Detection Methods and Knowledge Levels Regarding Breast Cancer

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Detection Methods and Knowledge Levels Regarding Breast Cancer

Kimberly D. Mitchell

Submitted to School of Graduate Nursing

Mountain State University

In partial fulfillment of the requirements for the degree of

Master of Science in Nursing

2008


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Acknowledgements

I would like to take this opportunity to thank GOD and everyone who helped me

achieve my goals. Special thanks to my family and the two most important and influential

people in my life; my daughters, Tara and Skylar. I would like to thank previous as well as

present Mountain State University instructors, faculty, preceptors, and committee members:

Wayne Ellis Ph.D, Director of Nurse Anesthesia program, Martha Richter, MSN, CRNA,

Shewana Workman, CRNA, Linda Williams, JD, CRNA, Jonnathan Bailey RN, MBA,

CRNA, Ann Bostic, CRNA, Diane Foley, RN, MSN, EDD, and Charles Milne. A big thanks

to Melody Tilley Administrative Assistant Nurse Anesthesia Program, for the endlessrevisions and all of your support. Thank you to all my classmates and friends.


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Abstract

The purpose of the study was to examine methods that individuals in rural West Virginia use

in the discovery of breast abnormalities. Further emphasis was placed on knowledge levels as

well as personal feelings regarding breast cancer detection methods. A research questionnaire

was used to obtain data which consisted of potential risk factors, personal health practices,

health history, perceived barriers, and demographic information. One hundred and fifteen

individuals participated in the study. One hundred and two participants were familiar with

various breast cancer detection methods. Eighty-three participants performed self breast

examinations. Eighteen participants answered that knowledge in detection methods was the

most common barrier associated with detecting breast abnormalities.


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Table of Contents

Chapter 1

Introduction

Introduction……………………………………………………………………………1

Problem………………………………………………………………………………..2

Purpose………………………………………………………………………………...2

Research Questions………………………………………………………………........2

Framework………………………………………………………………………….....2

Summary…………………………………………………………………………........4Chapter 2

Literature Review

Introduction………………………………………………………………………........5

Summary………………………………………………………………………………9

Chapter 3

Design and Methodology

Introduction…………………………………………………………………………..10

Design………………………………………………………………………………..10

Population……….…………………………………………………………………...10

Method of Data Collection…………………………………………………………..11

Analysis ……..…………………………………………………………………........11

Protection of Human Rights…………………………………………………………11

Summary……………………………………………………………………………..11


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Chapter 4

Data Analysis and Results

Introduction………………………………………………………………………......12

Data Analysis………………………………………………………………………...12

Summary……………………………………………………………………………..14

Chapter 5

Discussion and Conclusion

Discussion and Findings……………………………………………………………..16

Limitations…………………………………………………………………………...17Implications for Future Research………………………………………………….....17

References……………………………………………………………………………………19

Appendixes

A. Site permission letter from Victoria Champion……………………………...22

B. Questionnaire………………………………………………………………...23

C. Subject consent form.………………………………………………………...26

D. Site permission letter from American Cancer Society……………………….27

E. Security Statement …………………………………………………………..28

F. Institutional Review Board project review request…………………………...29

G. Tables…………………………………………………………........................30


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Chapter 1

Introduction

Breast cancer is a public health problem that puts all individuals at risk. According to

the American Cancer Society, breast cancer is the second leading cause of cancer death

among women in the United States. Statistics show that one out of eight women will develop

breast cancer in their lifetime (Benedict, 1996). It is important for individuals of all ages to

understand the importance of finding and treating breast cancer early.

With the exception of skin cancer, breast cancer is the most common type of cancer

among women in this country. Each year more that 211,000 American women learn theyhave this disease. According to the National Cancer Institute (NCI, 2008), estimated new

cases in the United States in 2008 are 182,460 (female); 1,990 (male) and deaths are 40,480

(female) and 45(male). The probability of breast cancer diagnosis increases by decade: from

age 30 to 40, 0.5%; from age 40-50, 1.49%; from age 50-60, 2.79%; and from age 60-70,

3.38%.

Although the breast cancer diagnosis rate has increased, the overall breast cancer

death rate has declined since the early 1990s. Statistics from the National Cancer Institute,

estimate that 12.7 percent of women born today will be diagnosed with breast cancer at some

time in their lives (National Cancer Institute, 2007).

Various methods are available for detection; however screening methods continue to

be underutilized. Although technology continues the advancement of various detection

methods, traditional methods of detection continue to be beneficial in the detection and

diagnosis of breast cancer. The importance of individuals becoming knowledgeable about

various techniques used in detecting breast cancer early is vital for survival.


