6 . Brief Resume of the Intended Work s1

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Cancer is one of the leading causes of mortality and morbidity in developed as well as developing countries. Breast cancer is the most common malignancy among women and rare among the men. The incidences of breast cancer increased approximately 74% between 1965-96, numbers are going up with an estimate of 80,000 new cases being diagnosed annually.1

There is a rising incidence of breast cancer in India. According to the International Agency of Research on cancer, which is part of WHO, there were approximately 79000 women per year affected by breast cancer in India in 2002 and over 87,000 women in 2003.2

Breast Self Examination has long been recommended by health care practitioners as a complement to mammography and clinical breast examination. Only a small percentage report doing breast self examination procedure proficiently. The individual and group training in Breast Self Examination with guided practice improved to measure of search, depth of palpation and duration of search time.3

6.1 NEED FOR THE STUDY

Breast Self Examination is less economic than mammography. Breast cancer can be detected earlier and survival rate of women can be improved. Rural population has less access to medical care facilities and their educational status is lower. There fore it is essential to educate them about breast cancer, is prevention and the early detection by systemic Breast Self Examination. The risk of developing breast cancer begins to rise in the early thirties and peaks by the time a woman enter a sixth decade of life. A teaching programme to women between the age group of 30 – 60 years would be highly beneficial because they are the high risk group. Improved knowledge about breast cancer and ability to perform breast self examination at this age would be effective, because of the perceived threat of breast cancer should motivate them to practice breast self examination regularly.4

A study revealed that five year survival rate of Breast Cancer patients, 75% has been observed self examiners and recommended that 50% of all Breast Cancer patients world wide could obtain a prolongation by increasing public awareness by early detection and efficient treatment at the community level.5

A study was conducted to find the effectiveness of planned teaching programme regarding Cancer prevention and early detection among 50 teacher trainees in Karnataka in terms of other knowledge. An evaluate research approach was used for the study. The mean post test knowledge scores of the teacher’s trainees (60%) were significantly higher than the mean pre-test knowledge scores (40%).6

According to researcher’s clinical and community experience found that women do not have adequate information about breast Cancer and BSE. On this basis the researcher wish to conduct to evaluate their knowledge regarding risk factors of Breast Cancer and Breast self Examination in a view to develop planned teaching programme among women in selected rural community.

3.2 REVIEW OF LITERATURE

Literature review involves the systematic identification, scrutiny of summary of written materials that contain information in a problem7.

Review of literature has been divided under the following headings.

a) Breast cancer and risk factors

b) Knowledge of breast cancer and early detection

c) Breast cancer and breast self examination

d) Effectiveness of planned teaching programme a. BREAST CANCER AND RISK FACTORS

Breast cancer is the most common form of cancer among women. A number of studies have highlighted the importance of information to women regarding breast cancer and risk factors. Because the definite cause of breast cancer is not known. There are various risk factors which predispose women to develop breast cancer.

A study was conducted to assess the prevalence of pre malignant lesion in prophylactically removed breast from women at hereditary risk for breast cancer. Prospective methods of breast specimens were taken from 67 women at Geneva. In 57% of the women, one or more different types of high risk histopathologic lesion were present 37% a typical tubular hyperplasia, 39% a typical ductal carcinoma in situ. This study supported the hereditary risk factors.8

A study was conducted to estimate the familiar predisposition to the breast cancer in a British population according to the age of the individual at risk and the age at which the relative was affected. Familiar relative risks were computed by comparing breast cancer incidence in relatives of 2009 breast cancer cases from a population. Form the data the authors estimated that in the general population 6.8% of women under the age of 50 years, 9.7% of women aged 50-60 years have at least a first degree relative affected with breast cancer. The women under 50 years have a positive family history which confirms an increased risk of at least 2.5 fold.9 b. KNOWLEDGE OF BREAST CANCER AND EARLY DETECTION

Breast cancer detection at an early stage by various training programmes before the disease has spreads beyond the breast improves the chances of cure and normal life. Breast self examination should be part of every woman’s monthly health care routine.

