INTRODUCTION Breast cancer is one of the most common cancers in women worldwide, accounting for approximately 570,000 deaths in 2015. Over 1.5 million women (25% of all women with cancer) are diagnosed with breast cancer every year throughout the world [1,2]. In America, it is estimated that 30% of all new cancer cases (252,710) among women are breast cancer in 2017 [3]. Breast cancer is a metastatic cancer and can commonly transfer to distant organs such as the bone, liver, lung and brain, which mainly accounts for its incurability. Early diagnosis of the disease can lead to a good prognosis and a high survival rate. In North American, the 5-year relative survival rate of breast cancer patients is above 80% due to the timely detection of this disease [4]. Mammography is a widely used screening approach in the detecting of breast cancer and proved to help reduce the mortality effectively. Other screening methods, such as Magnetic Resonance Imaging (MRI), which is more sensitive than mammography, have also been implemented and studied during the last decade [5]. There’re numerous risk factors such as sex, aging, oestrogen, family history, gene mutations and unhealthy lifestyle, which can increase the possibility of developing breast cancer [6]. Most breast cancer occur in women and the number of cases is 100 times higher in women than that in men [3]. Although the incidence rate of breast cancer in America increases year after year, the mortality rate decreases due to the widespread early screenings and advanced medical therapies. Biological therapies have been developed in recent years and proved to be beneficial for breast cancer. BACKGROUND OF THE STUDY Cancer is one of the frequently talked about and most teared diseases. 'The incidence of breast cancer is rising in every country of the world especially in developing countries in the past two decades. The disease, which was earlier in its initial years of discovery dubbed as the death sentence for the person diagnosed with it, has now become more manageable, thanks to the frequent efforts of researchers and oncologists. Though science has made rapid strides to evolve many preventive and curative strategies to fight cancer, it has not been able to break the fear and confusion that surrounds a person when diagnosed with the disease. Worldwide, breast cancer is the most common cancer in women, after skin cancer, representing 16% of all female cancers. Mortality worldwide is 25% greater than that of lung cancer in women. Even with all the advances in medicine, cancer continues to be a dreaded disease. And, of all the cancers affecting women, breast cancer is one of the most common. The incidence of breast cancer in India is on the rise and is rapidly becoming the number one cancer in females pushing the cervical cancer to the second spot. The seriousness of the situation is apparent after going through recent data from Indian Council of Medical Research in the year 2010, (ICMR). breast cancer to come into play. These include late age at first childbirth, fewer children and shorter duration of breast-feeding and obesity etc. United States has the highest annual incidence rates of breast cancer in the world 128.6 per 100,000 in whites and 112.6 per 100,000 among African Americans. It is the second most common cancer (after skin cancer) and the second-most common cause of cancer death (after lung cancer). In 2007, breast cancer was expected to cause 40,910 deaths in the US (7% of cancer deaths; almost 2% of all deaths) this figure includes 450500 annual deaths among men out of 2000 cancer cases. World Cancer Report provides clear evidence that Lung cancer is the most common cancer worldwide, accounting for I .2 million new cases annually followed by cancer of the breast. just over one million cases. Of the breast cancer cases, some 580,000 cases occur in developed countries and the remaining in developing countries. In 2000, the year for which global data exist, some 400,000 women died from breast cancer, representing I .6 per cent of all female deaths. 'WHO and World Cancer Report', a global report by the International Agency for Research on Cancer, which is the part of World Health Organization. NEED FOR THE STUDY Increased public awareness and improved screening have led to earlier diagnosis, at stages amenable to complete surgical resection and curative therapies. Consequently, survival rates for breast cancer have improved significantly, particularly in younger women whether aggressiveness of this disease has any relation to evolution of the disease, the disease being a late arrival in the subcontinent. Breast self-examination has been universally accepted by the experts as a very simple, significant and effective method of early detection of breast cancer. As with all other types of cancer early detection and a high index of suspicion are the keys to combating the menace of cancer. Cancer is to a large extent avoidable, much cancer can be prevented, and breast cancer when integrated with the preventive measures offers the greatest potential of cure. Early diagnosis often involves the patient's awareness of early signs and symptoms .Despite cancer being a global public health problem many of us are not aware of the importance of early diagnosis. Brest self-examination is a key factor for early diagnosis of breast cancer. Early detection and prompt treatment offer the greatest chance of long-term survival. Mammography, clinical breast examination