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Problem

Screening for breast cancer before there are symptoms is important in the early

detection of cancer. Treatments are more likely to be effective when cancer is detected at an

early stage. Various methods may be used to detect abnormalities in breasts leading to the

diagnosis of breast cancer. However, many abnormalities are not diagnosed until a

mammogram is performed. Many individuals do not perform self breast or clinical breast

exams routinely which increases the risk of late discovery through more advanced methods,

primarily mammography.

PurposeThe purpose of this study is to examine differential methods that individuals in rural

West Virginia utilize in the discovery of breast abnormalities. Further emphasis was placed

on determining how knowledgeable participants are regarding the different methods

associated with the detection of breast cancer. Questions were directed toward demographic

data, potential risk factors, breast examinations performance, and perceived barriers.

Research Questions

1. Which method was most commonly used in detecting breast abnormalities?

2. What were the knowledge levels demonstrated by participants in cancer detection

methods?

Framework

The Health Promotion Model originated in 1982 by Nola Pender following her

publication in 1975 “A Conceptual Model for Preventative Health Behavior.” This model

was a basis for studying how individuals made decisions about their health care in a nursing

context. Revisions were made in 1987, 1996, and in 2002. Pender’s holistic nursing


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perspective comes from an extensive background in nursing, psychology, education, and

human development which served as the foundation for the Health Promotion Model.

The Health Promotion Model encompasses behaviors for enhancing health rather than

including threats or fear as a motivational source. The revised Health Promotion Model

incorporates concepts affecting health actions. The concepts are: 1) Prior related Behavior, 2)

Personal Factors, 3) Personal Biological Factors, 4) Personal Psychological Factors, 5)

Personal Sociocultural Factors, 6) Perceived Benefits of Action, 7) Perceived Barriers to

Action, 8) Perceived Self-Efficacy, 9) Activity-Related Affect, 10) Interpersonal Influences,

11) Situational Influences, 12) Commitment To A Plan of Action, 13) Immediate CompetingDemands and Preferences, and 14) Health-Promoting Behavior.

“The Health Promotion Model was proposed as a framework for integrating nursing

and behavioral science perspectives on factors influencing health behavior” (Pender, 1996, p.

51). Cognitive and perceptual factors are determinants of the model with a competence or

approach oriented focus. “The framework was offered as a guide for exploration of the

complex biopsychosocial processes that motivate individuals to engage in behaviors directed

toward the enhancement of health” (Pender, 1996, p. 51).

The Health Promotion Model incorporates economical, financial, and human burdens

which may hinder individuals from participating in healthier lifestyles. “The Health

Promotion Model contributes a nursing solution to health policy and health care reform by

providing a means for understanding how consumers can be motivated to attain personal

health” (Sakraida, 2006, p. 460).

The concepts used in Pender’s model are applicable to the present study. An

individual’s personal health care beliefs play a significant role in handling a disease process.


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Also an individual’s lifestyle and personal habits may contribute to the disease. Certain

factors such as family history of cancer and social habits such as smoking and diet may

increase the risk of developing cancer. Socioeconomic status may explain why certain

individuals choose a particular breast cancer detection method; perhaps individuals do not

have access to certain medical technology or simply do not have financial resources to have

extensive exams.

Others may not have been properly educated on the risks associated with breast

cancer and may not practice routine breast cancer detection methods. Individuals should

commit to performing routine exams which would promote a healthier lifestyle. Propertechnique is important in detection methods. Continually educating individuals about the

dangers associated with breast cancer is an important role for the nurse.

Pender’s model is ideal for studying how individuals make decisions about their

health care. Individuals are more likely to comply with routine detection methods when

education regarding the topic is enhanced. This model aids individuals in understanding the

benefits to personal health.

Summary

Breast cancer is the second leading cause of cancer death in women, with highest

mortality rates in women younger than 35 and older than 75. The importance of finding

breast abnormalities through differential methods is crucial for positive outcomes. Although

many risk factors are involved, early detection is a key component in ensuring increased

survival rates. By determining which detection method is most commonly used, knowledge

gaps and target populations may be identified.


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Chapter 2

Literature Review

Mortality rates have declined for white women younger than 55 (Costanza 2004, p.

342). Numerous studies (Champion, 1999; Leslie, 2003; Mahon, 2003) examined breast

cancer screening methods and modalities. Variables which were included in the studies

included race, age, socioeconomic status, personal history, knowledge and other factors as

well. Based on literature reviews, studies concluded that early detection, no matter what

method was used, was a crucial factor for survival.

In the mid 1990s, a retrospective study by Benedict was used to determine the methodof discovery of malignant breast tumors according to age, race, family history, and education

level. The study concluded that few women used all of the three methods recommend by the

American Cancer Society, which are breast self exam (BSE), clinical breast exam (CBE), and

mammography. The African American women included in the study did not utilize the three

recommended methods. BSE was the most frequent method for women in the age groups of

thirties and forties, in addition to other palpable modes. Within this study, three incidences of

breast cancer were discovered through CBE. The most frequent method of discovery was

mammography for the total sample.

