Breast self-examination among diagnosed breast cancer patients

A Cross Sectional Survey on Breast Self Examination Practice, Utilization of Breast Professional Examination, Mammography and Associated Factors in Romagna, Italy

In 1988, a cross-sectional survey was carried out in the Romagna region (Italy) to evaluate the association between knowledge of breast pathophysiology and preventive attitudes and screening tests practice for breast cancer. A self-administered questionnaire was distributed to a sample of asymptomatic women aged 20–64 years living in the city of Faenza (Northern Italy). Of the 657 responders, 58 % reported that they practiced breast self-examination; 55% had had a professional breast examination, and only 9 % had had a mammogram as a screening test. Logistic regression analysis (including variables such as age, education, employment) was performed to explore the relationship between screening tests practice and factors associated with their use. Breast self-examination practice (n = 590) was associated with preventive attitudes (aOR = 1.67, 95°/o CI = 1.09–2.53) and with a positive history of breast disease (aOR = 3.48, 95 % CI = 1.72–7.04). Professional breast examination (n = 480) was related to preventive attitudes (aOR = 2.37, 95 % CI = 1.51–3.71), knowledge of breast pathophysiology (aOR = 2.07, 95 % CI = 1.31–3.28), and use of oral contraceptives (aOR = 1.81, 95% CI = 1.12–2.91). Mammography use (n = 540) was associated with preventive attitudes (aOR = 3.08, 95 % CI = 1.40–6.76). The results show an inadequate utilization of screening tests in our population. Breast self-examination is strongly related to a positive history of breast disease, and this could reflect the lack of health educational programs aimed at the general population.

A Randomized Trial on Breast Self-Examination in Faenza (Northern-Italy)

Aims and background

The aim of this randomized controlled trial was to compare two methods for teaching breast self-examination: theoretical and practical session versus mailed material.

Methods

A random sample of women aged 20-64 years was drawn from the demographic file of the city of Faenza (Northern-Italy). Of 825 sampled eligible women, 168 declined participation, 657 were randomly assigned, after completing a pretest questionnaire aimed at evaluating practice and quality of breast self-examination. Individualised instruction was administered to the treatment group invited to be taught breast self-examination in a medical practice setting. The control group received mailed information about breast self-examination. One year later, 443 women completed the posttest questionnaire.

Results

As far as concerns the first outcome of the trial (change in practice of breast-self examination) our study showed, after adjusting for lost-to-follow-up, no difference between the treatment and the control group. The analysis performed to evaluate the second outcome (change in quality of breast self-examination practice) showed that women of the treatment group improved the quality of breast self-examination practice more than the control group (Wilcoxon test, z=2.4, P<0.01). The same results have been confirmed by multiple regression analyses taking into account all potential confoun-ders. No selection bias affected these results.

Conclusion

Theoretical and practical sessions resulted in an improved quality of examination technique than did mailed material.

Total parenteral nutrition vs oral diet in autologous hematopoietic cell transplant recipients

Autologous HCT patients often have poor oral intake for 2-4 weeks post transplant. To compare outcomes between patients provided prophylactic total parenteral nutrition (TPN) or an oral diet (OD), 55 well nourished breast cancer/ hematopoietic cell transplantation (HCT) patients were randomized to TPN (n=27), beginning day -1, or OD (n=28). Parameters studied include length of stay (LOS), engraftment, infections, survival, weight, anthropometrics, handgrip strength, and quality of life (QOL) In all, 50% of OD patients were given TPN due to poor oral intake for 10 consecutive days. No significant differences were found between the groups for any of the above parameters except weight and anthropometrics, which were better maintained in the TPN group than the OD group. Trends were seen for increased infections, more stable handgrip strength, and improved QOL in the TPN group vs the OD group. Prophylactic TPN did result in a more intact nutritional status and preservation of lean body mass post transplant but did not impact LOS or survival when compared to OD. For this reason, TPN should be reserved for autologous HCT patients with pretransplant nutritional depletion, complications post transplant, or prolonged poor oral intake. These results should not be extrapolated to allogeneic HCT patients but are likely applicable to other well nourished autologous HCT patients.

