PROPORTION OF SPECIFIC FACTORS RISK OF BREAST CANCER ON WOMEN

AGE 25-65 YEARS

Bina Melvia Girsang

Email :binamelvia@gmail.com
Nursing Faculty
North Sumatera University

Abstract

Women who do early detection of breast cancer can be said to be still a little. Though the
importance of breast examination since early is to know a woman's breasts under normal
circumstances or not. This study aims to determine the proportion of several specific factors
that cause the risk of breast cancer incidence in women aged 25-65 years with an
observational analytic method with case control design. Sampling is done by using
probability sampling with simple random sampling technique approach. The sample size was
23 women in the case group and 46 women in the control group in the working area of
Gandus and Dempo, South Sumatera – Palembang sub-districts from May to September
2017. Screening data were collected using a questionnaire and analyzed by bivariate analysis
using chi square and fisher's exact statistical tests, continued with multivariate analysis using
multiple logistic regression statistic test. Based on the results of bivariate analysis found that
there are 7 specific risk factors from the overall 15 related factors (p value <0.05) with risk
factors for breast cancer incidence. The seven specific risk factors were age (OR: 0.6, 95%
CI: 0.53-0.79), first menstrual period (OR: 24; 95% CI: 2.76-207.98), history of tumor (OR:
3.2, 95% CI: 2.28-4.75), long breastfeeding (OR : 95% CI: 2.23-4.54), consumption of fatty
foods (OR: 0.2; 95% CI: 0.07-1.00), types of hormonal contraceptives (p value <0 , 05). The
result of multivariate analysis with multiple logistic regression was found that menstrual age
was the specific factor of a person detected at risk of breast cancer (p value 0.05-0.55) is very
important because most women are not aware of breast cancer symptoms and risk factors that
are difficult to handle.

Keywords: factors, breast, cancer, risk

1. Introduction occur in developing countries (Rasjidi,

2010).
Breast cancer is a disease with the
highest rate in Indonesia after cervical 2. Background
cancer is 0.8% in cervical cancer and
Women who do early detection of
0.5% in breast cancer. Breast cancer is
breast cancer can be said to be still a
often encountered by women. It is
little. Though the importance of breast
estimated that new cases are not less
examination since early is to know a
than 1,050,346 per year. Of these,
woman's breasts under normal
580,000 cases occur in developed
circumstances or not. The problem that
countries and the rest occur in
occurs is the handling of cancer in
developing countries. Based on
Indonesia is still less than optimal,
estimates by the International Agency
because almost 70% of new cases are
for Research on Cancer, by 2020 there
found in stage three and stage four. The
will be 1.15 million new cases of breast
cure of cancer is determined by the
cancer with 411,000 deaths. As many as
condition of breast cancer when first
70% of new cases and 55% predicted to
discovered. Cancer found in stage I the
 possibility of cure reaches 80-90%. In
stage II where the cancer begins to
spread to the lymph glands around the
breast, the chances of cure decrease to
60-70%. The likelihood of cure
decreases in stage III patients is 30-
40%. The worst condition in stage IV
with a possible cure of less than 10%
(Purwanto, 2010)
When there is a change in the
breast, whereas it is unknown where the
change is a sign of breast cancer,
consequently a slow diagnosis is
enforced eventually the required
treatment should be greater than if the
diagnosis of breast cancer is established
from the beginning. This study aims to
identify and present the proportion of
specific risk factors and clinical breast
examination results or clinical breast
examination (CBE) in the study
subjects in women of childbearing age
25-65 in urban areas indicated and
exposed to risk factors. This study aims
to determine the proportion of specific
risk factors of breast cancer incidence
and clinical breast examination results
in women aged 25-65 years in the
working area of Gandus and Dempo
sub-district, South Sumatera,
Palembang.
3. Methodology
This research is analytic
observational research with case control
design. Sampling is done by using
probability sampling with simple random
sampling technique approach. The controls
were randomly selected with the first
respondents detected abnormal results of
CBE issued, then obtained the ratio of the
number of cases and control is 1: 3. The
number of samples in the study in which
the data collected from May to September
2017 was found to be 69 people with a
ratio of 23 in the case group, and 46 in the
control group screened for CBE where
abnormal results were a case of risk of
breast care incidence.

4. Result

The proportion of women at risk of breast cancer incidence was 33.3% of the 69
women aged 25-65 years.