Weingerg, Cooper, Lane, and Kripalani conducted a study (1993) evaluating the

screening behaviors and long-term compliance of 239 asymptomatic women over age 50 who

participated in the program. Subjects were female employees at a large hospital with various

occupations and under the age of 51 years. Data collection consisted of questionnaires and

medical records at two different intervals. Time 1 was considered at enrollment and annual


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reenrollment, time 2 represented recent data. Long- term compliance with mammography

guidelines was measured by calculating a compliance quotient for each participant.

Women listed reasons why they did not receive a mammogram which included the

lack of physician recommendation or did not know that a mammogram was needed.

Additional barriers were embarrassment, radiation exposure, poor accessibility,

procrastination, lack of insurance and cost, lack of regular doctor, and fear of cancer

diagnosis. Mammography was a more commonly practiced in younger, educated, married

individuals with a, family history of breast cancer, and increased efficacy. The study reported

that clinical breast exams were utilized by younger, non-white women, with a higher level ofeducation, employed and with a perceived vulnerability to breast cancer.

Reports indicated from time 1 to time 2 subjects increased their use of

mammography, clinical breast exams, and breast self exams. The compliance quotient was

higher among women who remained in the program longer, were still active in the program

at the time of the study, and used screening prior to enrollment. The results showed that a

worksite program that eliminates common barriers to screening can significantly increase use

of early detection practices.

A study conducted from 1995-2002 by Eheman et al. (2006) described the results of

breast screening among low-income and uninsured women in the National Breast and

Cervical Early Detection Program which was the only national organized screening program

in the United States. Data reported included history of previous mammogram, reported breast

symptoms, clinical breast examination results, mammogram results, and final diagnosis.

Information of race, ethnicity, and age were also available and categorized. The study

analyzed mammography and diagnostic follow-up methods for 789,647 women who received


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their first mammogram through the program as well as 454,754 subsequent mammograms by

the women. The results showed that women aged 40-49 years had the highest rates of

abnormal mammograms and a diagnostic follow-up, nearly 64% of the women ages 50-64

years of age and 46% were members of racial or ethnic minority groups. Cancer detection

rates were highest in women ages 60-64.

Taplin (2004) conducted another study in which data were obtained from seven health

care plans with the age group of greater than fifty years, using a retrospective chart review

and automated data 3 years prior to the breast cancer diagnosis. Three categories were used

during the prediagnostic period: absence of screening, absence of detection, and potential breakdown during follow-up, if the interpretation of the earliest screening mammogram

during the prediagnostic period was positive but the diagnosis of breast cancer occurred more

than one year later. The women were placed into categories based on early or late stage

breast cancers. The data was collected on the three years after the time of diagnosis. The

findings were consistent in the absence of screening category had higher odds of having late-

stage disease. A higher portion of older women and women from neighborhoods with lower

income or less probability of college education were in the “absence of screening” category.

Research aimed at determining knowledge, attitudes, and practices surrounding breast

cancer screening in educated Appalachian women was conducted by Leslie in 2003.

Participants included 185 women at a mid-Atlantic university in a rural state. The type of

study was a longitudinal clinical intervention study utilizing a modified Toronto Breast

Examination Inventory tool. Research variables were demographics, knowledge of breast

cancer screening practices, adherence to breast cancer screening guidelines, motivation,

knowledge, and practice proficiency surrounding breast cancer screening.


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Recommendations from the United States Preventive Services Task Force were

published in September 2002. The article states that the goal of screening form breast cancer

is to find cancer at early, treatable stages. Methods for screening were listed as breast self

exams, clinical breast exams, and mammography. The article reported that evidence showed

women between the ages of 40-69 years who have screening mammography every one to two

years have a decreased mortality rate.

Literature Review Summary

A review of the literature related to breast cancer thoroughly examines aspects of the

disease process. Research was conducted to examine the differential methods breast cancersurvivors used in the detection of the abnormality leading to the cancer diagnosis. Evidence

supports the positive outcomes that self breast exams, clinical breast exams, and

mammography have on decreasing the mortality rate. The literature review examines

variables associated with lack of screening, as well as various types of studies.

Data obtained from combined studies indicates that further investigation is needed.

Barriers associated with each variable need to be examined. Continually encouraging the

three detection methods recommended by the American Cancer Society will increase early

detection and decrease mortality in women diagnosed with cancer.


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Chapter 3

Methodology

The purpose of this study is to examine differential methods that individuals in rural

West Virginia use in the discovery of breast abnormalities. Further emphasis is placed on

determining how knowledgeable participants are regarding the different methods associated

with the detection of breast cancer.

