)
Knowledge
Education Good Moderate Poor Chi squire P value
Illiterate 4 2 30
Primary 17 38 12
31.19 0.001
Secondary 57 14 0
University/above 26 0 0

Good knowledge on breast self examination was significantly associated

with secondary and university level of education (P value < 0.05) (Table
6).

Table (7) Distribution of the women according to correlation between

practice regarding breast self examination and age group (n=200)
Practice
Age Good Moderate Poor Chi squire P value
< 20 years 14 15 12
20-40 years 42 46 24 23.18 0.011
> 40 years 0 0 47

Good practice on breast self examination was significantly associated

with ages less than 40 years (P value < 0.05) (Table 7).

26
Table (8) Distribution of the women according to correlation between
practice regarding breast self examination and educational
level(n=200)
Practice
Education Good Moderate Poor Chi squire P value
Illiterate 0 10 26
Primary 2 25 40
29.16 0.004
Secondary 30 24 17
University/above 24 2 0

Good knowledge on breast self examination was significantly associated

with secondary and university level of education (P value < 0.05) (Table
8).

27
 Chapter Four
Discussion, Conclusion &
Recommendations
 Chapter Four
Discussion, Conclusion and Recommendations

4.1 Discussion
On definition of breast self examination 32% of the women mentioned
that breast self examination is the assessment made on the breast by
individual to check fro breast lumps. Overall good knowledge on breast
self examination was scored by 52% of the women followed by moderate
knowledge by 27% and poor knowledge by 21%. Good knowledge on
breast self examination was significantly associated with ages less than
40 years (P value < 0.05). Anderson et al (1998:1469) define breast self-
examination (BSE) as “a procedure done by a woman by examining her
breasts and their accessory structures for evidence of changes that could
indicate a malignant process”. BSE is usually performed one week to ten
days after the first day of the menstrual cycle, when the breasts are
smallest and cyclic nodularity is least apparent. BSE is encouraged during
all phases of a woman’s adult life. A woman who regularly and carefully
performs BSE is better able to detect small abnormalities than a woman
who is unfamiliar with her breasts (Anderson et al 1998:1469). Doing
BSE regularly is one way for women to know how their breasts normally
look and feel. Semarya, Worknish, Mignote, Mesfin and Alemseged
(2011:1-9) conducted an assessment of knowledge of breast cancer and
screening methods among nurses in University Hospital in Addis Ababa,
Ethiopia. Semarya et al (2011:9) found that only 57, 8% of the
participants were knowledgeable about breast cancer and its screening
methods and 42, 2% had no knowledge thereof. The findings emphasised
the need to improve the nursing curriculum and introduce ongoing
workplace training in the area of breast cancer and screening methods.

28
The most common correct practice was reported by 35% on the time of
starting breast self examination as soon as the female started menstruation
Overall good practice on breast self examination was reported by 28% of
the women, moderate by 30.5% and poor by 41.5%. In their study of BSE
practice among female secondary school teachers in a rural community in
Oyo state, Nigeria, Faronbi and Abolade (2012:113) found that 42% did
BSE before menstruation; 20% did BSE after menstruation, and 30% did
BSE any time. In a study on the practice of BSE among 250 women in
Malaysia, Al-Naggar, Bobryshev and Al-Jashamy (2012:3829-3833)
found that race, marital status, residency, regular exercise, awareness
about breast cancer, and other socio-demographic characteristics
significantly influenced the practice of BSE among Malaysian women.
Ghodsi & Hojjatolesmi, (2012:2561-2565) did a survey on educational
needs of breast cancer and BSE in Iranian women and found that most of
the participants had no previous information about BSE. The study
emphasised the need for women to be equipped with information to keep
their families healthy and share the knowledge gained with family and
friends. Yavan, Akyüz, Tosun and Iyigun (2010:189-201) examined
women’s breast cancer risk perceptions and knowledge of and their
attitudes to screening tests in Gulhane Military Medical Academy, Ankara
in Turkey. The study found that few of the women performed BSE, or had
CBE and mammography at least once. The main reason given for not
performing BSE was that they did not know how to do it. Risk perception
and educational status increased CBE and mammography rates and BSE
knowledge positively, but because of insufficient BSE application the rate
of practice did not increase as expected (Yavan et al 2010:201).

