INTRODUCTION:

The female breast has been regarded as a symbol of beauty, sexuality and motherhood. Any actual or suspected disease or injury affecting breast tends to reflect the prevailing societal view of the breast. It has an important role in modern culture. often viewed as measures of sexuality, femininity and attractiveness because it is visible for its size and shape.

However, it is a secondary sex characteristic. Its physiological function is milk secretion to feed infants.¹

WHO (2009) reported that Breast Cancer is the top cancer in women both in the developed and the developing world. The incidence of Breast Cancer is increasing in the developing world due to increase life expectancy, increase urbanization and adoption of western lifestyles. Although some risk reduction might be achieved with prevention, these strategies cannot eliminate the majority of Breast Cancers that develop in low- and middle-income countries where breast cancer is diagnosed in very late stages. Therefore, early detection in order to improve Breast Cancer outcome and survival remains the cornerstone of Breast Cancer control.²

Kalliguddi S et al (2019) reported that Breast cancer is one of the leading causes of cancer deaths among women in India. Overall outcome of this disease is largely dependent on early detection and medical intervention. Breast Self-Examination (BSE) is an easy, cost effective, and safe method of screening for the same. India is witnessing a soaring increase in the number of patients being diagnosed with Breast Cancer at a young age. Breast Cancer recently surpassed cervical cancer and has become the most common cancer among Indian women. The age-adjusted incidence rate of carcinoma of the breast was found as high as 41 per 100,000 women for Delhi, followed by Chennai (37.9), Bangalore (34.4), and Thiruvananthapuram District (33.7). There has been a significant increase in the incidence of Breast Cancer over the years and it continues to rise steadily. Breast Cancer-associated mortality is eminent, being the fifth highest due to cancer and the most common cause of death due to cancer among women.³

Godfrey K et al (2016) reported that Breast Cancer is the second leading cause of cancer deaths in women and poses a global public health concern. There is an increased burden of Breast Cancer in both developed and developing countries including Uganda. Globally, over one million Breast Cancer cases are diagnosed annually. These amount to a total 411,000 deaths from Breast Cancer accounting for 14% of female cancer deaths world-wide. It is estimated that about half (60%) of Breast Cancer deaths occur in economically developing countries.⁴

Yusra et al (2014) reported that Breast Cancer is the most common cancer among women. The most recent estimate indicated that more than 1.6 million new cases of Breast Cancer occurred among women worldwide in 2010. Control of modifiable Breast Cancer risk factors such as maintaining a healthy weight, regular exercise and reducing alcohol intake could eventually have an impact in reducing the incidence of Breast Cancer. However, these strategies cannot eliminate the majority of Breast Cancers. Therefore, early detection in order to improve Breast Cancer outcome and survival remains the cornerstone of Breast Cancer control.⁵

Joyce et al (2009) reported Breast Self-Examination is simple technique that women can use to assess for changes in their breast that may single breast cancer. The risk is highest in women older than 50 but women in their 20s should begin BSE. The women should become familiar with the normal appearance and fill the breasts to be confident of her ability to perform BSE. Advise the women to schedule a regular time each month to assess her breasts. The best time is approximately 1 week after the onset of the menstrual cycle each month.⁶

STATEMENT OF THE PROBLEM:

Assess the knowledge regarding breast self-examination among medical students in IGIMS, Patna, Bihar.

OBJECTIVES:

1. To assess the knowledge score of Medical students regarding Breast Self-Examination.

2. To find out the association of the knowledge score with selected demographic variables.

ASSUMPTIONS:

1. Medical students might have some knowledge regarding Breast Self-Examination.

2. Medical students’ knowledge regarding Breast Self-Examination might vary according to demographic variables.

INCLUSION CRITERIA:

1. Medical students of IGIMS-Medical College, Patna-14

2. Medical students who are present at the time of data collection

3. Medical students who are willing to participate

4. Medical students who are above 16 year and below 30 year.

EXCLUSION CRITERIA:

1. Medical students who are sick and having Breast Cancer and Tumor and other breast anomalies.

2. Medical students above 30 year.

METHODOLOGY:

Research approach:

In the present study non experimental research approach was used to assess the knowledge regarding Breast Self-Examination among Medical students.

Research design:

In the present study investigator selected descriptive research design to assess the knowledge the regarding Breast Self-Examination

Setting:

In the present study IGIMS Medical College, Patna, Bihar was selected to conduct the research study.

