Awareness, Knowledge and Attitude towards Breast Self-examination: A Cross-sectional Study among Female Pharmacy Students inMalaysia

Abstract

Aim: The aim of this study was 1) to assess awareness and knowledge towards breast cancer (BC) and breast self examination (BSE) among female pharmacy students in Malaysia. 2) to assess attitude towards practise of BSE among female pharmacy students in Malaysia and 3) to understand the association between awareness, knowledge and attitude towards breast self examination among socio-demographic variables. Study Design: Cross sectional study. Place and Duration of Study: Female students from Methodology: A pre-validated questionnaire containing socio-demographic details of the study participants, six awareness based items regarding breast cancer (BC), fourteen knowledge based items regarding breast self-examination (BSE) and fifteen attitude based items towards BSE behaviour. The questionnaire was distributed in class room setting after obtaining informed consent forms signed by participants. Summary statistics for categorical variables was used with chi-square test to see if there was any association between the variables. Results: The overall response rate was 92% (183/200). The average age of participants was 22 years (22.8 ± 1.1). Nearly 82% were Chinese, 30% belonged to year-4 tertiary education, 12% had family history of BC and 45% were from town areas. The overall awareness of the participants towards BC was moderate (64%, P < .05), whereas, knowledge towards BSE was poor (51%, P < .05). There was an overall positive attitude (62%, P < .001), followed by 29% neutral and only 9% with negative attitude regarding BSE practise. There were no association found between awareness, knowledge and attitude among any socio-demographic variables. Conclusion: This study results confirm that the study participants had a fair awareness, poor knowledge and positive attitude. Educational interventions directed to help young women familiarize with their breast self awareness (detect changes early) to start a lifetime habit of breast self-care, including BSE is important. Health education programs tailored to educate the correct BSE techniques are essential to encourage and improve women practise BSE for early identification and treatment initiation to reduce morbidity and mortality of BC.

Full text

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*Corresponding author: E-mail: nazer_ali@aimst.edu.my, abdul.nazerali16@gmail.com;
International Research Journal of Oncology
2(4): 1-10, 2019; Article no.IRJO.55055
Awareness, Knowledge and Attitude towards Breast
Self-examination: A Cross-sectional Study among
Female Pharmacy Students in Malaysia
Abdul Nazer Ali
1*
, Foong Ji Yuan
1
, Chuah Hui Ying
1
and Nazer Zulfikar Ahmed
2
1
Faculty of Pharmacy, AIMST University, Malaysia.
2
Cognizant Technology Solutions India Private Limited, Hyderabad, India.
Authors’ contributions
All authors contributed toward data collection, data entry, analysis, drafting and critically revising the
paper and agree to be accountable for all aspects of the work. Author ANA designed the study
protocol, questionnaire and obtained ethical clearance. Authors FJY and CHY were involved in data
collection and data entry. Authors ANA, FJY and CHY performed the statistical analysis and wrote the
first draft of the manuscript. Author NZA managed the analyses, literature reviews, citations and
references. All authors equally contributed, read and approved the final manuscript for submission.
Article Information
Editor(s):
(1) Dr. K. Poornima, Karpagam University, India.
Reviewers:
(1) Obiageli Chinyelu Chukwuemerie, Nnamdi Azikiwe University, Nigeria.
(2) Deepak Sethi, Rabindra Nath Tagore Medical College, India.
Complete Peer review History:
http://www.sdiarticle4.com/review-history/55055
Received 20 December 2019
Accepted 27 February 2020
Published 06 March 2020
ABSTRACT
Aim:
The aim of this study was 1) to assess awareness and knowledge towards breast cancer (BC)
and breast self examination (BSE) among female pharmacy students in Malaysia. 2) to assess
attitude towards practise of BSE among female pharmacy students in Malaysia and 3) to
understand the association between awareness, knowledge and attitude towards breast self
examination among socio-demographic variables.
Study Design: Cross sectional study.
