Primary prevention awareness of breast cancer in Georgia

TBILISI STATE UNIVERSITY, GEORGIADegree programme in Public HealthJuly 5th , 2013

L. GratiashviliT. NaroushviliL. NemsadzeI. BakhutashviliS. RodonaiaT. Maisuradze

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PURPOSE OF RESEARCH Assess the basic knowledge concerning awareness of breast cancer prevention.

SAMPLE POPULATION 50 women (non medical background) Low income population

DATA COLLECTION Self-designed questionnaires 9 questions (several sub-questions.) Quantitative method.

FOCUS Needs of raising the women’s awareness Breast self-detection abilities Improving the women’s well-beings

The findings showed the level of basic knowledge towards breast .

Abstract

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Breast Cancer - Number one Worldwide killer among the women

Introduction

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Breast cancer – 36.8% of women malignant cancersIncidence is increasing between 35 to 55 years oldAmong new cases – 17,5% died within first year after diagnose (NCDC, 2010).

Breast cancer - is the LEADING CAUSE of death for Georgian women.

_ Review of literature

SCREENING In Georgia breast cancer screening programme was initiated in 2008.In 2009 cancer screening programme has been launched in all regions of Georgia. Results:The reduction of morbidity and mortality.78% of breast cancer cases were detected at the stages I-II in first 6 months of 2011 (GNSC) BREAST SELF-EXAMINATION Developing Breast self detection abilities will reduce breast cancer mortality rate.According to Yip CH, Smith RA, Anderson BO’s guideline summary There is solid evidence that diagnosing breast cancer at an early stage will reduce breast cancer mortality rates. in a study by Gasalberti (2002), a reason of low rate for breast self-examination was: 1. Not knowing how to perform 2. Lack of awareness 3. Lack of confidence in self-examination skills and time 4. Fear of finding cancerous lumps 5. Perceiving the performance as unpleasant and embarrassing

Social support is important An empirical research from Korea identified spouses as important supporters for regular

breast self-examination. (Park et al.2007, 78-84.) Teaching breast self-examination will promote women’s efforts to do it regularly.Funke (2008) pointed out that the long term in teaching breast self-examination and breast

cancer wareness in seminars had profound effects on women in carrying out this performance regularly and correctly

• Young breast cancer patients have a lower rate of survival than old breast cancer patients –due to being diagnosed at advanced stages.

The study group from Turkey suggested the health care staffs should develop effective programme to help young women acquire information about breast cancer risks and practice of breast self-examination. (Özmen, Karayurt & Çetinkaya 2008, 359.)

• On the other hand, McGready, Littlewood and Jenkinson (2004) investigated that evidence on breast self-examination was clear. Therefore, there was no benefit to breast cancer mortality.

_ Purpose & research questions

PURPOSEassess the basic knowledge additional Objectives

Questions What kind of knowledge did the women have about breast cancer prevention ? What was the main source of information? Which source was prefered by sample population for getting information ? Was the offered information about screening and self-examination comprehensive? What were the obstacles, which prevented breast awareness? The data was collected using self-designed questionnaires. The questionnaires included 9 question. All the questions were easy to understand.

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20 -34 35 -49 50 +0

5

10

15

20

25

30

1. Age group

26 16 8

Age

The number of women

Although women aged 20-40 don’t participate in breast free screening programme, mentioned group was selected to show women interest and awareness.

2. Have you heard about screening program of breast cancer or self-examination?

Age total 20 -34 35 - 49 50 +

No 11 3 2 16

Yes

Yes, I’ve heard about screening program &self-examination

15

Media-4 8 Medical Staff-3 Other-1

13

Media-5 8 Internet-1 Other-2

6

Media-25 Medical staff-2 Other-1

34Yes, I’ve heard about screening program

Media-36 Medical staff-2 Other-1

Media-1 2 Medical staff-1

1(Medical staff)

Yes, I’ve heard about self-examination

1 (Media) 3(Media)

total 26 16 8 50

The majority of the respondents have heard about the screening programme from media. Medical staff involvement turns out to be low. Only 7 of the 34 women knew about primary methods of breast cancer prevention from medical staff. What in itself is a reason of low awareness

_ 3. Which source of information do you prefer?

Age total

20 -34 35 - 49 50 +

Media 8 3 2 13

Medical staff 17 13 6 36

Don’t answer 1 0 0 1

total 26 16 8 50

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4. Did you give yourself a breast exam during the last one year?

Age total

20 -34 35 - 49 50 +

Yes

Self-examination 1 1 2Breast cancer screening 3 3 6

No

Had no desire 6 4 1 11Financial problem 7 3 4 14Lack of Time 3 4 7Fear of diagnosing incurable disease

2 1 3 6

I don’t trust Physicians 3 3

Don’t answer 4 1 1 6

total 26 17 12 55

22% - positive family history of which 72%- heard about breast cancer

primary prevention, 27% - did not.68% - no family history of cancer were identified, of which 65% - knew breast cancer primary prevention, while 35% did not. 8% - didn’t know about the family history, 72% of them - knew about breast cancer prevention, and 28% - not. 2% of respondents - didn’t answer the quastion and 100% of them knew about Breast Cancer prevention.

positive

anam

nesis

negative

anam

nesis

unknown an

amnesis

don't answ

er0%

20%40%60%80%

100%

Yes, I don'I heard about thatNo, I've heard about thattotal

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5. Will you be eager to be a volunteer in breast cancer prevention activities? ( booklet distribution, giving trainings and etc.)

