The questionnaire was distributed to the female muslims participant in there respective

stores and house and some of it was just given to their mother and sisters.

BSE training program that is given to the participated students composes CD, booklet
and posters that are prepared by researchers in Arabic language after review related
literatures and includes data about anatomy of breast, epidemiology of breast cancer,
risk factors at the breast cancer, signs & symptoms of breast cancer, early diagnosis
methods, management strategies, principles of and time of BSE method. The
participating students were classified into groups according to their academic schedule.
The training has been given to the each group separately and training program took
averagely 45-60 minutes. Program implementation was in the form of small group
sessions, the program content has been sequenced through 10 sessions (2 sessions for
pre-test 6 sessions for program implementation (2 sessions for theory and 4 sessions
for practice) and 2 sessions for posttest and observation check list). Group consisted of
25 students chosen according to academic schedule. The lists of participants were
prepared and provided to the administration office for agreement, and then printed and
distributed in different sitting.

The fieldwork was carried out from October 2012 to March 2013 through assessment,
planning, implementation, and evaluation phases. During the assessment phase the
pre-test was carried out to identify students’ needs and to build-up the health education
intervention program accordingly. The planning phase involved preparation of the
educational program; this included seven sessions covering breast anatomy, definition
of breast cancer, signs and symptoms and predisposing factors, types and diagnosis,
BSE, health promotion related to breast cancer, and early treatment. The researchers
utilized various approaches of adult learning such as interactive lectures with open
discussions, brain storming, and demonstration-re-demonstration. Various teaching
media were used such as power-point presentations, pictures, model objects, booklet
and mirror, in addition to an illustrated pamphlet to enhance learning. In the
implementation phase, the program was offered to students in small groups each
consisting of 18 students in seven sessions each lasting 30-45 minutes. The evaluation
phase involved a posttest after completion of the intervention.

Lack of knowledge among general public influences the prevention and early diagnosis
of breast cancer.
Spreading awareness regarding breast cancer amongst public by educational programs
through mass media is the need of the hour.
Increase in BSE and mammography practice achieved by educating regarding breast
cancer.
By using HBM health care provider can understand beliefs that influence women BSE
and mammography practice.

It is expected to health care professionals, especially nurses to take preventive

measures through health promotion efforts on BSE that are starting from adolescence
either in schools or community.

According to Robertson (2009) stated that a woman of any age could complete self-
examination monthly because of the risk factors such as women who have a history of
breast cancer, who started menstruating before 12, who finish menopause after 55, who
have a first child after 30 and who never have children.
Several recent studies that examined the knowledge and attitudes toward breast
cancer and breast self-examination found that with increasing age, women doubted the
benefits of early screening for breast carcinomas. It was shown that awareness about
breast cancer screening was higher among younger women compared to older women
over 50 years( Abdel Hadil 2006)

The level of education has a role in knowledge about breast cancer and BSE (Dundar,
et al. 2006). The Study of Kimani and Muthumbi (2008) at the health student in Kenyan
University obtained the data that the majority of the students heard about BSE, 69.9%
having ever practiced it. Less than 20% students performed BSE regularly.

In study conducted by Dalal et al, (2014) Majority (89.2%) of the participants

knew that BSE is recommended to be done monthly and less than half of the study
sample (46.8%) was aware about the correct time of BSE.

In a study carried by Sideeq et al 2017. Knowledge regarding breast self-

examination was very limited and only nineteen participants had ever heard of breast
self-examination and among them only fourteen knew the correct method of breast self-
examination and all of them also had self-examined there breast. Out of these fourteen
participants eleven had started breast self-examination between age of 20 to 30 year

In study conducted by Iran et al (2013), majority of respondents (72.5%)had positive

attitude towards BSE and 94.2% agreed that early detection improves survival. Doshi et
al (2012) also reported that almost all participants in their study agreed that all the
women should do BSE.
Kudadjie et al (2005) suggested in their report that awareness regarding breast self-
examination and adherence to it is affected by education and cancer worry.(Sdeeq et al.
2017)Our study also found a significant relationship between awareness for breast self-
examination and education. In an Indian study by Shamar and Ganguly 2013 were
found that only 21.37% knew how breast cancer presents commonly and only 6.87%
had knowledge of breast self-examination and in terms of practice, only six participants
(4.58%) were aware of and periodically conducted BSE. In another south Indian study
done by Yerpude et al. 2013 they found a higher percentage about 30.89% of the
women being aware of breast self-examination and 22.61% of the females who had
checked their breast. .(Sideeq et al. 2017) This difference between our results could be
because of the gross difference in the education level of females in the two studies .Our
results indicate that education and occupation significantly influenced knowledge of
breast cancer and breast self-examination as found by other studies. In a similar study
done by Gwarzo et al 2009 in Nigeria among undergraduate students they found that
85.1% of them have heard of breast self-examination but only 57% were practicing
BSE; this study points towards the positive role of literacy and education level for better
knowledge for breast cancer and its screening methods. In a similar study in Kenya
done by Kimani et al 2008 found that among medical students majority (94.6%) had
heard about BSE and 69.9% having ever practiced it.