Place and Duration of Study: Female students from Faculty of Pharmacy, AIMST University,
Kedah State, Malaysia between September, 2018 and May, 2019.
Methodology: A pre-validated questionnaire containing socio-demographic details of the study
participants, six awareness based items regarding breast cancer (BC), fourteen knowledge based
items regarding breast self-examination (BSE) and fifteen attitude based items towards BSE
Original Research Article

Ali et al.; IRJO, 2(4): 1-10, 2019; Article no.IRJO.55055
2
behaviour. The questionnaire was distributed in class room setting after obtaining informed consent
forms signed by participants. Summary statistics for categorical variables was used with chi-
square test to see if there was any association between the variables.
Results: The overall response rate was 92% (183/200). The average age of participants was 22
years (22.8 ± 1.1). Nearly 82% were Chinese, 30% belonged to year-4 tertiary education, 12% had
family history of BC and 45% were from town areas. The overall awareness of the participants
towards BC was moderate (64%, P < .05), whereas, knowledge towards BSE was poor (51%, P <
.05). There was an overall positive attitude (62%, P < .001), followed by 29% neutral and only 9%
with negative attitude regarding BSE practise. There were no association found between
awareness, knowledge and attitude among any socio-demographic variables.
Conclusion: This study results confirm that the study participants had a fair awareness, poor
knowledge and positive attitude. Educational interventions directed to help young women familiarize
with their breast self awareness (detect changes early) to start a lifetime habit of breast self-care,
including BSE is important. Health education programs tailored to educate the correct BSE
techniques are essential to encourage and improve women practise BSE for early identification and
treatment initiation to reduce morbidity and mortality of BC.
Keywords: Awareness; knowledge; attitude; breast cancer; breast self examination.
ABBREVIATIONS
BC : Breast cancer
BSE : Breast self examination
CBE : Clinical breast examination
CI : Confidence interval
1. INTRODUCTION
Breast Self-Examination (BSE) was first tested in
Finland around 1970s developed by Gisela
Gastrin and later a women organization
promoted BSE training in 1992 [1]. BSE is the
inspection of a woman’s own breasts on a
regular, repetitive basis for the purpose of
detecting any abnormal lumps or swelling in
breast, preferably between the 7
th
and 10
th
day of
each menstrual cycle [2]. Women age 20-39
should have a physical exam of their breast or
Clinical Breast Exam (CBE) at least every three
years, performed by a health care professional
[3]. The American Cancer Society currently
recommends women to perform BSE starting
from early 20s and prompt, immediate reporting
of any abnormal breast symptoms to health care
professionals [4]. The recommended monitoring
techniques to reduce breast cancer morbidity
and mortality include BSE, CBE and
mammography [5].
Based on the latest global cancer data, female
breast cancer is one of the leading cancer types
worldwide in terms of number of new cases
diagnosed (11.6% total cancer incidence burden)
in 2018. Latest global cancer data: Cancer
burden risen to 18.1 million new cases and 9.6
million cancer deaths in 2018 [6]. In Malaysia,
the incidence, mortality and prevalence reported
by Globocan, 2018, breast cancer was the
number one with 7593 (17.3%) new cases and
2984 (11%) death [6]. BSE when performed
accurately and regularly, provides with the
opportunity to identify differences in breast tissue
and detect lumps due to breast cancer [7],
although the efficacy of BSE may sometimes be
questionable [8]. Thus, BSE in most cases,
would prompt for quick referral for early
diagnosis and timely treatment. Despite BSE
being five decades old, it is neither practised at
all nor practised using correct techniques, for
various reasons cited as primary barriers in
earlier studies [9].
It was therefore important to determine the level
of awareness and knowledge towards BC and
their influence on attitude towards performing
BSE among female pharmacy students in a
private University, Malaysia. The idea behind
choosing this population was that they had a
background of health science education and are
more likely to be familiar with the study topic
which would pave way for further studies among
non-health science and less educated
population. Hence this study was undertaken
with the following study objectives: 1) to assess
awareness and knowledge towards BC and BSE
among female pharmacy students in Malaysia. 2)
to assess attitude towards practise of BSE
behaviour among female pharmacy students in
Malaysia and 3) to understand the association
between awareness, knowledge and attitude
towards BSE among socio-demographic
variables.

