title: Knowledge and recommendations regarding breast cancer early screening in an upper middle income country: Primary and secondary health care professionals.
abstract: OBJECTIVE
  To compare the current breast cancer prevention and control Mexican standard with recommendations that health care professionals provide to women for breast self-exams, clinical breast exams and mammography, as well as health care professional knowledge of the risk factors for and main clinical signs of the disease.
  
  
  METHODS
  In 2012, using a cross-sectional design, trained interviewers surveyed health care providers in a sample of 798 medical units, of which 756 corresponded to the first and second levels of medical care. One health care professional from each unit was interviewed for the study. The sampling method was systematic and representative of the national and regional levels. Relative frequencies and 95% confidence intervals (CI) were obtained using the weighting factor assigned to each medical unit.
  
  
  RESULTS
  Regarding the indicator about recommendations provided to the population regarding early screening for and risk factors and clinical signs of breast cancer, the average number of health care professional responses in accordance with the Mexican standard was 10.7 (95% CI 10.0-11.4) out of a maximum of 28 points, which corresponds to an average rate of 38.2% of responses (95% CI 35.6-40.8). The percentage of correct answers increased in all areas of breast exam knowledge as training hours in the previous year increased.
  
  
  CONCLUSIONS
  Health care professionals are unaware of the current standards on breast cancer; therefore, these recommendations are not routinely translated into health care practice, which is a barrier to increasing the coverage of screening programs in health care services.
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud, Pública, Avenida Universidad, No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico. Electronic address: carolina.ortega@insp.mx.
authors.forename: C
authors.initials: C
authors.lastname: Ortega-Olvera
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud, Pública, Avenida Universidad, No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico. Electronic address: gtorres@insp.mx.
authors.forename: G
authors.initials: G
authors.lastname: Torres-Mejía
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud, Pública, Avenida Universidad, No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico. Electronic address: szamoran@insp.mx.
authors.forename: L M
authors.initials: LM
authors.lastname: Sánchez-Zamorano
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud, Pública, Avenida Universidad, No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico. Electronic address: aangelica@insp.mx.
authors.forename: A
authors.initials: A
authors.lastname: Ángeles-Llerenas
authors.affiliation: Departamento de Evaluación Clínica de Intervenciones para la Salud, Dirección de Evaluación de Tecnologías para la Salud, Centro Nacional de Excelencia Tecnológica en Salud, Paseo de la Reforma No. 450, Piso 13, Col. Juárez, Del. Cuauhtémoc, Distrito Federal 06600, Mexico. Electronic address: mat_pichu@hotmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Martínez-Matsushita
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud, Pública, Avenida Universidad, No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico. Electronic address: rrojas@insp.mx.
authors.forename: R
authors.initials: R
authors.lastname: Rojas-Martínez
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud, Pública, Avenida Universidad, No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico. Electronic address: efmontem@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Montemayor-Varela
authors.affiliation: Departamento de Salud Pública, Universidad del Norte, Km. 5 Vía Puerto Colombia, Barranquilla, Colombia. Electronic address: envararo@uninorte.edu.co.
authors.forename: Edgar
authors.initials: E
authors.lastname: Navarro-Lechuga
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud, Pública, Avenida Universidad, No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico. Electronic address: elazcano@insp.mx.
authors.forename: E
authors.initials: E
authors.lastname: Lazcano-Ponce
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D063127:Secondary Health Care / Q000706:statistics & numerical data
keywords: Breast cancer knowledge; Health care professionals; Prevention and control