A study conducted by Juanita et al. 2013 revealed that only 39.5% of the students
practiced BSE with more than half of the students saying they did not practice BSE
(60.5%). The main factors that influenced the students’ performing BSE were not having
a family history of breast cancer, single, and no history of breast illness. Among the
thirty students who practiced BSE, most of them did not practice it routinely (70%), nor
at the correct time (86.7%).

A study conducted by Al-Sharbatti, Shaikh, Mathew, and Al-Biate (2013) to assess the
prevalence of Breast Self-Examination (BSE) practice among female university students
in Ajman. It was found that 22.7% of the participants practiced BSE but only 3% of them
practiced BSE monthly. Marital status but not age as significantly associated with age
likelihood. The most frequent reported barriers for BSE were lack of knowledge,
considering oneself not at risk and the absence of doctor advice.

cross sectional study Conducted by Irurhe, Olowoyeye, Arogundade, and

Bassey (2009) to investigate the knowledge, attitude and practice of breast self-
examination (BSE) among female medical students in University of Lagos. Results
showed that majority of the respondents, 40.7% were from the age group 21-22 drawn
from first to sixth year medical students.97.3% had heard of breast cancer and breast
self-examination.54.8% of the respondents heard of breast cancer from television/
radio. Most of the respondents, 85.8% knew how to perform breast self-examination
correctly. Only 65.4% of the respondents thought that breast self-examination was
necessary. 43.5% of the respondents said that the last time they performed breast self-
examination less than a year ago. Majority of the respondents, 69.6% preferred to
perform breast self-examination in the morning while 47.7% of the respondents
preferred to carry out breast self-examination in front of the mirror.

cross sectional study conducted by Al-Sharbatti, Shaikh, Mathew, and Al-Biate (2013) to
assess the prevalence of Breast Self-Examination (BSE) practice among female
university students in Ajman. It was found that 22.7% of the participants practiced BSE
but only 3% of them practiced BSE monthly. Marital status but not age as significantly
associated with age likelihood. The most frequent reported barriers for BSE were lack of
knowledge, considering oneself not at risk and the absence of doctor advice. These
factors need to be taken into account in intervention efforts.

In a study Ahmed et al 2015). The age and marital status were variable found to have a
significant correlation (P < 0.05) with knowledge of CBE and mammography. On the
other hand, the perception of BSE was significantly associated (P < 0.031) with the
education level.

We found a significant relationship of knowledge of breast cancer and breast self-

examination with educational status and occupation but no significant relationship with
socioeconomic status.

Ayed et al. 2015 revealed that a highly statistically significant relation between age
groups and academic level with total mean knowledge of BSE (p˃0.000). Also it was
revealed that no statistical significant relation between total mean knowledge of BSE
and family history with breast cancer, information of breast BSE, and residence area.

Ayed et al. 2015 A highly statistically significant relation between age groups
and academic level with total mean knowledge of BSE (p= 0.000). This could be
attributed to the fact that 60% .of the total sample size in the current study were junior
nursing students (first and second year) who did not receive yet in-depth breast cancer
curriculum. A highly statistical significant difference was found between overall
knowledge and practice of BSE (P= 0.000) illustrating the desire among this population
to acquire correct knowledge regarding BSE. Also, this finding brings to light that if
awareness and health education programs are conducted in an intensive and planned
form, it might result in positive healthy practice

In study of Al Haj and Moawed 2015,Several other factors were significantly associated
with BSE knowledge and it practice are age and family history of breast cancer.
Research carried by Reganathan et al. 2014 in Omani women found a significant
association between family history of breast self-examination knowledge and practice.
The awareness and practice of BSE was more frequent in the age group of 21-20 years
(Bellgam and Buowari 2012). In addition, Monthly performance of breast self-
examination was more common among women who have recently graduated from high
school and university (Kara and Acikel 2009).
Awareness about breast cancer and early detection through regular breast screening is
to reduce the morbidity and mortality of the diseases (Reganathan et al. 2014). Efforts
to improve women’s education should be encouraged to increase women knowledge
about breast cancer and BSE. A person who has knowledge of something will influence
them in practice it (Fikree and Hamadeh 2011). The results showed that the Education
affects knowledge and practice of BSE. Peer educations is the most effective method in
educating female student about BSE ( Gursoy et al. 2009).