Ali et al.; IRJO, 2(4): 1-10, 2019; Article no.IRJO.55055
3
2. MATERIALS AND METHODS
2.1 Study Design, Settings, Period of
Study and Sample Calculation
A cross-sectional study was conducted using
convenience sampling in the classroom setting
among female pharmacy students, of a private
University in Malaysia between September, 2018
and May, 2019. The male students and/or those
not willing to participate were excluded from the
study. Out of about 250 female pharmacy
students, the estimated sample size was drawn
and calculated at 95% CI, 5% margin of error,
50% response distribution and 10% margin for
drop-outs. The final recommended sample size
was rounded off to 165 participants [10,11,12].
2.2 Development and Validation of
Questionnaire
The questionnaire was developed in English,
reliability and efficacy was established through
pilot studies using Cronbach’s alpha coefficient
for internal consistency among the potential
study population. The questionnaire showed
acceptable reliability and stability with positive
correlations. The interviewee feedback for the
questionnaire revealed that, most of the
respondents neither had difficulty nor confusion,
no embarrassing or displeasing contents with
any of the questions/statements regarding BC
and BSE for the entire questionnaire pilot tested.
Those participated in the pilot test were excluded
from the final survey. The contents incorporated
in the questionnaire were based on extensive
literature review and discussion with experts and
feedback from pilot study participants. The
questionnaire contained information on socio-
demographic variables including age, race,
literacy level, marital status, family history of BC,
location etc, 20 awareness/knowledge related
items and 15 attitude based items regarding
breast cancer and breast self-examination [13,
14,15,16,17]. Awareness and knowledge was
tested with yes/no options or multiple choice
options with one correct answer and a five point
Likert scale was used to test their level of
agreement towards each attitude based item.
The participants completed the questionnaire
within 15 to 20 minutes.
2.3 Statistical Analyses of Data
The analysis was performed using IBM SPSS
Statistics for windows (Version 23). Descriptive
statistics for frequency and percentage was
computed for categorical variables. Numerical
data was not normally distributed and hence
presented as median and inter-quartile range.
The Chi-square test for independence was used
to discover the association between categorical
variables and P-value < .05 were considered
significant. All percentages are displayed in text
or parentheses are with no decimal places [18].
3. RESULTS AND DISCUSSION
Out of 200 questionnaires distributed, the overall
response rate was 92% (183/200).
3.1 Socio-demographic Characteristics of
the Study Population
Table 1 shows the distribution of respondents’
socio-demographic characteristics. The average
age of respondents was 22 years (22.8 ± 1.1).
Nearly three fourth (70%) were aged 21-23
years, with 82% Chinese mostly (30%) belonging
to year-4 tertiary education, 12% had a family
history of BC and 45% were from town areas.
3.2 Awareness and Knowledge towards
BC and BSE
Table 2 shows the responses of the participants
towards awareness and knowledge-based items
regarding BC and BSE. The overall awareness of
the participants towards BC was moderate
(64%, P < .05), whereas, knowledge towards
BSE was poor (51%, P < .05) according to
Blooms original cut-off grades.
3.3 Attitude towards Breast Self-
examination
There was an overall 62% positive attitude,
followed by 29% neutral and 9% negative
attitude regarding BSE. The proportion of
agreement to the attitude-based items is
summarized in Table 3.
3.4 Association of Awareness and
Attitude towards BC and BSE among
Socio-demographic Variables
The distribution of awareness and attitude
response (frequency/percentage) was cross
tabulated against socio-demographic variables
and are summarized in Table 4. There were no
significant association found between awareness
and attitude among the socio-demographic
variables (P >.05).

