|Year : 2018 | Volume
| Issue : 4 | Page : 142-146
Knowledge, attitude, and practice regarding breast cancer among female students at college of medical technology/Derna
Raga A Elzahaf1, Ehdaa Ibrahim Mekraz2, Saria M Arhaim3, Mabrouka A Almansouri3
1 Department of Public Health, College of Medical Technology, Derna, Libya; Middle East and North Africa Research Group
2 Department of Statistics, Faculty of Sciences, University of Benghazi, Benghazi, Libya
3 Department of Public Health, College of Medical Technology, Derna, Libya
|Date of Web Publication||17-Jan-2019|
Dr. Raga A Elzahaf
Department of Public Health, College of Medical Technology, Derna
Source of Support: None, Conflict of Interest: None
Background: Breast cancer in women is a major health burden in developed and developing countries. It is the second leading cause of death in women worldwide. Recently, the global cancer statistics indicate that breast cancer incidence is rising faster among women in developing countries. Aim: The aim of this study was to assess the knowledge, attitudes, and practice regarding breast cancer among female students at the College of Medical Technology Derna, Libya. Methods: This study was designed as a descriptive cross-sectional survey. A self-administered questionnaire was used to collect the information from the female students. Results: A total of 200 female students were used for the study. The ages of female students ranged from 18 to 27 with mean 20.8 ± 1.88 years. Some of the female students 28.5% (n = 57) had used correct practices of self-examination, 12.5% (n = 25) reported high knowledge of breast cancer and majority of them 90% (n = 180) have a good attitude about breast cancer. However, there was no significant association different between knowledge and practice and attitude and demographic factors. Conclusion: The study results showed insufficient knowledge of breast cancer among female students whereas they were in medical programs. Therefore, more educational programs could be designed to provide comprehensive information of breast cancer and breast self-examination to improve women's knowledge, which can help in the early detection of breast cancer for the better treatment.
Keywords: Attitude, breast cancer, knowledge, Libyan female students, practices
|How to cite this article:|
Elzahaf RA, Mekraz EI, Arhaim SM, Almansouri MA. Knowledge, attitude, and practice regarding breast cancer among female students at college of medical technology/Derna. Libyan J Med Sci 2018;2:142-6
|How to cite this URL:|
Elzahaf RA, Mekraz EI, Arhaim SM, Almansouri MA. Knowledge, attitude, and practice regarding breast cancer among female students at college of medical technology/Derna. Libyan J Med Sci [serial online] 2018 [cited 2022 Sep 26];2:142-6. Available from: https://www.ljmsonline.com/text.asp?2018/2/4/142/250301
| Introduction|| |
Breast cancer in women is a major health burden worldwide. It is the most common cause of cancer death among women in both developed and developing countries. One in 10 of all new cancer diagnosed worldwide each year. The incidence, mortality and survival rate of breast cancer in different parts of the world vary from 4 to 10-fold. Recently, the global cancer statistics indicate that breast cancer incidence is rising faster among women in developing countries., These differences in breast cancer rates between developed and developing countries can be partly explained by the effects of diets, late reproductive age, low levels of gender parity, and reduced breastfeeding time.
Therefore, the early detection of breast cancer has an important role in reducing the mortality, survival and the prognosis of the disease., Consequently, early diagnosis can be successfully achieved by mass screening either by self-breast examination (SBE), clinical breast examination, and mammography or by the combination of these three. Although it is well-documented that mammography is the best choice for screening, breast self-examination (BSE) is also equally important and beneficial for mass awareness especially in a country with limited recourses.,
There has not been any regular approach to increase the awareness of breast cancer in some countries. Therefore, many women miss early detection and treatment opportunities due to lack of information, knowledge, and awareness of breast cancer, as well as cancer screening practices., Moreover, in Libya, there is no systematic approach to early detection due to the low awareness, shortage in health-care system and no expertise.
On 2004, in Libya breast cancer was the most common malignancy in females as recorded by Benghazi Cancer Registry. It represented 23% of all cancers in females. Preventive behavior is essential for reducing cancer mortality. Knowledge is a necessary predisposing factor for behavioral change. Knowledge also plays an important role in the improvement of health-seeking behavior and consequently enhances screening practice. Not only that knowledge might dramatically improve the attitude, disbelieve, and misconception but also consequently enhance screening practice.
