Breast cancer is the most common cause of cancer death among women worldwide . Globally, it has been reported that breast cancer ranks as the fifth cause of death from cancer overall, although still the leading cause of cancer mortality in women (the 411,000 annual deaths represent 14% of female cancer deaths) . The WHO estimated that 1.2 million cases of breast cancer are diagnosed worldwide each year which represented 10% of all diagnosed cancers and constituted 22% of all new cases in women in 2000 making it by far the most common cancer in women . In Nigeria, breast cancer has been reported as the most common cancer in women and the second leading cause of death  . Late presentation of patients at advanced stages of when little or no bene- fit can be derived from any form of therapy is the hallmark of breast cancer in Nigerian women . The peak age incidence of breast cancer in Nigeria is reported to be between 45 - 50 years , In contrast to Europe and America where it was reported to be 65 - 75 years. Some cases have been reported below 30 years in Nigeria . The three screening methods recommended for breast cancer include Breast Self-Examination (BSE), clin- ical breast examination (CBE) and mammography. Unlike CBE and mammography which require hospital visit and specialized equipment and expertise, BSE is inexpensive and carried out by women themselves. Although mammography remains the best diagnostic tool in the detection of breast cancer, it is not routinely performed in Nigeria because of cost, high technology equipment and expertise required. Mammograms miss most breast lump in the younger age groups; this is likely to happen in Nigeria where cases below 30 have been reported .
In some studies elsewhere, nurses’ knowledge about the risk factors of breast cancer has been found to be low [14, 16, 20] whilst other studies have reported nurses’ knowledge about risk factors of breast cancer to be high . The fact that there are many risk factors of breast cancer  and new factors have been found to be associated with breast cancer might have affected the knowledge of the nurses. The unit they work may influ- ence their knowledge. In the present study, nurses who worked at Orotta Maternity Hospital had the highest knowledge about the risk factors of breast cancer while nurses who were working at Orotta surgical ward had the lowest knowledge. Therefore, efforts need to be taken to increase the knowledge of nurses about the risk factors of breast cancer. Short on-site courses prioritiz- ing those nurses who work outside maternity units/ wards and nurses with associate level could help to up- date their knowledge.
There is evidenced that women who correctly practice BSE monthly are more likely to detect a lump in the early stage and early diagnosis has been reported to influence early treatment, to yield better survival rate.  Breast cancer mortality rate increase 5.3% annually during the last decade. 
Researchers found that those who were above 50, married and had a family history of disease more frequently engaged in screening activities than their counterparts (Chong et al., 2002; Ibrahim and Odunsanya 2009). In contrast, Mandanat and Merrill (2002) found that age was inversely related to breast cancer screening practices among Jordanian nurses, which they attributed to the fact that the younger nurses were more currently updated as continuing education is not required in Jordan. The practice of breast cancer screening is inconsistent and widely varied among nurses. A study conducted by Lawvere et al. (2004) in western New York found that while nurse practitioners (NPs) engage in breast screening, a notable variation existed with the approaches used. It was also discovered that while NPs utilize these methods, the age at which screening should commence was not agreed upon among respondents. It indicated that 80% of the 175 NPs reported that a CBE should begin at age 20, while about half reported baseline mammograms in average risk women should begin at age 35 (Lawvere et al., 2004).
Majority of participants in this study considered early detection and prompt treatment as an advantage of regular BSE practice while a little more than half consid- ered developing breast cancer as the danger of irregular or non practice of BSE practice. These views may not be shared among nurses in developed countries where organized National screening program made more effi- cient EDMs available. Screening mammography can de- tect lumps before they are palpable and if followed up by immediate and adequate treatment it reduces mortal- ity ranging from 12 to 70%, . The efficacy of BSE as a screening method for breast cancer is however not established in the literature.