Ali et al.; IRJO, 2(4): 1-10, 2019; Article no.IRJO.55055
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Table 1. Socio-demographic characteristics of the study population
Variables
Frequency (N=183)
Percentage (100.0)
Age in years
18-20 41 22
21-23 128 70
24-26 14 8
Race
Chinese 150 82
Indian 26 14
Malay 7 2
Year of study
Year 1 42 23
Year 2 47 26
Year 3 40 22
Year 4 54 30
Family history of breast cancer
Yes 22 12
No 161 88
Family relationship with breast cancer
Mother & Siblings 4 18
Aunts 11 50
Distant Relative 7 32
Native location
City 70 38
Town 83 45
Rural 30 17
Frequency and percentages distribution of the study participants
Table 2. Proportion of awareness and knowledge towards BC and BSE
Q.
no
Awareness and knowledge items
Yes
No
*p
value
N (%)
N (%)
Awareness towards BC
1. Have you heard of BC? 182 (99)
1 (1) <.001
2. Worldwide, BC is most common among women. 118 (65)
65 (35) <.001
3. Ages ≥ 50 years are at highest risk for BC in Malaysia? 57 (31) 126 (69)
<.001
4. Do you think BC could lead to death?
118 (65)
65 (35) <.001
5. Is there any treatment for BC? 107 (58)
76 (42) .02
6. Do you think early BC detection improves survival? 126 (69)
57 (31) <.001
Knowledge towards BSE
7. Have you heard of BSE? 132 (72)
51 (28) <.001
8. Do you know BSE is useful for early BC detection? 113 (62)
70 (38) .001
9. Do you think BSE is a good practise? 132 (72)
51 (28) <.001
10.
Have you been taught of how to perform BSE? 59 (32) 124 (68)
<.001
11.
Do you know BSE can be performed by themselves (BSE)? 166 (91)
17 (9) <.001
12.
Do you know BSE should be started at 20 years of age? 108 (59)
75 (41) .02
13.
Do you practise BSE? 44 (24) 139 (76)
<.001
14.
Do you know BSE should be done every month? 60 (33) 123 (67)
<.001
15.
Do you know to perform BSE for yourself? 129 (70)
54 (30) <.001
16.
Is a mirror required for performing BSE? 69 (38) 114 (62)
.001
17.
Do you know the best time to perform BSE is 3 to 5 days after
every menstrual period?
73 (40) 110 (60)
.01
18.
Do you know which part of the hand should be used to perform
BSE?
52 (28) 131 (72)
<.001
19.
Do you know the direction of hand movement during BSE? 41 (22) 142 (78)
<.001
20.
Do you know how to respond if breast abnormality is detected? 131 (72)
52 (28) <.001
*Pearson Chi-square test (P < .05) is significant

Ali et al.; IRJO, 2(4): 1-10, 2019; Article no.IRJO.55055
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Table 3. Responses to attitude based statements towards BSE
Qn.
no.
Attitude items
(-) ve
Neu
(+) ve
*p
value
N (%)
N (%)
N (%)
1. All females must be knowledgeable about BSE.
NR NR 183 (100)
a
-
2. All females >20 years should practise BSE
regularly.
NR 67 (37) 116 (63) < .001
3. BSE is useful for screening breast abnormality. NR 100 (55) 83 (45) .21
4. BC can be detected by BSE. 43 (23) 53 (29) 87 (48) < .001
5. BSE causes no harm. 12 (7) 84 (46) 87 (48) < .001
6. Early detection of BC increases survival rate. NR 72 (39) 111 (61) .004
7. BSE helps in prevention of BC. 23 (13) 75 (41) 85 (46) < .001
8. Females should look for medical help in case of
abnormal breast.
NR NR 183 (100)
a
-
9. I will immediately report when lump is in my
breasts or surrounding areas.
NR 24 (13) 159 (87) < .001
10. BSE is a good practise, and all women must
practise every month.
1 (1) 3 (2) 179 (98) < .001
11. I practise BSE because I do not want to be
diagnosed with BC later.
