Knowledge, Fear of Breast Cancer, And Breast Self-Examination Practices Among Female Undergraduate Students: A Cross-Sectional Study in Bekasi City, Indonesia Knowledge, fear, and BSE practices
Abstract
Background: The practical and free Breast self-examination (BSE) method can be used more widely for breast cancer screening in developing countries. This study aims to examine the relationship between a) knowledge of breast cancer, b) fear of breast cancer, and c) BSE practices among female undergraduate students..
Methods: This cross-sectional study was conducted in September 2023, surveying 261 female undergraduate students from a polytechnic of health in Bekasi City, Indonesia, using an online questionnaire via Google Forms.
Results: 66.3% of participants practiced BSE. The proportion of participants with good knowledge about BSE was 51.3%, while those with good knowledge about breast cancer risk factors were 29.1%. The proportion of participants who had a high fear of breast cancer reached 60.9%. Participants identified social media (28.7%), physician (28.3%), and websites (22.6%) as the top three sources of breast cancer information, out of a total of nine options. Multivariate logistic regression analysis revealed that having good knowledge about BSE (OR=2.460, 95% CI: 1.403-4.312, p<0.05) and being 20 years or older (OR=2.238, 95% CI: 1.282-3.907, p<0.05) were significant independent predictors of BSE practice. Knowledge about breast cancer risk factors and fear of breast cancer were not statistically significant as determinants of BSE practice.
Conclusion: Female undergraduate students with good knowledge of BSE and older are likelier to practice BSE. We recommend that breast cancer awareness campaigns targeting female undergraduate students emphasize practical, hands-on instruction on BSE techniques via social media or interactive mobile applications by physicians, including health information messages, video-based tutorials, and Q&A sessions.
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References
International Agency for Research on Cancer. Globocan Project - The Global Cancer Observatory: all cancer fact sheet [Internet]. 2020. Available from: https://gco.iarc.fr/today/data/factsheets/cancers/39-All-cancers-fact-sheet.pdf
International Agency for Research on Cancer. Globocan Project - The Global Cancer Observatory: Indonesia fact sheet [Internet]. 2020. Available from: https://gco.iarc.fr/today/data/factsheets/populations/360-indonesia-fact-sheets.pdf
International Agency for Research on Cancer. Breast Cancer Screening - IARC Handbooks of Cancer Prevention Volume 15 [Internet]. Lyon: International Agency for Research on Cancer; 2016. Available from: https://publications.iarc.fr/545
International Agency for Research on Cancer. World Cancer Report: Cancer Research for Cancer Prevention [Internet]. Wild CP, Weiderpass E, Stewart BW, editor. Lyon: International Agency for Research on Cancer; 2020. Available from: http://publications.iarc.fr/586
Ren W, Chen M, Qiao Y, Zhao F. Global guidelines for breast cancer screening: A systematic review. Breast. 2022;64(March):85–99. doi: 10.1016/j.breast.2022.04.003.
Mishra GA, Pimple SA, Mittra I, Badwe RA. Screening for breast cancer: Cost-effective solutions for low- & middle-income countries. Indian J Med Res [Internet]. 2021;154(2). Available from: https://journals.lww.com/ijmr/Fulltext/2021/08000/Screening_for_breast_cancer__Cost_effective.8.aspx
Black E, Richmond R. Improving early detection of breast cancer in sub-Saharan Africa: Why mammography may not be the way forward. Global Health. 2019;15(1):1–11. doi: 10.1186/s12992-018-0446-6.
Peraturan Menteri Kesehatan Republik Indonesia Nomor 34 Tahun 2015 Tentang Penanggulangan Kanker Payudara dan Kanker Leher Rahim [Internet]. Available from: http://hukor.kemkes.go.id/uploads/produk_hukum/PMK_No._34_ttg_Penanggulangan_Kanker_Payudara_dan_Leher_Rahim_.pdf
Wahidin M, Febrianti R, Susanty F, Hasanah SR. Twelve Years Implementation of Cervical and Breast Cancer Screening Program in Indonesia. Asian Pacific J Cancer Prev. 2022;23(3):829–37. doi: 10.31557/APJCP.2022.23.3.829.
