Breast Cancer And Breast Self Examination

heart Cancer And dummy ego Examination teat crabmeat is a major killer sickness of women both glob b arlyy and regionally. It is the intimately common land crab louse among women, and the second get along of deaths among women worldwide (World Health Organization WHO, 2010). The incidence of bureau genus Cancer in women remains graduate(prenominal)school. It is estimated that 1,000,000 women develops dummy lavcer distributively year and Approximately 519,000 women deaths be connect to titty crabby person (WHO, 2010 McPherson, poise, Dixon, 2000). correspond to Manning-Walsh (2004) thorax crabmeat incidence has pro departd and it is alarming for women affecting all ages. As a go, interpersonal relationships such as marital or sexual relationship atomic number 18 negatively affected. Stephen (2009) described white meat pubic louse as a cancerous (cancerous) growth that begins in the tissues of the thorax, cancer is a dis go in which aberrant cells grow in an uncontrolled appearance (p.1). nonwithstanding at that place is no cognise cause for knocker cancer but in that location argon risk factors that be closely link to development and progression of booby cancer. Breast cancer is assort into four plays. According to The American articulatio Committee on Cancer (AJCC) revise the four symbolises atomic number 18 establish on tumour size of it, the degree of lymph client involvement, the presence of inflammatory signs, and picture of metastasis (Singletary at el. 2002). Stage (I) depreciator cancer involves primarily small tumors (less than or equal to 2 cm) with no known lymph node involvement and no metastases to otherwise(a) organs, in Egypt few women present at this stage. stage (II) breast cancers are characterized by either slightly larger basal tumor than stage (I) (between 2 and 5 cm) or if at that place is lymph node involvement. stage (III) consists of large tumors (greater than 5 cm) with signs of inflammatory breast cancer, also if ipsilateral nodes are involved where the tumor has ca utilise the node to be fixed to another node or to other personify structures it is goalated stage (III), high percent of women present in this stage which treatment option are hold in. Stage 4 doer some(prenominal) metastatic breast cancer no matter what size the tumor or if there is nodal involvement or not. If it is metastatic, it is stage (IV), in general stage (IV) is not considered curable (Singletary at el. 2002). The occurrence of breast cancer prepares psychosocial stress for both the patient and her family, due to threat to the patients b claim and butter and other consequences of breast cancer such as metastasis to other body organs and parts. In adjunct stu glide bys obligate shown that center field aged women (40-60) are most likely to develop breast cancer, and most patients with breast cancer present for the first time at stages two and three (Khatib, Modjtabai, 2006). Breast cancer has high incidence among women during productive period and has effect on financial as breast cancer treatment is very costly.Breast cancer account for 37% of all types of cancer globally, more thanover incidence of breast cancer varies from nonpareil and however(a) country to another (WHO, 2010). In fall in State of America (USA) intimately 20 women allow for develop breast cancer each hour, moreover and around 5 women go out die with breast cancer each hour (Lancaster, 2005). Studies have established that the tell of breast cancer is highest in USA and Canada, one base away of cabaret women are pass judgment to develop breast cancer and it is most common among women age 47-73 age old, leading to epidemic proportions in USA and Canada (McPherson, Steel Dixon, 2000 George, 2000 Naeem at el., 2008). 182,460 cases developed breast cancer in USA in 2008 (Jemal at el., 2008). landal OverviewBreast cancer incidence in develop country is high almost as high as in developed countries. One out of nine Pakistani women are expected to developed breast cancer (50 per 100,000), which is high compared to Indian women (19 per 100,000) (Kumar, Imam, Manzoor, Masood, 2009). In Iran, one of the Arabic Country, in 2005 prevalence of breast cancer among women was (22 per 100,000) (Tavafian, Hasani, Aghamolaei, Zareand, Gregory, 2009). Breast cancer is a major wellness alarms for many a(prenominal) countries in the Mediterranean Region such as Bahrain represents 38.4% of all female cancers and in Jordan its represents 28% of all female cancers (Khatib, Modjtabai, 2006 Center for Arab Genomic Studies, 2003).Likewise, breast cancer is the most common cancer among Egyptian women. According to the Egypt National Cancer Institute (NCI) in Egypt, breast cancer represents 18.9% of all cancers cases (35.1% in women and 2.2 % in men) (Omar, et al. 2003). Incidence of breast cancer is not different comparing with other countries which represented (24 per 100, 000) and mortality sum up related to breast cancer is 9.3% of all cancers (Seif, Aziz, 2000). According to Khatib and Modjtabai (2006) Egyptian women downstairs the age of 50 are more likely to develop breast cancer, where women aged 50 years and older are the most ordinarily affected group. In Egypt breast cancer is usually detected at late stages (around 60% of cases detected in third stage of breast cancer), when treatment options are limited therefore breast cancer is high fetal (Bender et al. 2005 Ibrahim at el., 2010).In Aswan, breast cancer is most prevalent cancer among both males and females (Ibrahim at el. 2010). unless it is presents 63.9% of all cancer cases among Aswan females, and most women aged (40-59) are the most commonly affected group. According to Ibrahim at el. (2010) later on the age of 20 years, breast cancer became the most stalk cancer with a peak in the age group 40-59 years (p.72). In extension most cases are diagnosed in late stages only 3. 