Many studies on BSE, MMG and PST practice have been conducted among women worldwide and in Turkey in general and in certain groups of women such as health workers, academicians at college or university level, factory workers, and female students at college or university level [5, 8, 18, 24, 32]. However, only a few studies have been performed on female teachers regard- ing BSE and PST in the world [5, 6, 8, 33 – 35]. In our country, many studies have focused on BSE and MMG screening among teachers; however, there is no research on PST screening among them [11, 12]. As teachers inter- act with students, it is vital for them to serve as role models of character by practising BSE and applying for PST as well as becoming the educational role model by teaching and disseminating reproductive health know- ledge [6, 7, 33, 35]. The difference distinguishing this study from others in this field is that it comprises the transfer of information regarding educational programmes directed towards breast cancer and cervical cancer from researchers to teachers, and from teachers to students, and evaluation of the results. Furthermore, the main aim of this study was to evaluate the effect of breast and cervical cancer screening-structured teaching programme on the knowledge and behaviors of female teachers in a public training centre. The other objective was to encour- age teachers to teach and share the knowledge and skills with the women who attend their classes and courses in public training centres, and also to evaluate the diffuse- ness of the teachers ’ training efforts on the students ’ BSE, MMG and PST behaviors.
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tine mammography screening, emphasis should be on encouraging women to practice BSE and CBE. Health edu- cation programs should be targeted at women through various media including leaflets, television, and radio. In addition, health education should be channeled through women friendly agencies/organizations such as hospital antenatal and postnatal clinics, religious organizations, and Feminist organizations. Use of leaflets, although effective to some extent in literate societies, may be of lim- ited value in the Nigerian population. Even in highly liter- ate societies, there is evidence suggesting that leaflets produce only limited and short-lived changes in knowl- edge . Furthermore, many health professionals believe leaflets are often not read by the target audience . Television and radio appear to be better media to reach a wider audience but the benefits of these media may be limited in rural communities with limited access to these media. In the rural areas, it may be easier to reach a wide cross-section of women through organizations built around the pre-existing community institutional framework. Available data suggest that people prefer to learn about cancer-related issues from their doctors and health organizations. Within the hospitals, we suggest that breast awareness education be integrated into already existing health education programs. In addition, doctors should endeavor to educate women on "breast aware- ness" during regular physician office visits for other health
. In our study, the practice has a significant relationship with all variables except familial history of breast cancer (P ≤ 0.05). For example, women with breast lump or cancer history in the individuals themselves have a better practice (a significant relationship, P < 0.005) and these subjects do not necessarily have a higher knowledge and attitude level than the other subjects (No significant relationship, P > 0. 05). With respect to the mentioned results [17, 21, 27, 29, 32] , teachers and health professionals are often familiar with BSE methods but do not practice it because of other reasons. One explanation for this gap between knowledge and practice could be the fact that breast cancer screening is not a social norm. Participants in every screening program need both knowledge and belief that screening
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Breast cancer patients generally have low rates of survival due to being diagnosed at advanced stages raising critical issues about prevention and avoidance of risk factors. Breast self examination makes women more “breast aware”, which in turn may lead to an earlier diagnosis of breast cancer. In Nigeria, the sta- tistics of breast cancer have overtaken cancer of the cervix to become the commonest malignancy in women. This study was carried out to determine the awareness of breast cancer risk factors and practice of breast self examination among female students of the University of Nigeria Enugu Campus. The de- scriptive survey design was used for the study. The population of the study was all the female students that reside in hostels in the campus (2400) in number. A sample of 240 students was selected using quota sampling technique. Structured questionnaires based on the research objectives were used for data collec- tion. The results of the study showed that most of the students have little knowledge of breast cancer risk factors and majority of the students do not practice BSE monthly. It was recommended that there should be regular organization of seminars and workshops for students to address sensitive topics like breast cancer risk factors and breast self examination.