A study was conducted in Jordan to describe the level of breast cancer awareness and breast self examination among women nurses and teachers according to selected demographic variables, such as education, age, religion, insurance and family history of breast cancer. The study instrument was based on knowledge based questionnaire on Breast Self Examination and breast cancer awareness. Analysis of co-variance indicated that family history was associated with general breast cancer awareness. Professional age and family history significantly influences breast cancer and breast self examination awareness. The nurses were 38.3%, compared with 73.17% for teachers. These result provide women nurses and teachers in Jordan might be useful for developing future prevention and screening education programmes.10

A study was done in Leningrad on the effectiveness of early detection of breast cancer by Breast Self Examination in view of reduction of mortality. The study was done by having a control group comprising 31066 women and an experimental group that the breast Self Examination group comprising 31186 women. The number of breast cancer patients detected within the period of 15 months was 36 cases in the Breast Self group (1.15 per 1000 breast self examination taught women) and 16 cases in the control group (0.51 per 1000 women). The average size of the tumour detected was 1.3cms smaller in the Breast Self Examination group. Tumours larger than 5cms were more than double the number in the control group that is 37.5% versus 16.7%.11

c. BREAST CANCER AND BREST SELF EXAMINATION

The appropriate breast cancer screening measures currently is secondary prevention through early detection with breast self examination and mammography which offers a greatest hope for reducing mortality and improving survival. Among this breast self examination is the most cost effective simple method.

A study was conducted among 145 Thai women in Brisbane recruited through a snowball sample method, which used personal contacts and key person within the Thai community. Using the Health Belief Model (HBM) for identify socio demographic variables, 25% of the women performed breast self examination regularly. Beliefs in high personal susceptibility to breast cancer strongly increased the likelihood of Breast Self Examination. After adjusting for potential confounding were found to be important determinants of regular BSE.12

An experimental study was reported that teaching breast self care as breast changes occur in the 50 adolescent girls can influence positive behaviour such as performing Breast Self Examination and seeking regular professional Breast Examinations. Pre-test knowledge was assessed on knowledge; teaching one time interventions were carried out, and post test knowledge was assessed, return demonstration of Breast Self Examination was done by students on model with lumps on it. Descriptive statistics were used to analyze the knowledge and practice of Breast Self Examination. Analysis of variance was used to examine the differences between knowledge scores Pearson correlations were used to examine the relation between knowledge and health beliefs. There were no significance correlation between knowledge and perceived susceptibility between knowledge and perceive seriousness. Knowledge and practice of Breast Self Examination correlation were significant, 23.2% reported regular practice. Study supported the proposal of one time intervention can produce and increasing knowledge of Breast Self Examination and breast cancer in adolescent.13

A study was conducted to determine the knowledge and frequency of Breast Self Examination among Middle Eastern Asian Islamic Immigrant women residing in a metropolitan U.S. city. The purpose sample consisted of 39 Middle Eastern Asian Islamic immigrant sample women ranging in age from 20 to 40 years (mean 33, SD 8.29). Data was collected by Champion’s Breast Self Examination. The results indicated that 33 women (85%) had beard of Breast Self Examination and 29 women 74% had not examined their breasts for lumps. The result of this study showed that Middle Eastern Asian immigrant women may be a population over looked by health care professionals in the education of breast Self Examination. Suggestions to improve breast cancer screening practices among this population were provided.14 d. EFFECTIVENESS OF PLANNED TEACHING PROGRAMME This section of the review of the literature reports on selected studies on effectiveness of planned teaching programme which will help a person to take care of himself.

A study was conducted to determine the effectiveness of a planned teaching programme on early detection of Breast Cancer and BSE among women. The study adopted evaluative approach with pre-test control group design. The data were collected structured interview schedule and observational checklist. Findings showed that there was significant difference between pre test (K1=40%) post test (K2=55%) and post test II

(k2=45%) knowledge score and ability scores. This indicated that planned teaching programme contributed to enhance knowledge and ability scores regarding prevention of Breast Cancer and BSE .15

