Knowledge shown that there exists an inaccurate knowledge of

 

Knowledge
of Preventive Breast Cancer Screening in Women

According to the National Breast Cancer
Foundation(NBCF), breast cancer is the most commonly diagnosed cancer in women,
the second leading cause of death among women in the world and one in eight
women will be diagnosed with cancer in their life time, (2012). However, breast
cancer deaths are preventable when detected early and treated. Although death
from breast cancer has been declining since the 1990s due to increase in
knowledge, screening, early detection and improved treatment, it has not been
the case for low income women, (NBCF, 2012). My focus is on mammography as the
most effective preventive cancer screening tool, since “Regular mammography is the best tool available
to detect breast cancer in its earliest stages, availing opportunities for
effective life-saving treatment,” (American Cancer Society, 2011). Studies
have shown that there exists an inaccurate knowledge of breast cancer screening
among low income women around the world which leads to low screening and
consequently high breast cancer death among low income women in the world.

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A study done in Kenya showed that rural
and urban low-income women said that they saw no reason to have one’s breasts
checked if they looked healthy and not painful. And while most of the urban
middle-income women were able to describe early detection measures such as
self-breast exam, clinical breast exam, mammography in detail and even had
experienced them, most urban low-income and rural women had heard vague knowledge
that such things existed, (Muthoni & Miller, 2009). Another study conducted
among low income Hispanics, native Americans and Caucasians in Wyoming showed
that they had a poor knowledge regarding breast cancer screening and believed that the absence of a family
history of breast cancer implied a low risk for breast cancer, therefore, no
need to get a mammogram. Some of the women thought that an “Inverted nipple”
would be a sign for one to get a mammogram done, (Purtzer, 2012).

A hospital based cross sectional study was
conducted in Ibadan, Nigeria on the level of awareness of mammography among 818
randomly selected women attending the General outpatient clinic of the
University College Hospital. Only 5% of the women had heard of mammography and
their knowledge of the procedure was poor. The women with no college education
were far less likely to be aware of mammography compared with those college educated
ones. The most common source of information regarding mammography screening
were newspapers and magazines, (Obajimi et al, 2013).

Inadequate health literacy is strongly
associated with lower mammography screening as suggested by a study among
Mexican American women in Texas. Out of a sample of 722 women age 40 and above,
only 44% had a mammogram within the last one year. Participants in the survey
were also given the Short Test of Functional Health Literacy (STOFHLA) in
either English or Spanish. STOFHLA consisted of patient medical instructions
for X-ray preparation and the rights/responsibilities part of a Medicaid
application form. Out of 36 questions, 50.42% scored below 22, meaning they had
inadequate health literacy, and consequently a lower mammography screening
among the Hispanic women residing in the Lower Rio

Grande
Valley of Texas, (Pegan et al, 2012).

 Identify three factors that may affect achievement
of optimal health in the selected population.

Low socio-economic status, inadequate health
literacy related to low level of education, and old age were associated with poor
knowledge of mammography screening in low income women. The studies examined
supported that the above factors are interrelated in contributing to the poor
knowledge and use of mammography screening among low income women. Breast cancer screening knowledge and
practices among women in southeast of Iran study showed that overall knowledge
of breast cancer screening was inadequate in 67.4% and only 1.3% had a
mammography throughout their life. Further about mammography, 72.7% had poor knowledge, 24% had average
knowledge and 3.4% had good knowledge. A questionnaire was used that had
demographic characteristics such as age, educational level, socioeconomic
status and knowledge of mammography. Statistically, there was a significant
relationship between the overall knowledge of breast cancer screening and level
of education. The lower the level of education and socio-economic status, the
lower the knowledge of breast cancer screening. Also, statistically there was
an inverse relationship between knowledge of mammography with age. The older
the women, the poorer the knowledge of mammography. In older women of
40-49years of age, 94.4% had poor knowledge while women 15-24, 66% had poor
knowledge, (Heidari, Mahmoudzadeh-Sagheb & Sakhavar, 2008).

Select from these factors the one
that you believe is both a priority and most amenable to nursing

            The Iran study above revealed that
there is a direct relationship between low level of education and poor
knowledge on mammography screening in low income women. As a result, both low
level of education and low literacy on mammography screening will be considered
as one factor and nursing interventions will target this factor. It is
imperative to say that low income women with low level education have poor
knowledge of mammography screening for breast cancer leading to the higher rate
of death from breast cancer among them. Low level of education is related to poor
and insufficient knowledge of preventive breast cancer screening of mammography
among poorly educated low income women might be the reason why the decline in
death from breast cancer since 1990 has not been the case for them.