A profile of Australian women practicing breast self-examination

Breast self-examination (BSE) and medical breast examination practices were studied in a group of 1,103 women without diagnosed breast cancer, randomly sampled to conform in age and social status with breast cancer cases from the population of Brisbane, Australia between 1981 and 1985. Relationships between these practices and sociodemographic factors, breast cancer risk indicators, health related behaviors and source of knowledge about BSE were analyzed. Overall, 63% of women reported performing BSE. BSE was practiced frequently (monthly or more). BSE frequency was only weakly associated with breast cancer risk indicators. It was more strongly linked with age, the 20-44 year group being more likely to examine their breasts occasionally and the women 65 years and over being less likely to examine their breasts. Married women were the most likely to practice BSE frequently and widowed or single women most likely never to practice. Women who underwent cervical smear testing were more likely to perform BSE than those who did not have smear tests. Women who learned BSE from their doctors as opposed to other sources practiced BSE more frequently and were more likely to practice BSE exactly as taught.

Practice of breast self examination: disease extent at diagnosis and patterns of surgical care. A report from an Italian study. GIVIO (Interdisciplinary Group for Cancer Care Evaluation)

STUDY OBJECTIVE

The aim was to determine whether breast self examination leads to earlier diagnosis and whether this translates into a larger utilisation of conservative surgical procedures.

DESIGN

The study was a survey of a cohort of breast cancer patients diagnosed over the period September 1986-July 1988.

SUBJECTS

Participants were 1315 women enrolled in a clinical trial testing the effectiveness of two follow up regimens by 30 general hospitals throughout Italy.

MEASUREMENTS AND MAIN RESULTS

Overall, 511 patients (39%) reported some breast self examination practice, but only 109 (8%) did this regularly and in a way deemed correct by their physicians. Breast self examination practice was positively associated with patients' education and past history of benign breast disease and negatively with age. Self examiners were found to have a significantly greater chance of being diagnosed with a primary tumour coded as pT1 according to the 1982 TNM classification (odds ratio = 1.42, 95% CI = 1.13-1.79). This protective effect was mostly evident in the subgroup of optimal performers (odds ratio = 1.54, CI = 1.01-2.34). Nearly half the patients (319/655) eligible for conservative surgery still had an unnecessary radical procedure.

CONCLUSIONS

Premorbid breast self examination seems to have a modest effect on the extent of disease at diagnosis. The still widespread use of radical surgery suggests that a careful reanalysis of priorities among possible public interventions is needed before launching massive educational campaigns targeted exclusively at consumers.

Breast self-examination practices and attitudes of women with and without a history of breast cancer

Breast self-examination (BSE) practices and attitudes of three groups of women were compared using a mailed survey. Subjects were 59 women with previous breast cancer, 33 women with previously treated benign breast lump(s), and 80 general-population women with no history of breast disease. Groups were compared on frequency, proficiency, and knowledge of BSE. Determinants of practice were examined using attitudinal variables from the Health Belief Model. Results indicated that the breast cancer group had significantly higher rates of BSE frequency, proficiency, and knowledge than did the general-population group. The breast cancer group perceived cancer to be significantly less threatening than did the other two groups, although the general-population group reported significantly less susceptibility to breast cancer. Within-group analyses revealed that barriers to BSE practice accounted for the greatest amount of variance in BSE frequency in all three groups. These results are discussed.

Current evaluation of the contribution of self-examination to secondary prevention of breast cancer

The "state of art" in the problem of BSE and its role in breast cancer early diagnoses in analysed. Advantages and disadvantages of this method and a complex of socio-psychologic problems arising in healthy population due to its introduction are discussed. The absence of scientifically grounded data on the importance of BSE for early diagnosis of breast cancer suggests the necessity of further investigations in order to identify its efficacy. Such data can be obtained only on the basis of randomized population study with estimation of efficacy by the decrease of breast cancer mortality in population. Under the auspices of the WHO such investigation has been conducted in Leningrad and in Moscow (USSR). Methods or investigation applied are described in short.

Clinical measures to assess the practice and efficiency of breast self-examination

If women examine their breasts thoroughly and regularly they may promptly recognize abnormal tissue changes. The level of skill and motivation required for effective breast self-examination (BSE), however, is very high. In a prospective study of 304 patients with newly diagnosed breast cancer, 165 (54%) claimed to practice BSE. On comparison with the remaining 139, the BSE practitioners reported their symptoms sooner than the nonpractitioners, and presented more often with clinically early tumors. There was, however, no difference in tumor size, and pathologic status of axillary nodes between the two groups. There were 60 patients who discovered the abnormalities during self-examination. On comparison with the remaining 244, significantly more BSE discoverers had shorter patient delay in presentation, but there was no significant difference in tumor size, clinical stage, and nodal status. It is concluded that these or similar clinical measures must be used in assessing the effectiveness of population-based BSE campaigns.