Chapter three consists of the methods utilized to develop a research questionnaire as

well as data gathering, data organization, and data interpretation. Research design, sample,

data collection methods, data analysis, and protection of human rights will be included in thissection.

Methods examined in the study include self breast exam, clinical breast exam,

mammography and/or other in detecting a lump leading to the diagnosis of breast cancer in

individuals. Further emphasis was placed on determining how knowledgeable participants

are regarding the different methods associated with the detection of breast cancer and if

interventions such as early detection and other resources are being utilized appropriately for

an earlier definitive diagnosis.

Research Design

A comparative descriptive design was used and described differences in breast cancer

detection techniques. A questionnaire developed by Champion in 1998 and modified in 2007

for the study with permission from Champion (Appendix A) was completed by willing

participants and used (Appendix B).

The target population was a convenience sample selected from participants from the

Relays for Life, and included a minimum of 50 subjects over the age of 18 based on


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accessibility. The participants were individuals agreeing to complete a questionnaire at the

Relays for Life sponsored by the American Cancer Society following consent (Appendix C).

Data Collection

A formal request was submitted to Richard Totten, director, at the American Cancer

Society requesting permission to distribute a questionnaire during the Logan County and

Mingo County Relays for Life. Permission was granted (Appendix D). A contact person was

designated at each location and frequent follow-ups were made to ensure continuity. By the

subjects voluntarily answering the questions, this was considered consent for the study by the

subjects.Booths were set up at the Mingo County and Logan County Relay for Life events.

Subjects were asked to complete the questionnaire and place the questionnaire in a sealed

envelope returning it to the designated area (Appendix E). Data collections resumed until a

minimum of 50 subjects were included. The expected length of time to complete the

questionnaire was approximately 15-20 minutes.

Data Analysis

Results obtained from the questionnaire were categorized and analyzed using

descriptive statistics and percentages.

Protection of Human Rights

Following examination by Mountain State University Institutional Review Board,

permission to proceed with the study was provided (Appendix F). Permission was obtained

from all involved parties. Completion of the questionnaire acted as consent for participation.

The participants were asked to answer only the items listed on the questionnaire and not to

include additional or personal identifying information on the questionnaire.


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Chapter 4

Results

The purpose of this chapter was to present the analysis and findings of this study. The

purpose of this study was to examine differential methods that individuals in rural West

Virginia utilize in the discovery of breast abnormalities. Descriptive research provides an

accurate portrayal of characteristics of an individual, event, or group in real-life situations for

the purpose of discovering new meaning, describing what exist, and categorizing information

(Burns & Grove, 2005).

Survey ResponseData was gathered during the Relays for Life in Logan and Mingo counties. A contact

person was designated at each location and frequent follow-ups were made to ensure

continuity. A questionnaire was distributed to willing participants. By the subjects

voluntarily answering the questions, this was considered consent for the study by the

subjects. Fifty four questionnaires were completed at the Logan County Relay for Life. Sixty

one questionnaires were completed at the Mingo County Relay for Life.

Data Analysis

A descriptive survey was used in the study for assessment. The questionnaires

consisted of potential risk factors, personal health practices, personal and family health

history, perceived barriers, and demographic information.

For the purpose of this study (n) represents the number of participants included within

the study. Tables were included for summarization of findings (Appendix G). Table I

describes the demographic data of the participants in regards to sex, race, educational level,

marital status, and pregnancy status. Table II discusses potential risk factors including


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relatives diagnosed with breast cancer, age of first pregnancy, menarche, and menopause, as

well as the use of hormone replacement therapy. Table III discusses characteristics of self

breast examinations and performance including familiarity, detection methods, and detection

by whom. Table IV discusses several factors regarding perceived barriers that the

participants felt to be a hindrance regarding detection methods.

Participants completing questionnaires and giving more than one answer were

analyzed individually. A total of eleven participants answered question number 31 with more

than one answer. The question read: I feel that the following barriers are a hindrance to me

detecting breast cancer. Five participants answered income and insurance were barriers. Two participants answered income, insurance and knowledge about the disease as barriers. Two

participants listed insurance and knowledge about the disease were barriers.

A total of 115 participants answered question number seven, “Relatives with breast

cancer.” Fifty-four participants reported no relatives with breast cancer. Seven of the

participants had mothers diagnosed with breast cancer; six participants had sisters diagnosed

with breast cancer. Fourteen participants had maternal aunts diagnosed with breast cancer,

while eight participants report paternal relatives with breast cancer, with one participant

writing they had brother with breast cancer. 13 participants stated they did not know of

relatives with breast cancer. Twelve response sheets had multiple answers. For the first

research question, which asked about which detection method was most commonly used ;

eighty-three participants (72%) performed self breast examinations. Ninety-two participants

(80%) received breast examinations by healthcare providers. Fifty-one participants (44%)

had been taught by a physician and 18 participants (15%) were taught by a nurse to perform

breast examinations.


