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Khan et al. / Evaluation of Knowledge towards Breast Cancer.... Table 2: Respondents perception toward risk factors of breast cancer Risk Factor Malay 10(19.6%) Chinese 9(17.6%) Indian 10(19.6%) Arab 11(21.6%) Thais 11(21.6%) Total N(51) X 2 p-value Obesity 5 5 6 6 5 27 (52.9%) 0.518 0.993 Family history of breast cancer 10 8 7 10 9 44(86.3%) 4.264 0.416 Early Adolescents (< 12 years) 2 4 6 2 3 17(33.3%) 5.818 0.056* Late menopause (> 55 years) 3 7 8 3 7 28 (54.9%) 10.861 0.058* Smoking can result breast cancer 5 6 7 10 10 38 (74.5%) 8.832 0.006* Alcohol Use can result breast cancer 6 6 9 3 6 30 (58.8%) 8.851 0.040* Due to pregnancy after 30 years 3 5 6 4 8 26 (50.9%) 5.184 0.054* Lack of breast feeding 4 7 7 10 7 35 (68.6%) 6.829 0.331 Due to use of contraceptive 7 9 7 11 9 43 (84.3%) 6.871 0.532 Lack of physical activity 5 6 8 2 8 29 (56.9%) 10.566 0.395 The irritation due to tight bra 7 8 10 8 10 43 (84.3%) 5.030 0.468 Lack of blood flow to the breast 0 6 10 8 8 32 (62.7%) 23.777 0.016* Table 3: Preventive measure for breast cancer Malay Chinese Indian Arab Thais Total 10(19.6%) 9(17.6%) 10(19.6%) 11(21.6%) 11(21.6%) N(51) By reducing fatty diet that elevate cholesterol 7 8 6 4 7 32 (62.7%) By consuming soy products regularly 3 9 5 6 6 29 (56.9%) By Taking Multivitamin 3 7 8 6 8 32 (62.7%) Maintain a healthy body weight (BMI less than 25) throughout your life 7 5 7 5 7 31(60.8%) By avoid alcohol 7 7 8 4 11 37 (72.55) Consume as many fruits and vegetables as possible 9 7 9 11 8 44 (86.2%) Breast self examination can be beneficial to prevent breast cancer 10 9 8 10 11 48 (94.1%) Table 4: Knowledge about symptoms of breast cancer Symptoms of Breast cancer Malay 10(19.6%) Chinese 9(17.6%) Indian 10(19.6%) Arab 11(21.6%) Thais 11(21.6%) Total N(51) A swelling or thickening in or near the breast 10 7 9 11 11 48 A swelling in the underarm area 10 6 7 11 10 44 A change in the size or shape of the breast 10 9 6 11 10 46 Discharge of fluid from Nipple 8 8 7 6 11 40 The breast skin looks like the skin of an orange 6 3 9 3 9 30 Nipple looks swollen, red, or scaly 9 9 9 6 11 44 Table 5: Knowledge difference on ethnic grounds Score Race 0-3 Poor 4 Mode rate 5 Good 6 Excel lent Malay 1 1 2 6 Chinese 1 2 5 1 Indian 1 3 3 3 Arabs 3 4 1 3 Thais 1 1 2 8 df F p 50 2.691 0.043* One way ANOVA Perception regarding risk factors and preventive measure for breast cancer Findings demonstrated that lack of blood flow to the breast, early adolescents (< 12 years), late menopause (> 55 years) and pregnancy after 30 years were the mainly identified risk factors for breast cancer. Respondent’s perceptions in this regard are illustrated in Table 2. Majority of the respondents believe that use of vegetable, fruits and by avoiding alcohol use can be the preventive measures from breast cancer Table 3. Knowledge about symptoms of breast cancer, diagnosis and treatment of breast cancer Overall knowledge evaluation revealed that swelling or thickening in or near the breast, swelling in the underarm area and change in the size or shape of the breast were the frequently recognised symptoms of breast cancer (Table 4). Findings demonstrate that the Thai students have comparatively better knowledge than other groups (Table 5). However, further evaluation through post hoc analysis revealed significant knowledge difference among Thai and Arab student (Table 6). In term of diagnosis the mammography and physical examination were recommended by majority (Table 7). Surgery and radiation therapy were the preferred options to treat breast cancer (Table 8). DISCUSSION This is a qualitative study that evaluates young women knowledge toward symptoms, risk factor, causes and diagnosis of breast cancer among different ethic groups. Five ethnic groups were part of this study i.e Malay, Chinese, Indians, Arabs and Thais. Findings demonstrated a significantly (p=0.043) excellent knowledge regarding symptoms of breast cancer among Thai students. However, a poor knowledge level was observed among the Arab students (Table 5). Swelling or thickening of the breast was the most commonly recognized symptoms of breast cancer by all groups (Table 4). In terms of evaluation of respondents’ perception regarding prevention of breast cancer majority (94.1%) of the respondent’s belief that breast self examination (BSE) can be prevention from breast cancer. This statement reflects negative insight of respondents; BSE can be helpful in early diagnosis and treatment only. Majority of 11(21.65%) of Arab and Indian students have recommended excessive use of fruit and vegetables as preventive measure for breast cancer. However, the use of soya and soya products was highly recommended by the Chinese participants. Use of soya and soya products can be a preventive measure, high iso-flavone and phytoestrogen contents plays a vital role in minimizing the risk of breast caner. IJPCR October-December, 2009, Vol 1, Issue 3 (115-118) 117
