Abstract
Background
Breast cancer is the most common cancer among women worldwide.
Methods
This study aimed to assess the knowledge, awareness and practice of breast cancer screening for early detection of breast cancer among female personnel at a university. A cross‐sectional descriptive study was administered to female personnel of Walailak University in Nakhon Si Thammarat, Thailand. Data were analysed by SPSS version 16.
Results
Among total of 217 female personnel, the lecturers and laboratory scientists and general officers had a significantly higher mean knowledge score about the practice of breast cancer screening than temporary employees (P < 0.0001). The level of education and income of respondents may be involved with this difference in knowledge (P < 0.05).
Conclusion
This study concludes that knowledge about the practice of breast cancer screening could be attributed to different career groups, level of education and income of respondents. There is a very urgent need for regular learning courses for personnel concerning knowledge about the practice of breast cancer screening especially for those personnel with less formal education and low income.
Keywords: attitudes, breast cancer screening, knowledge, practice, Walailak University
Introduction
Globally, as well as in Thailand, breast cancer has been reported as the most common cancer among women and the second leading cause of death; the global age‐standardized incidence rate in 2012 was 29.3 per 100 000 and the death rate was 11.0 per 100 000 per year.1 According to the latest report by the National Cancer Institute of Thailand, breast cancer comprises 37.5% of all cancers among Thai women, with the highest rate occurring in those aged over 30 years.2 Various risk factors for breast cancer have been reported including increased age, being overweight, use of hormone replacement therapy (HRT), physical inactivity, high dietary fat, high breast tissue density, excessive alcohol consumption, early menarche, late menopause, having no children, smoking and family history.3
Early diagnosis of breast cancer results in treatment before metastasis and signifies a better outcome of management.4 To seek medical care which will help early in the course of disease, women need to have knowledge about risk factors and must perform surveillance of their breasts to detect any unusual condition. In addition, to ensure participation in future population‐based screening programmes, women must have knowledge about and a positive attitude towards breast cancer screening. Thus, it is important to educate the public about the importance of early detection of breast cancer by specific screening methods. The recognized screening methods for breast cancer include clinical breast examination (CBE), mammography and magnetic resonance imaging (MRI).5 Breast self examination (BSE) as a screening method has been subject to trials, but it has been reported that it makes women more aware of signs of breast cancer, which may lead to earlier diagnosis.6 It is stated that 90% of the times breast cancer is first noticed by the person herself.7 Women become familiar with both the appearance and the feel of their breast and detect any changes in their breasts as early as possible.8 Moreover, barriers to diagnosis and treatment can be addressed by increasing women's awareness of breast cancer.9 Mammography is the most effective diagnostic method for reduction of mortality due to breast cancer. However, it is not regarded as a suitable modality for poor countries due to its costly nature and requirement of technical specialty. Therefore, routine BSE on a monthly basis in all the women over the age of 20 is recommended because it is an easy to apply, economical, safe, non‐invasive procedure with no special material or tool requirements.
Few studies have examined the knowledge of women in Thailand about breast cancer.10, 11, 12, 13, 14 The low rate of breast cancer screening among Thai women is of concern in the public health and medical fields.15 Study findings have shown that 40.0% of Thai women perform BSE and 46% of those women perform BSE monthly. Nearly 29.0% had had CBE, and 8.0% had CBE regularly, while 5.8% of participants had a mammogram in the past, with only 4.0% having annual mammograms.15 This study was designed to evaluate the knowledge, attitudes and practices regarding breast cancer screening among female personnel at Walailak University in Nakhon Si Thammarat, Thailand.
Methods
This was a cross‐sectional, descriptive study carried out between August and December 2012 among female personnel at Walailak University in Nakhon Si Thammarat, Thailand. The study was approved by The Ethical Clearance Committee on Human Rights Related to Researches Involving Human Subjects of Walailak University (EC number 042/2556). The categories of female personnel included lecturers, laboratory scientists and general officers, and temporary employees. The minimum sample size required for the study was 84 based on a mammography practice rate of 5.8%15 using a formula for sample size determination for a cross‐sectional, descriptive study.16 All female personnel employed by the university at the time of the study were eligible to participate. A total of 217 of 240 eligible female personnel completed and returned questionnaires, for a response rate of 90.4%. Information was collected on socio‐demographic characteristics, knowledge of risk factors for breast cancer, and screening methods and practice of BSE, CBE, and mammography.