29
4.2 Conclusion
Overall good knowledge on breast self examination was scored by 52%
of the women followed by moderate knowledge by 27% and poor
knowledge by 21%.
The most common correct practice was reported by 35% on the time of
starting breast self examination as soon as the female started
menstruation.
Overall good practice on breast self examination was reported by 28% of
the women, moderate by 30.5% and poor by 41.5% Good knowledge and
practice on breast self examination was significantly associated with ages
less than 40 years (P value < 0.05)

30
4.3 Recommendations
Based on the findings, the researcher makes the following
recommendations:
1. In order to bridge the gap between knowledge and practice of BSE,
nurses and other health care personnel should ensure that all
women are educated on proper BSE practice as a health promotion
activity.
2. The Ministry of Health should design and implement an intensive
health education programme for schools, colleges, universities,
hospitals and clinics.
3. Educational materials such as posters and leaflets should be freely
available at hospitals and clinics to facilitate better learning.
4. Nurses should teach patients admitted in hospital about BSE and
demonstrate the proper examination before they are discharged to
improve awareness, knowledge and practice.

31
References
 References
 Allen, TL, Van Groningen, BJ, Barksdale, DJ & McCarthy, R.
2010. Breast selfexamination controversy: what providers and
patients should know. Journal for Nurse Practitioners 6(6):444-451
 Al-Naggar, RA, Bobryshev, YV & Al-Jashamy, K. 2012. Practice
of breast selfexamination among women in Malaysia. Asian Pacific
Journal of Cancer Prevalence 13(8):3829-3833.
 American Cancer Society (ACS). 2010. Breast cancer. Atlanta,
GA: ACS.
 American Cancer Society (ACS). 2011. ACS recommendations
(and rationale) for breast cancer screening. Atlanta, GA: ACS.
 American Cancer Society (ACS). 2014. Guidelines for the early
detection of breast cancer. Atlanta, GA: ACS.
 Anderson, KN, Anderson, LE & Glanze, WD. 1998. Mosby’s
medical, nursing and allied health dictionary. 5th edition. St Louis:
Mosby: pp1469.
 Brink, H, Van der Walt, C & Van Rensburg, G. 2006. Fundamentals
of research methodology for health care professionals. 2nd edition.
Cape Town: Juta.
 Burns, N & Grove, SK. 2010. Understanding nursing research:
building an evidencebased practice. 5th edition. Arlington, TX:
Elsevier/Saunders.
 Burns, N & Grove, SK. 2011. The practice of nursing research:
appraisal, synthesis and generation of evidence. 7th edition. St
Louis: Elsevier/Saunders.
 Chokunonga, E, Borok, MZ, Chirenje, ZM, Nyakabau, AM &
Makunike-Mutasa, R. 2011. Pattern of cancer in Zimbabwe 2010-
2012. Harare: Zimbabwe National Cancer Registry.

32
 Chokunonga, E, Borok, MZ, Chirenje, ZM, Nyakabau, AM &
Makunike-Mutasa, R. 2014. Pattern of cancer in Zimbabwe 2012-
2013: Harare: Zimbabwe National Cancer Registry.
 Clark JK, Sauter M, Totechi JE, (2010). Adolescent girls
knowledge and attitude towards Breast Self Examination,
evaluating on outreach education program, uc, Winter, Vol-15 (4)
 Collins English Dictionary. 1994. 4th edition. Glasgow:
HarperCollins.
 Faronbi, JO & Abolade, J. 2012. Breast self-examination practice
among female secondary school teachers in a rural community in
Oyo state, Nigeria. Open Journal of Nursing, 2:111-115.
 Ferlay, J, Shin, HR, Bray, F, Forman, D, Mathers, C & Parkin, DM.
2010. Cancer incidence and mortality worldwide. Lyon:
International Agency for Research on Cancer.
 Fitzpatrick, JJ & Kazer, MW (Eds). 2012. Encyclopedia of nursing
research. 3rd edition. New York: Springer.
 Ghodsi, Z & Hojjatoleslami, S. 2012. A survey about educational
needs of breast cancer and BSE in Iranian women. Procedia –
Social and Behavioural Sciences, 46:2561- 2565.
 Hughes, C. 2006. Quantitative and qualitative approaches to social
research. Coventry: University of Warwick. F
 Huitt, W, Hummel, J & Kaeck, D. 1999. Internal and external
validity: general issues. Valdosta, VA: University of Valdosta.
 Ignatavicius, DD & Workman, ML. 2013. Medical-surgical
nursing: patient-centered collaborative care. 7th edition. St Louis,
Missouri: Elsevier.