Among the urban women, decision to visit a health facil- ity on the discovery they had breast cancer was influenced by their knowledge and information about breast cancer. Women who are knowledgeable about breast cancer and its risk factors are known to be more likely to comply with such early detection behaviors than those who are not . Rural women decisions are influenced by lack of informa- tion on breast cancer with one of the leading factors to late presentation being lack of awareness about benefits of early detection of breast cancer as observed in varied setting and colloborated by the presented findings [48–51]. Conse- quently, there are high indications that women have mis- conceptions on breast cancer and its screening because they cannot access health information [12, 15]. This line of thought is reinforced by the Kenya Cancer Research and Control National Stakeholder Meeting action points that highlight: 1) Engaging community leaders and members to identify key drivers of stigma through Knowledge, Attitude, and Practice (KAP) studies, 2) Developing culturally appro- priate messages to address perceptions and knowledge gaps, 3) Coordinating knowledge sharing about community education efforts and 4) Raising public awareness about cancer prevention and early detection, targeting 60% of the population by 2018. Incidences of breast cancer have been observed to be low among rural women however, death
knowledge was observed among participants of third year (32%) and among participated students from fifth year (12.8%). Participants from third year were actively involved in a recently conducted breast cancer awareness campaign prior to the start of this study. The highest pos- itive attitude and the more regular practice of BSE were seen among fifth year’s students (89.7% and 28.2% re- spectively). A highly statistical significant difference was found between attitude towards BSE and years of uni- versity ( χ 2 = 32.1, p = 0.000). The same finding was found also for practice ( χ 2 = 14.3, p = 0.007). Senior medical students are more exposed to medical know- ledge and this could explain the highest percentage of positive attitude and of regular practice seen among them compared to juniors. Our study revealed a positive cor- relation between overall knowledge and practice of BSE (r = 0.449; P = 0.000) illustrating the desire among this population to acquire correct knowledge regarding breast cancer and BSE. Also, this finding brings to light that if awareness and health education programs are conducted in an intensive and planned form, it might result in posi- tive healthy practices.
A cross sectional survey was conducted among 300 nursing students and staff of Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh in 2016. A semi structured predesigned study tool was introduced to assess the demographic profile and KAP The adequate knowledge about all symptoms of breast cancer was observed to be >80% among younger age nurses (age <40 years).A positive attitude towards breast self-examination (BSE) promotion in mass media was observed in more than 80% of younger age group nurses (<30 years).Majority (78%) of them performed BSE once a month; 11.3% underwent clinical breast examination (CBE) and 11.6% mammography. Time constraint (14.6 %), lack of services and specialist (23.6%) and embarrassing to get examined (10.6%) were the quoted as the reasons behind In a given situation when the participant discovers a breast lump, around 87% Along with increasing knowledge we have to strengthen emotional status of women in our country. The frontline workers can prove to be a great asset in creating community awareness.
screened. A systematic review by Ojewusi et.al, (22) found that lack of knowledge on how to carry out a SBE was expressed by as one the most important factors in its uptake. Similarly in Lebanon, women who were more confident on their ability to perform a SBE were 2.65 times more likely to practice it. Morse et.al (20) found that 87.7% of the respondents who were aware of SBE in their study mentioned that knowledge of the SBE procedure was an encouraging factor for them to examine themselves and 56.9% would examine themselves if there was an instruction sheet available. Busakhala et.al (9) also found a strong association between reports of prior training on SBE and its practice. Women who examine themselves have been found to more often, easily and correctly identify small changes in their breast on a monthly basis upon which they will visit a doctor. SBE allows women to actively take part in the management of their wellbeing which results to increased awareness and adherence to various screening modalities (26).
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It’s evident from different studies done on breast cancer awareness that there has been positive association between breast cancer and BSE awareness and educational status, including the present study. 13-16 However, we must also note that the awareness about cancer being curable if detected early is in conjunction with the fact that simultaneously nearly half of the women think breast cancer to be incurable. This is probably due to the fact that very few women had seen other women cured of breast cancer and survive the disease. Hence, improving knowledge regarding the breast cancer and importance of BSE would help sustaining the practice.
Thus targeting this age group will be more appropriate as the asymptomatic phase of this group of patients will fall in their thirties considering the fact that patients in this environment delay for an average symptomatic period of 5 to 6 years before presentation (Ezeome, 2010 and Akanbi et al., 2015). Also, the concept of breast cancer should ordinarily not be new to this age group, our study revealed that 460 (97%) of the respondents have heard about breast cancer which is in agreement to some similar reports from previous studies in Nigeria which found 92 to 97% breast cancer awareness(Nwagbo DF, and CO Akpala,1996 and Ekanem and Etukudo, 1990) as compared to younger age group (the adolescents) who were more likely to have a relatively low level of awareness about breast cancer (Irurhe, 2012). Most of our participants belong to Yoruba ethnic group a finding not unexpected as the study was carried out in south western Nigeria, a geo political zone consisting mainly of Yoruba extraction.Our study also found that the general knowledge about breast cancer and screening was surprisingly low among our female undergraduate (Table 2).
