European Journal of Cardiovascular Medicine

Early diagnosis of breast cancer facilitates more effective treatment. Therefore, it is advised by several specialists that women who are 20 years old or older should conduct monthly breast self-examination in order to detect any new lumps or other alterations.

Although the personal breast inspection has certain limits, it plays a crucial role in early diagnosis, particularly in countries like India. However, it is important to remember the significance of regular breast examinations conducted by a doctor or screening through mammography.

Approximately 20% of cancer cases in Indian women are attributed to breast cancer. Cervical cancer is less prevalent than other types of cancer in both developed and developing countries. Over the past two decades, the occurrence of breast cancer worldwide has experienced a significant rise of 50-100%, providing compelling evidence for the necessity of breast cancer preventive and screening initiatives(1). The most effective approach to early detection lies in providing comprehensive breast cancer education to women. Nurses represent a distinct group with traits that are highly suitable for spreading breast cancer information to women(2).Nurses can have a significant impact on educating women by implementing tailored educational programs in clinical settings, as well as employing community outreach tactics that are suitable for our social and cultural contexts. Furthermore, they serve as a significant means of obtaining information inside their social circles (3). Given the significant impact that nurses have on the behaviour of women, it is imperative that they possess a comprehensive understanding of breast cancer risk factors and the criticality of early identification through screening.(1) The objective of this study was to objectively evaluate the level of awareness among nursing staff at district hospital chhindwara on the early detection of breast cancer

This cross-sectional study was conducted in the district hospital chhindwara among the 350 female nursing staff. A questionnaire was prepared by the author using data from available literature and using questions after modification from other similar studies.[8‑10] It was internally pre validated by subject experts in the different departments for content validation. Reliability test scoring was not done on the questionnaire as most of the questions were related to information available in standard textbooks and were taken from standard articles after modification and were validated by subject experts. The questionnaire was distributed among the female nursing staff in a tertiary hospital. Participation was voluntary with no incentives proposed and confidentiality was ensured. The questionnaire had three parts – personal data; respondent’s knowledge regarding breast cancer and associated risk factors; and their awareness of breast cancer screening methods. There were 25 items on the questionnaire. Each of the questions on knowledge regarding breast cancer and screening practices were equitably scored. Categorical answers (Yes/No/Don’t know) were assigned one point for correct answer and zero points for incorrect/don’t know response.

Inclusion criteria included

Being female staff nurses at the hospital and willing to participate in the study were included in the study.

Exclusion criteria included

Exclusion criteria were being unavailable due to changes in their shifts.

GNM: General Nursing Midwifery

The sociodemographic characteristics of the respondents (n=350) reveal that the majority of participants (84%) are aged between 20 and 30 years, with smaller proportions aged 31-40 years (14%) and 41-50 years (2%). Marital status is fairly evenly distributed, with 52% married and 48% unmarried. Regarding educational qualifications, 28% have a B.Sc. in nursing, 8% hold an M.Sc. in nursing, 12% have a post-basic B.Sc. in nursing, and the largest group, 52%, possess a GNM (diploma). When considering the presence of breast carcinoma among relatives, 4% of respondents reported a positive family history, 92% reported no family history, and 4% were unsure.

                                                    BSE: Breast self-examination

The awareness of the respondents regarding breast cancer (n=350) indicates that 60% recognize a lump in the breast as a symptom, followed by nipple discharge (38%), a lump in the axilla (22%), and an ulcer over the breast (20%). In terms of risk factors, 50% identify family history as a key risk, while others note diet and exercise (20%), age at parity (18%), age (16%), early age at menarche (14%), nulliparity (14.3%), and drug history, particularly oral contraceptives (12%); 4% are unsure. For early detection methods, 66% are aware of breast self-examination (BSE), 34% of mammograms, 28% of doctor examinations, 13% of biopsies, and 12% of fine-needle aspiration cytology. Regarding the common age of breast cancer onset, 42% believe it occurs after 40 years, 34% between 30-39 years, 18% between 20-29 years, 2% between 10-19 years, and 4% are uncertain. Finally, 70% think breast cancer affects only females, 24% know it can affect both genders, and 6% are unsure.