1% cases are diagnosed in first stage, on the other commit around 96.2% of breast cancer cases are diagnosed in second and third stage when treatment options are limited making breast cancer is high fetal. As a result it is important to hear Aswan females visualise or so breast egotism enquiry and other(a) maculation of breast cancer. Moreover the high incidence and mortality outranks of breast cancer, as hale as the high cost of treatment and limited resources available, require that it should exsert to be a focus of attention for health negociate stick outrs. The benefits of battle breast cancer, including the positive impact that early detection and screening can have, conduct to be conservatively reference booked.Early detectionThe early detection of breast cancer is the most important and beneficial area of protection techniques. Diagnosis of breast cancer during the early stages of disease has been positively linked to a pass in the mortality and morbidness of the illness (Budden, 1998 hoary 1990 Mele, Archer, Pusch, 2005). Early detection of breast cancer is very important to decline the morbidity and mortality of breast cancer outcome mammography and breast self trial have been employ as strategies for this solve (Budden, 1998 blue-eyed(a) 1990 Mele, Archer, Pusch, 2005). Moreover there are a number of approaches to the screening of breast cancer such as Breast self-examination ( mad cow disease), clinical breast examination and mammography (Khatib, Modjtabai, 2006). (I) mad cow disease is effective, cheap and less painful however, it is pendent on intimacy, spot towards bovine spongi image encephalitis use among women. (II) Clinical breast examination is one of the primary modes of screening for breast cancer. Its effectiveness is dependent upon the skills of the health care caterrs and the facilities available. (III) Mammography is known to reduce breast cancer mortality among women, but its benefits are dependent up on several factors such as the equipment used, the skills of the technician and it is expensive as well (Khatib, Modjtabai, 2006 Budden, 1998 Gray 1990 Mele, Archer, Pusch, 2005).Breast Self examination mad cow disease should be preformed both month starting at age 20 (ACS, 2009). The purpose of bovine spongiform encephalitis is for a woman to learn the natural features of her breast, know how her breasts normally feel, thus easier for her to hear and report any new changes to the physician. (Gray, 1990 Highton, 2002). in that location is strong evidence that BSE can reduce mortality from breast cancer, around 90% of breast cancer are detected by BSE. (Smith, 2002 Wilson Ayers, 2007). However the studies showed that BSE drill is very low. Therefore women should be aware of BSE tool. Consequently there seems to be general agreement on the enormousness to empower women with BSE knowledge and skill to promote BSE place. Several studies have shown that there is a gap in knowledg e active BSE and lend oneself among women. (Al Qattan, Alsaleh, Al Musallam, Masoud, 2008 Alkhasawneh, Akhu-Zaheya, Suleiman, 2009 Wilson Ayers, 2007).George (2000) the barrier to breast cancer screening could be classified to personal, caregiver or demographic barriers, personal barriers included lieu and inadequacy of breeding. At caregiver level, the assumption is lack of knowledge, skills, view, and consistency. For demographic it could be related to age, education level or culture. A fear of detecting any lump is also considered one of breast cancer screening barrier. The WHO (2010) suggested that to decrease the incidence of breast cancer in developing countries, breast cancer screening programs should be emphasized. The way this phenomenon is perceived by women influenced by many factors such as womens socio cultural beliefs, values, geographical environment, personal knowledge and so on. Women face many challenges in unpolished areas which may affect their tint of life. To enhance the quality of life of tenderness age women in verdant areas, it is important to have in depth pinch closely their BSE cognition.Breast self examination practice acquaintance and practice rate of BSE is varies from one country to another. According to Coleman (1991) around 96% of the American women had heard around BSE, however only 19-40% of them practice BSE every month. In the other hand 37% of the Kuwaiti women are practice BSE (Al Qattan, Al Saleh, Al Musallam Masoud, 2008). In literature review only two studies were founded that were conducted in Egypt about BSE one was on evaluation of effect of breast self examination training program on knowledge, attitude and practice (Seif Aziz, 2000 p. 105), among 122 worker women in Ain Shams University- Lower Egypt. The result showed that around 25% of the role players have knowledge about breast cancer and BSE, however only 10.6% and 11.5% of the total sample practiced BSE. In admission the participant ass erted that caregiver teams have an important role to provide the knowledge, skills and practice about BSE (Seif Aziz). The second try out is Breast self-examination practice and its impact on breast cancer diagnosing in Alexandria, Egypt (Abdel-Fattah, Zaki, Bassili, El-Shazly, Tognoni, 2000, p.34). The result showed that 10. 