Getu MA, Kassaw MW, Tlaye KG, Gebrekiristos AF. Assessment of breast self-examination practice and its associated factors among female undergraduate students in addis ababa university, Addis Ababa, Ethiopia, 2016. Breast Cancer Targets Ther. 2019;11:21–8. doi: 10.2147/BCTT.S189023.
Icanervilia AV, Choridah L, Van Asselt ADI, Vervoort JPM, Postma MJ, Rengganis AA, et al. Early Detection of Breast Cancer in Indonesia: Barriers Identified in a Qualitative Study. Asian Pacific J Cancer Prev. 2023;24(8):2749–55. doi: 10.31557/APJCP.2023.24.8.2749.
Luleci D, Kilic B. Factors Affecting Women’s Participation in Breast Cancer Screening in Turkey. Asian Pacific J Cancer Prev. 2022;23(5):1627–34. doi: 10.31557/APJCP.2022.23.5.1627.
Akhtari-Zavare M, Juni MH, Ismail IZ, Said SM, Latiff LA. Barriers to breast self examination practice among Malaysian female students: a cross sectional study. Springerplus. 2015;4(1):1–6. doi: 10.1186/s40064-015-1491-8.
Mihret MS, Gudayu TW, Abebe AS, Tarekegn EG, Abebe SK, Abduselam MA, et al. Knowledge and Practice on Breast Self-Examination and Associated Factors among Summer Class Social Science Undergraduate Female Students in the University of Gondar, Northwest Ethiopia. J Cancer Epidemiol. 2021;2021:1–9. doi: 10.1155/2021/8162047.
Sarker R, Islam MS, Moonajilin S, Rahman M, Gesesew HA, Ward PR. Knowledge of breast cancer and breast self-examination practices and its barriers among university female students in Bangladesh: Findings from a cross-sectional study. PLoS One. 2022;17(6 6):1–12. doi: 10.1371/journal.pone.0270417.
Abo Al-Shiekh SS, Ibrahim MA, Alajerami YS. Breast Cancer Knowledge and Practice of Breast Self-Examination among Female University Students, Gaza. Sci World J. 2021;2021. doi: 10.1155/2021/6640324
Champion VL, Skinner CS, Menon U, Rawl S, Giesler RB, Monahan P, et al. A Breast Cancer Fear Scale: Psychometric Development. J Health Psychol. 1 November 2004;9(6):753–62. doi: 10.1177/1359105304045383.
Aguirre-Camacho A, Hidalgo B, González-Cuevas G. Fear of breast cancer among young Spanish women: Factor structure and psychometric properties of the Champion breast cancer fear scale. PLoS One. 2021;16(4 April):1–12. doi: 10.1371/journal.pone.0249562.
Ezema RN, Igbokwe CC, Iwuagwu TE, Agbaje OS, Ofuebe JI, Abugu LI, et al. Association of Sociodemographic Factors, Breast Cancer Fear, and Perceived Self-Efficacy With Breast Cancer Screening Behaviors Among Middle-Aged Nigerian Women. Breast Cancer Basic Clin Res. 2021;15. doi: 10.1177/11782234211043651.
Bıçakçı NK, Karakaş D, Avcı İA. Fear of Breast Cancer and Assessment of the Efficiency of Mammography. Eur J Breast Heal. 2023;19(1):70–5. doi: 10.4274/ejbh.galenos.2022.2022-2-8.
Ghahramanian A, Rahmani A, Aghazadeh AM, Mehr E. Relationships of Fear of Breast Cancer and Fatalism with Screening Behavior. Asian Pacific J Cancer Prev. 2016;17:4427–32. doi: 10.7314/APJCP.2016.17.9.4427.
Emami L, Ghahramanian A, Rahmani A, Mirza Aghazadeh A, Onyeka TC, Nabighadim A. Beliefs, fear and awareness of women about breast cancer: Effects on mammography screening practices. Nurs Open. 2021;8(2):890–9. doi: 10.1002/nop2.696.