implemented it into practical life which indicates that their attitude towards the early detection of the disease was flawed. 78% of our respondents knew about this method of detection and 43.8% knew how to perform it out of which only 24.9% had actually performed it once in their lifetime. More or less similar results were reported in a study conducted in Punjab  where 41% respondents knew how to perform BSE but 25% actually practice it. Better practice than this was reported in another local study among medical students, which showed that 67% knew how to perform BSE and 56% actively perform BSE . If we compare with international studies we found that in a study conducted in Iraq, 90.9% participants had heard of BSE while only 48.3% had actually practiced . In an Indian research it was reported that 65% students were aware of BSE and only 11% practice it regularly . Likewise a study in Iran on 119 health professional claimed that 87.4% of the participants perform BSE and 39.5% perform it on regular monthly basis . Various other global researches also reported deficiency in BSE practice among females [12,24,26,27,29, 33].
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significant fraction of breast cancers are detected first by the patients themselves.SBE is also useful for patients in identification of tumors appropriate for conservative local therapy, and allows the patient to participate in making decision regarding her care (Marc et al., 2013). The American Cancer Society (ACS) recommends, as a good tool, Self-Breast Awareness (SBA) and Self-Breast Examination (SBE) for early detection of breast cancer. It benefits women in two ways: women become more familiar with the appearance and the feel of their breasts, and hence they are more likely to detect any changes or new developments in their breasts as early as possible (American Cancer Society, 2016). Self-Breast Examination (SBE) makes women more “breast ware”, which in turn leads them to an earlier detection of any changes in the breast. The rationale behind promoting the practice of SBE as a screening test is the fact that breast cancer is frequently detected by women themselves, who are otherwise healthy and without other symptoms (www.umgc.org). Women who regularly practise SBE present with smaller tumor size at earlier stages of the disease than women who do not practice. It is estimated that 25-30% of women in the United States perform SBE every month. However, among those women who practise SBE, there are often delays in seeking medical attention. The reason for this delay continues to be a subject of ongoing research; fear being the major factor, psychological factors, economic factors, lack of education, and reluctance to act on, are also among the factors (Ergete et al., 1999). Self- Breast Examination (SBE) is a simple procedure that every individual woman can perform by herself. It is private, safe, free, non-invasive, and can be done at home. It is important
The study found that the majority of the subjects under study had an above average knowledge scores about BSE and an excellent attitude scores whereas they exhibited very poor practice scores. The study also found that the Knowledge, Attitude and Practice scores were poor with the advancing age and the fact being that the incidence of breast cancer, associated with poor staging is prevalent among the elderly women. There is also a significant correlation of knowledge, attitude and practice scores with that of the occupational status as the KAP scores on BSE are found to be the lowest among the unskilled and the unemployed. There is also a significant positive correlation between the knowledge and attitude, knowledge and practice, and attitude and practice. The knowledge, attitude and practice scores were high among those subjects who had an access to health care information about BSE than those who did not have any access to health care information.
Results: The participants were aged between 25-94 years (mean age 40.15±13.17). 62.6% have heard about BSE. Among the 206 participants, 12% had good knowledge while 10.6% knew the correct technique of doing BSE and only 0.06% knew that BSE must be performed once a month. Though 80.5% have good attitude regarding BSE, only 36% practised BSE and only 0.04% performed it every month. Educational status (high school and below vs higher secondary and above) was found to be significantly associated with knowledge (p<0.001) and practice (p=0.003). Knowledge regarding BSE was significantly associated with practice (p<0.001) while family history of breast cancer was not (p=0.072).
A pre-coded designed questionnaire was used to collect information from all participants. An invitation letter was attached to the questionnaire to explain the research objective, methods and expected benefits. The questionnaire was distributed then collected via the Cancer program coordinators in Riyadh city. All female GPs working in PHC centers of Riyadh city (n= 180) were invited and they were completely free to opt to participate or withdraw, without any consequence at any time prior to or at any point during or after the activity. They were informed that any information provided will be kept confidential and will be used only for the research purposes and will not be used in any way that can identify them.