Awareness toward breast cancer and practice of breast self-examination among Iraqi female students at faculty of basic education

ABSTRACT

The most prevalent cancer and the one with the highest fatality rate is breast cancer, accounting for 27% of all malignancies in women and ranking one among all cancers in women. It appears that breast cancer affects both developed and developing nations. Hence, raising public awareness of breast malignancy prevention strategies is crucial in lowering the morbidity and mortality associated with the disease. The awareness and practices of female undergraduate students at Tikrit University regarding breast self-examination (BSE) were evaluated in this study. This cross-sectional investigation was performed on 420 Iraqi undergraduate scholars at the Faculty of Basic Education, University of Tikrit. The students were polled online using a self-administrated Google Forms that was disseminated through social media. Microsoft Office Excel and SPSS version 22 were used to analyze the data that had been gathered. The majority of responders (70.2%) claimed to be knowledgeable about breast cancer. Out of the participants, around 31.8% expressed the belief that a positive family history, followed by obesity 18.9% was responsible for its occurrence. BSE as a technique to find breast cancer early was only known by 33.2% of individuals who were aware of breast cancer. The significant relationships between BSE practice and breast cancer were demonstrated (P = 0.01). Timely identification and treatment of breast cancer potentially lead to improved outcomes and complete recovery when individuals promptly report signs and symptoms. By promoting awareness of breast cancer and conducting BSE, it is possible to minimize the financial burden of the treatment plan and mitigate the impact of synonyms.

INTRODUCTION

Breast cancer stands as the most widespread illness among women, providing for 23% of all malignancies in females worldwide. Moreover, it is the main reason for cancer-related fatalities in lower-income nations as reported by SPER market research.[1,2] Each year, breast cancer claims lives of numerous women worldwide, impacting countries across various technological spectrums.[3] According to the World Health Organization (WHO), 627,000 female cancer deaths were attributed to breast carcinoma in 2018. This number reflects 15% of all fatal cancer cases among women.[4]

The predominant risk factors of breast cancer include advanced age, a higher-than-average body mass index or obesity, smoking, lack of exercise, high-fat diet, youthful menarche, shorter intervals of breastfeeding, menopausal hormonal therapy or oral contraceptive use, density of breast, and hereditary breast malignancies.[5,6] Breast carcinoma holds the highest incidences among all the malignancies in Iraq, affecting over one-third of registered female cancer cases. The latest data from Iraq’s cancer registry indicate a concerning trend of the disease affecting younger women.[7,8,9] The critical need for developed comprehensive national cancer control programs is highlighted by the rising breast cancer burden in the eastern mediterranean region (EMR), particularly in Iraq. The WHO has identified that the most effective strategies for reducing mortality associated with breast cancer are early detection and screening methods with the highest immediate potential.[10] The prevention of breast cancer depends heavily on early detection. With timely discovery, the 5-year survival rate surpassed 85%, whereas it declined to 56% with late detection.[11]

For effective screening, the target audience should be knowledgeable about the techniques, hold a positive attitude toward them, and have practical experience in their application. Evidence indicates that the initial breast cancers are often self-discovered and breast self-examination (BSE) performers have made a significant number of early discoveries.[12]

Early identification could be achieved by improving public health awareness initiatives and promoting the utilization of screening programs. As future members of society, we have potential to educate our family members, neighbors, acquaintances, and the wider community to help recognize breast cancer in its early stages. The goal of the current investigation was to ascertain the degree of BSE knowledge and usage among female students pursuing higher education. Consequently, integrating the BSE concept into the degree education curriculum would be highly beneficial.

MATERIALS AND METHODS

Study design and settings

To evaluate the awareness of breast malignancies among female scholars in Iraq as well as their familiarity with and implementation of BSE and other breast cancer screening techniques, this study used a cross-sectional research methodology. The sample size was established at 420 students, 99% confidence intervals.

Data collection

A self-administered survey was used in a quantitative research technique. To make any necessary final adjustments, the questionnaire was tested on a sample of 15 participants who were not included in the primary target sample. The final study did not include data from the pilot sample. The research was conducted between June and December of 2022.