                                                     BSE: Breast self-examination

The knowledge of respondents regarding breast self-examination (BSE) among 350 individuals shows that 78% have heard of BSE, with 62% agreeing that it is a useful tool for early detection of breast cancer. Despite this, 40% have not been taught how to perform BSE. The majority (62%) believe BSE should be performed by the individual, while 22% think it should be done by a trained nurse, and 10% by a doctor. Regarding the appropriate age to start BSE, 70% recommend beginning at 20 years, while 26% suggest menopause and 2% believe it should start at birth. For frequency, 40% advise doing BSE weekly, 38% monthly, 12% daily, and 6% yearly. The preferred time for BSE is a week after the period (44%), with 26% suggesting anytime, 16% during menstrual flow, and 12% a week before the period. Lastly, 44% believe BSE involves 7 steps, 30% think there are 5 steps, 12% know it involves 9 steps, 6% think there are 11 steps, and 8% are unsure.

CBE: Clinical breast examination, BSE: Breast self-examination

The knowledge of respondents regarding other screening practices (n=350) shows that 72% are aware of clinical breast examination (CBE), with 42% recognizing that it is performed by a doctor, 40% by a trained nurse, and 18% by the individual, while 4% are unsure. For the frequency of CBE, 42% recommend it monthly, 22% yearly, 18% when BSE results are abnormal, 10% weekly, and 8% are uncertain. Additionally, 78% are aware of mammography, with 34% suggesting it should start from 20 years, 30% from 40 years, 22% from puberty, 6% after menopause, and 1.2% from birth; 6.8% are unsure. For mammography frequency, 30% recommend it monthly, 20% yearly, 16% every 3 years, 10% weekly, 16% when a lump is found on BSE or CBE, and 8% don’t know. Information sources include hospitals (42%), media (34%), books (30%), lectures (28%), and friends (4%).

We are a teaching hospital multiple surgical and medical speciality departments that provide care for patients with all types of malignancies, including breast cancer. The patients primarily come from the lower socioeconomic class. Among women in India, breast cancer constitutes 19%–34% of all cancer cases.[4] The general knowledge and understanding among the public regarding the elements that increase the likelihood of negative outcomes or dangers Examining the attitudes of individuals towards breast self-examination (BSE) can greatly contribute to the early detection of breast cancer.

Identifying diseases in their first phase and reducing the negative impact on health and the likelihood of death. Nurses can have a significant impact in fostering this consciousness. Our study was to assess the knowledge and awareness levels of female staff nurses in our hospital about BSE (breast self-examination) and risk factors for breast cancer. The results showed that only 12.5% had a high level of knowledge, 54.3% had an average level of knowledge, and 33.2% had a low level of knowledge.

A separate survey conducted among female staff nurses from seven teaching hospitals in Karachi revealed that 35% of the participants demonstrated a high level of knowledge, 45% had an average level of knowledge, and 25% had a low level of knowledge.[5] The researchers determined that nurses who were associated with a private nursing school and had experience caring for a patient with breast cancer possessed a higher level of knowledge regarding the disease.

The study population consisted of a randomly selected group of nurses employed in different departments. The primary source of information among our staff was obtained from hospitals, where they were exposed to people exhibiting the symptoms and indicators of the disease. These likely accounts for the limited understanding among nursing personnel who have not had experience working with patients diagnosed with breast cancer. Alkhasawneh[6] conducted a study on Jordanian nurses and discovered that their level of knowledge was not superior to that of other Jordanian women. Additionally, only 18% of the nurses practiced breast self-examination (BSE) on a monthly basis. The prevailing religious beliefs and cultural practices served as the foundation of their knowledge. Despite their medical experience, only a small number of nurses held a fatalistic perspective on the disease, perceiving it as a predetermined outcome. The absence of knowledge has been identified as the primary obstacle to implementing BSE.[6] In India as well, women commonly associated alcohol and tobacco intake with an unhealthy lifestyle, considering them significant risk factors.[7] Our study found that while around half of the nurses recognised family history as a significant risk factor, the majority of them did not disclose reproductive history, which is a more reliable risk factor.

A study was conducted to assess the understanding of breast cancer and the ability to perform breast self-examinations (BSE) among student nurses in Saudi Arabia. The researchers used questionnaires to measure their knowledge and competency before and after attending a workshop on the topic. The results showed a significant increase in their knowledge levels after the workshop.[8] Therefore, organising frequent workshops that include hands-on demonstrations of the screening technique, while also raising awareness about the risk factors and early symptoms, will enable nurses to improve their own abilities and confidence in advocating for breast cancer awareness among other women.