Azhar Y, Hanafi R V, Lestari BW, Halim FS. Breast Self-Examination Practice and Its Determinants among Women in Indonesia: A Systematic Review, Meta-Analysis, and Meta-Regression. Vol. 13, Diagnostics. 2023. doi: 10.3390/diagnostics13152577.
Dewi TK, Massar K, Ruiter RAC, Leonardi T. Determinants of breast self-examination practice among women in Surabaya, Indonesia: An application of the health belief model. BMC Public Health. 2019;19(1):1–8. doi: 10.1186/s12889-019-7951-2.
Rezano A, Utama MS, Wiraswati HL, Ekawardhani S, Adha MJ, Patahuddin NM, et al. Knowledge Level towards Breast Cancer and Breast Self-Examination among Medical Students of Indonesia. Glob Med Helath Comun. 2022;10(1):35–42. doi: 10.29313/gmhc.v10i1.8942.
Wang X, Cheng Z. Cross-Sectional Studies Strengths, Weaknesses, and Recommendations. Chest. 2020;158(1):S65–71. doi: 10.1016/j.chest.2020.03.012.
Lemeshow S, Hosmer Jr DW, Klar J, Lwanga SK. Adequacy of Sample Size in Health Studies. Chichester: John Wiley & Sons Ltd; 1990.
Albeshan S, Shubayr N, Alashban Y. Assessment of Knowledge and Awareness About Breast Self-Examination Among University Female Students in Saudi Arabia. Breast Cancer Targets Ther. 2023;15(January):91–9. doi: 10.2147/BCTT.S396903.
Ishtiak ASM, Ahmed N, Gaffar F, Khan MAS, Yasmeen F. Knowledge, practice and associated factors of breast self-examination among female university students of Bangladesh: Knowledge, practice and associated factors of breast self-examination. Heliyon. 2022;8(11):e11780. doi: 10.1016/j.heliyon.2022.e11780.
Rahman SA, Al-Marzouki A, Otim M, Khayat NEHK, Yousef R, Rahman P. Awareness about breast cancer and breast self-examination among female students at the University of Sharjah: A cross-sectional study. Asian Pacific J Cancer Prev. 2019;20(6):1901–8. doi: 10.31557/APJCP.2019.20.6.1901.
Kementerian Kesehatan RI. Pedoman Teknis Pengendalian Kanker Payudara dan Kanker Leher Rahim [Internet]. Jakarta: Kementerian Kesehatan RI; 2013. Available from: https://p2ptm.kemkes.go.id/uploads/2016/10/Pedoman-Teknis-Pengendalian-Kanker-Payudara-Kanker-Leher-Rahim.pdf
Yayasan Kanker Payudara Indonesia. Kenali dan Hadapi Kanker Payudara - Panduan Lengkap untuk Pasien Kanker Payudara [Internet]. Andinata B, Soeratman AR, Partahi JR, Kustiati R, editor. Jakarta: Yayasan Kanker Payudara Indonesia; 2021. Available from: https://www.yayasankankerpayudaraindonesia.org/content/7192/Kenali-Hadapi-Kanker-Payudara/
Tuyen DQ, Dung TV, Dong H Van, Kien TT, Huong TT. Breast Self-Examination: Knowledge and Practice Among Female Textile Workers in Vietnam. Cancer Control. 2019;26(1):1–7. doi: 10.1177/1073274819862788.
Heena H, Durrani S, Riaz M, Alfayyad I, Tabasim R, Parvez G, et al. Knowledge, attitudes, and practices related to breast cancer screening among female health care professionals: A cross sectional study. BMC Womens Health. 2019;19(1):1–11. doi: 10.1186/s12905-019-0819-x.
B.K. M, Kaphle HP. Breast self-examination: Knowledge, practice and associated factors among 20 to 49 years aged women in Butwal sub-metropolitan, Rupandehi, Nepal. PLoS One. 2023;18(6):e0286676. doi: 10.1371/journal.pone.0286676.
