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Importance of breast awareness in identification of breast cancer

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October 2003 is breast cancer awareness month - an event that aims to raise both funds and awareness of the issues surrounding breast cancer. Incidence of breast cancer is still increasing in the UK population, making health education and prevention work an important area of practice for all nurses.


VOL: 99, ISSUE: 40, PAGE NO: 18

Jacqueline English, MSc, Diploma breast care nursing, Cert (counselling skills), RGN, is breast health nurse specialist at Breast Cancer Care, London


October 2003 is breast cancer awareness month - an event that aims to raise both funds and awareness of the issues surrounding breast cancer. Incidence of breast cancer is still increasing in the UK population, making health education and prevention work an important area of practice for all nurses.



Breast cancer is the most common form of cancer in women in the UK. The lifetime risk of a woman developing breast cancer is one in nine. Each year there are approximately 41,000 new diagnoses (Cancer Research UK, 2003, figures for 1999). The incidence of breast cancer in men has slowly risen over time and approximately 300 new cases are diagnosed each year (Cancer Research UK, 2003). This highlights the importance of raising breast awareness in men, as well as women.



Although the incidence of breast cancer in the UK is rising (Cancer Research UK figures for 1998 were 39,500), the number of related deaths has fallen by 21 per cent over the last decade. In recent years, survival has increased significantly due to early detection and improved treatment options. Early detection involves individuals being breast aware and it is important to achieve this awareness without increasing anxiety and performing unnecessary investigations (Baines, 1983).



The move to breast awareness
In 1991 the Department of Health’s advisory committee for breast cancer recommended that breast awareness should replace self-examination (DoH, 1991). Significant evidence has shown that the ritualistic nature of breast self-examination leads to increased anxiety in women, who worry about not performing the examination properly or at the correct time (Baines, 1983).



Self-examination was recommended on a monthly basis before a woman’s period. However, this led to the false impression that the risk of breast cancer is greater during a woman’s reproductive years.



In fact, it is greater after menopause as 80 per cent of breast cancers occur in women over 50. In addition, there were a number of risks associated with breast self-examination, namely poor sensitivity in detection and poor specificity in exclusion of breast cancers (Austoker, 1994; Frank and Mai, 1985).



The evidence for breast awareness
In 1994 Austoker showed that in 90 per cent of cases the signs of breast cancer are detected by women themselves or by their partners. Therefore, a breast awareness message that optimises the chances of women finding cancers themselves and highlights the need for prompt reporting of changes is likely to lead to better outcomes. In 1995 the DoH and the RCN endorsed a breast awareness approach, which included a ‘five-point code’ (Box 1). In 2002 the RCN further endorsed this approach by reviewing its nursing guidelines on breast palpation and breast awareness. A study completed in Shanghai reconfirmed the importance of promoting breast awareness rather than self-examination (Thomas et al, 2002). However, in 2003 confusion about self-examination and breast awareness still remains. Women want to learn how to examine their breasts ‘properly’ and nurses are confused and lack confidence when explaining breast awareness to patients.



What does breast awareness mean?
Box 2 shows how breast awareness can be confusing because, like self-examination, it still requires a person to ‘look and feel’. There is no special technique, time or recommended frequency for doing this. Confusion is exacerbated by frequent media reports that advocate self-examination when discussing breast awareness.



The fact that so many cases of breast cancer are detected by women themselves or their partners highlights that detection is not about ritualistic examination or the learning of a new skill.



Breast screening
Earlier this year, 922 women between the ages of 18 and 99, with no previous personal experience of breast cancer, were surveyed. The survey was designed to assess the women’s knowledge of issues relating to breast cancer and to gauge the level of their understanding of breast awareness (Breast Cancer Care and Boots, 2003).



Results revealed that a relatively large proportion of women over the age of 50 do not know what is meant by being ‘breast aware’, and that one in five women over the age of 50 never look at or feel their breasts.



Breast screening also has a role to play in breast awareness and all women between the ages of 50 and 64 - the upper age limit will be extended to 70 in March 2004 - are entitled to be screened every three years.



However, the Breast Cancer Care/Boots survey found that 20 per cent of these women do not take up the NHS Screening Programme. It also showed that 13 per cent of women over the age of 50 think that an upper age limit for breast screening is because women are no longer at risk of breast cancer after the age of 70.



Using health education materials
As well as surveying women on breast awareness, Breast Cancer Care also surveyed a group of 25 health professionals on the educational materials available to them.



Only 57.1 per cent of respondents felt confident in educating others about breast awareness. These results are supported by an evaluation at Oxfordshire Health Authority, which found there was a need to clarify the breast awareness message for nurses and other health professionals in order to improve their confidence when disseminating information to the public.



The future: education
The biggest risk factor for developing breast cancer is age. The Breast Cancer Care survey highlighted that there is still a need to educate nurses, other health professionals and the public in order to improve understanding of breast cancer and breast awareness. Individuals will then be empowered to make better lifestyle choices without increasing their anxieties. All health professionals need to be clear and united about the breast awareness message. We cannot expect the public to understand these issues if we are giving conflicting messages.



The role of breast cancer care
Breast Cancer Care is committed to providing high-quality information and support both to the public and health professionals (Box 3). In July this year the policy and research team at Breast Cancer Care published a report entitled Breast Cancer in the UK: What’s the Prognosis? This clearly identifies areas of concern with regard to those who are considered to be at high risk of breast cancer. Breast Cancer Care also employs a breast health nurse specialist, who networks with nurses and other health professionals to clarify the breast awareness message in order to improve dissemination of information to the public.



Breast cancer awareness month
Breast cancer awareness month takes place every October. As well as raising vital funds, it is dedicated to highlighting issues relating to breast health and breast cancer among the general public.



The UK has one of the highest incidences of breast cancer in the world and therefore it is essential that women are informed in a non-alarmist way about the disease and how to identify it as early as possible in order to improve long-term prognosis. Breast cancer awareness month has proven to be an extremely effective way of directly informing the general public about breast cancer issues. This conclusion has been drawn as a result of evidence including helpline statistics, website hits and fundraising. This year the campaign will focus on the fact that 80 per cent of cases of breast cancer occur in women over the age of 50, and will specifically target women in this age group.

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