33
 Jebbin NJ, Adotey JM (2014). Department of surgery, university of
port Harcourt teaching hospital, port harcourt, nigeria. niger j med.
13(2):166-70.)
 Joe, B. 2014. Screening and testing: Mammography.
 Kozier, B, Erb, G, Berman, A & Snyder S. 2004. Fundamentals of
nursing: concepts, process and practice. 7th edition. Melbourne:
Pearson Prentice Hall.
 MacDonald, S & Headlam, N. 2011. Research methods handbook:
introductory guide to research methods for social research.
Manchester: Centre for Local Economic Strategies.
 Madanat, H & Merrill, R 2002. Breast cancer risk-factor and
screening awareness among women nurses and teachers in Amman,
Jordan. Cancer Nursing Journal, 25(4):276-282.
 Moodi, M, Mood, MB, Sharifirad, GR, Shahnaz, H & Sharifzadeh,
G. 2011. Evaluation of breast self-examination program using the
health belief model in female students. Journal of Research in
Medical Science, 16(3):316-322.
 Moule, P & Goodman, M. 2009. Nursing research: an introduction.
Los Angeles: Sage. Muchena, L. 2010. Relationship between
knowledge levels on malaria prevention and self-care actions in
actions in primigravidae aged 18 to 35 years at Harare Central
Hospital. National Research database of Zimbabwe: Harare:
Zimbabwe.
 Ncube, T. 2014. Breast cancer on the increase in Zimbabwe. From:
http://www.financial gazette.co.zw/
 Nebeker, C. 2011. Research design: descriptive studies. San Diego,
CA: University of San Diego.

34
 Nettina, SM. 2010. Lippincott manual of nursing practice. 9th
edition. Philadelphia: Lippincott Williams and Wilkins.
 Orem, DE.1991. Nursing concepts of practice.4th edition. St Louis,
MO: Mosby.
 Polit, DF & Beck, CT. 2010. Essentials of nursing research:
appraising evidence for nursing practice. 7th edition. Philadelphia:
Lippincott Williams and Wilkins.
 Polit, DF & Beck, CT. 2014. Essentials of nursing research
appraising evidence for nursing practice. 8th edition. Philadelphia:
Lippincott. Williams & Wilkins.
 Pswarayi, I. 2010. The relationship between pregnancy induced
hypertension (PIH) self care knowledge and hypertension control
among pregnant mothers aged 18-49 years in Bindura district,
Harare: National Research Database Of Zimbabwe: Harare:
Zimbabwe.
 Sankaranarayanan, R, Ramadas, K, Thara, S, Muwonge, R,
Prabhakar, J, Augustine, P, Venuqopal, M, Anju, G & Matthew, BS.
2011. Clinical breast examination preliminary results from a cluster
randomised controlled trial in India. Journal of the National Cancer
Institute, 103(19):1476-1480.
 Semarya, BL, Worknish, S, Mignote, H, Mesfin, A & Alemseged,
A. 2011. Assessment of knowledge of breast cancer and screening
methods among nurses in University Hospital in Addis Ababa,
Ethiopia. ISRN
 Smeltzer, SC & Bare, BG. 2004. Brunner & Suddarth’s Textbook
of Medical-surgical Nursing. 10th edition. Philadelphia: Lippincott
Williams & Wilkins.

35
 Taylor, SG. 2006. Dorothea E Orem: self-care deficit theory of
nursing. St Louis, MO: Mosby.
 Weber, JR & Kelly, JH. 2014. Health assessment in nursing. 5th
edition. Philadelphia: Lippincott Williams & Wilkins.
 Yavan, T, Akyüz, A, Tosun, N & IyigUn, E. 2010. Women’s breast
cancer risk perception and attitudes toward screening tests. Journal
of Psychosocial Oncology, 28(2):189-201.

