@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2018;24(1):53-60

Background
… [1-4]. According to the World Health Organization, the incidence of breast cancer in the world is increasing. Considering the recommendations of the American Cancer Society, with a monthly breast examination, the person will be aware of any changes in the early stages. With this method, 95% of breast cancer is diagnosed in advanced stage and 65% in early stages by women [5, 6].
Previous Studies
… [7-12]. Timely diagnostic strategies include knowledge of early signs and symptoms, breast self-examination, screening with a doctor's examination and mammography [13]. Factors that prevent regular breast self-examination in women include not knowing the importance of sequential examinations, fear and anxiety, and lack of awareness of how to properly perform breast self-examination [14, 15]. … [16, 17].Studies have shown that women who have more knowledge about breast self-examination do it correctly and regularly [18]. Health beliefs play an important role in people`s willingness to participate in behaviors related to health promotion [19]. … [20-22].
Aim(s)
The purpose of this study was to determine the factors related to women`s performance in performing regular breast self-examination in women or referral to health centers for examination and mammography.
Research type
This cross-sectional study is descriptive-analytic.
Research society, place and time
This research was conducted in 2012 among 20-50 year-old women in Isfahan province.
Sampling method and number
A sample of 10000 people was selected through multistage cluster sampling from different regions. To determine the sample size, the sample size of each city was divided by the share of women aged 20-65 years in the urban and rural areas. Then, the number of urban and rural cluster needed was determined based on sample size of urban and rural areas. Due to the fact that all urban and rural areas of Isfahan University of Medical Sciences are bordered by a health-care unit, to determine the names of clusters, the lists of health units of each city were used and the clusters were randomly assigned to the random numbers table and based on the numbers of rows of health units. A household number was randomly assigned to identify head of clusters in urban areas by referring to the health centers of urban area or the urban base and in rural areas by referring to the health home and using the Family Planning Office. From a total of 10000 women, 9260 expressed their satisfaction with participating in research.
Used devices&materials
The researcher-made questionnaire contained 42 multiple-choice questions and consisted of three parts; the first part was related to the personal profile; the second part was related to the field of knowledge, and the third part was questioning the field of attitude which was developed based on the Likert scale. Regarding the five-dimensional spectrum, the scores of 5, 4, 3, 2, and 1 were considered for “totally agree”, “agree”, “I have no idea”, “disagree” and “totally disagree” respectively. Performance was defined as a two-way variable of self-examination of the breast by the person herself or referring to a health center or lack of it. The raw scores of knowledge and beliefs were converted to linear scale of zero to 100. A larger score indicates better knowledge or belief in self-regulation or referral to service center. Specific questions were related to the type of screening method and frequency of repetitions. Age, education, occupation, knowledge of risk factors and signs and symptoms of breast cancer diagnostic methods were considered as predictors of women's performance. The above variables were categorized in two modes of continuous and double-sided less than 50, greater than or equal to 50, an beliefs about breast cancer diagnostic methods in two states of less than 35 and greater than or equal to 35. Regarding the validity and reliability of the questionnaire, the content validity and face validity of the questionnaire were verified by a survey of experts. In a preliminary study and completion of 50 questionnaires, the reliability of the questionnaire was measured that the Cronbach alpha was achieved 0.85. Initially, the research was approved by the Ethics Committee at the Research Council of Isfahan University of Medical Sciences with code 290194. Data were gathered by referring to the household door and using a questionnaire with interview method. Subsequent samples were selected for inclusion in the research according to the right-side law and 20 clusters were examined in each cluster. In the event that selected household as the head of cluster was not present, the question began with the first house on the right, with a women aged 20-65. Data analysis was performed using STATA 13 software and Pearson correlation coefficient, univariate and multivariate logistic regression.
Findings by Text