Knowledge of risk factors was assessed by requesting respondents to determine which of the following were risk factors for breast cancer – family history, use of oral contraceptives, hormone therapy, having a first child after age 30 years, early menarche (<12 years), late menopause (>55 years), alcohol drinking, increased age, obesity, and breast feeding. Each correct response was awarded one (1) point and each incorrect response was scored zero (0). The total score ranged from 0 to 10. Respondents with scores of 0–2 were considered to have poor knowledge, those with 3–6 points were considered to have fair knowledge, and those with 7–10 points were considered to have good knowledge. The mean knowledge score of risk factors for each personnel group was calculated and compared between groups using one‐way anova.
To determine knowledge of BSE, respondents were asked to answer the following questions: Should BSE be performed once a month for those with age>20? Should BSE be performed during the three days post‐menstruation? Are there two steps of breast self‐examination: (1) breast observation, (2) palpation of breast? Do signs of breast cancer include a lump, skin retraction, abnormal appearance of the breast including more blood vessels, skin edema, and water or blood leaking from the nipples? Are most breast cancers found when the breast is palpated for hard tissue and pain is felt or a palpable lump is detected?
For knowledge of CBE, respondents were asked to answer the following question: Should women aged over 35 years or at risk of breast cancer receive a clinical breast examination by a doctor with breast X‐ray once a year? For knowledge of mammography, respondents were asked to answer the following questions: What is mammography? How often should mammography be performed? Is mammography beneficial? Is mammography safe? Can mammography detect early stage breast cancer before it is palpable? Is mammography more beneficial for women ≥50 years than for those <50 years? Each correct response was awarded one (1) point and each wrong response was scored zero (0). The total score ranged from 0 to 12. Respondents with scores of 0–4 were considered to have poor knowledge, those with 5–9 points were considered to have fair knowledge, and those with 10–12 points were considered to have good knowledge. Mean scores for knowledge of BSE, CBE and mammography for each personnel group were calculated and compared between groups using one‐way anova. The practice of BSE, CBE and mammography was considered for each group and correlated with selected demographic variables using Pearson's chi‐squared test (χ2). Data analysis was performed using the SPSS version 16.0 (SPSS Inc., Chicago, IL, USA) statistical package, and differences were considered statistically significant at P < 0.05.
Results
Socio‐demographic data
Table 1 shows the demographic profile of the respondents. A total of 217 female personnel participated in the study. Most of the respondents were aged between 30 and 39 (108, 49.7%), followed by those aged 40–49 (72, 33.2%), those aged 20–29 (23, 10.6%), those aged 50–59 (11, 5.1%), those aged over 60 (2, 0.9%), and those aged under 20 (1, 0.5%). Fifty‐four respondents (24.9%) were lecturers, 87 (40.1%) were laboratory scientists or general officers, and 76 (35%) were temporary employees. Most respondents were married (136, 62.7%) and Buddhist (204, 94%). Many respondents had a bachelor's degree (78, 35.9%), income between 5000 and 10 000 baht per month (67, 30.9%) and had one or two children (105, 48.4%). One respondent reported a history of breast cancer (0.5%), and 44 respondents reported a history of cancer in their family (20.3%).
Table 1.