Data analysis

Following data collection, the information was arranged, coded, and tabulated using Microsoft Office Excel and SPSS version 22. For categorical variables, descriptive statistics including frequencies and percentages were generated. Pearson’s Chi-square tests were used in the statistical analysis.

Ethical considerations

The University of Tikrit Research Ethics Committee gave its clearance for the conduct of this study. Participation in the study was entirely voluntary and the participants received a detailed description of the study’s goals as well as an informational document. Participants were assured of complete anonymity, and it was emphasized that no personal data would be collected. All information obtained was treated with strict confidentiality and solely utilized for research purpose.

RESULTS

Awareness about breast cancer

Two hundred and ninety-five (70.2%) of the 420 female respondents had any knowledge about breast cancer, as shown in Table 1.

Table 1.

Breast cancer awareness among participants

Response	Frequency, n (%)
Aware	295 (70.2)
Not aware	125 (29.7)
Total	420 (100)

Knowledge about risk factors

Based on the findings presented in Table 2, out of the 295 respondents who possessed knowledge, 94 (31.8%) instances attributed the cause of breast cancer to a positive family history of the disease. The next prominent risk factor was obesity, as believed by 56 (18.9%) respondents, 28 (9.4%) respondents, believed that diet was to blame, whereas 85 (28.8%) respondents associated with breast cancer to old age. Notably, smoking (1.6%) exhibited the risk factor with the lowest prevalence.

Table 2.

Perceived risk factors for breast cancer among participants

Response	Frequency, n (%)
Family history	94 (31.8)
Age	85 (28.8)
Obesity	56 (18.9)
Food	28 (9.4)
Oral contraceptives pills	10 (3.3)
No breastfeeding	8 (2.7)
Smoking	6 (2)
Others	5 (1.6)
Alcohol	3 (1)
Total	295 (100)

Knowledge about signs and symptoms

Breast lump (91.4%), breast discomfort (83.3%), and changes in breast size and shape (77.8%) were the warning symptoms and signs that were more frequently accurately identified. Nipple alterations and breast skin redness (65.4% and 43.5%) respectively were the less prevalent breast cancer warning symptoms and signs as tabulated in Table 3.

Table 3.

Knowledge of symptoms about cancer of breast

Signs and symptoms	Frequency, n (%)
Lump in breast	350 (91.4)
Pain in breast	384 (83.3)
Change in the size of breast	327 (77.8)
Nipple discharge	308 (73.8)
Redness of breast	275 (65.4)
Change in nipple	183 (43.5)

Source of information about breast cancer

Social media (66.6%) emerged as a predominant source of information concerning breast cancer, followed by friends and family (17%) as illustrated in Figure 1.

Figure 1.

Source of breast cancer information among participants

Awareness about practice of breast self-examination

Only 33.2% of people who knew about breast cancer were also aware of BSE as a technique for detecting breast cancer at early stage shown in Table 4.

Table 4.

Knowledge of breast self-examination breast self-examination

Have you heard about BSE?	Frequency, n (%)
Yes	237 (56.4)
No	183 (43.5)
Total	420 (100)

BSE: Breast self-examination

Relationships between practice of breast self-examination and knowledge of breast cancer

Table 5 presents the relationships between breast cancer awareness and BSE practice. The relationship was assessed using Chi-square test and results demonstrated a significant relationship (P = 0.01).

Table 5.

The relations between awareness and practice of breast self-examination

Awareness of BSE	n (%)	Absent	P
Aware	295 (235)	60	0.01
Not aware	125 (14)	111

BSE: Breast self-examination

DISCUSSION

The assessment of public perceptions, beliefs, and behavior about BSE is essential for the successful implementation of breast cancer prevention programs.[13] As currently there are no known effective strategies to prevent the onset of breast cancer, the reliance on early detection methods becomes increasingly vital in improving patient outcomes grows. The main objective of breast cancer education programs in underdeveloped nations is to raise public awareness regarding the importance of early detection.[14] Although the incidence of cancer is rising at a rate that surpasses population growth, the underlying causes remain unknown. These forecasts ought to be utilized to plan for future demands in care of cancer and to find tools to raise survival rates.