The average knowledge and awareness score of the nurses who took part in our survey was 13.059, with a standard deviation of 4.673 (13.059 ± 4.673). This aligns with the results of a study conducted among female dentistry students, which also revealed a deficient level of awareness and a low frequency of practicing BSE (breast self-examination).[9] Several studies have attempted to evaluate the level of knowledge, attitude, and behaviour about BSE among college students in India. A research conducted among undergraduate college students revealed a significant deficiency in their total knowledge score. The results exhibited a substantial improvement when the pupils were reevaluated subsequent to the implementation of a teaching program intervention.[10]

This highlights the need of implementing health education initiatives that promote healthy behaviours from an early age. A survey conducted in Bengaluru on 1030 students, using a questionnaire, revealed that prior to an awareness session, just 18% of the participants were aware of BSE. Nevertheless, a survey conducted among college students in Pakistan revealed that 60.8% of the participants were knowledgeable of the accurate technique of BSE, whereas 50.8% were aware of the proper procedure.[11]

The time was shown to be a significant factor, as indicated by another study conducted among female college students in Cameroon, which demonstrated a lack of understanding of the issue. The percentages for both categories are 25.9% and 7%, respectively.[12]The majority of participants (78%) in our survey were aware of BSE, and 60% had received instruction on how to perform it. The results of a research conducted among nurses showed that 52% of them were aware of BSE.[11]

In a separate survey conducted among female health-care workers, 63% of the participants reported having a good level of awareness. Similarly, in a study involving nurses in Nigeria, all of the participants (100%) were aware of BSE, however none of them were able to accurately explain the manner or time of the procedure.[13] In our study, a mere 44% demonstrated awareness of the accurate number of steps required for BSE and the optimal timing for its execution. While a significant number of participants acknowledged the effectiveness of BSE as a means of early breast cancer detection, the majority of them were not adequately informed on its implementation. The variation in knowledge among health workers and nurses can likely be attributed to differences in their work experience. Nurses who had provided care for breast cancer patients and had conducted Clinical Breast Examinations (CBE) possessed a higher level of knowledge on screening procedures and risk factors. This indicates the insufficient focus on illness prevention in their training programs. The nursing curriculum should prioritise the emphasis on the changeable and preventative elements of diseases, as well as provide education on risk factors and screening procedures.Gupta et al. conducted a study on breast cancer awareness among women in India. They discovered that Indian women, regardless of their socioeconomic background and educational credentials, had low levels of literacy regarding cancer risk factors.[7] A significant number of patients in underdeveloped nations come with advanced-stage breast cancers. This is due to the pervasive societal standards, cultural beliefs, lack of knowledge, and fear of mastectomy. In these populations, where resources are scarce, the presence of screening technologies like mammography or ultra sonogram is uncommon.

Therefore, it is imperative that these ladies are educated about the practice of BSE. It is a straightforward and cost-effective technique that necessitates a hospital visit and may be performed at her convenience.The vast majority (98.9%) of our participants fell between the age range of 21-40 years, which aligns with a study conducted in Pakistan among staff nurses who also reported a comparable age group (32 ± 8).[5] Conversely, the other research, which mostly focused on the awareness levels among college students, have shown a cohort of individuals in a younger age bracket.[14,15] The primary sources of their knowledge regarding various screening techniques were obtained from hospitals (42%), followed by the media (34%). Other research have made similar observations.[12,16] A lack of understanding among health-care professionals about risk factors can immediately lead to a lack of information among the public, particularly in primary care settings. Our study revealed a lack of awareness among our staff nurses of the modifiable risk variables that can assist in identifying high-risk individuals and aid in prevention or early diagnosis. Gupta et al. made a comparable observation. 12.5% of nurses had a satisfactory level of expertise. Several further studies have similarly documented a decreased proportion of nurses with proficient expertise.[17,5] Our study found that nurses who had experience working with breast cancer patients demonstrated a higher level of knowledge on the risk factors and screening procedures associated with the disease. Additional research has indicated that nurses with higher qualifications or those who attended more prestigious colleges demonstrate a greater level of awareness.[17,7,5]

This study aimed to evaluate the knowledge and awareness levels of female nurses in our hospital on breast cancer and its screening measures, specifically breast self-examination (BSE). The findings revealed a significant lack of awareness among our nurses. Given that nurses have the ability to engage with women in society and contribute to their understanding of risk factors and early detection procedures, it is crucial that they possess sufficient awareness of these matters themselves. Regular educational sessions can be conducted to enhance their knowledge and enable them to successfully educate the audience. National-level screening guidelines should be established to assist nurses in implementing and instructing early detection techniques. Training programs for nurses and healthcare workers should prioritise the preventive elements of disease.

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