ELRAZI UNIVERSITY KHARTOUM SUDAN

FACULTY OF MEDICINE
COMMUNITY MEDICINE DEPARTMENT

TITLE: AWARENESS OF BREAST SELF

EXAMINATION AMONGST ELRAZI UNIVERSITY
FEMALE MEDICAL STUDENTS, KHARTOUM
SUDAN,2017-2018.

A thesis done in partial fulfilment of the requirements of the

MBBS degree in Elrazi University, Al-azhari, Khartoum Sudan.

BY:
 BUHARI ABDULLAHI LAWAL
 SALEH SULEIMAN GARBA
 NEHAL KHAMAL
 AISHA J.G MUHAMMAD
 AISHA BALARABE AHMAD

SUPERVISED BY: DR MOHAMMED AHMED

ALSHARIF M.D COMMUNITY MEDICINE
TOPIC: Awareness of Breast Self Examination among the El-
razi University medical student, Khartoum Sudan 2017-2018.

GENERAL OBJECTIVES: To study the awareness of breast

self examination(BSE) amongst the medical students in El-razi
University.

SPECIFIC OBJECTIVES:
1. Identification of the knowledge of students on breast self
examination(BSE).
2. To assess the knowledge of how to perform breast self
examination(BSE).
3. Practice of breast self examination (BSE).
DEDICATION
AKNOWLEDGEMENT
TABLE OF CONTENTS

S/N PAGE
NUMBER
1. Chapter one (1): Introduction
2. Justification
3. Chapter two (2): Literature review
4. Previous studies
5. Chapter three (3): Methodology
6. References
7. Chapter four (4): Results
8. Chapter five (5): Discussion
9.
10.
11.
LIST OF TABLES
ABSTRACT
CHAPTER ONE (1)
INTRODUCTION
The breast is the tissue overlying the chest muscle.
Woman breast are made of specialized tissue that produce milk.
Connective tissue and ligament provide support to the breast and
give it it’s shape. Nerves provide causation to the breast. The
breast also contains blood vessels, lymph vessels and lymph
node. (1)

Breast self examination is a screening method used to detect

early breast abnormalities. The method involves the woman
herself looking at and feeling each breast for possible changes.

Changes that could be found by breast self examination (BSE)

include: lump, changes in shape, discharge and swollen lymph
nodes. (2)

How to perform breast self examination (BSE)

 Begin by looking at your breast in front of the mirror with
the shoulders straight and the arms on the hips.
 Raise the arms and look for the changes.
 While you are at mirror, look for any signs of discharge.
 Feel the breast while laying down, using each hand to feel
the opposite breast.
 Finally feel the breast while standing or sitting. (3)
BREAST CANCER
Breast cancer refers to as malignant tumors that develops from
the cells in the breast.
A tumor can be either benign or malignant, benign tumors are
not dangerous to health while malignant tumors can be very
dangerous to health.
Malignant tumors are cancer cells which can spread to other
parts of the body. Usually breast cancer either originates from
the cells in the lobules {which are with producing glands}, or
the ducts {passages that drains milk from the lobules to the
nipples. If cancer cells get their way to the lymph nodes, they
then have a pathway into other parts of the body.
Types of breast cancer: -Ductal carcinoma
-Lobular carcinoma
STAGES OF BREAST CANCER
• Stage 0: cancer cells remain inside the breast duct without
invasion into normal adjacent breast tissue.
• Stage I-a: The tumor measures up to 2cm and the cancer
has not spread outside breast. No lymph nodes are
involved.
• Stage II-b: No tumors are found in the breast, but cancer
cells are found in the axillary lymph nodes {The lymph
nodes under the arm}.
• Stage III-a: No tumor is found in the breast. Its found in the
axillary lymph nodes that are sticking together or to
structures, or the lymph nodes near the breast bone.
• Stage III-b: The tumors may be of any size and has spread
to the chest wall or the skin of the breast.
• Stage IV: The cancer has spread to the other parts of the
body, meaning it has metastasized.
 RISK FACTORS OF BREAST CANCER
This refers to anything that increases your risk to developing
breast cancer.
• The risk factors include:
• -Age.
• -gender
• -Family history.
• -Medical history.
• -Diet.
• -obesity
• -breast feeding.