Demographic characteristics of respondents
| Characteristics | Frequency (n = 217) | % |
|---|---|---|
| Age group (years) | ||
| <20 | 1 | 0.5 |
| 20–29 | 23 | 10.6 |
| 30–39 | 108 | 49.7 |
| 40–49 | 72 | 33.2 |
| 50–59 | 11 | 5.1 |
| >60 | 2 | 0.9 |
| Career | ||
| Lecturers | 54 | 24.9 |
| Laboratory scientists and general officers | 87 | 40.1 |
| Temporary employees | 76 | 35.0 |
| Marital status | ||
| Single | 72 | 33.2 |
| Married | 136 | 62.7 |
| Separated | 9 | 4.1 |
| Religion | ||
| Buddhist | 204 | 94 |
| Christian | 2 | 0.9 |
| Islam | 11 | 5.1 |
| Education | ||
| Primary school | 36 | 16.6 |
| Secondary school | 33 | 15.2 |
| Bachelor's degree | 78 | 35.9 |
| Master's degree | 43 | 19.8 |
| Ph.D. degree | 27 | 12.4 |
| Income (baht) | ||
| <5000 | 4 | 1.8 |
| 5000–10 000 | 67 | 30.9 |
| 10 001–20 000 | 42 | 19.4 |
| 20 001–30 000 | 54 | 24.9 |
| >30 000 | 50 | 23 |
| Number of children | ||
| 1–2 | 105 | 48.4 |
| ≥3 | 21 | 9.7 |
| No children | 91 | 41.9 |
| History of breast cancer | ||
| Yes | 1 | 0.5 |
| No | 216 | 99.5 |
| History of cancer in family | ||
| Yes | 44 | 20.3 |
| No | 173 | 79.7 |
Risk factors for breast cancer
Table 2 shows the responses to questions about the knowledge of specific risk factors for breast cancer. A majority of the sample group (161, 74.2%) were aware of that a positive family history of breast cancer was a risk factor for developing breast cancer, followed by increased age (134, 61.8%), use of oral contraceptives (126, 58.1%), use of hormone therapy (126, 58.1%) and drinking alcohol (113, 52.1%). The same trends of knowledge were noted for lecturers, laboratory scientists and general officers, and temporary employees. The overall mean knowledge score was 4.75 ± 2.66 out of a maximum score of 10 points, (95% CI = 4.39–5.10). There was no significant difference in mean knowledge scores between the categories of personnel (P > 0.05).
Table 2.
Knowledge of specific risk factors of breast cancer among respondents
| Parameters | Lecturers Freq% | Laboratory scientists and general officers Freq% | Temporary employees Freq% | Total Freq% |
|---|---|---|---|---|
| Family history | 50 (92.6) | 63 (72.4) | 48 (63.2) | 161 (74.2) |
| Contraceptives | 40 (74.1) | 46 (52.9) | 40 (52.6) | 126 (58.1) |
| Hormone therapy | 39 (72.2) | 49 (56.3) | 38 (50) | 126 (58.1) |
| Having first child after age 30 | 18 (33.3) | 32 (36.8) | 32 (42.1) | 82 (37.8) |
| Early menarche (<12 years) | 17 (31.5) | 29 (33.3) | 26 (34.2) | 72 (33.2) |
| Late menopause (>55 years) | 16 (29.6) | 28 (32.2) | 19 (25.0) | 63 (29.0) |
| Drinking alcohol | 28 (51.9) | 42 (48.3) | 43 (56.6) | 113 (52.1) |
| Increased age | 38 (70.4) | 45 (51.7) | 51 (67.1) | 134 (61.8) |
| Obesity | 29 (53.7) | 31 (35.6) | 35 (46.1) | 95 (43.8) |
| Breast‐feeding | 9 (16.7) | 23 (26.4) | 26 (34.2) | 58 (26.7) |
| Mean score (X ± SD) | 5.26 ± 2.47 | 4.46 ± 2.94 | 4.71 ± 2.42 | 4.75 ± 2.66 |
| 95% CI | 4.58–5.93 | 3.83–5.08 | 4.15–5.26 | 4.39–5.10 |
Freq, frequency.
Knowledge about breast cancer screening
Assessment of knowledge about breast cancer screening among respondents is shown in Table 3. Results revealed that 76 respondents (35%) had good knowledge, while 125 (57.6%) had fair knowledge and 16 (7.4%) had poor knowledge of breast cancer screening. A majority of the sample group (207, 95.4%) knew that there are two steps of breast self‐examination, that women aged over 35 or at risk of breast cancer should receive CBE by a doctor with a breast X‐ray once a year 206 (94.9%) and that most breast cancers are found when the breast is palpated for hard tissue, and pain is felt or a palpable lump is detected (203, 93.5%). There were different trends of knowledge. For lecturers and temporary employees, the trend was the same as trend of the majority of the total population. For laboratory scientists and general officers, 86 (98.9%) knew that women aged over 35 or at risk of breast cancer should receive a CBE by doctor with a breast X‐ray once a year.
Table 3.