Sample size:

Total 100 students from 1^st, 2^nd, 3^rdand 4^th year of IGIMS Medical College were selected to assess the knowledge regarding Breast Self-Examination.

Population:

In the present study the subjects are students of IGIMS Medical College Patna.

Sample and sample Technique:

In the present study, the samples are the Medical students of IGIMS, Medical College Patna, Bihar. A purposive sampling technique was used in the present study to select the sample.

Description of tool:

A Self-Structured Knowledge Questionnaire was developed to assess the knowledge regarding Breast Self-Examination.

Part 1: Socio demographic profile:

It consists of the personal information of the students such as age, year of study, type of habitat, religion, marital status, mother's education, father's education, health personnel in the family, family history of breast cancer, attended previous classes on Breast Self-Examination (BSE), ever done Breast Self-Examination (BSE).

Part 2: Self-Structured Knowledge Questionnaire on knowledge regarding Breast Self-Examination (BSE).

It consists of thirty-two close ended questions regarding the Breast Anatomy, Breast Cancer, Breast Self-Examination.

Content validity:

To ensure the content validity of self-structured knowledge questionnaire tool was submitted to experts from the field of mental health nursing, community health nursing, medical surgical nursing, midwifery and obstetric nursing. They gave their suggestions and further modifications were made according to their suggestions with the help of guide and co-guide.

Ethical Considerations:

Written informed consents were taken from Principal of IGIMS-Medical College, Patna and Medical students who participated in the study. The study procedure was explained and written information was also given to Medical students. They were assured that the information given by them will be kept confidential and will be used purely for research purpose.

Data Collection Procedure:

For major study, the data collection procedure started from 21^stAugust, 2018 to 4^th October, 2018. A written permission was obtained from Principal of Medical College, IGIMS, Patna (Bihar). A Self-Structured Questionnaire was used to collect data for the study. The total numbers of 100 Medical students were selected using purposive sampling technique.

ANALYSIS AND INTERPRETATION:

Section I:

Description of demographic variables of the Medical students:

Demographic variables of the Medical students observed over the factors of “Age, Year of study, Type of Habitat, Religion, Marital status, Mother's education, Father's education, Health personnel in the family, Family history of Breast Cancer, Attended previous classes on BSE, Ever done BSE” were analyzed.

Section II:

Objective I: To assess the knowledge score of Medical student regarding Breast Self-Examination

Table 1: Level of knowledge regarding Breast Self-Examination N=100

Knowledge level	Frequency (f)	Percent (%)
Adequate	34	34
Moderately adequate	61	61
Inadequate	5	5
Total	100	100

It is noted from the table 1 that the level of knowledge for 34% of the Medical students had Adequate, for 61% of the Medical students had moderately adequate and 5% of the Medical students having inadequate knowledge.

SECTION III:

Objective: To find out the association of the knowledge score with selected demographic variables.

Table 3. Association of knowledge score among Medical students regarding Breast Self-Examination with their demographic variables.

	Chi square	df	p	Sig.
Age	6.88	6	0.332	Not Significant
Year of study	10.66	6	0.099	Not Significant
Type of Ha0bitat	6.00	4	0.199	Not Significant
Religion	0.98	2	0.613	Not Significant
Marital status	1.88	2	0.391	Not Significant
Mother's education	6.70	8	0.570	Not Significant
Father's education	22.77	8	0.004	Highly Significant
Health personal in the family	7.34	8	0.500	Not Significant
Family history of breast cancer	4.43	2	0.109	Not Significant
Attended previous classes on BSE	1.41	2	0.495	Not Significant
Ever done BSE	5.25	2	0.072	Not Significant

The cross-tabulation analysis was employed effectively and the results of chi square analysis were observed and shown in Table-3.

It is noted from the table-3 that level of knowledge for 5% of the Medical students is Inadequate, for 61% of the Medical students are Moderately adequate and only 34% of the Medical students have adequate knowledge regarding Breast Self-Examination. Further in order to find the association between the demographic variables and their Level of knowledge the chi-square test was used and result of the test is shown in table-3.

It is noted from the table-3 that the ‘p’ value is less than 0.05 only for the demographic variable of Father's education and hence the result is significant at 5% level. From the analysis it is concluded that there is significant association between the level of knowledge and Father's education.

