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Title: The promotion of breast self examination in the context of diagnosis and management of breast disease
Author: Adam, Sheila
ISNI:       0000 0001 3393 7244
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1983
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The incidence and mortality rates from breast cancer continue to increase in the United Kingdom, and the disease is the most common cause of death in women aged 35 to 54 years. Various aetiological factors have been identified, but the known risk factors are not sufficiently predictive to form the basis of programmes for the primary prevention of breast cancer. A range of studies are currently evaluating the benefits of screening by clinical examination and mammography to increase the likelihood of early diagnosis and treatment. This report describes a study which examines the alternative approach of an education programme designed to promote breast self-examination (BSE) among women aged 15 to 64 years, and which, at the same time, documented the diagnosis and management of breast disease in a circumscribed community in Daventry, Northamptonshire. The education programme was carried out over 6 months by a full-time research health visitor. Women were taught within established work or leisure groups, with additional open meetings in the health centre. The teaching consisted of a set of slides, which were presented by the health visitor, and followed by an open-ended discussion. A teaching model was available for women to practise their BSE technique. As well as teaching the method of BSE, the education programme stressed that most breast problems are not due to cancer, that earlier diagnosis improves the chance of curing breast cancer and that BSE both increases the likelihood of early diagnosis and gives reassurance that everything is all right. Publicity was provided (iii) through posters, leaflets, an article and advertisements in the local newspaper and by word of mouth. The leaflets explaining BSE were distributed at each talk, and the health visitor was available in the health centre at certain times for women who wanted an individual consultation. Using the age-sex register as an age-stratified sampling frame, postal questionnaires were sent to 600 women before the education programme and to the same 600 and to a new sample of 600 women afterwards. f Before the programme, most women (87%) had heard of BSE, although only 13% said that they practised it regularly each month. Those women who had heard about BSE from, or been taught BSE by, a health professional were more likely to report practising it. Other factors which increased the level of reported practice were uptake of cervical cytology and a history of breast cancer in a relative or close friend. After the programme only 2% women reported that they had not heard of BSE, and 23% now said that they practised it every month. About one-fifth of the sample had attended a talk given by the health visitor, over half of these at their place of work. Almost all of those who used the practice model reacted favourably to it. Very few women expressed anxiety about the programme itself or about BSE, although there were various indications of underlying fears about breast cancer, which probably stem from direct experience of the disease rather than from health education. The GP consultations were monitored, and there were no instances of women attending because of unreasonable anxiety caused by the programme. The number of women consulting with breast symptoms did increase slightly during the programme, but there was no evidence that this resulted from ill-founded worries. Data were collected during the programme and in the 6 month periods immediately before and immediately afterwards on all women consulting their GP with breast symptoms. A total of 239 women, age range 13 to 90 years, were seen by the 9 general practitioners, with the only woman partner seeing the greatest number of patients. About one-third of women presenting with either a breast lump or pain had waited for one month or more before consulting their GP. Although 20% women were referred to hospital, only 4% were found to have primary breast cancer. Thus, the breast disease seen in general practice is almost entirely benign and often appeared to represent physiological variation. The women who had primary breast cancer were diagnosed by the GP in two-thirds of cases. Diagnostic difficulty and delay in general practice and hospital tended to occur in those women without the typical symptom of a painless lump. The follow-up arrangements in general practice for women referred to hospital and for women who were asked to re-attend their GP for subsequent review of their symptoms appeared rather haphazard. These data on GP workload indicate that to improve the management of breast cancer by reducing the delay in diagnosis it may be necessary to make several changes. Both women and their doctors need to recognise the potential significance of symptoms other than the classical painless lump. GPs may have to accept a greater number of women consulting with what prove to be minor breast symptoms, and a larger proportion of women may need to be referred to hospital. All women who are found not to have breast cancer require reassurance about this, and about the value of their consultation. At the same time, review and follow-up procedures should be improved to ensure that symptomatic women are monitored and that adequate assessment and support is given to those women who require treatment for breast cancer. Any changes in practice should be carefully evaluated. Although the programme to promote BSE achieved some modest changes, the scope of such programmes is probably limited. Several specific problems were identified - for example, the value and difficulty of involving health professionals, the continuing gap between knowledge and behaviour in BSE and the uncertainty about the benefits afforded by BSE. Health education at a more general level faces a variety of difficulties, some of which are discussed, and BSE must be considered within this context. It is suggested that any teaching about BSE should be coupled with education about the benefits of reducing diagnostic delay. Wherever possible, this teaching should be given within routine health care, with the health professionals being provided with the appropriate expertise, literature and materials. BSE would thus become part of a wider strategy designed to promote the secondary prevention of breast cancer.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Medicine