Knowledge of breast cancer screening among respondents
| Parameters | Lecturers Freq% | Laboratory scientists and general officers Freq% | Temporary employees Freq% | Total Freq% |
|---|---|---|---|---|
| Should BSE be practised once a month for age>20 | 41 (75.9) | 68 (78.2) | 58 (76.3) | 167 (77.0) |
| Should BSE be practised in the 3‐day period post‐menstruation | 34 (63) | 59 (67.8) | 48 (63.2) | 141 (65.0) |
| There are two step of breast self‐examination: (1) breast observation and (2) palpation of breast | 53 (98.1) | 83 (95.4) | 71 (93.4) | 207 (95.4) |
| Breast cancer signs are a lump, skin retraction, abnormal appearance of the breast including more blood vessels, skin oedema and water or blood leaking from the nipples | 53 (98.1) | 82 (84.3) | 60 (78.9) | 195 (89.9) |
| Most breast cancers are found when the breast is palpated and hard tissue, pain or a palpable lump is found. | 51 (94.4) | 84 (96.6) | 68 (89.5) | 203 (93.5) |
| Women over 35 years or with a risk of breast cancer should receive a clinical breast examination by a doctor with a breast X‐ray once a year | 51 (94.4) | 86 (98.9) | 69 (90.8) | 206 (94.9) |
| What is mammography? | 44 (81.5) | 68 (78.2) | 12 (15.8) | 124 (57.1) |
| How often should it be done? | 33 (61.1) | 58 (66.7) | 11 (14.5) | 102 (47.0) |
| Is its beneficial? | 41 (75.9) | 66 (75.9) | 12 (15.8) | 119 (54.8) |
| Is mammography safe? | 36 (66.7) | 43 (49.4) | 6 (7.9) | 85 (39.2) |
| Can it detect early stage breast cancer before it is palpable? | 35 (64.8) | 51 (58.6) | 11 (14.5) | 97 (44.7) |
| Is mammography more beneficial in women ≥50 years than those <50 years? | 20 (37) | 38 (43.7) | 6 (7.9) | 64 (29.5) |
| Mean score (X ± SD) | 9.22 ± 2.19 | 9.10 ± 2.24 | 5.89 ± 1.95 | 8.01 ± 2.63 |
| 95% CI | 8.62–9.82 | 8.62–9.58 | 5.45–6.34 | 7.66–8.36 |
Freq, frequency.
The overall mean knowledge score of breast cancer screening was 8.01 ± 2.63 out of a maximum score of 12 points (95% CI = 7.66–8.36). The lecturers and laboratory scientists and general officers had significantly higher mean knowledge scores (9.22 ± 2.19 and 9.10 ± 2.24, respectively) than temporary employees (5.89 ±1.95) (F = 57.586, P < 0.0001). Overall assessment of temporary employees' knowledge revealed that 76 (35%) had good knowledge, 125 (57.6%) had fair knowledge and 16 (7.4%) had poor knowledge about breast cancer screening. The lecturers and laboratory scientists and general officers groups (48.9%) had significantly higher knowledge scores for breast cancer screening than those of temporary employees (9.2%) (X 2 = 50.173, d.f. = 2, P < 0.0001).
Information in Table 4 shows that the majority of the respondents (172, 79.3%) performed BSE, and 67 reported performing BSE monthly (39%). A majority of respondents (105, 48.4%) had received a CBE; 62.9% of respondents who had received a CBE were in the 30–39 age group (66); 83.8% received a CBE annually. A majority of the respondents (136, 68.7%) had never received a mammogram and were in the 30–39 age group (49, 60.5%) and mostly (66, 81.5%) received one annually.
Table 4.