CONCLUSION:

This study was conducted to assess the knowledge regarding breast self- examination among Medical students in IGIMS, Patna. In this study, descriptive research design was used by taking 100 samples using purposive sampling technique at the selected area of IGIMS-Medical College, Patna. Data was collected by using Self-Structured Knowledge Questionnaire which, provided to Medical students. Data was analyzed and interpreted by applying respective statistical methods.

The conclusion of the study was drawn on the basis of major finding which are as follows:

· Among 100 sample majority of the Medical student.

· It was concluded that demographic variables such as age, year of study, type of habitat, religion, marital status, mother education, health personnel in the family, family history of Breast Cancer, have you attended any previous classes on Breast Self-Examination and have you ever done Breast Self-Examination was non-significant whereas there was significant association with the father education.

LIMITATIONS:

· The data collection is only in the area of IGIMS-Medical College, Patna.

· The data collection is through Self-Structured Knowledge Questionnaire method.

· The study was conducted with only 100 samples.

NURSING IMPLICATION:

The study findings have certain very important implications for the Nursing profession i.e. clinical practice, community health nursing, obstetrical and gynaecological nursing, nursing education. In these entire area nurses can motivate in increasing the level of knowledge regarding Breast Self-Examination among Medical students.

Nursing education:

The nursing curriculum should have emphasis on Breast Self-Examination and its consequences which help the nurse to interview the target group in the form of health awareness, early detection and treatment related to breast problems and prevention of Breast Cancer.

Nursing administration:

Institutions provide knowledge regarding Breast Self-examination and nurses should review their knowledge related to Breast Self-examination. A separate unit or trained nursing team can be provided knowledge regarding Breast Self-Examination. Nursing administrator should involve in formulating the policies for health education in hospital as well as community. A public health workshop can be organized to improve the knowledge regarding Breast Self-Examination.

Nursing research:

Findings of this study can be utilized to improve the knowledge of Public and females regarding Breast Self-Examination. This study will form the base for more extensive research in future in this direction as few studies have been conducted in the area of assessing Medical students’ knowledge regarding Breast Self-Examination. The study can be conducted on large sample to make the picture clearer and the findings generalizable.

RECOMMENDATIONS:

· The study can be replicated on a large sample to validate and generalize its findings.

· Similar study can be undertaken with a multi-setting approach.

· The study can be undertaken in community settings to have true picture of knowledge regarding Breast Self-Examination.

· A comparative study can be done between urban and rural females regarding Breast Self-Examination.

· More and more research should be conducted in order to develop more innovative strategies to improve the knowledge regarding Breast Self-Examination.

References:

1. ALSD Kommula, S Borra, V M Kommula. Awareness and practice of breast self-examination among women in South India. International Journal of current Microbiology and Applied Sciences. 2014; 3(1): 391-4.

2. World health organization (WHO) Breast cancer: prevention and control.2009. Available from: https://www.who.int/cancer/detection /breastcancer/en/

3. Kalliguddi Samarth, Sharma Sahithi, and A Gore Chaitali. Knowledge, attitude, and practice of breast self-examination amongst female IT professionals in Silicon Valley of India. [Serial online] 2019 Feb [28]; 8(2): [568-572]. Available from: http:// www.jfmpc.com/article.asp?issn=2249.4863;year=2019;volume=8;issue=2;spage=568;epage=572;aulast=Kalliguddi

4. GodfreyKatende, AgathaTukamuhebwa and Nankumbi Joyce, Breast Cancer Knowledge and Breast Self-Examination Practices among Female University Students in Kampala, Uganda: A Descriptive Study. [Serial online] 2016 Mar; 31(2): [129–134]. Availablfrom: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4861385/

5. Yusra E E, Grivna Michal, Nagelkerke Nico et.al. Breast Cancer Screening Awareness, Knowledge, and Practice among Arab Women in the United Arab Emirates: A Cross-Sectional Survey [serial online] 2014; 9[3]. Availablefrom:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179300

6. Joyce, Jane Hokanson Hawks; (2009) “Medical Surgical Nursing”, 8th Edition, Publisher Reed Elsevier India Private Limited, P-1101

Received on 04.10.2020 Modified on 19.11.2020

Int. J. of Advances in Nur. Management. 2021; 9(1):7-10.

DOI: 10.5958/2454-2652.2021.00003.2