36
Appendix
 Appendix
Questionnaire
Basic Information
Age group
a) < 20 years ( ) b) 20-40 years ( ) c) > 40 years ( )
Marital status
a) Married ( ) b) single ( ) c) divorced ( ) d) widowed ( )
Educational level
a) Illiterate ( ) b) primary ( ) c) secondary ( ) d)
university/above ( )
Occupation
a) Housewife ( ) b) Employee ( ) c) worker ( ) d) Student ( )
Income level per month
a) Low ( ) b) moderate ( ) c) high ( )
A. Knowledge on breast cancer early warning signs and symptoms
Which of the following features could be early warning signs and
symptoms of breast cancer?
a) Breast lump that is fixed , not tender?
b) Skin or nipple retraction
c) Nipple discharge in a non-lactating woman
d) Enlarged lymph nodes in axillae
e) Small pimple on the breast
B. Knowledge on breast self-examination and practices
B.a Knowledge on breast self-examination
B.a.1 What do you understand by the Term breast self-examination?
a) The assessment made on the breast by an individual to check for breast
lumps.
b) The assessment made on the breast by a doctor or nurse to check for
breast lump
c) The use of X-rays to assess breast cancer
B.a.2 What do woman inspect for during breast self-examination?
a) Fluid coming from the nipple in a non-lactating mother
b) Shape and size of the breast
c) Skin for changes in the contour, any swelling and nipple appearance
B.a.3 What does a woman feel for when doing breast self- examination?
a) Breast lump which may be painless or painful and fixed
b) Pimples on the breast
c) Enlarged lymph nodes in the axillae
B.1.4 When should a woman start doing breast self-examination?
a) As soon as she starts menstruating
b) At the age of 20 years
c) At the age of 40 years
d) When she has been diagnosed with breast cancer
B.a5 How often should breast self-examination be performed?
a) Monthly 1-7 days after menstruation
b) Once every 4th months
c) When one suspects something abnormal is developing in the breast
C. Level of practices for breast self-examination
C.1 Do you do breast self-examination?
Yes ( ) No ( )
C.1.a If you answered “yes” to question (C.1.a) when do you do it?
a) Monthly 1-7 days after menstruation
b) When I remember but not regularly
c) I may remember and do it twice per year
C.1.b If you answered “No” on the question (C.1a) which method do you
use to examine your breast for lumps?
a) Mammogram
b) breast examination done by a health care practitioner
c) nothing
C.2 How often do you go for the stated method in question 21?
a) once yearly
b) did it once when I was diagnosed breast cancer
c) after every 3 years
C.3 At what period of menstruation cycle do you perform breast self-
examination?
a) Before menstruation
b) After menstruation
c) Any time
C.4 When did you start doing breast self-examination?