A study was conducted to determine the effectiveness of a planned teaching programme on prevention of Breast Cancer among 50 women in the community at Uduppi District. The research approach used was evaluative approach with one group pre test-post test, pre experimental design. Descriptive and inferential statistics were used to analyse the data. The planned teaching programme was found to be effective in increasing the knowledge of women on prevention of breast cancer with 49 ±7.86, P<0.05 and ability to perform BSE with 49 ± 12.64, P<0.05.16

6.3 STATEMENT OF THE PROBLEM

“A study to evaluate the effectiveness of planned teaching programme on knowledge of risk factors of Breast Cancer and Breast Self Examination among women in selected rural community at Mangalore”

6.4 OBJECTIVES OF THE STUDY 1. To assess the level of knowledge of women on risk factors of Breast Cancer and Breast self Examination (BSE). 2. To administer planned teaching programme on knowledge of risk factors of Breast Cancer and BSE. 3. Evaluate the effectiveness of planned teaching programme on risk factors of Breast Cancer and BSE. 4. To find out the association between knowledge of risk factors and BSE among women with their selected demographic variables such as age, education, occupation, income, and exposure to mass media.

6.5 OPERATIONAL DEFINITIONS

1. EVALUATE

In this study it refers to the statistical measurement of knowledge on riskfactors of Breast Cancer and Breast self Examination.

2. EFFECTIVENESS In this study the effectiveness refers to the extend to which planned teaching programme has achieved the desired effect about knowledge of risk factors of Breast Cancer an Breast Self Examination and it measured by structured questionnaire.

3. PLANNED TEACHING PROGRAMME

In this study planned teaching programme refers to systematically developed teaching programme regarding risk factors of Breast Cancer and Breast self Examination. It means that the risk factors and BSE by lecture, discussion and demonstration of breast Self Examination on Breast model and return demonstration on samples own breast in a view to improve the knowledge and improve the performance of Breast Self Examination.

4. RISK FACTORS In this study it refers to chance for developing Breast Cancer such as pre malignant lesion, genetic, environmental, alcohol intake, decreased calcium, Vit. D and high fat diet etc.

5. WOMEN

In this study woman refers to the female between the age group of 30-50 years. 6. KNOWLEDGE

In this study knowledge refers to the correct response of women to the questions in the knowledge questionnaire.

7. BREAST SELF EXAMINATION

In this study Breast Self Examination refers to systematically examining the breast model as well as their own breast by the person themselves to find abnormalities. 8. RURAL COMMUNITY

It refers to the area which is not fully developed in education, health facilities, economy and mass media etc.

6.6 ASSUMPTIONS

This study assumes that: 1. Breast Cancer is the second most common malignancy seen in Women. 2. Breast cancer is generally seen among women between the age group of 30-50 years. 3. Breast Self Examination is the easy method of early detection of breast cancer. 4. Teaching programme for high risk group would help in early detection of breast cancer. 5. Women in rural population would willingly participate in the study. 6. Knowledge of women regarding risk factors and BSE may vary with demographic Variables namely age, Education occupation, income and exposure to mass media.

6.7 DELIMITATIONS The study was delimited to: 1. A group of women between 30-50 years of age in selected rural community at Mangalore. 2. Those who are willing to participate in the study. 3. Those who can read or write Kannada or English.

6.8 HYPOTHESIS

All the hypothesis will be tested at 0.05 level of significance:

H1 – Mean post test knowledge scores of women will be significantly higher than the mean pre-test knowledge scores of women regarding risk factors of breast cancer and BSE.

H2 – There will be a significant association between level of knowledge on risk factors of Breast Cancer and BSE among women with their selected variables such as age education, occupation, income and exposure to mass media.

7 MATERIAL AND METHODS

7.1 SOURCES OF DATA A group of women between the age of 30-50 years.

7.1.1 RESEARCH DESIGN One group Pre-test Post-test design Pre-test Administration of PTP Post – test

01 X 02

01= Administration of structured interview schedule on risk factors of Breast Cancer and BSE among women. X = Conducting planned teaching programme on risk factors of Breast Cancer and BSE 02= Administration of structured interview schedule on risk factors of Breast Cancer and BSE on 7th day.

7.1.2 SETTING The study will be conducted in a selected rural community at Mangalore. 7.1.3 POPULATION Women between 30 to 50 Years of age.