TREATMENT OF BREAST CANCER

• Chemotherapy
• Radiotherapy
• Mastectomy
• Hormonal therapy. (4)
JUSTIFICATION
Most breast cancers or diseases require early detection for a
good treatment and a better prognosis. Early detection of any
abnormal conditions of the breast lead to a better result after
treatment.
Awareness of breast self examination (BSE) helps in the early
detection of any lumps in the breast, because now breast cancer
mortality rate in the Sudan is very high.
CHAPTER TWO (2)
LITERATURE REVIEW
PREVIOUS STUDIES

 A study was conducted in Malaysia titled “Practice of breast self

examination among women in Malaysia by Ridwan Ahmad Al-
Naggar et al. The objective of this study was to examine the
practice and associated factors of breast self- examination (BSE)
among Malaysian women. Methods: For this cross-sectional study
250 women were selected by a simple random sampling
technique. The questionnaire was consisted of three parts: socio-
demographic characteristics, knowledge about BSE, and practice
of BSE. Obtained data was analyzed using SPSS version 13. T-
test and ANOVA test were used to explore the relation between
socio-demographic characteristics and the practice of BSE. The
results of this research were; About 32% of the participants
reported that they have had family history of cancer and about
20% of the participants reported that they have had family history
of breast cancer. The majority of the participants (88.8%) have
heard about breast cancer and 78.4% of the participants have
heard about BSE. Race, marital status, residency, regular exercise,
awareness about breast cancer, belief that breast cancer can be
detected early, belief that early detection improves the chance of
survival, family history of cancer, family history of breast cancer,
awareness about BSE, and belief that BSE is necessary,
significantly influenced the practice of BSE among women.
Practice of BSE on monthly basis was found to be 47.2% among
the study participants.
The conclusion that was gotten here was: The socio-demographic
characteristics significantly influence the practice of BSA among
women in Malaysia. (5)
 A study was aimed at assessing practice and associated factors of
breast self-examination (BSE) among female Debre Berhan
University students in Ethiopia Kalayu Birhane et al. A cross-
sectional study was conducted in 2015 among 420 using self-
administrated questionnaire. Multistage sampling technique was
used to select the study participants. Bivariate and multivariate
logistic regression analysis were done. Results. Majority of the
study participants, 338 (84.5%), were between 20 and 24 years old
with the mean age of 21.1 ± 1.65. Only 14 (3.5%) had family
history of breast cancer. Two hundred y-six (64%) of the
participants had heard about BSE and 30.25% had good knowledge
about BSE. Mass media were the most common source of
information about breast cancer. Few of the participants (28.3%)
had performed BSE. Lack of knowledge on how to perform BSE
was cited as the main reason for not practicing BSE. Knowing how
to perform, when to perform, and position to perform BSE and
having a perception that BSE is important and useful to detect
breast cancer were significant predictors of practices of BSE.
Conclusions; study revealed that most of the participants had low
knowledge and practice of BSE. therefore, it important to develop
health educational programs in the university to raise awareness
about BSE and breast cancer so as to practice self-breast
examination. (6)
 A study was performed in the south-eastern part of Nigeria titled
“Knowledge and practice of breast self examination among female
undergraduates in south-eastern Nigeria" by Ebirim Chikere
Ifeanyi Casmir . A multi-stage sampling design was used to select
participants. Interview using structured questionnaire was
conducted on randomly selected respondents in six faculties from
each tertiary institution. Questionnaire was pre- pared in English
and was self-administered. Permission to conduct the survey was
requested and obtained from the university ethical review board.
Informed verbal and written consent was obtained from
participants. Confidentiality of information was maintained
throughout the study. Knowledge and practice of BSE was
examined among 720 randomly selected female undergraduates
aged 16 to 28 years. It was found that 98.9 percent have heard of
BSE but only 32.5 percent of them performed this examination
accurately and monthly as required. The results and conclusion
were as follows: Knowledge and practice of BSE was examined
among 720 randomly selected female undergraduates aged 16 to
28 years. It was found that 98.9 percent have heard of BSE but
only 32.5 percent of them performed this examination accurately
and monthly as required. There is a statistically significant
relationship between knowledge of risk factors for breast cancer
and practice of BSE, source of information on BSE and practice of
BSE and the age of the respondents and practice of BSE. These
female undergraduates had a poor knowledge of the right
procedure and practice of BSE; therefore, there is need for
awareness creation on the risks of breast cancer and benefits of
early detection among female undergraduates through BSE.(7)
 A study was conducted in the Adama university of science and
technology, Ethiopia, titled “Breast Self-examination: Knowledge,
Attitude, and Practice among Female Health Science Students at
Adama Science and Technology University Ethiopia” by Mesfin
Tafa Segni et al, A cross-sectional study design was used to select
368 study subjects randomly. Self-administered questionnaires
were used to collect information. After cleaning the data it was
exported to SPSS version 21 for further analysis. Bivariate and
multivariate analyses were also performed with logistic regression
to measure the association between dependent and independent
variables. A total of 368 respondents participated in the study, of
these, only 8.7% of them had good knowledge and 59.2% had
positive attitude towards BSE. About (39.4%) of the respondents
had done breast self- examinations, from these only 9.7% of them
practiced monthly. Statistically significant association was
obtained only with, level of education of the participant, father’s
educational level and program of enrolment. Conclusion made
was that Knowledge and practice of BSE was low, even though
majority of them have positive attitude. Being health was the major
mentioned reasons for not doing BSE. (8)
CHAPTER THREE (3)
METHODOLOGY
STUDY DESIGN
 Non interventional, descriptive case only.

