Empowering
against breast cancer
(Community based Breast cancer prevention
programme in targeted group)
Table
of contents
1. Introduction
2. Rationale
3. Background
4. Objectives
5. Activities
6. Outcomes
7. Evaluations
8. References
Introduction
Breast is
one of the reproductive organs which make the sustainability of living being in
earth since the evaluation of mammals. Breast cancer begins as like all the
cancers at cellular level. New cells form when the body doesn't need them, and
old or damaged cells don't die as they should. The build-up of extra cells
often forms a mass of tissue called a lump, growth, or tumor. Tumors in the
breast can be benign and malignant. Malignant growth of breast tissue called
breast cancer, which is more dangerous than benign growths.
Breast
cancer is a major public health problem for women throughout the world - it
means both developed and developing countries. There are about 1.38 million new
cases and 458 000 deaths from breast cancer each year (IARC Globocan, 2008).
This dangerous disease is one of the challenging diseases for the modern
Biological Technology. As per the most recent statistics, incidence of breast
cancer in Sri Lanka has increased among the female population and this is the
most common cancer among women in Sri Lanka. As with most cancers, Currently
there is not sufficient knowledge on the causes of breast cancer and Experts
believe that it may be due to genetic and environmental factors therefore,
early detection of the disease remains the cornerstone of breast cancer control
but, The majority of deaths occur in low- and middle-income countries, it is
because of breast cancer are diagnosed in late stages due mainly to lack of
awareness on early detection. Lot of choices for early detection are available
such as self-breast examination (SBE), mammogram and MRI scanning of breast.
Out of these, SBE is the affordable method for all women. As it is cost free
this method can be applied in all countries regardless of socio-economical
status. Many studies have shown the effectiveness of SBE. Women’s privacy is
well maintained in this method.
Breast
Cancer Awareness Month in 2013 focuses on the need to screen for early
detection to save lives as early detection is the key to tackle breast cancer.
The knowledge, skill and behavioral change on early detection is very poor in
developing countries because the opportunities are very much restricted. We
hope that by empowering our people to detect the breast cancer at early stage
and to reduce morbidity and mortality due to breast cancer in our target
community.
Rationale
More than 1.2 million women are diagnosed with breast cancer annually
worldwide. Worldwide breast cancer accounts for almost 1% of all deaths thus
the cause of death in over 400,000 women. According to American association of
cancer research, breast cancer is the second leading cause of cancer related
deaths in women after lung cancer. One in 33 women who have breast cancer will
die. Survival for women with breast cancer has improved significantly. In the
early 1970’s five year survival rate were 52%, and the latest figure is 81%.
Breast cancer incidence in Sri Lanka has risen in the recent past. A
crude incidence is 18.7 per 100 000 female population and it has increased from
6.8 to 18.7 per 100 000 female population in last 20 years. There is very
strong evidence that delayed presentation of breast cancer is associated with
lower survival. All these epidemiological report has shown the importance and
severity of breast cancer, this is the reason why we are selecting this issue
for our community intervention.
Our main aim is to prevent breast cancer before its occurrence, it mean
in a pre-clinical stage of the disease. We are applying health education and
early detection as primary and secondary prevention strategies. The treatment
of breast cancer is not much successful unless we detect the breast cancer at
its early stage and the treatment
options such as radiotherapy and chemotherapy
will make harm to body in advanced stage of disease and those modalities
are very expensive. At the advanced stage of the disease, patients suffer a lot
physically and mentally and their family also had to suffer a lot. As there is
a stigma regarding breast cancer in our community, this will further worsen the
patients’ condition ultimately health of the patient will be severely affected.
Our setting of this program is girls’ school. Here we are primarily
targeting students in grade 11 to grade 13 and female teachers. As school is a
well-organized setting, it is a better place to apply the setting approach of
health promotion. The reason for selecting students is that they are very
curious to know, they can easily understand concepts, they can easily form
awareness groups against breast cancer, students often respond more effectively
to peers than to adults, we can continuously evaluate their activities and we
can aim their family members like mother sisters and aunties as a secondary
target group. Teachers are also included in this programme as they can
continuously empower the students against breast cancer and with the guidance
and encouragement of teachers, students will be able to form awareness groups
against breast cancer.
Our target setting is situated in Batticaloa district. The geographical
advantages in empowering the people against breast cancer are that the location
is 32 km away from Faculty of Health Care Sciences. So, visiting the place and
conducting the necessary community interventions will be much easier and more
useful as high incidence of breast and cervical
cancer in Sri Lanka is recorded in Batticaloa district recently.