and breast self-examination (BSE) are the preventive methods used for screening in the early detection of breast cancer. Screening tests play a pivotal role in reducing breast cancer related mortalities. It is good to be in the habit of breast self-examination (BSE) on a regular basis since early detection leads to early investigation and treatment. Women of all ages should perform self-examination since breast problems can occur at any age. A woman who regularly examines her breasts will have a very clear idea of her normal breast texture and consistency, and help her to notice if something is different. The investigator have seen and care of various female patients with breast cancer While working in clinical field, the patients were of different age groups with breast cancer and researcher felt that unfortunately, women in low-resource countries generally present at a later stage of disease than women elsewhere .0ne factor that contributes to later detection is women's delay in having breast lumps evaluated , Some may not realize how serious their condition is or that cancer are available, while others may believe their symptoms are best treated with local remedies. To improve quality of care and survival rates for breast cancer patients, health care systems with limited resources need to formulate evidence-based diagnostic and treatment plans and protocols that reflect the technical and financial resources available. Nurses play a unique role in alerting the community to the early detection of breast cancer as they usually have the closest contacts with female patients. Nurses can use their knowledge of the health services to educate women about breast cancer risk factors and available breast cancer screening and practices. Mass media campaigns and health education activities are other simple ways to raise awareness and encourage to seek medical care promptly. So, the researcher feels need that awareness on breast self-examination is important and will effective through computer assisted instructions. PROBLEM STATEMENT “Effect of awareness programme on knowledge regarding Breast cancer and Breast self- Examination (BSE) among the girls in selected higher secondary school, West Bengal.” OBJECTIVES OF THE STUDY 1. To assess the knowledge regarding breast cancer and breast selfexamination among the higher secondary school girls. 2. To determine the effect of awareness programme on the knowledge regarding breast cancer and breast self-examination among the higher secondary school girls. 3. To find out the association between knowledge regarding breast cancer and breast self-examination with selected demographic variables. PURPOSE OF THE STUDY To increase the knowledge regarding breast cancer and breast self-examination among girls in higher secondary school. ASSUMPTION The study assumes that • Higher secondary school girls have minimum knowledge regarding breast cancer and breast self-examination. • Awareness programme may increase the knowledge regarding breast cancer and breast self-examination among girls. HYPOTHESIS H0- There is no significant difference between mean pre-test and post-test knowledge score regarding breast cancer and breast self -examination among girls at 0.05 level of significance. H1- The mean post-test knowledge score regarding breast cancer and breast selfexamination is significantly higher than mean pre-test knowledge score at 0.05 level of significance. OPERATIONAL DEFINITIONS Effect - In this study, effect refers to the acquisition of knowledge about breast cancer and breast self-examination after the administration of awareness programme measured by structured knowledge questionnaire. Awareness programme – refers to a specific programming activities or strategies that increase the knowledge of breast cancer and Breast selfexamination of higher secondary school girls. Knowledge – Refers to the familiarity about breast cancer, importance of breast self-examination, and steps of breast self-examination and is measured by structured knowledge questionnaire. School girls – In this study, school girls refer to the girl student of class IX and class XI. VARIABLES UNDER STUDY Independent variables - Awareness on breast cancer and breast selfexamination. Dependent variables – Knowledge of girls on breast cancer and breast selfexamination. Demographic variables – Age, educational status, menarche, family history of breast cancer. CONCEPTUAL FRAMEWORK In this study the conceptual framework is based on System Model. LITERATURE REVIEW Literature review is done on the basis of i) ii) Breast cancer Breast self-examination DELIMITATION OF THE STUDY • The study will be conducted in a selected government higher secondary school. • The study is delimited to only girl student. RESEARCH METHODOLOGY Research Approach – Quantitative approach Research Design – Pre experimental One group pre-test post-test design SETTING OF THE STUDY Pilot study – will be conducted in Harisabha Girls’ school, Purba Bardhaman. Final study – will be conducted in Achra Girls’ school and Mohila Samiti school, Paschim Bardhaman. Rational for selecting this setting – • • • • Familiarity with the schools. Easy accessibility of the area. Availability of adequate subject for the study. Feasibility of conducting the study. POPULATION All girls studying in class IX and XI in higher secondary schools, West Bengal. SAMPLE In this study samples will be selected among the girls studying in class IX and XI in Achra Girls’ School and Mohila Samiti School, West Bengal. SAMPLE SIZE Sample size for this study will be 384 on the basis of 50% awareness of girls regarding breast cancer, 95% confidence interval and 5% margin of error. Formula: n = Z2 × p(1-p)/m2 n = Required sample size Z = Confidence level (95%), Standard value = 1.96 P = Estimated Awareness 50% m = margin of error at 5% (0.05) n = Z2 × p(1-p)/m2 n = (1.96)2 x 0.5(1-0.5)/ (0.05)2 n = (3.84 x 0.25) / 0.0025 n = 384 SAMPLING TECHNIQUE In this study sample size is 384. Samples will be chosen from class IX and XI from Achra Girls’ School and Mahila Samiti School, Paschim Bardhaman, who are willing to participate in the study and fulfilled predetermined criteria. Total number of eligible subjects in each class will be included by complete enumeration. If the population is more than sample size then subjects will be chosen by simple random sampling technique and if the population is less than sample size then I include class X and XII in my study setting to conduct the research with appropriate sample size. POPULATION CRITERIA Inclusion criteria – ➢ The school girls who have attended menarche and who are present on the day of data collection at particular school. ➢ Students who are willing to participate during the time of data-collection. Exclusion criteria – ➢ The school girls who are on leave on that day. ➢ Girls who are present but sick at the time of data collection. SELECTION OF DATA COLLECTION TOOL DATA COLLECTION TOOLS Semi structured Questionnaire Structured questionnaire VARIABLES TECHNIQUES Demographic data Paper pencil Breast cancer and Breast selfexamination Paper pencil DEVELOPMENT OF TOOL For development of tool the following steps will be taken – ▪ ▪ ▪ ▪ An extensive review of research and related literature. Guidance of guide and other experts. Development of first draft tool with the help of guide and co-guide. Establishment of content validity. ▪ Pretesting of the tool. ▪ Reliability of the tool. ▪ Development of final draft of the tool. PLAN FOR VALIDITY AND RELIABILITY OF THE TOOLS Validity - Validation of the tool will be done by opinion from experts. Reliability – Reliability will be calculated by statistical methods. PLAN FOR DATA COLLECTION A formal permission will be obtained from the concerned authority (Principal ). The data collection procedure will be conducted in Achra girls’ school and Mahila Samiti School, Paschim Bardhaman, West Bengal within a given time period of 4 weeks. The formal administrative permission will be taken from Principal of Govt. College of Nursing, Burdwan. Also, the permission taken from Principal of Achra Girls’ School and Mahila Samiti School, Paschim Bardhaman. To collect data, at first self-introduction will be given to the students. Informed consent will be taken. Knowledge regarding breast cancer and BSE will be assessed (pre-test) by knowledge questionnaire before administration of awareness programme. Awareness programme on knowledge regarding breast cancer and BSE will be given in planned teaching method separately to the student of class IX and XI. After 8 days again the knowledge regarding breast cancer and BSE will be assessed (post-test) by same scheduled knowledge questionnaire. To get the findings, pre-test and post test score will be compared. Score will be analysed by inferential statistics. ETHICAL CONCIDERATION • Ethical permission will be taken from institutional ethical committee. • Informed consent will be taken from the participant. ADMINISTRATIVE PERMISSION ▪ ▪ ▪ ▪ Principal of Govt. College of Nursing, Purba Bardhaman. Directorate of Health service, West Bengal. Joint Directorate of Health Services, Nursing. DI Office of Burdwan and School authority. PLAN FOR DATA ANALYSIS Data analysis will be done by using of descriptive and inferential statistics. BUDGET FOR TOTAL STUDY Proposed budget ITEM Computer type, photo copy, printing Developing questionnaire Travelling expenses Binding Miscellaneous & stationary Total Total expenditure 19000. COST 8000 1000 3000 4500 2500 19000 RESEARCH PROPOSAL ON “Effect Of Awareness Programme on Knowledge Regarding Breast Cancer and Breast Self-Examination (BSE) Among the Girls in Selected Higher Secondary School, West Bengal” GUIDE CO-GUIDE Madam Dipanwita Sen Madam Tapati Baishya Senior Lecturer Senior Lecturer Govt. college of nursing Govt. college of nursing Purba Bardhaman Purba Bardhaman INVESTIGATOR SUMANA MAJI M.Sc. Nursing (2021-2023) Govt. college of nursing Purba Bardhaman Email – sumanamaji0709@gmail.com Mob – 8918001974 REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. Stewart BW, and Wild CP. World Cancer Report 2014. Geneva, Switzerland: WHO Press; 2014. 20.06.2022. 07:30pm. [Internet] WHO: Geneva, Switzerland. Breast cancer. 20.06.22.7.45pm http://www.who.int/cancer/prevention/diagnosis-screening/breast-cancer 20.06.22.8pm. Siegel RL, Miller KD, and Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017; 67: 22.6.2022. 8pm DeSantis CE, Fedewa SA, Goding Sauer A, et al. Breast cancer statistics, 2015: 22.06.2022.8pm. Convergence of incidence rates between black and white women. CA Cancer J Clin. 2016; 66: 31-42.23.06.2022.8pm. Drukteinis JS, Mooney BP, Flowers CI, et al. Beyond mammography: new frontiers in breast cancer screening. Am J Med. 2013; 126: 472-479.23.06.2022.6pm. Majeed W, Aslam B, Javed I, et al. Breast cancer: major risk factors and recent developments in treatment. APJCP. 2014; 15: 3353-3358. 22.06.2022.8pm.