STUDY POPULATION
 Female medical students of El-Razi university Al-azhari,
Khartoum Sudan.
SAMPLE SIZE
𝑁
𝑛=
1 + 𝑁(𝑑)2
where:
n=sample size (258)
N=Total population (743)
d=degree of deviation (0.05)

STUDY AREA
 El-Razi university Al-azhari, Khartoum Sudan.

DATA COLLECTION
 Questionnaires
DATA COLLECTION TECHNIQUE
 Self administered

DATA ANALYSIS
 manual analysis with Microsoft excel

VARIABLES UNDER STUDY

 family history
 age group
 knowledge of BSE
 practice of BSE
WORK PLAN AND BUDGET
 Printing of questionnaires: 250 SDG
REFRENCES
1. Webmd.com/women/picture of the breast. Cited on 14th
November 2017.

2. Wikipedia.org/wiki/breast self examination. 2016. Cited on

14th November 2017.

3. Breast cancer.org/symptoms/testing/types/self exam. Cited

on 14th November 2017.

4. Robbins basic pathology textbook, twelfth edition.

5. Redhwan Ahmed Al-Naggar, Yuri V Bobryshev, Karim Al-

Jashamy. Asian pacific journal of cancer prevention, volume
13, 2012. “practice of Practice of Breast Self-Examination
Among Women in Malaysia”.

6. Kalayu Birhane, Miskir Alemayehu, Belayneh Anawte,

Gebru Gebremariyam, Ruth Daniel, Semeneh Addis,
Teshome Worke and Abdurrahman Mohammed.
International journal of breast cancer, volume 2017.”
Practices of Breast Self-Examination and Associated Factors
among Female Debre Berhan University Students”.

7. Ebirim Chikere Ifeanyi Casmir, Nwoke Eunice Anyalewechi,

Ibe Sally Nkechi Onyeka, Amadi Chinasa Orie Agwu,
Nwufo Chinyere. Regina Department of public health,
Federal university of technology owerri, Imo state Nigeria
2015, “Knowledge and Practice of Breast Self-Examination
among Female Undergraduates in South-Eastern Nigeria”.
8. Segni MT, Tadesse DM, Amdemichael R, Demissie HF
(2016) Breast Self-examination: Knowledge, Attitude, and
Practice among Female Health Science Students at Adama
Science and Technology University, Ethiopia. Gynecology
Obstetrics (Sunnyvale) 6: 368
CHAPTER FOUR (4)
RESULT
TABLE 1: DISTRIBUTION OF THE AGE GROUP OF STUDENTS IN
ELRAZI UNIVERSITY AL-AZHARI, KHARTOUM SUDAN.2017/2018.
n=258
Frequency Percent
15-20 98 38.0
21-25 139 53.9
26-30 16 6.2
31 and more 5 1.9
Total 258 100.0

Table shows that 53.9% of the students of Elrazi university as of 2017/2018 are aged between
21 years to 25 years.