Age total

20 -34 35 - 49 50 +

Yes 14 9 5 28

No 11 6 3 20

Don’t answer 1 1 0 2

total 26 16 8 50

28 respondents had desire to be engaged in the prevention of breast cancer and its not bad indicator.However, our study could not provide reason why 20 respondents refused to participate. For further research qualitative method was needed, what due to lack of time couldn’t be done.

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9. Do you think that you are provided with comprehensive information about breast cancer prevention?

Age total

20 -34 35 - 49 50 +

Yes 10 10 5 25

No 15 5 3 23

Don’t answer 1 1 0 2

total 26 16 8 50

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68% (n=34 ), who claimed to know about breast cancer screening and / or self examination

Main obstacles which prevented women to do breast exam

Hand no desire

Finansial problem

Lack of time

Fear of diagnosing incurable disease

I don’t trust Physicians

Screening or/and selfexamination

Don't answer

_ Discussion

Main findingsPoor awareness of breast self-examination among Georgian women was indicated in this study.

Approximatly 68%(n=34 ) of the women in this sample population were provided with some kind of knowledge about breast cancer prevention ( screening program and self-examination). Half of them (50%) didn’t know about self-examination 34% (n=16) didn’t know about breast screening program as well as about self-examination.

As our sample showed 78% (n=36) of women preferred to get information about breast awareness from Medical staff. Community health care workers should make big efforts on breast health counseling. A suggestion promoting breast health in community should develop in the counseling system.

Our recomantation: If breast self-examination teaching will become essential part of visiting doctor in the frame of new public insurance, ( which was initiated in 28th february, 2013 ( moh.Gov.Ge ) by ministry of labour, health an social affairs of georgia), it will increase women motivation, reduce fear and ignorance and perhaps decrease breast cancer mortality.

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The research highlighted :

Knowledge deficits in main aspect.

The needs of counseling and education

Focused on: Raising the women’s awareness. Self-protection abilities . Improving the women’s quality of life.

Moreover, it would also support the health promotion in public health nursing working.

Conclusions

_ Limitations

Lack of time was one of the main problem in making research.

Perhaps this was the reason why many interesting things which also take important place in breast cancer prevention, like breast feeding, carring baby, or physical activity were left undefined.This issues must be assassed with qualitative method also, which would explore more realistic status of population in terms of breast cancer awareness.The research was limited with small number of population, that’s why data can’t be validate to be exact.

THANK YOU!

_ PREFERENCES:

1. Yip CH, Smith RA, Anderson BO, Miller AB, Thomas DB, Ang ES, Caffarella RS, Corbex M, Kreps GL, McTiernan A, Breast Health Global Initiative Early Detection Panel. Guideline implementation for breast healthcare in low- and middle-income countries: early detection resource allocation. Cancer. 2008 Oct 15;113(8 Suppl): 2244-56. ( http://www.guideline.gov/content.aspx?id=15171&search=public+information+cancer+prevention )

2. Gasalberti, D. 2002. Early Detection of Breast Cancer by Self-examination: TheInfluence of Perceived Barriers and Health Conception. Oncology Nursing Forum 29(9), 1341–1347.( http://www.ons.org/Publications/ONF/ )

3. Park, K. and Chang, S. et al. 2009. Big Gap between Risk Perception for Breast Cancer and Risk Factors: Nationwide Survey in Korea. Patient Education Counseling 76, issue 1, 113-119.( http://www.ons.org/Publications/ONF/ )

_ PREFERENCES:

4. Funke, L., Krause-Bergmann, B., Pabst, R. and Nave, H. 2008. Prospective Analysis of The Long-term Effect of Teaching Breast Self-examination and Breast Awareness. European Journal of Cancer Care 17, 371–376.

( http://www.ejcancer-breast.com/?utm_source=Google&utm_medium=banner&utm_term=Latest%2Barticles&utmcontent=Breast%2Bcancer%2BV4&utm_campaign=Latest%2Barticles )5. Karayurt, Ö., Özmen, D., and Çetinkaya, A. 2008. Awareness of Breast

Cancer Risk Factors and Practice of Breast Self-examination Among High School Students in Turkey. Biomedcentral Public Health 8, 359.

McGready, T., Littlewood, D. and Jenkinson, J. 2005. Breast Self-examination and Breast Awareness: A Literature Review. Journal of Clinical Nursing 14, 570–578.6. http://www.moh.gov.ge/files/01_GEO/Kanonmdebloba/Brdzanebebi/165.pdf7. UNFPA Standard Progress Report 2011 GEO2R21A Support to Breast and Cervical Cancer Prevention - http://www.gnsc.ge/upload/files/SPR_GEO2R21A_2011_F.pdf