Breast cancer screening practice among respondents
| Practice | Frequency | % |
|---|---|---|
| Breast self‐examination | ||
| Have had a breast self‐examination | ||
| Yes | 172 | 79.3 |
| No | 45 | 20.7 |
| Frequency (per month) | ||
| 1 | 67 | 39.0 |
| 2–3 | 34 | 19.8 |
| Rarely | 71 | 41.3 |
| Clinical breast examination | ||
| Have had a clinical breast examination by a doctor | ||
| Yes | 105 | 48.4 |
| No | 112 | 51.6 |
| Age when having clinical breast examination | ||
| <30 | 20 | 19.0 |
| 30–39 | 66 | 62.9 |
| 40–49 | 17 | 16.2 |
| ≥50 | 2 | 1.9 |
| Frequency (per year) | ||
| 1 | 88 | 83.8 |
| 2–3 | 16 | 13.3 |
| 4–5 | 1 | 1.0 |
| ≥6 | 2 | 1.9 |
| Mammography | ||
| Have had a mammogram | ||
| Yes | 81 | 31.3 |
| No | 136 | 68.7 |
| Age when had mammography | ||
| <30 | 10 | 12.3 |
| 30–39 | 49 | 60.5 |
| 40–49 | 18 | 22.2 |
| ≥50 | 4 | 4.9 |
| Frequency (per year) | ||
| 1 | 66 | 81.5 |
| 2–3 | 8 | 9.9 |
| 4–5 | 7 | 8.6 |
Practice of breast cancer screening
Table 5 shows the correlation of BSE, CBE and mammography practices with selected demographic variables. Laboratory scientists and general officers (37.8%) and temporary employees (38.4%) had higher proportions of those respondents who practice BSE than lecturers (23.8%), but the difference was not statistically significant, X 2 = 4.118, d.f. = 2, P = 0.128. Practice of BSE was not significantly different with respect to age groups, X 2 = 4.789, d.f. = 5, P = 0.442 (data not shown). However, it was significantly difference among married respondents (116, 85.3%) compared to others groups, X 2 = 13.932, d.f. = 2, P = 0.001. Lecturers (64, 37.2%) and laboratory scientists/general officers (89, 51.7%) with at least one child practised BSE at significantly higher proportions than those without children, X 2 = 7.956, d.f. = 2, P = 0.019. The proportion of laboratory scientists and general officers who had received a CBE (54, 62.1%) was significantly higher than the proportion of lectures (22, 40.7%) and temporary employees (29, 38.2%) who had, X 2 = 10.970, d.f. = 2, P = 0.004. Practice of CBE was significantly different with respect to age groups of respondents, X 2 = 23.552, d.f. = 5, P < 0.001. Practice of CBE was also significantly different for married respondents (76, 55.9%) compared to other groups, X 2 = 8.499, d.f. = 2, P = 0.014. Moreover, practice of CBE was significantly different with respect to the education level of respondents; 60.3% of respondents with a bachelor's degree had received a CBE, a rate which is higher than those of others groups, X 2 = 10.281, d.f. = 4, P = 0.037. Practice of CBE was significantly different with respect to the income of respondents, income of 20 001–30 000 baht was proportion 36 (66.7%), which higher than those of others groups, X 2 = 17.526, d.f. = 4, P = 0.002. Practice of CBE was significantly different with respect to children; respondents who had one or two children (34, 37.4%) and more than two children (59, 56.2%) had higher rates of CBE practice than those who had no children, X 2 = 7.633, d.f. = 2, P = 0.022.
Table 5.
Comparison of breast cancer screening practice with selected demographic variables
| Variable | Practice | P‐value | |
|---|---|---|---|
| Yes freq % | No freq % | ||
| BSE | |||
| Marital status | |||
| Single | 47 (65.3) | 25 (34.7) | 0.001a |
| Married | 116 (85.3) | 20 (14.7) | |
| Separated | 9 (100) | 0 (0) | |
| Number of children | |||
| 1–2 | 64 (70.3) | 27 (29.7) | 0.019a |
| ≥3 | 89 (84.8) | 16 (15.2) | |
| No children | 19 (90.5) | 2 (9.5) | |
| Clinical breast examination | |||
| Age group (years) | |||
| <20 | 0 (0) | 1 (100) | 0.001a |
| 20–29 | 3 (13) | 20 (87) | |
| 30–39 | 47 (43.5) | 61 (56.5) | |
| 40–49 | 46 (63.9) | 26 (36.1) | |
| 50–59 | 7 (63.6) | 4 (36.4) | |
| >60 | 2 (100) | 0 (0) | |
| Career | |||
| Lecturers | 22 (40.7) | 32 (59.3) | 0.004a |
| Laboratory scientists and general officers | 54 (62.1) | 33 (37.9) | |
| Temporary employees | 29 (38.2) | 47 (61.8) | |
| Marital status | |||
| Single | 25 (34.7) | 47 (65.3) | 0.014a |
| Married | 76 (55.9) | 60 (44.1) | |
| Separated | 4 (44.4) | 5 (55.6) | |