93 (51) 79 (43) 11 (6) < .001
12. I do not know how BSE is done correctly. 16 (9) 61 (33) 106 (58) < .001
13. I do not like touching my breasts. 62 (34) 70 (38) 51 (28) .23
14. Every women should perform BSE by
themselves.
1 (1) 48 (26) 134 (73) < .001
15. I will recommend the practise of regular BSE to
family members and friends.
1 (1) 56 (30) 126 (69) < .001
*Pearson Chi-square test; NR-No Responses;
a
- P value not computed; (-)ve - Negative; Neu- Neutral; (+)ve -
positive
Table 4. Comparison of awareness vs. attitude (N=183)
Variables
N (%)
Awareness [N(%)]
Attitude
positive
Poor
Moderate
Good
P
value
Age in years
18-20 41 (22) 13 (32) 13 (32) 15 (36) .35 41 (100)
21-23 128 (70) 43 (34) 54 (42) 31 (24) 128 (100)
24-26 14 (8) 6 (43) 3 (21) 5 (36) 14 (100)
Race
Chinese 150 (82) 47 (31) 60 (40) 43 (29) .60 150 (100)
Indian 26 (14) 12 (46) 8 (31) 6 (23) 26 (100)
Malay 7 (4) 3 (67) 2 (0) 2 (33) 7 (100)
Year of study
Year 1 42 (23) 11 (26) 16 (38) 15 (36) .08 42 (100)
Year 2 47 (26) 21 (45) 19 (40) 7 (15) 47 (100)
Year 3 40 (22) 17 (43) 11 (28) 12 (29) 40 (100)
Year 4 54 (29) 13 (24) 24 (44) 17 (32) 54 (100)
Marital status
Single 165 (90) 56 (34) 62 (38) 47 (28) .77 165 (100)
In a relationship 18 (10) 6 (33) 8 (44) 4 (23) 18 (100)
Family history of breast cancer
Yes 22 (12) 8 (36) 8 (36) 6 (28) .85 22 (100)
No 161 (88) 54 (34) 62 (39) 45 (27) 161 (100)
Native location
City 70 (38) 28 (40) 26 (37) 16 (23) .07 70 (100)
Town 83 (45) 22 (26) 38 (46) 23 (28) 83 (100)
Rural 30 (17) 12 (40) 6 (20) 12 (40) 30 (100)
*Pearson chi-square test (p < .05)

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Table 5. Comparison of knowledge vs. attitude (N=183)
Variables
N (%)
Knowledge score
Attitude
Poor
Moderate
Good
P value
positive
Age In years
18-20 41 (22) 31 (76) 10 (24) 0 (0) .61 41 (100)
21-23 128 (70) 99 (77) 28 (22) 1 (1) 128 (100)
24-26 14 (8) 9 (17) 43 (83) 0 (0) 14 (100)
Race
Chinese 150 (82) 113 (75) 36 (24) 1 (1) .28 150 (100)
Indian 26 (14) 19 (73) 7 (27) 0 (0) 26 (100)
Malay 7 (4) 7 (100) 0 (0) 0 (0) 7 (100)
Year of study
Year 1 42 (23) 31 (74) 11 (26) 0 (0) .08 42 (100)
Year 2 47 (26) 35 (74) 12 (26) 0 (0) 47 (100)
Year 3 40 (22) 30 (75) 10 (25) 0 (0) 40 (100)
Year 4 54 (29) 43 (80) 10 (19) 1 (1) 54 (100)
Marital status
Single 165 (90) 124 (75) 40 (24) 1 (1) .42 165 (100)
In a relationship 18 (10) 15 (83) 3 (17) 0 (0) 18 (100)
Family history of breast cancer
Yes 22 (12) 17 (77) 5 (23) 0 (0) .84 22 (100)
No 161 (88) 122 (76) 38 (23) 1 (1) 161 (100)
Native location
City 70 (38) 53 (76) 17 (24) 0 (0) .78 70 (100)
Town 83 (45) 62 (75) 20 (24) 1 (1) 83 (100)
Rural 30 (17) 24 (80) 6 (20) 0 (0) 30 (100)
*Pearson chi-square test (p < .05)
3.5 Association of Knowledge and
Attitude towards BC and BSE among
Socio-demographic Variables
Table 5 summarizes the distribution of
knowledge and attitude responses (frequency/
percentage) cross tabulated against socio-
demographic variables. There were no significant
association found between knowledge and
attitude among the socio-demographic variables
(P >.05).