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For the second research question, what were the knowledge levels demonstrated by

participants in cancer detection methods. One hundred and two participants (89%) were

familiar with various breast cancer detection methods. Ninety-eight participants (95%) were

shown how to perform breast examinations. Forty-three participants (37%) agreed that they

were confident in performing a breast self exam correctly. Only 10 participants (0.09%)

strongly agreed that having a mammogram or breast x-ray would be painful and only three

participants (.03) felt that it would be embarrassing. Forty-nine participants (43%) strongly

agreed that a mammogram would help find a lump before it could be felt individually or by a

health care professional. Forty participants (35%) answered that they had access to a varietyof resources which would allow the use of different methods to detect breast cancer.

Eighteen participants (16%) answered that knowledge in detection methods was the

most common answer regarding barriers associated with detecting breast cancer with 12

participants (10%) listing insurance as a hindrance in detecting breast cancer.

In conclusion 87.8% (101) participants were females. Twenty-seven percent (31) of

the participants were ages 50-59. Ninety-six (110) participants were Caucasian and five

participants (0.04) were African American with no participation from Hispanic or Asian ethic

groups. High school diploma or GED accounted for 35% (40 participants) of the participant’s

educational level. Sixty-six percent (76) of the participants were married.

Summary

The purpose of this study was to examine differential methods that individuals in

rural West Virginia utilize in the discovery of breast abnormalities. Questions were directed

toward demographic data, potential risk factors, breast examinations performance, and

perceived barriers. Participants included both men and women ages 18 and older. Self breast


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examinations and examinations by healthcare providers were common detection methods. By

examining the factors that influence an individual’s decisions regarding breast cancer, ideally

future education techniques will improve.


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Chapter 5

Discussion and Conclusion

The purpose of this study was to examine differential methods that individuals in

rural West Virginia use in the discovery of breast abnormalities. This chapter discusses

research findings regarding demographic data, potential risk factors, breast examination

performance, and perceived barriers. Results were summarized based on findings.

Discussion and Findings

Early recognition of breast abnormalities is a vital component in the detection breast

cancer and increasing survival rates. The study was conducted in two counties in WestVirginia, Logan and Mingo. A contact person was designated at each location and frequent

follow-ups were made to ensure continuity. A questionnaire was distributed to willing

participants. Subjects were asked to complete the questionnaire and place the questionnaire

in a sealed envelope returning it to the designated area. Data collections resumed until a

minimum of 50 subjects were included.

Data Analysis

A descriptive survey was used in the study for assessment. The questionnaires

consisted of potential risk factors, personal health practices, personal and family health

history, perceived barriers, and demographic information

The importance of individuals becoming knowledgeable about various techniques

used in detecting breast cancer early is vital for survival. Once potential risk factors,

perceived barriers, breast examine methods, and demographic data have been identified,

future research may be directed toward preventive approaches regarding breast cancer.


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Limitations

The study was limited to non-pregnant individuals over the age of eighteen who were

present during the Logan or Mingo County Relay for Life. The possibility of biased

responses was also an issue since the Relay for Life is an annual event which raises money

and awareness of cancer. Individual’s responses may have been influenced by personal

experiences regarding cancer. Also, geographic locations may have been a limiting factor.

Implications

In retrospect, two additional questions should have been included in the

questionnaire. The first question would have been: “Have you been diagnosed with breastcancer?” and the second question would have been: “How was the breast cancer

discovered?” The inclusion of these questions would have given a more definitive answer to

the actual research questions presented in this project.

Also, the answer to the question: “Who taught you to perform a breast examination?”

surprisingly the most common answer was a physician (44%). The second highest percentage

was 15 % being a nurse, and only 4 (0.03%) being a nurse practitioner. The response to this

question, in which only 0.03% indicated that a nurse practitioner was the person who had

taught them how to do a self breast examinations, points to the need for advanced practice

nurses in rural West Virginia.. These answers could also implicate another important survey

question, “Who is your primary care provider?”

Screening for breast cancer before there are symptoms is important in the early

detection of cancer. Although the breast cancer diagnosis rate has increased, the overall

breast cancer death rate has decreased since the early 1990s. Treatments are more likely to be

effective when cancer is detected at an early stage. Various methods may be used to detect


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abnormalities in breasts leading to the diagnosis of breast cancer. In conclusion, based on the

findings, there is a need to continue investigating various issues regarding the detection and

diagnosis related to breast abnormalities and breast cancer.


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References

American Cancer Society. Overview: Breast Cancer How Many Women Get Breast Cancer?

(2007). Retrieved September 26, 2007 from American Cancer Society on World

Wide Web: http://www.cancer.org/docroot/CRI/content/CRI

Benedict, S., Williams, R. D., & Hoomani, J. (1996). Method of discovery of breast cancer.