Tabel 1. Result of Descriptive Statistics

Variables Case Control

N N %
Level of education
Graduated from elementary school 18 78,3% 12 26,1%
Graduated from Junior High School 1 4,3% 2 4,3%
Graduated from high school / vocational school 4 17,4% 32 69,6%
Graduated Higher Education 0 0% 0 0%
Total 23 100% 46 100%
Marital status
Married 23 100% 46 100%
Not / Not Married 0 0% 0 0%
Total 23 100% 46 100%
Menopause Status
Menopause 0 0% 0 0%
Not yet menopause 23 100% 46 100%
Total 23 100% 46 100%
Breast Cancer History
Yes 0 0% 0 0%
No 23 100% 46 100%
 Total 23 100% 46 100%
Stress Level
Normal 0 0% 0 0%
Light 23 100% 0 0%
Medium 0 0% 0 0%
Severe 0 0% 0 0%
Awfully 0 0% 0 0%
Total 23 100% 0 0%
Passive smoker
Yes 23 100% 46 100%
No 0 0% 0 0%
Total 23 100% 46 100%

Education level is categorized into 4 categories, Graduated from elementary school,

graduated from junior high school, high school / junior high school, graduated from PT. The
education level of respondents in this study is majority of primary school (78.3%) in the case
group and graduated from high school (SMK / SMA / SMK) in control group (69.6%) and
overall 100% of respondents are married. In this study 100% of respondents have not
experienced menopause, mild stress, and is a passive smoker. In this study all respondents in
both case and control group did not have a history of breast cancer.

Tabel 2. Results of Bivariate Analysis

Variables p value OR 95% CI

Age
17-46 Years 0,000 0,650 0,531-0,795
First Menstrual Age 0,000 24 2,76-207,98
<12 Years
≥ 12 Years
History of Benign Tumor In Breast 0,04 3,19 2,23 – 4,54
Yes
No
Family Cancer History 0,012 3,3 2,28 – 4,75
Yes
No
Long Breastfeeding 0,042 3,190 2,23 – 4,54
<6 Months
≥ 6 months
Consumption of Fatty Foods 0,043 0,279 0,077-1,007
High
Low
Types of Hormonal Contraception
*
Pill 0,019
Inject
Susuk / Implan
Never
Ovarian Cancer History 0,154 3,09 2,19-4,359
Yes
No
Consumption of Fibrous Foods 0,843 1,12 0,35-3,551
Low
High
Physical Activity 0,154 3,09 2,192-4,359
 <30 Minutes
≥ 30 Minutes
Duration of Oral Contraceptive Use
*
> 10 years
≤ 10 years
Never
Pregnancy Age During Abortion
> 5 Months
Never Abortion
*Fisher’s Exact
Clinical breast examination results
are not normal (case group) most found at
age ≥ 40 years. Mean age of respondents
between case group and control group 1: 3.
Mean age of respondents in case group
39.79 ± 5.71, while in the control group
30.46 ± 5.33. In the distribution of the first
menstrual age is categorized into 2 namely
<12 Years, and ≥ 12 Years.
The majority of respondents in the
case group experienced first menstruation
at age ≥ 12 years (65.2%), as well as in the
control group (97.8%). In this study there
is a relationship between the first
menstrual age of respondents with the risk
of breast cancer incidence (p value <0.05).
The results of chi-square analysis showed
that in the history of benign tumors in
breast (p <0.05) with abnormal CBE
examination (case group), 8.7% of
respondents had a history of benign tumors
in the breast.
The OR value indicates that women
with a history of benign tumors in the
breast 3.19 times will be at risk of breast
cancer (2.23-4.54, 95% CI). In the
distribution of family history of cancer,
13% of cases have a family history of
cancer. Cancer family history variable was
associated with risk of breast cancer (p
value <0,05). In this study all respondents
were good in case group and control group
0,134 0,41 0,12-1,34
0,28 2,21 0,49-9,78
had no history of breast cancer. In this
study 8.7% breastfeeding <6 months,
where the results of the analysis prove that
there is a relationship between
breastfeeding duration and risk of breast
cancer incidence. In this study there was
no ridge between the consumption of
eating fibrous foods with the risk of cancer
incidence breast (p value> 0,05). Most
case groups consumed a high-fat diet
(69.6%), as did the control group (89.1%).
There is relationship between fatty food
consumption and risk of breast cancer
incidence (p value <0,05). The majority of
respondents in the group of cases doing
physical activity ≥ 30 minutes in a day
(95.7%), in this study respondents
considered that doing housework is also a
sport so that most respondents in the
control group also the majority of physical
activity ≥ 30 minutes per day (100%).
The results of statistical analysis
prove that there is no relationship between
physical activity with risk of breast cancer
incidence (p value> 0,05). There was no
association between the use of oral
hormonal contraceptives and the risk of
breast cancer incidence (p value> 0.05).
The pregnancy age variable during
abortion was not associated with cancer
risk (p value> 0.05). This is because the
majority of respondents in the case group
never had an abortion (82.6%) as well as using multiple logistic regression statistic
in the control group (91.3%). Specific test. Some specific factors have p value
factors associated with the risk of breast <0.05 hereinafter is explained in table 3
cancer incidence were then analyzed by below.

