VOL: 101, ISSUE: 41, PAGE NO: 23
Helen Graham, RGN, DipHealth Service Management, DipBreast Care Nursing, is breast health nurse specialist, Breast Cancer Care, London
Breast cancer is the most common cancer in women and the second biggest cause of death from cancers in women in the UK. Every year around 40,790 women are diagnosed with the disease. While it predominantly affects women, 290 men are diagnosed each year in the UK (CRUK, 2004).
The incidence of breast cancer in the UK is rising but death rates have fallen by about 21 per cent over the past decade, reflecting improved benefits in treatment options and early detection (CRUK, 2004).
It is well documented that early presentation of breast cancer improves outcomes (Department of Health, 2000). Survival rates from breast cancer in the UK have increased significantly in recent years, and this can partly be attributed to early presentation and from individuals being breast aware.
The lifetime risk of developing breast cancer is one in nine (over the age of 85) and while it is likely that many factors are attributed to an individual developing breast cancer, it is clear that advancing age is the most important factor in increasing risk, with 80 per cent of breast cancers occurring in women over the age of 50. However, each year around 8,000 women are diagnosed before they reach menopause (CRUK, 2004).
Breast awareness has been advocated in the UK since the early 1990s, but while it is now widely accepted as a method of self-care there is still confusion about what it is among health professionals and the general public. Austoker (2003) claims that much of this confusion has existed since its introduction back in the 1990s. Many women confuse breast awareness with breast self-examination and often believe they are the same thing. However, breast awareness advocates that women no longer need to worry how to examine their breasts in a particular way or to remember to do it at a particular time, as is recommended with breast self-examination. Instead it focuses on breast awareness becoming a normal part of caring for their bodies.
Breast awareness encourages women to become familiar with what is normal for them through looking at and feeling their breasts. Most women will know how their breasts look and feel simply by carrying out daily activities such as washing and dressing, although this knowledge and awareness may be subconscious.
Austoker (1994) reports that 90 per cent of breast cancers are found by women themselves or their partners. This reinforces the anecdotal evidence that women know what is normal for them. Breast awareness is not about searching for cancer - it is part of general body awareness, ensuring everything remains the same. It does involve looking at and feeling the breasts from time to time but not in any taught way or at a set time. By being breast aware women become confident in knowing what is normal for them so they are more able to recognise when something is not the same and can report these changes to their GP.
Confusion around breast awareness
The breast awareness approach includes the introduction of the breast awareness five-point code (Box 1) and encourages women to take some responsibility for their own health. Many health initiatives have been implemented with the aim of dispelling the ongoing confusion around breast awareness. These initiatives include the NHS Cancer Plan commitment to detecting cancers earlier by raising public awareness and the RCN review of the nursing guidelines on breast palpation and breast awareness (DoH, 2000; RCN, 2002). The RCN review recommends that nurses no longer teach women how to examine their breasts but take a more educational role, encouraging women to become familiar with what is normal, offering written and verbal information, being aware of the management of breast problems and informing women of the breast screening programme.
More recently we have seen the extension of the upper age limit for breast screening from 64 to 70 (to be effective in Wales by April 2006). This aims to increase early detection and reduce mortality. Women over the age of 70 may still be screened but they will no longer be sent an invitation and are required to request screening through their screening unit or GP. Despite these initiatives confusion still remains, with continuing media reports and written information advocating breast self-examination using a set technique along with an array of aids to assist in detecting lumps.
A survey undertaken by Macmillan Cancer Relief (2004) found that one in five women never check their breasts, and that their biggest concern was that they might actually find a cancer. This is supported by a survey undertaken by Breast Cancer Care and Boots (2003), which found one in five women over the age of 50 never look at or feel their breasts. This finding suggests that women still do not understand that age is the most important risk factor in developing breast cancer.
Promoting breast awareness
Any change in a woman’s breasts can be extremely distressing and cause uncertainty, with many women fearing they have developed breast cancer. However, many breast changes do not indicate cancer and are often normal changes that occur naturally as the breast ages. It is well-documented that women who are advised about breast awareness by a health care professional demonstrate a greater knowledge and confidence than those who receive information from other sources (Morrison, 1996).
Nurses working in primary care are in the best position to use their everyday activities to educate and empower women to be breast aware in an informative and non-alarmist way. They have the potential to reduce women’s anxieties by providing verbal and written information about what is normal and what changes in the breasts occur naturally. They can also offer support and encourage women to report concerns and - equally importantly - encourage them to accept routine breast screening when it is offered.
Patnick (1995) reinforces the notion that every nurse has the opportunity to encourage women to attend mammography screening when invited. Enterkin and McMillan (1993) suggest that nurses are not breast aware themselves and do not encourage their patients to be breast aware. A survey by Breast Cancer Care and Boots (2003) showed that only just over 50 per cent of participants felt comfortable in educating others about breast awareness. The guidelines in the NHS Cancer Plan (DoH, 2000), which encourage information-giving and good communication, in conjunction with the RCN (2002) initiative on breast awareness, may go some way to addressing these inequalities among health professionals.
Breast cancer awareness month
Breast cancer awareness month takes place in October every year and aims to raise issues around breast cancer and breast awareness among the general public. This year’s campaign focuses on diversity. This follows a study last year that investigated the breast cancer-related knowledge, beliefs and attitudes among women from minority ethnic groups living in the UK. Scanlon (2004) suggests there is a general lack of knowledge and understanding of breast cancer and breast awareness in some groups - particularly Asian and Arab women - compared with white British women.
In their efforts to raise public awareness this October nurses may need to take a broader look at the services they provide and establish how they can contribute to raising awareness among a diverse range of women.
- This article has been double-blind peer-reviewed.
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