a) As soon as I started menstruating
b) When I was diagnosed with breast cancer
c) When my close relative was diagnosed with breast cancer
d) At a later stage after menstruation started
 ‫استبيان‬
‫معلومات اساسية‬
‫‪ .1‬الفئة العمرية‬
‫(‬ ‫( ج(< ‪ 40‬سنة )‬ ‫( ب( ‪ 40-20‬سنة )‬ ‫أ( >‪ 20‬سنة )‬
‫‪ .2‬الحالة الجاتماعية‬
‫(‬ ‫( د( أرمل )‬ ‫( ج( مطلق )‬ ‫( ب( أعزب )‬ ‫أ( متزوج )‬
‫‪ .3‬المستوى التعليمي‬
‫(‬ ‫( د( الجامعة ‪ /‬أعله )‬ ‫( ج( الثانوية )‬ ‫( ب( البتدائي )‬ ‫أ( المية )‬
‫‪ .4‬الوظيفة‬
‫(‬ ‫( د( الطالب )‬ ‫( ج( العامل )‬ ‫( ب( الموظف )‬ ‫أ( ربة البيت )‬
‫‪ .5‬مستوى الدخل في الشهر‬
‫(‬ ‫( ج( عالية )‬ ‫( ب( معتدلة )‬ ‫أ( منخفضة )‬
‫المعرفة‬
‫أ ‪ -‬معرفة علمات وعلمات النإذار المبكر لسرطان الثدي‬
‫أي من الشإارات التالية يمكن أن تكون علمات وأعراض إنإذار مبكر لسرطان الثدي؟‬
‫أ( تورم الثدي من غير تحجر‬
‫ب( انكماش الجلد أو الحلمة‬
‫ج( إفرازات الحلمة عند المرأة غير المرضعة‬
‫د( تضخم الغدد الليمفاوية في البط‬
‫هـ( بثرة )حبة( صغيرة على الثدي‬
‫أ‪ /‬المعرفة عن الفحص الذاتي للثدي وممارساته‬
‫‪ .1‬ما الذي تفهمه من مصطلح الفحص الذاتي للثدي؟‬
‫أ( التقييم الذي يجري على الثدي من قبل شخص للتحقق من وجود كتل الثدي‪.‬‬
‫ب( التقييم الذي أجري على الثدي من قبل الطبيب أو الممرضة للتحقق من وجود كتلة الثدي‬
‫ج( استخدام الشعة السينية لتقييم سرطان الثدي‬
‫‪ .2‬ما الذي تفحصه المرأة أثناء الفحص الذاتي للثدي؟‬
‫أ( السائل القادم من الحلمة في الم غير المرضعة‬
‫ب( شكل وحجم الثدي‬
‫ج( تغيرات جلد الثدي‪ ،‬أو أي مظهر تورم ونغيرات في حلمة الثدي‬
 ‫‪ .3‬ما الذي تشعر به المرأة عند إجراء الفحص الذاتي للثدي؟‬
‫أ( تورم الثدي الذي قد يكون غير مؤلم أو مؤلم وثابت‬
‫ب( البثور على الثدي‬
‫ج( تضخم الغدد الليمفاوية في البطين‬
‫‪ .4‬متى يجب أن تبدأ المرأة الفحص الذاتي للثدي؟‬
‫أ( بمجرد أن تبدأ الحيض‬
‫ب( في سن الا ‪ 20‬سنة من أجل التعرف على ثديها‬
‫ج( في سن ‪ 40‬عاما‬
‫د( عندما تم تشخيصها بسرطان الثدي‬
‫‪ .5‬كم مرة يجب إجراء الفحص الذاتي للثدي؟‬
‫أ( شهريا ‪ 7-1‬أيام بعد الحيض‬
‫ب( مرة كل ‪ 4‬أشهر‬
‫ج( عندما يشك المرء في حدوث شيء غير طبيعي في الثدي‬
‫الممارسة‬
‫‪ .1‬هل تقوم بفحص الثدي الذاتي؟‬
‫ل‬ ‫نعم‬
‫‪ .2‬إذا كانت إجابتك "نعم" على السؤالا )‪ (1‬متى تفعل ذلك؟‬
‫أ( شهريا ‪ 7-1‬أيام بعد الحيض‬
‫ب( عندما أتذكر ولكن ليس بشكل منتظم‬
‫ج( قد أتذكر وأقوم بذلك مرتين في السنة‬
‫‪ .3‬إذا كانت إجابتك "ل" على السؤالا )‪ (1‬ما هي الطريقة التي تستخدمها لفحص ثدييك عن‬
‫الكتل؟‬
‫أ( تصوير الثدي‬
‫ب( فحص الثدي من قبل ممارس الرعاية الصحية‬
‫ج( ل شيء‬
‫‪ .4‬كم مرة تذهب إلى للقيام بعمل الطريقة المذكورة في السؤالا )‪(1‬؟‬
‫أ( مرة واحدة سنويا‬
‫ب( فعلت ذلك مرة واحدة عندما تم تشخيص سرطان الثدي‬
‫ج( بعد كل ‪ 3‬سنوات‬
‫‪ .5‬في أي فترة من دورة الحيض تقوم بإجراء الفحص الذاتي للثدي؟‬
‫أ( قبل الحيض‬
‫ب( بعد الحيض‬
‫ج( في أي وقت‬
‫‪ .6‬متى بدأت الفحص الذاتي للثدي؟‬
‫‪ (a‬بمجرد أن بدأت الحيض‬
‫ب( عندما تم تشخيص إصابتي بسرطان الثدي‬
‫ج( عندما تم تشخيص حالتي القريبة من سرطان الثدي‬
‫د( في مرحلة لحقة بعد أن يبدأ الحيض‬