Table 3. Multivariate Analysis Specific Candidate Factors In Multiple Logistic Regression

Analysis

Variable Specific Factors p value

Age 0,00
17-46 Years 0,00
First Menstrual Age 0,04
<12 years 0,04
≥ 12 Years 0,04
History of Benign Tumor In Breast 0,01

Table.4 Final Model Multiple Logistic Regression Analysis Of Specific Breast Cancer Risk
Factors

Variables B P value Exp (B) 95% CI

First Menstrual Age -2,83 0,014 0,05 0,06-0,55
Constant 0,75 0,324 2,148

Based on the result of multivariate analysis that the first age mestruasi is a specific risk factor
in the last modeling (p value <0.05, Exp (B): 0.05, 95% CI: 0,06-0,55) with multiple logistic
regression statistic.

5. Discussion Menopause

Age Based on Marice's research (2014), that

Age is one factor that can increase rapidly
entering reproductive age (Wakai et al,
2000).
First Menstrual Age
In this study found 34.8% of respondents
who experienced the first menstruation>
12 years, according to Indrati (2005) states
that early menstrual age associated with
duration of exposure to estrogen and
hormone progesterone. This hormone
affects the proliferation of tissue, including
the breast tissue. This is stated also by
Sirait et al (2009) states that breast tissue
is very sensitive to estrogen hormones
because exposure to estrogen hormone in
the long term will increase the risk of
breast cancer.
menopause meiliki 3.58 times the risk of
having breast tumor than in women who
have not menopause. However, other
studies suggest that the early age of
menopause is unrelated to breast cancer
risk. At age <55 Years at risk 2 times
breast cancer than women who experience
menopause <55 Years.
History of Benign Tumor In Breast
Dupont (2004), said that women who had
previously had benign tumors in the breast
are at risk for developing breast cancer. In
the Indrati study (2005), it was discussed
that an increased risk of breast cancer in
women who previously had benign tumors
in the breast was associated with an
excessive proliferation process.
Proliferative events that occur in the breast
tissue without accompanied by the control
of cell death programmed by apoptosis
process cause malignancy because the
body is unable to detect any damage to
DNA.
Family Cancer History
Genetically the cause of a person can be at
risk of breast cancer is a mutation of genes
BRCA1 and BRCA2 (Van de Velve et al,
1999). In the Yulianti study (2016), it also
proves that this study is in line where a
person with a family history of 2.77 times
had breast cancer, where in the study it
was discussed that the BRCA gene present
in DNA serves to control cell growth in
order not to proliferate . Women who
inherit a mutated gene from a family will
be at risk of breast cancer. (Lanfranchi,
2005).
History of Breast Cancer and Ovarian
Cancer
Breasts are organs on the right and left
sides of the body where the system is
strongly influenced by the same factors
(Indrati (2005), Scheinn (1997)). Women
who have a previous history of breast
cancer are at risk for developing breast
cancer. Women who have a history of
ovarian cancer may also be at risk of
developing breast cancer. This is because
the discovery of the relationship between
breast cancer and ovarian cancer is
estimated due to imbalance hormone
estrogen (Indarati (2005); Dupont (2004);
Pherson (2000)).
Length of Breastfeeding
The duration of breastfeeding is associated
with the risk of breast cancer incidence,
this is stated by Azamris (2006). That with
the longer a mother breastfeed her child
will decrease exposure to estrogen in the
breast will decrease. During breastfeeding
the hormones estrogen and progesterone
will decrease so that the exposure of these
hormones in the breast organ will prevent
the occurrence of proliferation that may
occur so that the risk of causing breast
cancer (Indrati (2005), Tjindarbumi
(2003), Wakai (1995)). But this study is
not in line with research Rianti (2012)
which proves that there is no relationship
history menyusi with incidence of breast
cancer. This proves that the history of
breastfeeding is not specifically linked to
breast cancer incidence. According to