The aim of this study was to assess the knowledge, attitudes, and practice regarding breast cancer among female students at the College of Medical Technology Derna, Libya.
| Methods|| |
A descriptive cross-sectional survey among female students at College of Medical Technology/Derna was used to gather data from June 1 to August 30, 2016. The number of female students at the college is 531, male 139. The number of female students required to be screen from the study population was calculated according to Raosoft software. The assumptions were: there is 95% power at the 5% significant level to find a 30% response distribution. It was therefore calculated that a minimum sample size of 200 female students would provide an estimate of knowledge, attitude, and practice with 5% error.
Permission and Ethical Approval to conduct the study was granted from the College of Medical Technology, Derna, Libya.
A self-administered questionnaire was used to collect information from the female students. The questionnaire was derived from other published studies dealing with the same topic. It included questions related to personal data and history of related health events. It also investigated the knowledge and awareness of female students regarding breast cancer and their practice of screening procedures. The structured English form was first translated into Arabic by the authors. An Arabic version of the questionnaire was used to collect the data. This version was revised and translated back to English by another expert and compared with the original form to ascertain the precision of translation.
A written consent form explaining the purpose of the research was prepared to be signed by the female student. To maintain confidentiality, questionnaires were made anonymous.
Data analysis was analysis using SPSS software version 24 (IBM, Ottawa, Canada). Descriptive statistics, including percentage, mean, range, and standard deviations, were calculated for all variables. Proportions were compared using Chi-square tests and P < 0.05 was considered statistically significant.
| Results|| |
A total of 200 questionnaires were distributed to 1st, 2nd, 3rd, 4th years of undergraduate female students. Their ages ranged from 18 to 27 with mean 20.8 ± 1.88 years nearly 50% of them were aged from 21 to 23, 50% of them were in the first year of their education level, and most were single (92.5%). Nearly 2% were have breast problems and 6.5% had a family history [Table 1].
|Table 1: Characteristics of female students at college of medical technology Derna|
Click here to view
Knowledge regarding the symptoms and signs, important risk factors, and diagnostic methods of breast cancer among female students were recorded. The percentages of those who answered for each items were presented in [Table 2]. The most common symptom regarding breast cancer showed lump in the breast (98.0%) and the lowest level weight loss (36.5%). The most know risk factors were family history (83%) and the lowest early onset of menarche (13.5%) [Table 3].
|Table 2: Percentage of female students having correct knowledge about symptoms and sign of breast cancer|
Click here to view
|Table 3: Percentage of female student at college medical technology Derna having knowledge about risk factor for breast cancer|
Click here to view
More commonly answer on knowledge of ways of diagnosing breast cancer was a self-breast examination (82.5%), pathological examination of breast tissue by using FNAC (82.5%), and the lowest answer was ultrasound (47.5%) [Table 4].
|Table 4: Percentage of female student at college of medical technology Derna having knowledge of ways of diagnosing breast cancer|
Click here to view
This study showed that 28.5% (n = 57) of female student had used correct practices, and 71.5% (n = 143) of female had used incorrect practices of breast examination. Moreover, found there was no significant association different between breast practices examination and demographic factors in [Table 5].
Furthermore, showed that 12.5% (n = 25) of the female students reported high knowledge of breast cancer and 87.5% (n = 175) reported low knowledge of breast cancer. And found there was no significant association different between knowledge of breast cancer and demographic factors [Table 6].
However, in this study, 90% (n = 180) of female students reported that have a good attitude about breast cancer and 10% (n = 20) have a bad attitude. And show there was no significant association different between attitude and demographic factors [Table 7].
| Discussion|| |
The main focus of this study was to assess breast cancer knowledge, attitude, and practice among female students at the college of medical technology. Knowledge is an important issue for early detection and improvement of health seeking behavior.
Our overall results showed 12.5% (n = 25 of 200) of the female students reported high knowledge of breast cancer, which in general, there is a lack of breast cancer knowledge among female students. This is consistent with previous studies done in different parts of the world have shown that there is very limited knowledge of breast cancer even among health-care professions such as nurses., This may be because of 25% of the female students included in the first year and low sample size.