3.6 Discussion
The main findings of this study is that the
awareness regarding BC was moderate whereas,
the knowledge regarding BSE was poor. About
99% (P <.001) knew about BC, 57% (P <.001)
knew the age standardized risk, 58% (P <.001)
knew the treatment options available for BC and
69% (P <.05) thought early detection improves
BC survival rate. Early detection of BC is
imperative for early intervention by health care
professionals for any positive treatment
outcomes. Hence, the need for improving
females knowledge of BC and BSE are important
because it reduces the rate of morbidity and
mortality [19]. A study in India reported 81% of
study population were unaware of BC when
compared to our findings (36%) [20]. Those who
were aware in this study were either older in age,
higher educated or belonged to Chinese Ethnicity.
A similar trend was observed in other studies
regarding older age and higher education [20,
21]. It is very important to investigate women
knowledge regarding BC and BSE as they are
the prime factors that motivate females to be
conscious about their health protective behaviour
over different cultures and countries [22].
As far as knowledge regarding BSE is concerned,
about 72% (P <.001) of the study participants
have heard of BSE, 72% (P <.001) thought it is
good to practise BSE, 91% were aware, BSE
could be self-examined, 70% knew where to
report if any abnormality was noticed. However,
poor levels of BSE practise (24%); frequency and
best time for performing BSE (33% & 40%); the
part of hand and direction of hand movement for
performing BSE (28% & 22%) respectively were
noticed. Significantly limited knowledge were
noticed on self practise, frequency, time and BSE
performing techniques. If we compare the results
of this study, (24%) regarding BSE practise with

Ali et al.; IRJO, 2(4): 1-10, 2019; Article no.IRJO.55055
7
other studies, we find that it is better than the
observations from studies reported as 7.6% in
Iran, 11% in India and 21% in Kuwait [20,21,22].
Only 31% of the study population were aware
that BC risk is highest among Malaysian women
at 50 years or older, however, more than half of
the participants thought BC could lead to death
and early detection facilitates treatment
opportunities and improves survival rate. On the
contrary, few studies have reported that early
detection of BC through BSE was non-existent
until training for BSE techniques was promoted
by a European women organization in early
1990s [23]. Screening by mammography has
been recommended and established to
substantially reduce mortality from BC which is
quite expensive and only opportunistic screening
is offered in majority of Asian countries including
Malaysia due to lack of funding [24]. Recently,
BSE, breast self-awareness, clinical breast
examination and mammography, all have been
used alone or in combination to screen for BC.
Varying judgements about the appropriate
balance of benefits and harms have led to
differences among the major guideline
recommendations for BC screening and for
economical reasons, BSE has been
recommended to be beneficial at all ages [25,26].
Though, BSE is not recommended in average-
risk women because of false-positive test results
and a lack of evidence of benefit. Average-risk
women should be counselled about breast self-
awareness (awareness of normal appearance
and feel of breasts) and encouraged to notify
health care provider if they notice any change
such as pain, mass, nipple discharge, or redness
in their breasts. Positive health-care behaviour
can go a long way in increasing health
awareness among the population and also health
seeking behaviour [27].
3.7 Association of Awareness,
Knowledge and Attitude towards BC
and BSE among Socio-demographic
Variables
About 70% of the study participants were in age
categories 21-23 years however, participants
aged 18-20 years showed comparatively better
awareness and knowledge towards BC and BSE.