Lanfranchi (2006), that there is a process
that occurs from the time of pregnancy
until breastfeeding for breastfeeding. At
that time there is a change of cell type
from type 3 to type 4 and will produce
milk. Based on this, the duration of
breastfeeding is a specific factor to be
known.
Stress Level
In the Marice study (2014), proving that
there is a relationship between stress levels
with breast tumors (p value <0.05). The
statement of Walta Gautama (2014) in
Asep Chandra (2014), on Kompas media,
that stress can trigger the occurrence of
breast cancer where stress will increase
one's estrogen hormone, so that can trigger
the occurrence of breast cancer. In severe
stress conditions can lead to disruption of
the body's cellular balance. The state of
stress can affect the cell to become
hyperactive and may experience
proliferation so that it can experience a
proliferation that can be at risk of breast
cancer incidence. (KKP, MOH, 2017).
Consumption of Fibrous Foods
Eating fibrous foods such as vegetables
can be protective or prevent the
development of cancer, including breast
cancer (Zhang et al, 2009). One of the
causes of high rates of cancer in Indonesia
is caused by a diet that is less fiber (MOH,
2010). Fiber-containing foods contain
anticariogenic substances such as vitamin
C, vitamin E, carotenoids, complementary
Isoflavones (Mahan & Escott-Stump,
2008).
Consumption of Fatty Foods
In the Willet (2001) study, proving that not
all foods containing fat is a risk factor in
the incidence of breast cancer. Sutadyo
(2011), states that eating foods high in
calories and fat may increase the risk of
cancer. Consumption of food sources of
meat, preserved meat, French fries, sweet
foods and sources of fat may increase the
risk of breast cancer incidence.
Physical Activity
Peter et al (2009), proving that there is a
correlation between physical activity and
risk of breast cancer incidence. Some
sources note that proliferation will be
hampered by physical activity or exercise
because it can affect the hormonal work
system (Enger, (2000), Tjindarbumi
(2004), Wakai (1995)).
Passive smoker
In a study conducted by Miller et al (2006)
presented data that in 10 case control study
and 4 study cohort found a relationship
between passive smokers with breast
cancer incidence. Indrati (2011) noted that
women smokers will have higher levels of
hirmon estrogen metabolism.
Types and Lengths of Hormonal
Contraceptive Use
Herianto et al (2005), said that a person
will be at risk of breast cancer 1.8 times
higher in users of hormonal contraceptives
pill type combination. Research Suryani
(2016), states that there is a relationship of
old factors of contraceptive use with breast
cancer 5.7 times in women who use
hormonal contraceptive ≥ 10 years. The
hormones estrogen and progesterone can
cause the effects of cell proliferation
continuously, causing apoptisis and
abnormal proliferation of cells (Wakai
(1995); Willet (1997); Devita (1989)) in
Indrati (2005).
Pregnancy Age During Abortion
In the Indrati study (2011), there is no
relationship between fetal age ≤ 10 weeks
at the time of abortion at risk of breast
cancer incidence, it is said that aspects of
dose respone, consistency, biologic,
plausibility and stregth have causal
association so that fetal age at the time of
abortion> 10 weeks a risk factor for breast
cancer incidence.
6. Conclussion
Specific risk factors for the incidence
of breast cancer were 7 factors out of 15
precise specific risk factors, including age,
first menstrual period, history of benign
tumors in the breast, family history of
cancer, duration of breastfeeding,
consumption of fatty foods, and types of
hormonal contraceptives. Based on the
results of multivariate analysis that the first
age mestruasi merupakah risk factors
specific to the last modeling. Prevention of
breast cancer by screening is very
important because many women are not
aware of the risk of cancer breast that
occurs. Most women detect breast cancer
in an advanced stage so it will require
serious treatment.
.
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