Furthermore, this study found there was no significant association different between breast cancer knowledge and demographic factors this was different than other study had found age,,,, education level,,, and marital status , significantly increase the breast cancer knowledge. The family history of breast cancer and previous history of breast problem also positively influence breast cancer knowledge level., Different studies show the different result to good knowledge about breast cancer. For examples, among Nigerian nurses, knowledge about symptoms, methods of diagnosis, and self-breast examination (SBE) were generally very good  similar to our finding. About 35% of Pakistani nurses had good knowledge of breast cancer risk factors. Iranian nurses knowledge on risk factors of breast cancer was not satisfactory. The majority of female students have reported that have a good attitude about breast cancer 90% (n = 180) and 10% (n = 20) have bad attitude. The findings show there was no significant association different between attitude and demographic factors. It has been documented that younger women show more positive attitude toward health education about breast cancer and early screening.
The use of screening methods was very low among female students, 28% were used BSE. And found there was no significant association different between breasts practices examination and demographic factors.
Majority of the female students did know that BSE (82%) and mammography (78%) as the ways of diagnosing breast cancer. This agrees with a previous study, which also showed that the use of screening methods was very low among female students where only 34.9% practiced BSE and none ever had a mammogram.
BSE is simple and cost-effective methods for early detection of breast cancer. However, there is some debate over the effectiveness of BSE. Kotka pilot project found that BSE has improved the early detection and reduced mortality. However, St. Petersberg, Shanghai, and Swedish study, revealed no improvement in stage shifting or mortality reduction. However, it has a great role in awareness program and initial screening especially countries with limited resources. Higher education and socioeconomically status increase practice of BSE. The age is also an important predictor for BSE. Young women practice more BSE than older women. Mammography is the most effective screening tools for early detection of breast cancer. Poverty and literacy rate is the strong predictors of underutilization of mammography. Access to mammography screening is an important issue for successful breast cancer screening campaign.
There are several barriers for no utilization of breast cancer screening. Among them, cost, lack of timing, embarrassment, unsure of benefit, no recommendation, language, and fear are mostly reported.,,,, There is no data on the incidence and prevalence of breast cancer in Derna.
To fight against breast cancer, we need a constructive integrated national policy. That will focus on mass awareness and improvement of women health-seeking behavior.
| Conclusion|| |
The study results showed insufficient knowledge of breast cancer among female students whereas they were in medical programs. The majority of the participants were not aware of some of the early signs of breast cancer such as change in color or shape of the nipple, even though they appreciated the need for monthly BSE.
Majority of the participants knew about the BSE, but they lack knowledge regarding frequency and appropriate time to practice BSE. Thus, more educational programs could be designed to provide comprehensive information of breast cancer and BSE to improve women's knowledge and awareness, which can help in the early detection and reporting of breast cancer for the better treatment.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bray F, McCarron P, Parkin DM. The changing global patterns of female breast cancer incidence and mortality. Breast Cancer Res 2004;6:229-39.
Parkin DM, Whelan SL, Ferlay J, Raymond L, Young J. Cancer Incidence in Five Continents. Lyon: IARC Press; 1997. p. 8.
Rahimzadeh M, Baghestani AR, Gohari MR, Pourhoseingholi MA. Estimation of the cure rate in Iranian breast cancer patients. Asian Pac J Cancer Prev 2014;15:4839-42.
Mia MS. Knowledge, Attitude and Practice Regarding Breast Cancer among Medical Students of Bangladesh – A Protocol Study. Master Thesis in Public Health, Umeå University, Umeå, Sweden; 2006-2007.
Miller AB, Baines CJ, To T, Wall C. Canadian national breast screening study: 2. Breast cancer detection and death rates among women aged 50 to 59 years. CMAJ 1992;147:1477-88.
Tu SP, Reisch LM, Taplin SH, Kreuter W, Elmore JG. Breast self-examination: Self-reported frequency, quality, and associated outcomes. J Cancer Educ 2006;21:175-81.
El Mistiri M, Verdecchia A, Rashid I, El Sahli N, El Mangush M, Federico M, et al.
Cancer incidence in Eastern Libya: The first report from the Benghazi cancer registry, 2003. Int J Cancer 2007;120:392-7.