In addition to the knowledge about the symptoms of breast cancer, the perception regarding the risk factor is another vital issue to be explored. Overall, majority 86.3% of respondents stated that family history is the potential most risk factor for breast cancer. However, segregation of responses on ethnic grounds revealed that majority of the Chinese and Arab respondents’ has stated contraceptive use as a risk factor for breast cancer. Whilst Indians perceive irritation due to tight bra and lack blood flow to breast are the factors leads to breast cancer. On other hand Thai students hold smoking responsible for the progression of breast cancer. Comparatively Malay Chinese and Indian students’ were found to have a lack of awareness towards the symptoms and risk factors for breast cancer. Public health department is playing its part through educational programs Khan et al. / Evaluation of Knowledge towards Breast Cancer.... on media. However, educational session at the schools and college levels can be helpful to reduce these knowledge gaps. The knowledge about diagnosis and treatment of breast cancer are the other two important aspects of the knowledge domain. Evaluation of respondents’ knowledge about diagnosis revealed that 25 (49.0%) of the respondents have recommended mammography followed by physical examination. Arabs and Malays were found to have a better knowledge regarding diagnosis of breast cancer. However, Thai students have poor knowledge regarding diagnosis as majority has recommended ultrasound as the diagnostic method. In terms of treatment surgery was the recommended by the majority followed by radiation therapy. About 4(7.8%) of the respondents have recommended the use of herbs to treat breast cancer. Majority among these were Malay and Indians. Table 6: Multiple comparisons among ethnic groups Race (I) Race (J) Mean difference (I-J) Sig CI 95% Chinese .63333 .673 -.7169 - 1.9836 Malay Indian Arabs .60000 .93636 .695 .250 -.7142 - 1.9142 -.3477 - 2.2204 Thais -.33636 .945 -1.6204 - .9477 Malay -.63333 .673 -1.9836 - .7169 Chinese Indian Arabs -.03333 .30303 1.000 .966 -1.3836 - 1.3169 -1.0178 - 1.6239 Thais -.96970 .244 -2.2905 - .3512 Chinese .03333 1.000 -1.3169 - 1.3836 Indians Malay Arabs -.60000 .33636 .695 .945 -1.9142 - .7142 -.9477 - 1.6204 Thais -.93636 .250 -2.2204 - .3477 Chinese -.30303 966 -1.6239 - 1.0178 Arabs Malay Indians -.93636 -.33636 .250 .945 -2.2204 - .3477 -1.6204 - .9477 Thais -1.27273(*) .045* -2.5258 - -.0197 Chinese 96970 .244 -.3512 - 2.2905 Thais Malay Indians .33636 .93636 .945 .250 -.9477- 1.6204 -.3477 - 2.2204 Arabs 1.27273(*) .045* .0197 - 2.5258 Table 7: Knowledge about diagnosis of breast cancer Race Mammography Ultrasound Physical examination Biopsy Chinese 4 1 4 0 Malay 8 1 1 0 Indian 3 1 5 1 Arab 8 0 2 1 Thais 2 6 2 1 Total 25 9 14 3 Table 8 Knowledge about treatment of breast cancer Race Herbs Hormone therapy Radiation therapy Surgery Chinese 0 0 1 8 Malay 2 1 2 4 Indian 2 0 3 5 Arab 0 0 0 11 Thais 0 1 3 7 Total 4 2 9 35 CONCLUSION Thai students have good knowledge about the symptoms of breast cancer. However, knowledge level toward diagnosis was best among Malays and Arabs. Overall findings highlight the need of further educational session among all groups for the substitution of negative perceptions with positive and evidence beliefs towards the symptoms, causes, prevention diagnosis and treatment of breast cancer. REFERENCES 1. Hisham AN, Yip CH. Overview of Breast Cancer in Malaysian Women: A Problem with Late Diagnosis. Asian J Surg 2004; 27(2): 130-3. 2. Hisham AN, Yip CH. Spectrum of Breast Cancer in Malaysian Women: Overview. World J Surg 2003; 27(8): 921-3. 3. Ferlay F, Bray F, Pisani P, et al. Globocan 2000 (online software). Cancer incidence, mortality and prevalence worldwide, Version 1.0. IARC Cancer Base No.5. IARC Press, Lyon, France, 2001 4. Fry RB, Prentice-Dunn S: Effects of a psychosocial intervention on breast self-examination attitudes and behaviors. Health Educ Res 2006; 21: 287-295. 5. Rosenberg R, Levy- Schwartz R: Breast cancer in women younger than 40 years. Int J Fertil Womens Med 2003; 48: 200-205. 6. Nor Aina E. Cancer Patient Registry-Breast Cancer (NCPR-Breast Cancer) Med J Malaysia Vol 63(c), 2008. 7. Sheridan JC, Lyndall GS. SPSS analysis without anguish version 10.0 for Windows, Singapore: John Wiley & Sons Australia, Ltd., 2001. IJPCR October-December, 2009, Vol 1, Issue 3 (115-118) 118
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