Sulu SM a. M, Mukuku O, Sulu AMS, Massamba BL, Mashinda DK, Tshimpi AW. Knowledge regarding breast cancer among Congolese women in Kinshasa, Democratic Republic of the Congo. Cancer Rep. 2023;6(3):1–9. doi: 10.1002/cnr2.1758.
Bloom BS, Engelhart MD, Furst EJ, Hill WH, Krathwohl DR. The Classification of Educational Goals. Taxon Educ Object [Internet]. 1956 [dikutip 6 Oktober 2023];62–197. Available from: https://web.archive.org/web/20201212072520id_/https://www.uky.edu/~rsand1/china2018/texts/Bloom et al -Taxonomy of Educational Objectives.pdf
Wang L, Abualfoul M, Oduor H, Acharya P, Cui M, Murray A, et al. A cross-sectional study of knowledge, attitude, and practice toward COVID-19 in solid organ transplant recipients at a transplant center in the United States. Front Public Heal. 2022;10. doi: 10.3389/fpubh.2022.880774.
Moshki M, Shahgheibi S, Taymoori P, Moradi A, Roshani D, Holt CL. Psychometric properties of the mammography self-efficacy and fear of breast cancer scales in Iranian women. BMC Public Health. 2017;17(1):1–9. doi: 10.1186/s12889-017-4404-7.
Cal A, Yildiz MK, Avci IA. Examination of knowledge and fear levels of breast cancer with the spiritual characteristics of nurses. Front Public Heal. 2018;6(NOV):1–7. doi: 10.3389/fpubh.2018.00331.
Conroy RM. The RCSI Sample size handbook: a rough guide [Internet]. 2021 [dikutip 12 September 2023]. Tersedia pada: https://www.beaumontethics.ie/docs/application/samplesize2021.pdf
Stoltzfus JC. Logistic Regression: A Brief Primer. Acad Emerg Med. 2011;18:1099–104. doi: 10.1111/j.1553-2712.2011.01185.x.
Dahlan MS. Statistik untuk kedokteran dan kesehatan; deskriptif, bivariat, dan multivariat dilengkapi aplikasi menggunakan SPSS. 6 ed. Jakarta: Epidemiologi Indonesia; 2020.
Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3(17). doi: 10.1186/1751-0473-3-17.
Zhang Z. Model building strategy for logistic regression: purposeful selection. Ann Transl Med. 2016;4(6):1–7. doi: 10.21037/atm.2016.02.15.
Dimock M. Defining generations: Where Millennials end and Generation Z begins [Internet]. Pew Research Center. 2019 [dikutip 16 September 2024]. Available from: https://www.pewresearch.org/short-reads/2019/01/17/where-millennials-end-and-generation-z-begins/
Asosiasi Penyelenggara Jasa Internet Indonesia. Survei Penetrasi Internet Indonesia 2024 [Internet]. 2024. Available from: https://survei.apjii.or.id/
Lee M, Lee H, Kim Y, Kim J, Cho M, Jang J, et al. Mobile app-based health promotion programs: A systematic review of the literature. Int J Environ Res Public Health. 2018;15(12). doi: 10.3390/ijerph15122838.
Yusuf A, P. Iskandar YH, Ab Hadi IS, Nasution A, Lean Keng S. Breast awareness mobile apps for health education and promotion for breast cancer. Front Public Heal. 2022;10. doi: 10.3389/fpubh.2022.951641.
Majid MA, Achmad A, Holik HA, Kartamihardja AHS. Breast Cancer Awareness among Bandung Adolescents. J Pengabdi Kpd Masy (Indonesian J Community Engag. 2022;8(1):35. doi: 10.22146/jpkm.60270.
Al-Ismaili Z, Al-Nasri K, Al-Yaqoobi A, Al-Shukaili A. Awareness of breast cancer risk factors, symptoms and breast self-examination among omani female teachers: A cross-sectional study. Sultan Qaboos Univ Med J. 2020;20(2):194–201. doi: 10.18295/squmj.2020.20.02.010.
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