TABLE 2: DISTRIBUTION OF FEMALE MEDICAL STUDENTS

WITH THE KNOWLEDGE OF BREAST CANCER IN ELRAZI
UNIVERSITY AL-AZHARI, KHARTOUM SUDAN.2017/2018.
n=258
Frequ
ency Percent
Good 158 61.2
knowledge
Moderate 85 32.9
knowledge
Poor 15 5.8
knowledge
Total 258 100.0

Table shows that 61.2% of the female medical students in Elrazi university as of 2017/2018
have good knowledge of breast cancer
.

TABLE 3: DISTRIBUTION OF FEMALE MEDICAL STUDENTS

WITH A FAMILY HISTORY OF BREAST CANCER IN ELRAZI
UNIVERSITY AL-AZHARI, KHARTOUM SUDAN.2017/2018
n=258
Frequency Percent
DO NOT 180 69.8
HAVE
HAVE 78 30.2
Total 258 100.0

Table shows that 69.8% of female medical students of Elrazi university as of 2017/2018 have a
family history of breast cancer.

TABLE 4: DISTRIBUTION OF FEMALE MEDICAL STUDENTS

THAT HAVE HEARD OF BREAST SELF EXAMINATION IN
ELRAZI UNIVERSITY ALAZHARI, KHARTOUM
SUDAN.2017/2018.
n=258
Frequency Percent
HAVE 53 20.5
NOT

HAVE 205 79.5

Total 258 100.0

Table shows that 79.5% of female medical students of Elrazi university as of 2017/2018 have
heard of breast self examination.
TABLE 5: DISTRIBUTION OF WHERE THE FEMALE MEDICAL STUDENT
ACQUIRED THEIR KNOWLEDGE OF BSE IN ELRAZI UNIVERSITY AL-AZHARI,
KHARTOUM SUDAN.2017/2018.
n=258
Frequency Percent
Family 62 24.0
Friend 42 16.3
I HAVE NOT HEARD OF IT 7 2.7
Internet 39 15.1
Others 32 12.4
social media 62 24.0
Television 14 5.4
Total 258 100.0

Table shows that 24% of female medical students in Elrazi university got their knowledge from
family and another 24% got their knowledge from the social media.

TABLE 6: DISTRIBUTION OF FEMALE MEDICAL STUDENTS

THAT KNOW HOW TO PERFORM BREAST SELF
EXAMINATION IN ELRAZI UNIVERSITY AL-AZHARI,
KHARTOUM SUDAN.2017/2017.
n=258
Freque
ncy Percent
Valid DO NOT 106 41.1
KNOW
KNOW 152 58.9
HOW
Total 258 100.0

Table shows that 58.9% of female medical students know how to perform BSE in Elrazi
university 2017/2018
TABLE 7: DISTRIBUTION OF FEMALE MEDICAL STUDENTS
THAT PRACTICE BREAST SELF EXAMINTION IN ELRAZI
UNIVERSITY AL-AZHARI, KHARTOUM SUDAN.2017/2018.
n=258
Frequency Percent
DO NOT 128 49.6
PRACTICE
PRACTICE 130 50.4
Total 258 100.0

Table shows that 50.4% female medical students practice breast self examination in
Elrazi university as of 2017/2018

TABLE 8: DISTRIBUTION OF REASONS WHY FEMALE MEDICAL STUDENTS OF

ELRAZI UNIVERSITY AL-AZHARI, KHARTOUM SUDAN DO NOT PERFORM
BREAST SELF EXAMINATION.2017/2018.
n=135
Frequency Percent
Valid I am afraid of finding cancer 21 15.6
I am healthy 50 37.0
I don't know about it 22 16.3
i feel shy 19 14.1
It may be painful 11 8.1
Other 12 8.9
Total 135 100

Table shows 37.0% of female medical students do not practice BSE because the think they are
healthy
TABLE 9: DISTRIBUTION OF THE ACTIONS THAT WILL BE TAKEN
BY FEMALE MEDICAL STUDENTS OF ELZARI UNIVERSITY AL-
AZHARI, KHARTOUM SUDAN.2017/2018.
n=258
Frequency Percent
Valid Do nothing 14 5.4
other 14 5.4
See a doctor 190 73.6
Tell a friend 24 9.3
Tell a relative 16 6.2
Total 258 100.0

Table shows 73.6% of female medical students of Elrazi university would tell their doctor if they
find any changes as of 2017/2018.
CHAPTER FIVE (5)
DISCUSSION