The majority of participants (70.2%) in the current study were aware about breast cancer in which social media was the primary source of information. These findings were aligned with a study conducted among Egyptian students, which revealed 89.1% of participants acquired information on breast cancer primarily through radio and television.[15] Similarly, research conducted in Yemen found that 81.6% of individuals cited the media as their principal source of information.[16] Similarly, 48.6% of Turkish female school students identified the media as their primary source of information, whereas 44.4% cited health experts as an information source.[17] This could be clarified by the fact that cellular technology adoption rates in Iraq and Egypt are comparable. In addition, our sample included university students which are known for their proficiency with technology. Another survey of Chinese women aged 20 or older found that 73.2% of respondents named newspapers and television as their primary sources of breast cancer information, with 16.1% naming doctors or other medical professionals as their primary source.[16,18,19] These results suggested that the media remains one of the most significant information sources on BSE and breast cancer.

Within this study, approximately half of the participants demonstrated awareness of risk factors, symptoms, and early indicators associated with breast cancer. The highest prevalent risk element revealed was hereditary breast cancer (31.8%) and was in accordance with a study carried out in Turkey among higher school students (68.7%).[17] In a study aimed at assessing the awareness of risk factors and the practice of BSE among female students at University of Nigeria Enugu Campus, the most commonly known risk factors were hereditary breast cancer (50%) and cigarette use (36%). Furthermore, the study indicated that only a minority of students possessed knowledge about risk factors (such as alcohol consumption, obesity, nulliparity, and early menarche).[20]

About the symptoms and warning signs, the most frequent warning symptom which was consistent with earlier findings, was a breast lump. A cross-sectional study of students at university in Angola indicated that a significant majority of the contributors nearly 80% stated that the cancerous breast tumors would be associated with discomfort or unpleasantness.[21] Although many people equate pain with the existence of cancer, although the reality is that it is not typically a primary symptom in the early stages of breast carcinoma and it has been observed that the misconception that connects pain to cancer is widespread.[22] Unfortunately, knowledge of further symptoms and indicators was insufficient. Therefore, there is a preference for increased health education regarding the triggers, indications, and influencing factors of breast cancer. Comparable to the Egyptian researcher’s conclusion that 63.4% of contributors had heard of BSE, the current investigation demonstrated that 56.4% of the sample was aware of BSE.[15] Our results were comparable with those of a survey of students from University at Yemen, where 76.9% of participants were aware of BSE.[16,23] Only 37.9% of the 718 female school students in Turkey who participated in the cross-sectional survey were aware of BSE and mere 13.2% of the participants provided the correct response within appropriate timeframe.[17] Based on our research, there is a clear implication that raising awareness about BSE screening is crucial. By making women more “breast conscious,” this practice can contribute to an early detection of breast tumors and potentially lead to timely diagnosis.

CONCLUSIONS

The level of awareness regarding breast cancer among undergraduate female students at the faculty of basic education was limited and their engagement in BSE practices was also low. With the objective of imparting knowledge, not just the female university students but also to the broader public regarding the triggers, potential causes, indications, influencing factors, medical interventions, and precautionary measures of breast cancer, significant health education initiatives must be encouraged. The distinctive ability of mass media, in particular radio and television to simultaneously get to a vast audience, as a means to reach a wide audience, should be thoroughly explored for the distribution of information on breast cancer. Refuting misconceptions and spiritual precepts regarding the disease should be a goal of campaigns to increase public knowledge of breast cancer. BSE can play a crucial role in a resource-limited environment with a higher prevalence of breast cancer, there is a critical requirement for targeted approaches to implement and strengthen current awareness of cancer and the potential advantages of self-examination.

To lower the mortality rate in breast cancer, we recommend the following measures:

1. The conduct of regular interventional health training programs to improve the knowledge and attitude of women over the age of 14 concerning malignancies

2. Trying to establish cancer treatment centers in every city

3. Physicians in rural and urban health centers to conduct clinical breast examination, active screening tests, and mammograms on women over 40.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.