Cancer Practice, 4, 147-155.

Bickley, L. S., & Szilagyi, P.G. (2007). Bates’ guide to physical examination and history

taking (9 th ed.). Philadelphia: Lippincott, Williams, & Wilkins.

Burns, N., & Grove, S. K. (2005). The practice of nursing research: Conduct, critique andutilization. (5 th ed.). Philadelphia: W. B. Saunders.

Champion, V. (1999). Revised susceptibility, benefits, and barriers scale for mammography

screening. Research in Nursing & Health, 22 , 341-348.

Costanza, M. E. Epidemiology and risk factors for breast cancer. In Bickley, L. S., &

Szilagyi, P. G. (2007). Bates’ guide to physical examination and history taking (p. 342).

Philadelphia: Lippincott, Williams, & Wilkins.

Eheman, C. R., Benard, V. B., Blackman, D., Lawson, H. W., Anderson, C, Helsel, W., &

Lee, N. C. (2006). Breast cancer screening among low-income or uninsured women:

Results from the National Breast and Cervical Cancer Early Detection Program, July

1995 to March 2002 (United States). Cancer Causes and Control , 17 , 29-38.

Humphrey, L. L., Helfand, M. C., Benjamin, K. S., & Woolf, S. H. (2002, September).

Screening for breast cancer: Recommendations from the U.S. Preventive Services

Task Force. Annals of Internal Medicine, American College of Physicians, 137 , 347-

360.


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Leslie, N. S., Deiriggie, P., Gross, S., DuRant, E. M., Smith, C., & Veshnesky, J. G. (2003).

Knowledge, attitudes, and practices surrounding breast cancer screening in educated

Appalachian women. Oncology Nursing Forum, 30, 659-666.

Mahon, S. M. (2003). Evidence-based practice: Recommendations for the early detection of

breast cancer. Clinical Journal of Oncology Nursing, 7 , 693-696.

National Cancer Institute Breast Cancer. (2008) Retrieved June 17, 2008 from

National Cancer Society World Wide Web:

http:www.cancer.gov/cancertopics/types/breast

Pender, N. J. (1996). Health promotion in nursing practice. (3rd

ed.) Stanford,Connecticut: Appleton & Lange.

Sakraida, T. J. (2006). Health promotion model. In Tomey, A. M. & Alligood, M. R., (2006),

Nursing theorists and their work (pp. 452-464). St. Louis, MO: Mosby Elsevier.

Smeltzer, S. C., & Bare, B. G. (2000). Brunner and Suddarth’s textbook of medical surgical

nursing. (9 th ed.) Philadelphia: Lippincott.

Taplin, S. H., Ichikawa, L., Yood, U., Marianne, M. M., Geiger, A. M., Weinmann, S.,

Gilbert, J. et al. (2004). Reason for late-stage breast cancer: Absence of screening or

detection, or breakdown in follow-up? Journal of the National Cancer Institute , 96 ,

20, 1518-1526.

Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work. (6 th Ed.). St.

Louis, MO: Mosby Elsevier.

United States Preventative Task Force (2003). Screening for breast Cancer:

Recommendations from the U.S. Preventative Services Task Force. Annals of

Internal Medicine. American College of Physicians , 137 , 344-346.


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Weinberg, A. D., Cooper, H. P., Lane, M., & Kripalani, S. (1997). Screening behavior and

long-term compliance with mammography guideline in a breast cancer screening

program. American Journal of Preventive Medicine, 13, 29-34.

Yarbrough, S. S., & Braden, C. J., (2001). Utility of health belief model as a guide for

explaining or predicting breast cancer screening behaviors . Journal of Advanced

Nursing , 33, 677-688.


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Appendix A

Appendix B


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BRE ST C NCER DETECTION METHODS

1. Male___ Female___ (Please Circle)

2. Are you pregnant:a. yesb. no

3. Age (years)a. 18-29b. 30-39c. 40-49d. 50-59e. 60-69f. 70 and above

4. Race or Ethnicity:a. Caucasian (White)

b. African Americanc. Hispanicd. Asiane. Other

5. Education Level:a. High School Diploma of GEDb. Some vocational or technical training or diplomac. Some college or Universityd. Some graduate studye. Graduate degreef. Never graduated high school

6 Marital Status:a. Singleb. Marriedc. Divorcedd. Separatede. Widowed

7. Relatives with Breast Cancer:a. Noneb. Motherc. Sisterd. Maternal Grandmothere. Maternal Auntf. Paternal Relativesg. Do not know

8. Do you Smoke?a. Yesb. No

9. Age of Menarche (first period)a. less than age 12


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b. greater than age 12

10. Age at first pregnancy:a. no pregnancyb. less than age 30c. greater than age 30

11. Age at menopause:a. Still menstruatingb. Greater that age 55c. Less than age 55d. hysterectomy

12. Have you used any type of hormone therapy, for example birth control, fertility regimens,hormone replacement therapy?