4% of breast cancer patient practiced BSE after being diagnosed with breast cancer as playing area was centre on breast cancer patients, to monitor for spread of the cancer to the superior(predicate) breast (Abdel-Fattah, Zaki, Bassili, El-Shazly, Tognoni, 2000).The gap in the two finding, (I) they focused only on percentage of knowledge and practice of BSE. (II) Both studies recommended follow up for studies to measure BSE knowledge and positive attitude and level of practice among women. (III) There is BSE negative attitude among women (72.1%) without explain the reasons. (IV) Both studies show the importance of attitude and perception of women relate d to BSE practice. Limitations of the two studies as one published in 2000 and the other one in 2003 and both are quantitative re ascertainup. Usually people life style knowledge, attitude and sort changes can be implicationfully captured through soft studies. In addition this entropy could be too old and no longer valid. close of the studies on this subject were quantitative, and were designed to describe the demographic variables associated with BSE practice, increase the compliance or technique of women, or evaluate it as a screening technique. However there were recommendations for further studies to look for women beliefs and attitude about BSE.The purposeThe purpose of this guinea pig is to under(a)stand the perception of BSE among nerve center age women, and explore barriers to practice of BSE among Egyptian women. Furthermore, it allow foring facilitate separate knowledge, skills and practice gaps and recommend strategies to address the gap in BSE. seek Questio nWhat is the perception related to knowledge, attitude and practices of middle age women regarding breast self examination in artless areas of Aswan, Egypt?Re await objectiveTo explore the perception of middle age women related to breast self examination (BSE).To understand Egyptian womens experience about BSE.To assess BSE knowledge and its sources among middle age women.To assess if nurses teach women in community about BSE.To evaluate whether women practice BSE in rural areas.Significance of Proposed mull to NursingIncidence of breast cancer has increased and it seems that it leave behind lapse to rise, as predicted by scientists, physicians and previous studies. To decrease breast cancer morbidity and mortality rate, early detection is important. BSE is an important tool and should be practice to help in early diagnosis breast cancer. This survey impart enable interrogationer to understand perception of BSE among middle age women. Nurses who are working in the hospital or other health institute should be aware of breast cancers knowledge, altitude and practice among women. Hence, help them in early detection and intervention. In addition the findings of this instruction leave alone enhance awareness among health professionals about BSE perception related to knowledge, practice and attitude among women. It also forget provide need to curriculum intervention program about aware of breast cancers early detection knowledge, altitude and practice. As patient education is an integral segment of nursing role. (Saarmann, Daugherty Riegel, 2002). So those who are working in different areas in different status, nurses, health workers, lady health visitor and nurse practician should be able to provide health education according to their socio-cultural and specify sessions on sharing the women experience, perception of BSE and guide in understanding early detection techniques. Moreover can expand the research and may help other in further research if the y want to search more information on BSE in relation to particular(prenominal) aspects such as cultural and religion.CHAPTER THREEMethodologyStudy foundingQualitative descriptive-exploratory design volitioning be used for this study. This design is selected science, weensy is known about BSE experience among women, as the majority of studies carried out on womens knowledge, beliefs, attitudes, and practices related to BSE have been quantitative (Kearney, 2006). Which are chiefly designed to describe the demographic variables associated with its practice, increase the compliance or proficiency of women, or evaluate it as a screening technique. According to Polit and Beck (2008) qualitative approach is conducting the study within naturalistic pattern. A qualitative order deals with experiences of human being in real life by exploring it directly. It helps to understand the phenomenon in- deeply, by giving well-fixed and most appropriate information. In addition according to Po pe and Mays (1995) suggested that qualitative research helps to understand complex behaviors and attitude. The purpose of exploratory study is to examine a specific concept about which little is known (Burns and Grove, 2007). It emphasizes on identification of factors related to a phenomenon of interest. As this study aims to explore perception related to BES