| Education | |||
| Primary school | 11 (30.6) | 25 (69.4) | 0.037a |
| Secondary school | 14 (42.4) | 19 (57.6) | |
| Bachelor's degree | 47 (60.3) | 31 (39.7) | |
| Master's degree | 22 (51.2) | 21 (48.8) | |
| Ph.D. degree | 11 (40.7) | 16 (59.3) | |
| Income | |||
| <5000 | 1 (25) | 3 (75) | 0.002a |
| 5000–10 000 | 26 (38.8) | 41 (61.2) | |
| 10 001–20 000 | 13 (31) | 29 (69) | |
| 20 001–30 000 | 36 (66.7) | 18 (33.3) | |
| >30 000 | 29 (58) | 21 (42) | |
| Number of children | |||
| 1–2 | 34 (37.4) | 57 (62.6) | 0.022a |
| ≥3 | 59 (56.2) | 46 (43.8) | |
| No children | 12 (57.1) | 9 (42.9) | |
| Mammography | |||
| Career | |||
| Lecturers | 21 (38.9) | 33 (61.1) | <0.0001a |
| Laboratory scientists and general officers | 53 (60.9) | 34 (39.1) | |
| Temporary employees | 7 (9.2) | 69 (90.8) | |
| Marital status | |||
| Single | 20 (27.8) | 52 (72.2) | 0.003a |
| Married | 61 (44.9) | 75 (55.1) | |
| Separated | 0 (0) | 9 (100) | |
| Education | |||
| Primary school | 2 (5.6) | 34 (94.4) | <0.0001a |
| Secondary school | 4 (12.1) | 29 (81.9) | |
| Bachelor's degree | 44 (56.4) | 34 (43.6) | |
| Master's degree | 19 (44.2) | 24 (55.8) | |
| Ph.D. degree | 12 (44.4) | 15 (55.6) | |
| Income | |||
| <5000 | 1 (25) | 3 (75) | <0.0001a |
| 5000–10 000 | 6 (9) | 61 (91) | |
| 10 001–20 000 | 10 (23.8) | 32 (76.2) | |
| 20 001–30 000 | 34 (63) | 20 (37) | |
| >30 000 | 30 (60) | 20 (40) | |
P‐value by chi‐square test.
For the practice of mammography, laboratory scientists and general officers (53, 60.9%) had a significantly higher proportion than others groups, X 2 = 46.438, d.f. = 2, P < 0.0001. Practice of mammography was significantly different with respect to marital status (61, 44.9%) compared to other groups, X 2 = 11.459, d.f. = 2, P = 0.003. Practice of mammography was significantly different with respect to respondents with bachelor's degree (44, 56.4%) compared to other groups, X 2 = 38.087, d.f. = 2, P < 0.001. Practice of mammography was significantly different with respect to income of respondents of in the 20 001–30 000 baht income group (34, 63%) compared to other groups, X 2 = 52.751, d.f. = 4, P < 0.001. Practice of mammography was not significantly different with respect to age groups of respondents, X 2 = 9.62, d.f. = 5, P = 0.087 (data not shown).
Sources of breast cancer knowledge
Table 6 shows respondents' reported sources of information about risks, knowledge and practice of breast cancer screening. These include medical personnel (127, 58.5%), the Internet (103, 47.5%), television (99, 45.6%), journals (79, 36.4%), friends at the workplace (73, 33.6%), posters (68, 31.3%), close friends (45, 20.7%), radio (30, 13.8%), seminars (19, 8.8%) and conferences (17, 7.8%), respectively.
Table 6.
Sources of information about risks, knowledge and practice of breast cancer screening
| Sources | Frequency (n = 217) | % |
|---|---|---|
| Medical personnel | 127 | 58.5 |
| Internet | 103 | 47.5 |
| Television | 99 | 45.6 |
| Journals | 79 | 36.4 |
| Friends at workplace | 73 | 33.6 |
| Posters | 68 | 31.3 |
| Close friends | 45 | 20.7 |
| Radio | 30 | 13.8 |
| Seminars | 19 | 8.8 |
| Conferences | 17 | 7.8 |
Discussion
Clinical presentation of breast cancer in Thailand has been observed in the last decade, which has affected women's quality of life.17 Early diagnosis and treatment is still considered the best defence against breast cancer morbidity and mortality. Patients diagnosed and treated at an early stage of the disease will have better quality of life and longer survival.18 Early detection of breast cancer is directly related to the increasing levels of awareness about risk factors and practice of screening methods among women. There have been studies about knowledge, attitudes and practices of breast cancer screening among female workers in various parts of Thailand.10, 11, 12, 13, 14 To promote effectiveness of breast cancer control through early detection, female personnel in universities should possess relevant knowledge as well as appropriate attitudes and beliefs concerning the disease and its early detection methods.
