[Strategies for teaching self-examination of the breast to women in reproductive age].
OBJECTIVE
To develop an effective strategy to inform Mexican women between 12 and 47 years of age about breast cancer (BC) and train them to perform breast self-examination (BSE).


METHODS
Between April, 1996 and July, 1998, two different strategies to teach BSE were designed and evaluated in Cuernavaca, State of Morelos, Mexico. These strategies included teaching materials and were based on opinions of women participating in the first stage of this study. Both strategies consisted of the presentation of a leaflet and a video. The first strategy was delivered by a public health nurse in charge of leading the session. The second one was presented by a BC survivor. This second strategy included slides and silicon breast models. These two strategies were then compared to a third one, consisting of a primary care nurse handling out a leaflet and showing a video, based on Health Secretariat's guidelines. In total, 149 women were trained. They were randomly assigned to any one of these three strategies. The effectiveness of the teaching strategies was determined by assessing the changes in the women's knowledge of BC and BSE, as well as in their ability to identify the largest number of lumps on a natural size silicon breast, before and after training. Statistical analysis included Student's t test, variance analysis, McNemar's chi 2, Pearson's chi 2, and multiple linear regression.


RESULTS
With all three strategies, there was an increase of approximately 30% in women's knowledge of BC and BSE as well as in their ability to detect lumps. Although at the beginning of the training only one out of every 20 women were able to identify more than three lumps in the silicon model, by the end between 3 and 4 of every 10 women were able to do this, with values of p < 0.05. Some factors determine women's learning of both BSE and information about BC as well as their ability to identify lumps.


CONCLUSIONS
Teaching BSE with any of the strategies evaluated could be included in an integral program to educate Mexican women on breast cancer prevention and early detection. The appropriate and monthly practice of BSE is linked both to a decrease in the amount of time elapsing between the identification of suspect signs and the demand for medical care, such as requesting a clinical breast examination, which entails identifying small tumors when BC is present.
Ortega-Altamirano
D
D
Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, México. dortega@insp3.insp.mx
López-Carrillo
L
L
López-Cervantes
M
M
D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D016504:Breast Self-Examination / Q000379:methods*; D002648:Child; D005260:Female; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008800:Mexico; D008875:Middle Aged; D013664:Teaching Materials