Breast Self Exam Education

1. Breast Self Exam Education Keli S Holley Auburn University/Auburn Montgomery

2. The American Cancer Society estimates that 232,620 women are diagnosed with breast cancer each year and 39,970 women will die. • Breast cancer is second only to lung cancer as a cause of cancer deaths in American women, accounting for one of every three cancers diagnosed in the United States. • Poverty, inferior health care, barriers to health care access, health beliefs, personal behaviors, and later stage of disease at diagnosis are some of the reasons attributed to this disparity (American Cancer Society, 2012). Breast Cancer

3. Breast Self Exam (BSE) • According to the American Cancer Society and the US Preventive Services Task Force, screening is the key to finding breast cancer in its early, treatable stages. • The role of the nurse practitioner (NP) is to identify sociocultural factors that may influence screening and incorporate them into health messages for women. Being proactive in preventive measures may help lessen the existing disparity and improve survivability (Registe & Porterfield, 2012).

4. Need for Health Education • Studies have found that older women have less knowledge about and are less likely to perform breast self-examination. • Less educated women and those without health insurance also have significantly lower use of mammography and clinical exams. • Women of color use breast cancer screening methods less frequently than Caucasian women at all ages. • Nationwide studies have found that the women most likely to be unaware of the need for a mammogram and never to have received one are women of color, low-income women, and women with a high school education or less (Hurdle, 2007).

5. BSE Compliance According to Race 10 out of 15 participants stated that they do not perform a BSE after only receiving a brochure at the Cambers County Health Department

6. Compliance with BSE

7. Project and Theory • When this disparity was noticed, the NP of the health department and the student NP collaborated to incorporate a demonstration and teach back method on how to perform a BSE along with the brochure during the patient’s visit. • The theory underpinning the methodology of the educational intervention in this study is feminist pedagogy. • Feminist pedagogies have been developed that maximize the involvement and learning of female students. Elements of the educational intervention used in this study that relate to feminist pedagogy were an emphasis on personal empowerment, connection of personal experience with new information, and developing connection and support.

8. Theory of Self-Efficacy • Another theory used is the self-efficacy theory, which was derived from social cognitive theory, has proven to be a useful guide in understanding health behaviors and facilitating behavioral change including breast health and BSE. • Bandura suggested that four information sources increase self-efficacy expectations: enactive attainment, vicarious experience, verbal persuasion or exhortation and physiological state or physiological feedback during a behavior. • Judgments of these factors affect the individual’s confidence in her ability to accomplish a given task.

9. SBE Teachings • The best time for a woman to examine her breasts once a month the week after menses. • While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, dimpling, or redness of the nipple or breast skin. • Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area.

10. Teachings cont. • Lie down on your back and place your right arm behind your head. Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue. Use three different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs.

11. SBE Teachings • Use each pressure level to feel the breast tissue before moving on to the next spot. • Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone. Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone.

12. Teachings cont. • There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast without missing any breast tissue. • Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam. • This procedure for doing breast self-exam is different from previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increase a woman's ability to find abnormal areas (American Cancer Society, 2012).

13. Teachings cont. • After the BSE is explained and demonstrated by the NP, questions were asked about when, how, and what to look for, which the patient answers and is encouraged to demonstrate the right technique. • Then an up-to-date brochure created by the Alabama Health Department is given to them as a reference or as something they can give to a friend or family member.

14. Results • Out of the 15 participants, all agreed they would perform the exam every month as taught. When asked if they feel knowledgeable on how to perform a BSE, they all stated that the demonstration was helpful along with the brochure. • For the participants that stated that they forget to perform the exam. The NP suggested that they tie a pink ribbon in their shower or tape it to their bathroom mirror as a reminder.

15. Evaluation • By spending the time to teach the patient and emphasizing the benefits of the exam, encouraged the 15 participants to perform a BSE monthly. • Conclusions about breast health education must be made with caution due to the small sample size and the low response rate. • If allowed more time a study should be done on a larger group over one year to validate the effectiveness of demonstration and teach back education of BSE. This would allow more efficient follow-up with the helpfulness of a questionnaire. • A study done by Yi and Park, 2012 resulted that a one-time breast health class provided by trained breast cancer survivors can be useful in motivating young women to adopt behaviors that help to prevent breast cancer morbidity and mortality. A class such as this may be a great asset for health promotion along with this study.

16. Summary • Along with a healthy lifestyle and early detection through the use of various screening methods such as a BSE is the best hope for saving lives. • This study was found to be effective in improving breast cancer and BSE knowledge, skills, performance and self-efficacy. • By empowering women on how to perform a BSE by demonstration, teach back method, and a brochure will increase compliance and detect breast cancer during the early stages.

17. References • American Cancer Society. (2012). Breast cancer information and resources. Retrieved from: www.cancer.org/fightbreastcancer • Bandura, A. (1986). Social foundations of thought and action. Prentice Hall, Englewood Cliffs, NJ. • Hurdle, D. (2007). Breast cancer prevention with older women: A gender-focused intervention study. Health Care for Women International, 28(10), 872-887. • Registe, M., & Porterfield, S. (2012). Health beliefs of African American women on breast self-exam. Journal for Nurse Practitioners, 8(6), 446-451. doi:10.1016/j.nurpra.2011.09.025 • Yi, M., & Park, E. (2012). Effects of breast health education conducted by trained breast cancer survivors. Journal of Advanced Nursing, 68(5), 1100-1110. doi:10.1111/j.1365-2648.2011.05815.x