Awareness and impact of education on breast self examination among college going girls
Introduction: Breast cancer accounts for 19-34% of all cancer cases among women in India. There is high mortality due to late stage diagnosis as patients usually present at an advanced stage because of lack of awareness and nonexistent breast cancer screening programs. Early detection and prompt treatment offer the greatest chance of long-term survival and breast self-examination (BSE) seems to be a important viable optional substitute for early detection of cancer.
Keywords: Awareness, Breast cancer, Breast self-examination, Knowledge
Cancer is the second leading cause of mortality and morbidity in both developed and developing countries. In India, cancer prevalence is estimated around 2.5 million, with over 0.8 million new cases and 0.5 million deaths occurring each year . Cancer registries listed as the second most common cancer among women. There is an increase in the incidence of breast cancer and found to be gradually overtaking cancer of the cervix. 
Breast self-examination (BSE) is an important screening measure for detecting breast cancer.  There is evidence that women who correctly practice BSE monthly are more likely to detect a lump in the early stage of its development, and early diagnosis has been reported to influence early treatment, to yield a better survival rate. 
Thus the present study aimed at identifying the level of knowledge and practice of BSE among degree female students who are the citizen of the future and they can teach their family members, neighbors, friends and the community which helps the people to detect breast cancer in early stage. Thus the morbidity or mortality can be reduced. In the current study only one participant was practicing BSE occasionally so incorporating the BSE concept in the degree education curriculum is very useful and helpful.
The present study aimed at assessing the level of knowledge and the effectiveness of planned teaching program among degree female students on BSE.  It is a patient-centred, inexpensive and noninvasive method of screening for breast cancer. Based on increased incidence of breast cancer and unawareness of BSE among young women, researcher felt a need to provide awareness of BSE among young women and can be reduced the incidence and prevalence of breast cancer in future. ,
The objectives of the study were to:
The study attempted to test following hypotheses
All the hypotheses were tested at 0.05 level of significance.
The study assumed that:
Independent variables: Teaching program on BSE.
Selected variables: age, education, parent's education and exposure to mass media.
A pre-experimental one group pretestpost-test study was conducted among degree female students from selected colleges of Udupi district. A cluster sampling technique was used to select the college and 40 students selected by convenient method from all the streams of study.
Data collection instruments
Data was collected by using structured and validated questionnaire and planned teaching program. The questionnaire had three parts [Appendix].[Additional file 1]
Demographic proforma consisted of age, stream of study, education and occupation of parents, income of parents and sources of information on BSE.
A structured questionnaire consisted of 25 Multiple Choice Questions (MCQ) was developed to assess the knowledge on BSE. Each correct response carried one mark. Total score was 25. Knowledge scores were categorized into poor (0-8), average (9-16) and good (17-25).
Planned teaching program. Lesson plan with power point presentation given for validation contained basic anatomy and physiology, risk factors for breast cancer and steps of BSE.
Validity of the tools was established by submitting to seven experts and there was 100% agreement on all items. Reliability was established by administering the tool to10 students. Reliability coefficient of knowledge questionnaire was established by split half method using Spearman Brown prophecy formula. Reliability coefficient was found to be 0.9.
Data collection procedure
Administrative permission was obtained from the Principal of selected colleges. Written consent was obtained from the study participants. Questionnaire was administered to them in the classroom setting. The time taken to respond to the questionnaire was 40-45 minutes. Data was collected by administering knowledge questionnaire on BSE and planned teaching program was introduced for them. On 8 th day post-test was done by administering the same tool.
Data were analyzed using SPSS package version 11.5. The data was analyzed using descriptive (frequency and percentage) and inferential statistics based on the objectives and hypotheses.
The data presented in [Table 1] shows that among 40 samples, the majority (52.5%) of the samples were in the age group of 18-19 years and majority (90%) of them were studying in basic science group.
Only 35% of them were heard about BSE through mass media and 8.5% of participant (only one participant) were practiced BSE only one time at the time of study.
The description of knowledge scores shows that 72.5% of students had average knowledge on BSE in pre test and 85% of students had good knowledge score in post-test [Figure 1],[Table 2]. The paired 't' test computed to test the effectiveness of planned teaching program on BSE (t=12.46) shown in [Table 3]. It shows the awareness program on BSE was very effective.
The χ2 computed to find the association between knowledge and selected variables shows no significant association between knowledge and selected variables. Hence the null hypotheses was accepted and research hypotheses was rejected shown in [Table 4].
A survey conducted among nurses and midwives in Turkey found that among 80 samples only 52% of samples performed BSE, no significant relation was found between sociodemographic factor and BSE.
A study conducted in Chennai by S. Aruna supported this study as no significant association found between demographic variables and level of knowledge of breast cancer and BSE among working women. 
Study conducted among resettlement colony women, shows that they have poor knowledge on breast cancer and risk factors, warning signs and early detection procedure.
The World Health Organization stresses on promoting awareness in the community and encouraging early diagnosis of breast cancer, especially for women aged 40-69 years who are attending primary health care centres of hospitals for other reason, by offering clinical breast examination.
There are other many methods to detect the breast cancer but those are expensive for the community. Allwomen may not be able to afford the cost of the procedure. Breast-related matters are sensitive issues for few females; unless the breast lesions starts bothering them they may not seek medical attention. BSE is the cheapest and convenient method to detect the breast cancer in the early stage.
In this study majority of the samples acquired good knowledge on BSE. BSE plays a major role in early detection and prevention or prompt treatment of breast cancer. By giving teaching to the young girls, they can teach their mother and siblings so that the incidence of the breast cancer may be reduced. It is essential task of each and every woman to do BSE and protect herself and her family. The nurse has to play an important role in health promotion and it is only possible when she teaches or educates her client. However, the teaching of BSE can help women to be alert to any abnormal changes in their breasts and seek medical advice immediately.
[Table 1], [Table 2], [Table 3], [Table 4]