This results of this study show that the majority of respondents (78.0%) had fair or good knowledge about the risk factors for breast cancer with an overall mean knowledge score of 4.75 ± 2.66, whereas the remaining respondents (22%) had poor knowledge. This finding was unexpected when compared with reports from Iran.19, 20 However, this was consistent with a report from Germany.21 This finding may be explained by the fact that lecturers, laboratory scientists and general officers, and temporary employees were included in this study, and these categories of personnel may have adequate knowledge about the pathology of breast cancer as personnel in hospitals or have close contact with breast cancer patients and the doctors and nurses who treat them. Although the majority of the respondents had fair or good knowledge about the risk factors for breast cancer, it is still important that they be included in a new model for creating life‐long knowledge and awareness as part of general health maintenance.
In this study, a misconception that breast‐feeding is a risk factor for breast cancer and that early menarche and late menopause were not risk factors for breast cancer was observed. This misconception needs to be corrected, as breast‐feeding or giving birth have been reported as protective factors for breast cancer, whereas early menarche and late menopause are risk factors of breast cancer.3
Knowledge of breast cancer screening was very high (overall mean knowledge score was 8.01 ± 2.63). The majority of respondents had good or fair knowledge, but some had poor knowledge (7.4%) about the importance of mammography for early detection of breast cancer. The results of this study show that the lecturers and laboratory scientists and general officers had a significantly higher mean knowledge of breast cancer screening than temporary employees. Among the predictors of a high knowledge level in this study were higher income and level of education. Temporary employees were gardeners, house cleaners and guards at the university, and their level of education was mostly primary and secondary school (89.5%). This supports the results of a previous study that found awareness of breast cancer could be attributed to the level of education of respondents.22 The income of the respondents with a poor knowledge level was mostly between 5000 and 10 000 baht per month (84.2%), which supports the previous study that income is associated with breast cancer knowledge.23, 24 However, all personnel who participated in this study were supported to receive health‐care services once a year so income may not be the reason why temporary employees had low levels of practice of breast cancer screening.
Many factors were found to be significant for better breast cancer screening practices. Married women tended to have breast cancer screening practices including BSE, CBE and mammography. This may be explained by the fact that married women have the advantage of having economic and emotional support from their husbands. A theoretical model pointed out that marriage may be beneficial to health because spouses positively influence their partner's health behaviours.25, 26 On the other hand, this also indicates that women without spouses lack such support and need help from other quarters to improve their health seeking behaviours and opportunities for obtaining optimum health care. Unmarried women delayed breast cancer screening more than married women.25
Moreover, this study showed that woman who had children was more likely to practise BSE. This finding was supported by a previous study.27 Woman who had at least one child tends to practise breast cancer screening including BSE and CBE, but not mammography. This may be explained by the collaborative reanalysis from 47 epidemiological studies in 30 countries that woman who breast‐feed after they have had a child or have a long duration of breast‐feeding during their lifetime may be protected against breast cancer.28
The media play a significant role in the determination of risks, knowledge and practice of breast cancer. A majority of respondents got their information from medical personnel (58.5%) and searching on the Internet (47.5%). However, this benefit is limited to people who have access to these sources. Proper counselling should be routinely given by health‐care providers to improve breast cancer knowledge.
The study has several limitations. First, the sample included the respondents that were present at the time of data collection. Second, this study is a cross‐sectional survey which was not Follow‐up the respondents. Third, this study had a small sample size. The results of this study can be used to conclude that there is a need for health professionals at all levels to promote BSE, CBE and mammography. Health staff at the university may play a significant role in providing information about health matters. First of all, staff involved in medical and health promotion at the university need to be trained and motivated to routinely provide comprehensive health education services to all residents of the university. Cheap, effective and efficient educational opportunities such as conferences, seminars, posters, discussions with friends, searching the Internet, radio, television and reading journals for promoting information about breast cancer screening should be implemented to increase breast cancer awareness among female university personnel. This study can conclude that knowledge and practice of breast cancer screening among female university personnel, especially temporary employees, was found to be inadequate. There is a very urgent need to update the various courses of knowledge improvement and practice for early detection of breast cancer in this group of personnel. In addition, government hospitals need to establish breast imaging units that include CBE and mammography in the recently commenced national health insurance scheme.
Acknowledgement
This work was supported by fund from Walailak University (WU56413).
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