The mean age of participants was 37.52±11.74 years with the mean age 35 years and the mean number of children was 2.54±1.98 with the mode of 2 children (Table 1).58.3% of women were performing breast self-examination. The mean score of knowledge of cancer risk factor was 44.68±21.59. 55.7% had a poor knowledge of cancer risk factors. Knowledge of signs and symptoms of breast cancer in 83.7% of the subjects was relatively good and the mean was 72.83±30.00. Also, the mean score of attitude was 33.89±8.70 in women. Overall, women's belief in diagnosis and treatment of breast cancer was poor (Table 2).There was a significant positive correlation between awareness of risk factors and breast cancer awareness (r=0.40; p<0.001), but it did not have any correlation with attitude score (p=0.169; r=0.01). However, the increase in awareness of breast cancer increased the attitude score (r=0.14; p<0.001). Women whose knowledge of cancer risk factor score was at least 50, had 30% more performance than women with score of less than 50%. The score of knowledge of cancer risk factors over 50 and the score of belief over 35 increased the performance of women 90% and 40% respectively. In general, women aged 30 or over had at least 60% and a maximum of 180% better performance than women under the age of 30, except for those over 60 who were performing less. Residents of cities had a 20% better performance than residence of rural areas. Women who were manual workers, 100% had better performance than housewives. Literate women at all levels of education compared to illiterate women, married women and women with children compared to women with no children or single women, and women with a history of lactation and cancer in their families had significantly more performance (Table 3).Increasing each score to knowledge about the risk factors of cancer (95%CI=1.01-1.03; OR=1.02), awareness of signs and symptoms of breast cancer (95%CI=1.003-1.008; OR=1.005) and beliefs (95%CI=1.003-1.006; OR=1.003). increased 2%, 0.5%, 0.5% to women`s performance respectively (Table 4).
Main comparison to the similar studies
… [23]. In a study on the knowledge, attitude, and behavior of 5000 female breast cancer teachers in southern Turkey, it was found that more than half of the teachers did not perform breast self-examination and only 12.5% performed breast self-examination on a regular basis [24]. In the present study, more than 58% of women had breast self-examination which is more than 4.6 times the study of teacher in Turkey. … [25-28]. Another study in Nigeria, on 1000 women in suburb aged 15 to 91, found that women had poor knowledge of the risk factors for breast cancer. Only 43% of women considered breast self-examination as a way of detecting breast cancer, and last year, 35% had breast self-examination and 9.1% had clinical examination. Their main source of knowledge was doctors' offices. Significant predictors were knowledge, performance, education and employment status and age was reported as border predictor. Additionally, knowledge of breast cancer risk factors was a significant predictor of performance [29]. Despite the environmental and cultural differences, research results in Nigeria confirmed the results.
Suggestions
The recommendation of this study include coordinating interbranch organization including the health and prevention system, radio and television and the press and other public and private centers in coordinating women`s education and conducing intervening studies and assessing their impact on women's performance. It is also important to implement and evaluate the effectiveness of breast cancer screening programs by health system and prevention which can be effective in protecting and improving the health of women in the community.
Limitations
Due to the cross-sectional nature of the research, the causal relationship between the factors associated with the performance cannot be concluded. Also, the fear of collecting data by interviewing the questionnaire and possibly the shame and femininity of women in response to some specific questions reduced the evaluation of performance and may not reflect the true performance of women surveyed. Therefore, in order to minimize the bias, the performance was defined in two frames of self-examination of breast or referring to health center for examination.
Conclusions
Ground factors such as age, place of residence, occupation, level of education, as well as awareness of cancer risk factors, knowledge of signs and symptoms of breast cancer, and the belief in effectiveness of examination increase the performance of breast cancer screening.
Acknowledgments
Thanks and appreciation to all the women participating in the research and the respectable interviewers who were busy with the interviews.
Conflict of interest
Non-declared
Ethical Permissions
This research was approved by the Research Committee of Isfahan University of Medical Sciences with the code 290194 and approved by the Ethics Committee of this University.
Funding Sources
This research was sponsored by the research council of Isfahan University of Medical Sciences with the code 290194.

TABLES and CHARTS

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