Knowledge, attitude and practice of middle age women in Egypt, therefore, a qualitative exploratory descriptive design is best suited to this study.The purposeThe purpose of this study is to understand the perceptionrelated to knowledage , attitude and practice of BSE among middle age women, and explore barriers to practice BSE among Egyptian women. Furthermore, it result help identify knowledge, skills and practice gaps and recommend strategies to address the gap in BSE.Research QuestionWhat is the perception related to knowledge, attitude and practices of middle age women regarding Breast self examination in rural areas of A swan, Egypt?Study Setting and PopulationHealth care clinics in rural areas in Aswan- Egypt testament be selected as setting for recruiting participant. The study macrocosm would be middle aged (40-60 years) women, coming to the health care clinics. The organise population exit be all the middle age women who bequeath meet the following inclusion criteria (I) aged women between 40-60 years. (II) the women who have not been diagnosed with breast cancer. (III) They are living in rural area. (IV) They can talk Arabic or English. (V) They are allowing to go into in the study and use audiotape. Women allow for be excluded if they have any mental illness, as this may affect their judgment, or are not willing to participate in the study.Study Sample and SizeThe sampling method would be used is purposive sample. This type of sampling is often use by qualitative tec because the aim is to contact participants who can give in-depth, rich information about the study phenomenon (Polit B eck, 2008). The study samples comprise of 8-12 women who are in middle age or to the point at which information fertilisation is actiond.Participants RecruitmentHealth care clinics director, physicians and nurses will be met and discuss about the study and request them to identify potential participants. The women who will come to the health care clinic and who meet the inclusion criteria for the study, nurses will give them invitation and try for letter. The women who will be willing to participate will be asked for informed indite and oral consent. Then discuss and agree on the date, time and locale of one to one question according to the womans convenience. The audience will be held in noise unbosom setting either at health care clinic or at participants house/ convenient place. data assemblagePolit and Beck (2008) Polit study help to assess adequacy of the study and quality of instruments (p. 214). earlier to collecting the data, the pilot testing of interview guide w ould be do on 1-2 middle age women who would be coming to the health care clinic of Aswan, Egypt, after taking the participants consent. The objectives of Polit study to evaluate the understanding of the outfit structure questions, to assess the comfort level of the women, to identify the amount of time compulsory by the participants and to determine the time of the day that suits best for the interview to be conducted. The data store from pilot testing will be used as part of the data accumulation.Data will be collected from April 2011 to June 2011 in Aswan, Egypt. For this study, the data will be collected using semi structured questions to guide an in-depth interview. The time for interview is approximately 50-70 minutes. Individual interview will help to explore undivided perception in feature and while asserting confidentially. It is assumed that the participants may feel more comfortable and free while expressing and sharing their experiences in privacy. Audiotape will be used to write down the interview. Notes will be taken for ceremonial occasion make onthings might be applicable to the study, such as participants non vocal communication (facial expressions, posture and other body language). At the end of the session the data will be verified/ cross checked with participants for clarity consistency. After audio magnetic tape the interview, the data would be transcribed and will be checked for matching. discourse ProcessThe written consent will be taken from the participants earlier to the interview. Interview will be conducted in Arabic as it is participants ease so the data will be understood well and warp would be reduced in this way. Probes would be used to explore more information and will provide direction to the participant. Field notes will be taken observation would be noted such as non verbal communication of the patient. Does the non verbal and verbal communication matches or not and observation related to the environment that provides and clue related to the data or experience. The data analysis will be proceeded by guidelines (unrau coleman, 1997) (a) the transcribed interview of the participants will be coded for analyzing data, (b) identifying emerging themes in the data, (c) labeling the themes with monumental code words, (d) codes will be clustered and labeled using broader themes and sub themes throughout analytic forge, (e) the thematic strands will be weaved together into an integrated picture of phenomena under investigation. Data analysis will be carried out manually. The research worker will read the data over and over in search of meaning and deeper understanding, carefully reading the interviews to obtain a general sense of the experience.Data abbreviation PlanData analysis in qualitative research is