There were no statistical significance between
participants age and awareness of BSE
observed in our study. A study in Nigeria
conferred our findings with no statistically
significant difference between participants age
and awareness of BSE among market women in
Abakaliki [28], whereas, a study in India reported,
72% were in the age group of 21- 40 years, 61%
were illiterates, 96% knew about BC, 17% were
aware of BSE and only 2% were practising BSE
[29].
Among the race category, Chinese represented
82% of the study population and also showed the
greatest of awareness and knowledge towards
BC and BSE. A similar study conducted in China
reported a lower awareness of only 12% among
Chinese nurses [30].
Participants year of study showed good
awareness and knowledge towards BC and BSE
among year four education category (P = .08),
meaning, higher the education, better was the
knowledge. A study in Ghana supported our
findings with significantly higher knowledge
(P=.002) in tertiary educated participants rather
than secondary school students [31,
32]. However, in contrast, a study among Iraqi
women reported a better knowledge of
secondary educated participants compared to
diploma or tertiary educated female students [33].
Among marital status category, 90% of
participants were singles, however, there were
no much difference in awareness and knowledge
regarding BC and BSE. The study finding is
supported by a recent study in Vietnam [32].
Among the participants with positive and
negative family history of BC categories, both
showed identical poor levels of awareness and
knowledge towards BC and BSE [32]. For native
location categories, the town dwellers showed
better awareness (P = .07) and knowledge
towards BC and BSE than rural areas
respondents. The result was supported by a
study in Iraq and may be due to the better
opportunity for health care facilities [33].
3.8 Attitude Regarding BSE
The highest percentage (100%) of positive
attitude were reported for: ‘females must be
knowledgeable about BSE; seek medical help if
abnormal breast; lump in or surrounding areas of
breasts are noticed; all women must practise
BSE every month. The overall attitude among the
socio-demographic characteristics towards BC
and BSE were all positive (P < .001). Many
studies have revealed a significant improvement
in the practise of BSE screening behaviour by
providing appropriate awareness of BC and

Ali et al.; IRJO, 2(4): 1-10, 2019; Article no.IRJO.55055
8
knowledge of correct BSE techniques [34,35].
This, in turn is noted, will improve the women
health motivation and self-efficacy, increase
perceived benefit towards regular practise of
BSE and decrease perceived barrier of BSE [36,
37].
4. CONCLUSION
In conclusion, the results presented in this study
give an insight into the awareness, knowledge
and attitude status of the study population. The
awareness of BC were moderate in comparison
to other studies, however, the knowledge of BSE
were poor. No significant association were found
between awareness, knowledge and attitude
regarding BC and BSE among socio-
demographic variables. Educational interventions
in the form of education, directed toward young
women to help them familiarize with their breast
self awareness (detect changes early), and start
a lifetime habit of regular breast self-care,
including BSE are important. The positive
attitude shown among all the participants in this
study towards BSE indicates the participants’
willingness to perform regular BSE. Health
education programs tailored to help educate the
correct BSE techniques are essential to
encourage and improve women BSE practise for
early identification and treatment initiation to
reduce BC morbidity and mortality.
5. STUDY LIMITATIONS
In spite of taking adequate care to follow the
scientifically valid methods, selection bias cannot
be ruled out as only a small proportion of the
target population was studied. The study
participants may not have been truthful all the
times. The results may not be representative of
the age eligible population as this study focused
on only part of a private university students.
However, all attempts were taken to minimize
errors.
DISCLAIMER
The authors disclosure that there is a
supplementary manuscript published elsewhere
with the source data and overlapping methods.
However, the objective and scope of this
manuscript is different [38].
CONSENT AND ETHICAL APPROVAL
The research proposal was submitted to the
Institutional Review Board (IRB), AIMST
University Human Ethical Committee (AUHEC)
along with the proposal, study instrument and
informed consent form. The ethical clearance
was obtained and informed consent forms signed
before distribution of survey forms to the study
participants.
COMPETING INTERESTS
Authors have declared that no competing
interests exist.
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