a. yesb. no

13. I am familiar with various breast cancer detection methodsa. yesb. no

14. Do you perform self breast examinations?a. yesb. no

15 Do you receive breast examinations by your healthcare provider?a. yesb. no

16 Have you ever been shown how to perform breast examinations?a. yesb. no

17. Who taught you how to perform a breast examination?a. never taughtb. self-taughtc. non-healthcare professionald. breast cancer screening classe. nursef. nurse practitionerg. physicians assistanth. physician

Strongly Disagree Neutral Agree Strongly


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Disagree AgreeI am confident in performing abreast self exam correctlyI feel funny doing self breastexaminations

Self breast examinations areembarrassingBased on lifestyle and familyhistory, my chances of gettingbreast cancer are greatThe thought of breast cancerscares meHaving a mammogram or x-ray of the breast would bepainfulHaving a mammogram or

breast x-ray would beembarrassingHaving a mammogram wouldtake too much timeHaving a mammogram willhelp me find a lump before itcan be felt by myself orhealth care professionalHaving a mammogram wouldcost too much moneyI have access to a variety of

resources which will allow meto use different methods todetect breast cancerMaintaining good health isvery important to me

31. I feel that the following barriers are a hindrance to me detecting breastcancer:

a. income

b. insurancec. residenced. knowledge about diseasee. knowledge in detection methods

Appendix C


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Subject Consent Form:

Title of Research Project : Breast Cancer Detection Methods Principle Investigator/Department: Kimberly Mitchell RN, BSN, SRNA, MSU Nurse AnesthesiaProgramOrganization/Location: Mountain State University Nurse Anesthesia Department, Beckley WV

My name is Kimberly Mitchell. I am a graduate nurse anesthesia student at Mountain StateUniversity. As part of my requirement for completion of the MSN degree, I am required to complete aresearch thesis. You are being invited to participate in my research study designed to assess breastcancer detection methods among women in rural West Virginia. I would appreciate your assistance incompleting the attached survey. This will required approximately 15 minutes of your time.

This information may assist individuals in examining differential methods that women inrural West Virginia utilize in the discovery of breast abnormities. Emphasis is placed on determininghow knowledgeable participant are regarding the different methods associated with the detection of

breast caner.Your identity in this study will be kept confidential. The results of the study may be

published for scientific purposes but will not give your name or include any identifiable references to

you. However, any resources or data obtained as a result of our participant in this study may bereviewed by the Institutional Review Board of Mountain State University, the thesis committee andstatistician, by any relevant government agency, or by the person completing this study provided thatsuch inspectors are legally obligated to protect any identifiable information form public disclosure.Complete surveys will be stored at a secure location designated by the researcher and maintained in alocked fireproof safe for a minimum of five years.

You are free to choose whether or not to participate in this study, and there is no penalty ifyou decide to participate or choose to complete the attached survey questions regarding breast cameradetection methods?

Please contact the Intuitional Review Board with further questions regarding this studywhich will be answered by the principle investigator,

Kimberly Mitchell RN, BSN, SRNAMountain State University, P.O. Box 9003 Beckley, WV 25802-9003

Any questions you have about your rights as a research subject will be answered by:Wayne Ellis, Ph.D., Chair, IRB committee at Mountain State University Beckley, WV

Authorization:Return of the questionnaire will be deemed as your consent to participate in this study. In giving yourconsent, Understand that consent does not take anyway any legal rights in the case of negligence oflegal fault of anyone who is involved in this study.

_____________________________________________________________________________Investigator Signature Date

Appendix D


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To whom it may concern,

I have been in contact with Kim Mitchell and she has the American Cancer Society’s permission to do the Breast Cancer questionnaire at the Relay For Life on June 8 th. If you needany additional information please feel free to contact me at 1-800-288-3618.

Richard D. TottenCommunity ManagerAmerican Cancer SocietyKanawha,Boone,Logan, [email protected]

Appendix E

Security Statement


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Disclosure of Raw Data

All collected data will be kept in a fireproof locked storage box at the principle investigatorssite. Access to this storage will be limited to myself, Kimberly Mitchell, and will be

maintained for a minimum of 5 years and a maximum of ten years before destruction viashredding.