Background
There are a lot of determinants of breast
cancer such as family history of breast cancer in first degree relatives, Age
(50-55 years), socio economic state, knowledge on breast cancer. Even though
the etiological agent of breast cancer is not clear, there are a lot of risk
factors for breast cancer such as having a family
history of breast cancer, A history of malignant or benign (non-cancerous)
breast disease, A history of ovarian cancers, early onset of menstruation, late
menopause, having first child after the age of 30, having fewer children or
never having children, being on hormone replacement therapy, weight gain, especially
after menopause. We are going to target some intervention on determinants such
as knowledge and skill and also modifiable risk factors.
We will conduct our programme at
Oddamavadi Fathima Balika Maha
Vidyalayam. Which is situated at Koralai pattu west MOH(Medical Officer of
Health) Division in Batticaloa district. During our clinical clerkship, we
found out many breast cancer patients from this area. That’s the reason for
selecting this school.
We will empower our target group against breast
cancer. In this programme we are trying to deliver Knowledge, motivation,
enthusiasm and skill to our target group by conducting two episodes of
programme. Over the period of time, we hope that the positive behavior change
can be observed in our primary and secondary target groups and that positive behavioral change will help the people to prevent the occurrence of breast cancer
Objectives
·
General objectives
Empowering against breast cancer among
grade 11 – grade 13 school girls and female
teachers.
·
Specific objectives
1. To
give knowledge about breast cancer and its consequences.
2. To
improve the skill in performing self examination of breast.
3. To
enable the participants to identify breast lumps and signs of breast cancer
4. To
give awareness about early treatment and cure.
5. To
facilitate hospital visiting and specialist referral in case of any suspicion
6. To
encourage the participants to convey the messages to secondary target groups.
7. To
clear their doubts regarding breast cancer.
8. To
empower the target group against breast cancer and to encourage them to form an
awareness group on breast cancer at their school.
Activities
1. We
will select the field activity & submit the proposal and get permission
from Department of Primary Health Care
2. We
will get permission from the principal of the particular school to carry out
our activities.
3. We
will discuss with the teachers about the heading & the task group as a pre
evaluation of programme
4. We
will receive sponsorship from Advanced Level Development Association.
5. We
will prepare a presentation on breast cancer including risk reduction, early
detection, healthy lifestyle choices, dispelling myths & fears, and
facilitating guidance from the health professionals.
6. We
will make a dummy breast model for demonstration of self breast examination
7. We
will prepare a leaflet to facilitate the understanding of the presentation
& to target the secondary audience.
8. We
will prepare a questionnaire for evaluation.
9. We
will discuss the possibilities and importance of forming an awareness group in
their school with the students and teachers.
10. We
will select the proper auditorium with privacy for the presentation and
demonstration programme and we will set a date
11. We
will design an invitation for the program.
12. Invitation
will be displayed on the school notice board
13. We
will conduct the program as announced. In that program we will issue the
leaflets. In our presentation, we will reinforce regular examinations, healthy
lifestyle with regular exercises, proper nutrition and we will encourage
participants to pay attention in selecting food, fat intake, portion sizes
& information contained on food product packings. Participants will be
given the unique opportunity to practice proper self-examination on the breast
model. They will be demonstrated for essential skills in detecting tumors in
their early stages.
14. We
will give opportunity for the audience to clarify their doubts regarding breast
cancer.
15. We
will give opportunity for the participants to be examined by medical students
in case of any suspicion.
16. Evaluation
questionnaire will be issued and collected.
17. We
will inform our second visit to the participants.
After 2 months of our
first visit we will meet the target group again and we will do the evaluation
by means of questionnaire and direct conversations
1.
Out comes
We are expecting the following outcomes from
our field activities
1. Students
should get adequate knowledge on breast cancer.
2. Students
should get motivation to do self breast examination regularly and to encourage
others to do so.
3. Students
should be able to do self breast examination in proper manner.
4. Students
should be able to identify breast lump and signs of breast cancer.
5. Improvements
in personal skills for risk reduction
6. Participants
should be able to instruct others regarding breast cancer and motivate them to
consult doctors immediately in case of any suspicion
7. Participants are
expected to make healthy lifestyle choices
Evaluation
1. Feedbacks
will be collected to assess their enthusiasm.
2. Assess
the knowledge of the students regarding breast cancer through questionnaire
before and after programme.
3. Randomly
select the students and ask to explain the breast self examination technique at
second visit of the programme.
4. During
our second visit, participants will be evaluated with the same questionnaire
and knowledge will be assessed again.
5. Assess
the percentage of students who convey the message to secondary audience via
questionnaire.
6. Enthusiasm
will be evaluated by asking the students to prepare PowerPoint presentations,
handmade posters, drawings, leaflets and
collecting news paper articles on breast cancer.
By comparing
subsequent results, success of the programme will be evaluated
Reference
4. .World
Health Organization. Guidelines for management,
of
breast cancer. Eastern Mediterranean, WHO 2006
5.
National
Cancer Control Programme. Cancer incidence,
data:
Sri Lanka Year 2001 to 2005. National
Cancer Control Programme; 2009
