Awareness and Practice of Breast Self-Examination

INTRODUCTION: Breast cancer affects approximately 1 in 3000 pregnant women and is the second most common malignancy affecting pregnancy. Presently 75,000 new cases occur in India every year. The first noticeable symptom of breast cancer is typically a lump that feels different from the rest of the breast tissue. Pregnancy Associated Breast Cancer [PABC] is defined as breast cancer diagnosed during pregnancy or in the first postpartum year. It is one the most common tumour of reproductive age group. Previous studies have suggested that approximately 10% of breast cancers diagnosed in patient’s aged ≤40 years were diagnosed during the pregnancy. It is a dangerous myth that women who are pregnant or breastfeeding cannot get breast cancer. So, it is still vitally important to check the breast even during pregnancy. More than 80% of breast cancer cases are discovered when the woman feels a lump. Lack of awareness, no clinical breast examination or mammography, no access to proper healthcare are risk factors for developing breast lesions.

Breast Self Examinations [BSE] or regularly examining your breasts on your own, can be an important step for early detection of breast lesions and making them more likely to be treated successfully and it has been positively linked to a decrease in mortality and morbidity. Though debates have been going on about how valuable Breast Self Examination is in detecting breast lesions, the procedure can be very beneficial to women of the rural population who lack the means to proper healthcare or general mammography.

Multiple socio-demographic factors, myths, cultural beliefs, lack of accessibility to the health care services have been identified as the reasons for the poor uptake of BSE. BSEs have been seen to be very useful and essential screening strategy, especially in combination with regular physical examination by a doctor and mammography.

OBJECTIVES OF THE STUDY

1. To assess the awareness and practice of Breast Self Examination among pregnant women residing in an urban and rural areas of Bangalore. 2. To determine the socio demographic factors affecting the awareness and practice towards Breast Self Examinations in pregnant women.

METHODOLOGY

STUDY AREA: 1. Pregnant women attending the OBG OPDs at M.S Ramaiah hospitals 2. Rural Field practice area of Ramaiah Medical College.

INCLUSION CRITERIA

All pregnant women attending the OBG OPDs at Ramaiah hospitals and the rural centres attached to the Community Medicine Department of Ramaiah Medical College who give consent to participate. EXCLUSION CRITERIA: Pregnant women who have already been diagnosed with breast cancer. It was found that 16.5% of the women were aware of BSE. In the present study expecting a difference of 20% in the knowledge level regarding Breast Self Examination between rural and urban pregnant women; considering the power of 80% and confidence level of 95%, the sample size worked out to be minimum of 97 pregnant women in each group.

STATISTICAL ANALYSIS

Qualitative variables like socio-demographic characteristics of the participants and practice regarding BSE will be presented using frequency and percentages. Quantitative variables like awareness scores will be analysed and presented using descriptive statistics like mean and SD. The knowledge scores of urban and rural women will be computed and tested for statistical significance difference using Mann Whitney U test. Chi-Square test will be used to find the association between knowledge level and select sociodemographic factors. SPSS version 17 will be used for statistical analysis. PROCEDURE: The study subjects will be recruited from the OBG OPDs at Ramaiah hospitals and its attached rural centres.

The study questionnaire is translated into the local language and the subject is requested to fill it. If the subject is not literate, the investigator will ask the questions orally and fill the questionnaire for the subject. Subjects are requested to assemble individually or in groups at a convenient common point where health education about Breast Self Examination [BSE], its advantages will be explained by the investigator through pictorial references. This will be followed by an interactive session where their doubts on BSE will be clarified. If they are already aware of BSE, a demonstration is asked of the subject, where they are corrected if needed, while those unaware are taught the complete process. The sessions are expected to last for a period of approximately 15-20 minutes.

IMPLICATION OF THE STUDY

Literature review suggests that pregnant women in whom diagnosis was delayed or treatment deferred have a lower survival rate. BSE involves visualization and palpation of the breast by oneself for lumps, shape, texture, size and contour. The purpose of this is for a woman to learn the topography of her breasts, know how her normal breasts feel and be able to identify changes in them should they occur in the future. It is cost effective and more readily available than any other method of early detection of breast cancer in our environment. This study emphasizes on the importance of creating awareness and accurate knowledge about Breast Self Examination to pregnant women and thus help in early detection of breast lesions.