real begins when data collection begins (Polit Beck, 2008) therefore, the tec will start analyzing the data after taking the first interview. The qualitative data analysis involves four c ognitive processes comprehension- identifying the themes synthesis- merging of the themes to make a composite pattern theorizing- connecting the findings with the larger body of knowledge re-con textbookual matterualization- applying the findings to other setting or the context in which the findings fit (Morse, 1994). Therefore, these processes will be utilize to the data analysis of this study. (a) for analyzing data, the transcribed interview will be coded (b) identifying emerging themes in the data, (c) labeling the themes with probative code words, (d) codes will be clustered and labeled using broader themes and sub themes throughout analytic process, (e) the thematic strands will be weaved together into an integrated picture of phenomena under investigation.Data analysis will be carried out manually. The detective will read the data over and over in search of meaning and deeper understanding, carefully reading the interviews to obtain a general sense of the experience. Acco rding to Morse and Field (2005), tack togethering the responses according to the question is a significant procedure for semi structured interviews. Therefore, the researcher will read the transcripts and gather the responses to each question in a separate file. The gathered responses to each question will be organized in a text that will have three mainstays. The centre column will keep back the participants responses, the left column will show the coding and the right column will include my comments and thoughts concerning the text. The qualitative content analysis will be used as analytic method, while for content analysis the form which is referred by Morse and Field (1995) will be utilized. The form dual-lane into manifest and potential content analysis. In manifest analysis, the researcher search for specific words, phrases or ideas used in the content of interview. In possible analysis, the researcher search for the underlying meaning of the message showed in the text. The latent content analysis has greater validity than manifest analysis as it permits for the coding of the meaning and not just the words of the participants (Morse Field, 1995). Therefore, the researcher will use both analysis methods. For coding, the researcher will reread the text and underline words or phrases and will copy them into the left hand column of the document. At the same time, the researcher also aggregate codes into relevant categories in a separate document. Pseudonyms and identification number to each individual text will be given.The pseudonyms will help to imagine the responsive and to make sense of it, whereas, identification number will facilitate to identify patterns during coding and categorization exercises. The codes with each category will be identify from its origin through identification number. The short form of category will also be assign to a code as well. each category will be compared and contrast that may help to create sub categories. After s orting the major categories into smaller ones, the researcher will look for atypical and representative cases that will help to explain the significant experience found in the research. The researcher will also look for the relationships among categories to find common themes. The researcher will also refer to the notes that have non verbal expressions of the participants and her own feelings in the analysis process. The researcher will be involving the committee members and supervisor throughout the analysis process.Ethical ConsiderationsThe proposal will be sent to the Universitys Ethical review committee (ERC) which will give a written permission for the study. Informed consent and Permission will be obtained from Aswan Directors of Health. The principle of autonomy will be followed which means that Participants will be approached to consent for voluntary participation. Complete information about the study will be provided to the participants. The participant will be informed abo ut the study purpose, risks and benefits of participating. Participants will be approached to consent for voluntary participation and will have freedom to choose or to terminate their participation at any time during the study. No potential physical or mental harm is expected. Those willing to participate will sign a consent form and a copy of the consent form will be provided to the participants. Confidentiality refers to the researchers assurance to the participants that the shared information will not be publicise (Burkhardt Nathaniel, 2002). Thus, confidentiality in this study will be maintained by not sharing the participants data with any other participant and will be observed throughout the study. Anonymity and confidentially is the key principle to maintain privacy (Burkhardt Nathaniel, 2002). The participants identity will not be revealed in the study. Codes will be used instead of the name. The researcher will assure the participants of their confidentiality. The data will not be utilized for any other purpose, there being aneed for secondary analysis of the data permission will be obtained from relevant bodies. This study will help middle age women to babble their perceptions, feelings and