Implications
for practice

            Low income women with low level of
education have poor knowledge of breast cancer screening and, therefore, need
to be educated on preventive breast cancer screening of mammography. Healthcare
providers should not only recommend mammography screening for low income women
but teach them that preventive breast cancer screening is important at age 40
and above, whether or not risk factors and symptoms are present, in order to
detect breast cancer in its earliest stages. Follow up with patients to

Primary care nurses need to teach low
income patients with only high school diploma or lower level of education that
at age 40 and above, women need to get mammogram screening for breast cancer
every 2 years. Community health nurses practicing in low income neighborhoods
need to educate community members and encourage them to get mammogram screening
every 2 years. Advanced practice nurse care providers need recognize risk
factors for poor knowledge of mammogram screening such as low level of
education in low income patients. And provide resources such as breast cancer
clinics to low income women with no college degree.

            As an acute care nurse who also
works in a Subacute, Rehab and Nursing home facility, there are always
educational resources regarding breast cancer screening on the company’s
educational website that could be handed over to patients and families. In the
near future when I become a primary care provider at the forefront of health
care, I would incorporate into my practice the habit of teaching and
encouraging my patients about breast cancer screening. When I come across
patients in teachable states, regardless of the healthcare setting, it would be
important to recognize these risk factors: Are they low income women? Is high
school their highest level of education? If the answer to my assessment is yes,
then it would be important to go ahead and make them aware of mammogram
screening for breast cancer at age 40 and above even in the absence of breast
cancer are not present.

                                   

 

References

 Muthoni, 
A. & Miller, A. (2010). An Exploration of Rural and Urban Kenyan. Health
Care for Women International, 31:801–816. http://www.tandfonline.com.lib
proxy.calvin.edu/doi/pdf/10.1080/07399331003628453

Atlanta: American
Cancer Society. (2012). Cancer Facts and Figures . Retrieved from http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-031941.pdf

Davis, T. C. (1998).
Knowledge and attitude on screening mammography among low-literate, low-income
women. Cancer, (78)1912-1920. http://www.ncbi.nlm.nih.gov/pubmed/8909311

Eisner,  J., Zook, G., Goodman, N., & Macario, E.
(2002). Knowledge, Attitudes, and Behavior of Women Ages 65 and Older on
Mammography Screening and Medicare: Results of a National Survey. Women and
Health, (36),1. http://www.ncbi.nlm.nih.gov/pubmed/12555798

José A. & Pagán,
C. (2012). Health Literacy and Breast Cancer Screening among Mexican American
Women in South Texas. Journal of Cancer Education, 27(1),132-137. http://dx.doi.org.lib-proxy.calvin.edu/10.1007/s13187-011-0239-6 

National Breast Cancer
Foundation. (2012). Breast Cancer. Retrieved from
nationalbreastcancer.org: http://www.nationalbreastcancer.org/

 Ahmed, N., 
Ford, J., Fair, M., Samenya. K., & Haber, G., (2009). Breast cancer
knowledge and barriers to mammography in a low-income managed care population. Journal
of Cancer Education, 24 (4): 261-6. http://dx.doi.org.lib-proxy.calvin.edu/10.1080/08858190902973077 

Obajim O. et al.
(2013). Level of awareness of mammography among among women attending outpatient
clinics in a teaching hospital in Ibadan, South-West Nigeria . BMC Public Health, (13),1471-2458. http://www.biomedcentral.com/1471-2458/13/40/

Purtzer, M. (2012). A
Transformative Decision-Making Process for Mammography Screening Among Rural,
Low-Income Women. Public Health Nursing, (29),3. http://www.ncbi.nlm.nih.gov/pubmed/22512426

Ramirez, F. &
Aparicio, T. (2009). Breast and Cervical Cancer Knowledge, Attitudes, and
Screening Practices of Hispanic Women Diagnosed with Cancer. Journal of
Cancer Education, 18(4):230-236. http://www.ncbi.nlm.nih.gov/pubmed/14766334

Terry C. & Davis,
A. (1998). Knowledge and attitude on screening mammography among low-literate,
low-income women. Cancer, (78),1912-1920. http://onlinelibrary.wiley.com/doi/10.1002/(SICI)1097-0142(19961101)78:9%3C1912::AID-CNCR11%3E3.0.CO;2-0/abstract

Vahabi, M. (2011). Knowledge of Breast Cancer and Screening
Practices
among Iranian immigrant women in Toronto . Jounal of Community Health,
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Heidari, Z., Mahmoudzadeh-Sagheb, H., & Sakhavar. N.
(2008). BREAST CANCER SCREENING KNOWLEDGE AND AMONG WOMEN IN SOUTHEAST OF
IRAN . Acta Medica Iranica, 46(4): 321-328. http://acta.tums.ac.ir/files/journals/1/articles/3528/public/3528-3885-1-PB.pdf