Breast cancer knowledge and associated factors among female registered nurses working in teaching hospitals

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Breast cancer is the most common cancer among women in both the developed and the developing world. Though the incidence of breast cancer in developing countries is relatively lower compared to the developed countries, the rate of increase has been higher in the developing economies. The incidence of breast cancer in Karachi, Pakistan averaged for the years 1998-2002, was 69.1 per 100,000 constituting the highest rate of recorded breast cancer in Asia. Studies in different regions of Pakistan demonstrate a high proportion (Z 50%) of late stage breast cancer presentation. At present, the most pragmatic solution to early detection lies in breast cancer education of women. In order to implement public educational programs, the health professionals should be adequately aware of the disease. Nurses constitute a special group having characteristics most suited for disseminating breast cancer information to the women. The objective of this study was to assess the level of knowledge of breast cancer among female registered nurses working in teaching hospitals of Karachi and to identify factors associated with this knowledge. An institution based cross-sectional survey using a stratified sample was conducted between July 2003 and September 2003 in seven teaching hospitals of Karachi. A total of 609 female registered nurses were interviewed using a structured questionnaire adapted from the validated Stager's Comprehensive Breast Cancer Knowledge Test. The response rate was 95%. Breast cancer knowledge comprised of three components; risk factors, symptoms and curability; categorized into good, fair and poor categories respectively. The proportion of nurses with good knowledge was 35%, 19% and 56% for risk factors, symptoms and curability respectively. Graduation from a private nursing school was associated with good knowledge of risk factors (aOR=4.23, 95% CI: 2.93, 6.10), symptoms (aOR=1.78, 95% CI: 1.31, 2.42) and curability (aOR=2.33, 95% CI: 1.42, 3.80). Similarly, nurses who had ever cared for a breast cancer patient had higher odds of good knowledge of risk factors (aOR=1.87, 95% CI: 1.34, 2.61), symptoms (aOR: 1.76, 95% CI: 1.27, 2.43) and curability (aOR=1.37, 95% Cl: 0.97, 1.95). A nurse having received a breast examination (aOR=1.56, 95% CI: 1.08, 2.26) or having examined a patient's breast (aOR=1.87, 95% CI: 1.34, 2.61) had higher odds of good risk factor knowledge. History of breast cancer among family members (aOR: 2.17, 95% CI: 1.24, 3.71) or friends (aOR=1 .65, 95% CI: 0.99, 2.75) was associated with good symptom knowledge. Good curability knowledge was more likely among nurses employed in private hospitals (aOR=1.69, 95% CI: 1.06, 2.69) and nurses with higher general education (intermediate: aOR=1.57, 95% CI: 1.07, 2.30 and graduate: aOF=1.72, 95% CI: 1.03, 2.88). This nursing population has low to moderate levels of knowledge of the three breast cancer components. Breast cancer knowledge is associated with nursing school status, professional breast cancer exposure, breast cancer history among social contacts, status of hospital of employment and general education of the nurse. There is a need to improve breast cancer education in nursing schools particularly in the public sector. Continuing medical education at the workplace can be of additional benefit.

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