Disclosure of Completed Data

Once all the data has been processed and completed, a copy of the data collected will bemaintained in the form of a completed thesis study which shall be available in the Graduate

Nursing Office and in the Mountain State University Library

Appendix F


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Appendix G

Table I. Demographics

Characteristic________________________________________ n ________ %____

Sex (n=115)Female 101 87.8Male 14 12.1

Pregnant (n = 115)Yes 0 0

No 115 100

Age (years) ( n = 115)18-29 11 0.1030-39 19 0.1740-49 29 0.2550-59 31 0.2760-69 21 0.1870 and above 4 0.03

Race/Ethnicity (n = 115)Caucasian 110 0.96African American 5 0.04Hispanic 0 0.00Asian 0 0.00Other 0 0.00

Education Level (n = 115)High school Diploma or GED 40 0.35Some Vocational or technical training or diploma 6 0.05Some college or university 36 0.31Some graduate study 3 0.03Graduate Degree 25 0.22

Never graduated high school 5 0.04

Marital Status (n = 115)Single 15 0.13Married 76 0.66Divorced 11 0.09Separated 2 0.02Widowed 11 0.10


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Table II Potential Risk Factors

Characteristic n %____

Relatives with breast cancer

None 54Mother 7Sister 6Maternal Grandmother see narrativeMaternal Aunt 14Paternal Relatives 8Do not know 13Multiple answers 12 see narrative

Smoker (n = 115)Yes 22 0.19

No 93 0.81Age of menarche (first period) ( n = 115)Less than age 12 31 0.27Greater than age 12 70 0.61

No answer 14 0.12

Age at first pregnancy (n = 115) No pregnancy 20 0.17Less than age 30 77 0.67Greater than age 30 4 0.03

No answer 13 0.11Multiple answers 1 0.00

Age at menopause (n = 115)Still menstruating 38 0.33Greater than age 55 11 0.09Less than age 55 26 0.23Hysterectomy 23 0.20

No answer 17 0.15

Have you used any type of hormone therapy?for example birth control pills, fertility regimens,hormone replacement therapy? (n = 115)Yes 59 0.51

No 52 0.45 No answer 4 0.03


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Table III Breast Examination Performance n %

Characteristic

I am familiar with various breast cancers

detection methods (n = 115) Yes 102 0.89 No 10 0.08 No answer 3 0.03

Do you perform self breast examinations? (n = 115)Yes 83 0.72

No 30 0.26 No answer 2 0.02

Do you receive breast examinations by your

healthcare provider? (n = 115)Yes 92 0.80 No 22 0.19 No answer 1 0.00

Have you ever been shown how to perform breastexaminations? (n = 115)Yes 98 0.85

No 16 0.14 No answer 1 0.00

Who taught you how to perform a breastexamination? (n = 115)

Never taught 12 0.12Self taught 10 0.08

Non-healthcare professional 2 0.01Breast cancer screening class 4 0.03

Nurse 18 0.15 Nurse practitioner 4 0.03Physician Assistant 3 0.20Physician 51 0.44

No Answer 5 0.04Multiple answers 6 0.05


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Table IV Perceived Barrier

Strongly Disagree Neutral Agree Strongly Nodisagree agree Answer

n % n % n % n % n % n %

I am confident in performinga breast self exam correctly 9 0.08 7 0.06 14 0.12 43 0.37 37 0.32 5 0.04

I feel funny doing breastexaminations 37 0.32 33 0.29 17 0.15 12 0.10 4 0.03 12 0.10

Self breast examinationsare embarrassing 46 0.4 36 0.31 18 0.16 8 0.07 2 0.02 2 0.02

Based on lifestyle and familyhistory, my chances of gettingbreast cancer are great 22 0.19 19 0.17 33 0.29 20 0.17 14 0.12 7 0.06

The thought of breastcancer scares me 10 0.09 7 0.06 10 0.09 40 0.35 43 0.37 5 0.04

Having a mammogram orbreast x-ray would bepainful 28 0.24 28 0.24 22 0. 19 22 0.19 10 0.09 5 0.04

Having a mammogram orbreast x-ray would beembarrassing 42 0.37 28 0.24 20 0.17 18 0.16 3 0.03 4 0.03

Having a mammogramwould take too much

time 56 0.48 40 0.35 9 0.08 3 0.03 1 0.01 6 0.05

Having a mammogram willhelp me find a lumpbefore it can be felt bymyself or health careprofessional 7 0.06 7 0.06 14 0.12 35 0.30 49 0.43 3 0.03

Having a mammogram wouldcost too much money 40 0.36 45 0.39 11 0.09 9 0.08 6 0.05 4 0.03

I have access to a variety ofresources which will allow me

to use different methods todetecting breast cancer 3 0.03 6 0.05 23 0.2 40 0.35 35 0.30 8 0.07

Maintaining good health isImportant to me 4 0.03 1 0.01 3 0.03 32 0.28 73 0.63 2 0.02


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I feel that the followingbarriers are a hindrance to medetecting breast cancer (n = 115) n %Income 8 0.07Insurance 12 0.10Residence 2 0.02Knowledge about disease 8 0.07Knowledge in detection methods 18 0.16

No answer 56 0.49Multiple answers 11 0.09

Documents

Detection Methods and Knowledge Levels Regarding Breast Cancer