Introduction

Breast cancer is the most common cancer among women. It is expected that

by the end of 2009, approximately 40,170 women will die from breast cancer, only

second to the number of lung cancer deaths among women.1 According to the

National Cancer Institute (2008), breast cancer is the leading cause of cancer

death in young women ages 15-54.2 A projected 11,100 women under age 40 will

be diagnosed with breast cancer in 2009, and more than 1,100 will die from it.1

Very few studies have examined what college women know about this topic and

none have assessed predictors of breast health screening among this group.3,4,5

Sample• Ethnicity: 62.3% Euro-American, 11.5% African American,

12.7% Hispanic/Latina, 6.5% Asian/Pacific Islander, 7.0% Other.

• Age: 18.0% <20 years, 48.1% 20-29, 17.4% 30-39, 10.7% 40-49,

5.7% >50 years.

Results Multiple linear and logistic regression analyses revealed that knowledge, attitudes, cost of copay, and age

were significant predictors of BSE, CBE, and mammography:

Cost of insurance co-pay was a significant hindrance of practicing mammography (0.032, p < .01) and

CBE (0.338, p < .01) .

As women age, their attitudes toward BSE, CBE, and mammography were significantly more positive,

F (18, 2118) = 2.87, p < .01, η = .024.

Knowledge and practices are inconsistent in younger women and they have misconceptions about

mammography (Table 3).

Conclusions The findings from this study can be used by college health

professionals to develop more effective, culturally relative campus-

based programs, activities, and events to improve college women’s

breast health knowledge, attitudes, and screening behaviors. Myths,

misconceptions, and scientific evidence should be discussed,

especially in light of current U.S. events. Although awareness of

breast cancer and the importance of early detection have become

public health priorities, media storylines and controversies can be

confusing and adversative to the general public.

Results from this study underscored the continued need to educate

and empower college women with the knowledge and skills they need

in order to reduce their breast cancer risk and catch it in its earliest

stages. There are more women now enrolled in higher education than

ever before; therefore, college is a perfect setting to educate them

about breast health. By increasing women’s exposure to breast health

education, women may be more likely and less fearful to practice

breast health screening as older adults. Campus wellness

representatives, staff, faculty, and student education groups should be

prepared to provide tailored breast health education messages in a

variety of formats and ideally more than just during Breast Cancer

Awareness Month. In addition, educational efforts focused on

modifiable risk factors (i.e. alcohol use, obesity, etc.) may promote

positive health behavior change among young women, which lowers

their risk for breast cancer as well as other chronic diseases. The

cost of a co-pay was also found in this study to be a screening barrier,

so providing resources or linking women without financial means to

breast health services is not only imperative but ethically responsible.

NEW IMPLICATIONS FOR FEMALE COLLEGE STUDENTS’ BREAST HEALTH EDUCATION: DETERMINANTS OF KNOWLEDGE, ATTITUDES, AND SCREENING

Sloane Burke, Ph.D., CHES, Department of Health Education & Promotion, East Carolina University, Walden UniversityShelley N. Armstrong, Ph.D., MAT, Department of Health & Exercise Science, Centenary College of Louisiana & School of Health Sciences, Walden University

Jody Early, Ph.D., M.S.,CHES, Program Director, Undergraduate Programs, School of Health Sciences, Walden UniversityDoris L. Thompson, Ph.D., MPH, State of Alaska Public Health

Purpose The purpose of this study was to assess college women’s knowledge, attitudes,

and breast cancer screening practices and to determine whether knowledge,

attitudes, ethnicity, age, family history, and cost of copay, were significant predictors

of breast self exam (BSE), clinical breast exam (CBE), and mammography.

Table 3. Multiple Logistic Regressions Predicting Practice of BSE, CBE, & Mammography

CBE Mammography BSE

African American 0.645 M 1.789 0.900

Hispanic 0.462 ** 1.363 0.965

Ages 20-29 0.336 ** 0.016 ** 0.313 **

Ages 30-39 4.564 ** 23.799 ** 2.782 **

Ages 40 and above 8.527 ** 241.380 ** 4.732 **

Marital Status 2.278 ** 1.180 0.969

Education Level 1.042 1.017 0.912

Cost of Copay 0.338 ** 0.032 ** 0.851

Genetic History 1.250 1.868 * 1.242

Knowledge 1.514 * 1.189 * 1.028

Attitude 1.132 0.828 3.262 **

Note. *p < .05, ** p < .001, M is marginally significant

References1. American Cancer Society. Cancer facts and figures 2008. Available at: http://www.cancer.org. 2. National Cancer Institute. Cancer statistics 2008. Available at: http://www.cancer.gov. 3. Powe B, Underwood S, Canales M, & Finnie R. Perceptions about breast cancer among college

students: implications for nursing education. J Nurs Educ. 2005; 44(6):257-2654. McCready T, Littlewood D, & Jenkinson J. Breast self-examination and breast awareness: A literature

review. J Clin Nurs. 2005; 14: 570-578. 5. Chouliara Z, Papadioti-Athanasiou V, Power K, & Swanson V. Practice of and attitudes toward breast

self-examination (BSE): A cross cultural comparison between younger women in Scotland and Greece. Health Care Women Int. 2004; 25(4): 311-333.

Table 1. College Women’s Knowledge about Breast Self Exam (n = 1074).

Disagree

%

Agree

%

Don’t know

%

Puckering of the breast may be a sign/symptom of breast cancer. 3.8 48.4 47.8

A lump in the breast may be a sign/symptom of breast cancer. 2.0 91.0 7.0

A dimple in the breast may be a sign/symptom of breast cancer. 3.9 59.6 36.4

The incidence of breast cancer increases with age. 4.8 77.3 17.9

Older women who have never had a baby have a higher chance of developing breast cancer.

14.5 38.2 47.3

Women who have their first baby late in life have a higher chance of developing breast cancer.

11.9 32.6 55.5

Women who complete menopause late in life have a higher chance of developing breast cancer.

15.7 16.0 68.3

After menopause, breast self exams should:

--Be done weekly. 33.0 12.6 54.4

--Be done at the same time each month. 8.1 46.8 45.1

Before menopause, the best time to do a monthly breast exam is:

--During the menstrual period. 38.8 12.1 49.1

--During the first week after the menstrual period. 7.1 41.8 51.1

Table 2. Attitudes toward Breast Self Exam (n = 1074).

Disagree

%

Agree

%

Don’t know

%

It is important for me to do breast self-examination because:

I should be involved in my own health care. 2.8 89.5 7.7

Breast self-examination contributes to early detection of breast cancer.

1.7 92.0 6.3

I can best discover breast lumps/changes myself.

6.3 77.0 16.6

My doctor does not examine my breasts for abnormalities.

59.1 18.5 22.3

I do not do breast self-examination because I have never been shown how to do the technique.

54.6 26.8 8.2

Compared with other women my age, I would rate my chances of getting breast cancer as higher than theirs.

21.0 69.6 9.2

I cannot discover breast cancer through doing breast self-examinations.

68.3 7.9 23.8

I feel so uncomfortable with touching my breasts that I do not do breast self-examination.

89.4 2.5 8.1

I do not have the time to do breast self-examination.

83.4 3.8 12.8

It is not good for me to do breast self-examination because it causes me to worry about breast cancer.

86.3 4.2 9.5

Methods A purposive convenience sample of 1,071 college women from

three Southern universities participated in the study. Respondents

completed an electronic, modified version of the Toronto Breast Self-

Examination Instrument (TBSEI), with additional subscales relating to

CBE and mammography.