Odusanya OO, Tayo OO. Breast cancer knowledge, attitudes and practice among nurses in Lagos, Nigeria. Acta Oncol 2001;40:844-8.
Ahmed F, Mahmud S, Hatcher J, Khan SM. Breast cancer risk factor knowledge among nurses in teaching hospitals of Karachi, Pakistan: A cross-sectional study. BMC Nurs 2006;5:6.
Okobia MN, Bunker CH, Okonofua FE, Osime U. Knowledge, attitude and practice of Nigerian women towards breast cancer: A cross-sectional study. World J Surg Oncol 2006;4:11.
Grunfeld EA, Ramirez AJ, Hunter MS, Richards MA. Women's knowledge and beliefs regarding breast cancer. Br J Cancer 2002;86:1373-8.
Darrow SL, Schoenfeld ER, Cummings KM, Wilkes E, Madoff S. Women's knowledge and beliefs about breast cancer risk factors, symptoms, detection methods, and treatments. J Cancer Educ 1987;2:165-76.
Dolan NC, Lee AM, McDermott MM. Age-related differences in breast carcinoma knowledge, beliefs, and perceived risk among women visiting an academic general medicine practice. Cancer 1997;80:413-20.
Paul C, Barratt A, Redman S, Cockburn J, Lowe J. Knowledge and perceptions about breast cancer incidence, fatality and risk among Australian women. Aust N
Z J Public Health 1999;23:396-400.
Pöhls UG, Renner SP, Fasching PA, Lux MP, Kreis H, Ackermann S, et al.
Awareness of breast cancer incidence and risk factors among healthy women. Eur J Cancer Prev 2004;13:249-56.
Milaat WA. Knowledge of secondary-school female students on breast cancer and breast self-examination in Jeddah, Saudi Arabia. East Mediterr Health J 2000;6:338-44.
Jones AR, Thompson CJ, Oster RA, Samadi A, Davis MK, Mayberry RM, et al.
Breast cancer knowledge, beliefs, and screening behaviors among low-income, elderly black women. J Natl Med Assoc 2003;95:791-7, 802-5.
Ceber E, Soyer MT, Ciceklioglu M, Cimat S. Breast cancer risk assessment and risk perception on nurses and midwives in Bornova health district in Turkey. Cancer Nurs 2006;29:244-9.
Haji-Mahmoodi M, Montazeri A, Jarvandi S, Ebrahimi M, Haghighat S, Harirchi I, et al.
Breast self-examination: Knowledge, attitudes, and practices among female health care workers in Tehran, Iran. Breast J 2002;8:222-5.
Semiglazov VF, Moiseyenko VM, Manikhas AG, Bavli JL, Seleznyov NK, Popova RT, et al
. Role of breast self-examination in early detection of breast cancer: Russia/WHO prospective randomized trial in St. Petersburg. Cancer 1999;1:145-51.
Thomas DB, Gao DL, Ray RM, Wang WW, Allison CJ, Chen FL, et al.
Randomized trial of breast self-examination in Shanghai: Final results. J Natl Cancer Inst 2002;94:1445-57.
George SA. Barriers to breast cancer screening: An integrative review. Health Care Women Int 2000;21:53-65.
Chua MS, Mok TS, Kwan WH, Yeo W, Zee B. Knowledge, perceptions, and attitudes of Hong Kong Chinese women on screening mammography and early breast cancer management. Breast J 2005;11:52-6.
Luquis RR, Villanueva Cruz IJ. Knowledge, attitudes, and perceptions about breast cancer and breast cancer screening among Hispanic women residing in South central Pennsylvania. J Community Health 2006;31:25-42.
Bener A, Alwash R, Miller CJ, Denic S, Dunn EV. Knowledge, attitudes, and practices related to breast cancer screening: A survey of Arabic women. J Cancer Educ 2001;16:215-20.
Crump SR, Mayberry RM, Taylor BD, Barefield KP, Thomas PE. Factors related to noncompliance with screening mammogram appointments among low-income African-American women. J Natl Med Assoc 2000;92:237-46.
Garbers S, Jessop DJ, Foti H, Uribelarrea M, Chiasson MA. Barriers to breast cancer screening for low-income Mexican and Dominican women in New York City. J Urban Health 2003;80:81-91.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]