experience about BSE. Women might get emotionally upset in the process of sharing their experience. In these instances break would be provided during the interview. The researcher will answer all the participants queries in order to provide complete information regarding the study to easy tension and promte comfort.RigorTrustworthiness is the term used in the qualitative research to show rigor (Poilt and Beck, 2008). In this study the rigor will be maintained throughout by utilizing capital of Nebraska and Guba (1985) guidelines. capital of Nebraska and Guba identified four criteria for maintaining trustworthiness of a qualitative research (i) credibility, or (Truth value), (ii) dependability, reliability or Auditability, (iii) confirmability or Neutrality, a nd (iv) Transferability, Fittingness. The research will be described clearly the procedures will be used to ensure that the data will be recorded accurately. The researcher will ensure that findings and the themes will be logical and reflective of the data. Credibility, dependability, conformability, and transferability will be maintained.CredibilityLincoln and Guba (1985) credibility presented such faithful descriptions or interpretations of a human experience that the people having that experience would immediately manage it . . . (p. 30). Also when others can recognize the experience by reading about it. To confirm the credibility of the findings, the researcher will share the outcomes with women, who recognized the findings and conformed that they were true to their experiences and perception, this establishes the credibility. One technique to break credibility is to give out sufficient time for data collection activities to gain an in-depth understanding of the individuals ex perience.Dependability/ Auditabilityit could be maintained when another researcher can clearly follow the decision trail used by the investigator. In addition, another researcher could arrive at the same or comparable but not contradictory conclusions given the researchers data, perspective, and situation.To provide dependability, the researcher applied and recorded the audit trial. Lincoln and Guba (1985), state, Conformability is termed as a process to provide the study records in order to maintain the objectivity and to put forward the quality and adequacy of the results and interpretation. (Lincoln Guba, 1985).In this study the audit trail and research plan will be shared with the thesis supervisor and to the committee members so that they would verify its dependability. Dependability relies on three factors and should be ensured by the researcher the sample size, the analysis approach, and the dissemination of the research result. The sample size will be sufficient for the re search design as the researcher will achieved saturation, and the researcher plans to disseminate the study findings through publication of articles and presentations at the issue and international level.Conformabilitywhen auditability, fittingness, and credibility have been established by an audit trail, conformability could be achieved. Audit trail consist of raw data, memos, communications, records of gestures, etc. the researcher applied an audit trail to meet these conditions by constructing and maintaining a record of rude data, data reduction and reconstruction, synthesis products and consequent analysis (Lincoln Guba, 1985).TransferabilityIt will be achieved when study findings fit into contexts outside the study situation and when the audience views the findings as meaningful and transferable to the rest of the potential users. Lincoln and Guba (1985) termed transferability as the way of presenting adequate data such that external conclusions may be made about the findin gs. These in-depth interviews, with rich descriptions about menopause experience allow the readers to steady down about its transferability. Through rich and extensive description, the researcher will provide with in-depth information about the contexts, the data, and the participants.LimitationsLimitations of the study includes (I) the data collection plan is limited to three months only as it is a part of masters syllabus that may affect the quality of the study. (II) The researchers own experiences and opinion there is a chance of biasness. (III) The transferability of the study findings will be limited to Aswans population as each community has specific culture. (IV) Because of the culture and the topic some of the participant will not share full information about their experience.decision Dissemination PlanResults will be presented to nurses and nurse leaders of Aswan Directors of Health. The researcher will give recommendations and will work with Aswan nurse and their leader s to achieve the recommendations. The study will be presented at national scientific conferences and seminars, as well as published in local and international journal.ReferencesAbdel-Fattah, M., Zaki, A., Bassili, A., El-Shazly, M., Tognoni, G. (2000). Breast self- examination practice and its impact on breast cancer diagnosis in Alexandria, Egypt. Eastern Mediterranean Health Journal, 6(1), 34-40.Al Qattan, M. M., Al Saleh, K. A., AlMusallam, S. S., Masoud, G. M. (2008). Knowledge and factors affecting breast self examination among Kuwaiti women. Kuwait medical checkup Journal, 40 (2), 103-110.Alkhasawneh, I. M., Akhu-Zaheya, L. M