7.2 METHOD OF DATA COLLECTION

7.2.1. SAMPLING PROCEDURE Simple random sampling technique.

7.2.2 SAMPLE SIZE 50 Number of women between 30-50 years of age.

7.2.3 INCLUSION CRITERIA a.i. Women who under the age between 30 to 50 years. a.ii. Women who are willing to participate.

7.2.4 EXCLUSION CRITERIA a) Women who are not willing to participate. b) Women who has undergone same type of study.

7.2.5 INSTRUMENT INTENDED TO BE USED a.ii.1. Demographic Performa. a.ii.2. Structured knowledge questionnaire. a.ii.3. Structured teaching schedule. a.ii.4. Observational check list.

7.2.6 DATA COLLECTION METHOD Prior to data collection permission will be obtained from the village authority. Firstly the pre test knowledge of women will be measured by the structured questionnaire. Planned teaching programme will be administered to women. After 7 days of the planned teaching programme administration, Post test knowledge will be measured to evaluate the effectiveness.

7.2.7 DATA ANALYSIS PLAN Data will be analyzed using descriptive and inferential statistics.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR ANIMALS OR HUMANS? IF YES DESCRIBE BRIEFLY.

Yes, a Planned teaching programme on risk factors of Breast Cancer and BSE will be administered to the women.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF THE ABOVE?

Yes, ethical clearance will be obtained from the research committee of Karavali College of Nursing Science, Mangalore. Permission will be obtained from the women who are involved in the study before collecting the data. 8. REFERENCES

1. Park JE. Parks Text book of preventive and social medicine. Jabalpur: Banarasidas Bhanbal publishers;17th edition; 2002.

2. Youhannanas CV. Breast Cancer. Retrieved on October 13th 2000

from www.breast cancer.com/healthcare.html.

3. Leight SB, Eiriggi P, Hursh D, Miller D, Leight V. The effect of structured Training on Breast Self Examination Nursing Research; 2000; 49(5).

4. Clarke VA, Savage SA. Breast Self Examination a brief review Cancer Nursing; 1999; 22(4): 320 – 6.

5. Stax.P. Detection of Breast Cancer, Cancer; 1990; 66: 130-48.

6. Prathiba S.A study to find the effectiveness of a structured teaching programme on knowledge about Cancer Prevention and early detection among teacher trainees in selected college of Udupi DT. ( Un Published); 1997.

7. Polit DF, Hungler BP. Nursing Research: Principles and methods; 6th Edition, Philadephia, Lippincott; 1999.

8. Hoogerbrugge N, Butt P, Dewidt LM, Brex LV. Incidents of invasive breast cancer by hormones receptor status. Journal of Clinical Oncology; 2003; 21(1): 28 – 34.

9. Pharoak PO, Lipscombe JM, Redman KL, Kay NE, Easton DF, Pander BA. Familiar predisposition to Breast Cancer in a British population, Journal of Cancer; 2000; 136(6):773-9. 10. . Madanat H, Berrill R B. Breast Cancer factor and Screening awareness among women nurses and teachers in Amman, Jordan Cancer Nursing; 2002; 25(4): 276- 82.

11. . Seminglazov V F , Moisenko VM. Breast Self Examination for early detection of breast cancer,WHO Bulletin; 1981; 65: 391-96.

12. Jirojwang S. Health beliefs, perceived self efficiency and breast self examination among Thai Mighants in Brisbane, Journal of Advanced Nursing; 2003.

13. . Luduwick R,Gaczkowski T. Teenagers outcome of a teaching programme. Cancer Nursing; 2001; 24(4), 315-19. 14. Rashidhi A, Rajaram SS. Middle Eastern Asian Islamic Women and Breast Self Examination. Cancer Nursing; 2000; 23(1):64-70. Colbert K. Why opt for unnecessary delay Professional Nurse,1999; 19(3):643 – 645. 15. Colbert K. Why opt for unnecessary delay Professional Nurse,1999; 19(3):643 – 645. 16. Daisy Jose. A study to determine the effectiveness of structured teaching programme on prevention of Breast Cancer among women in selected community Uduppi Dt; 2005.