Ortega-Altamirano D, López-Carrillo L, López-Cervantes M
Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, México.
Salud Publica Mex. 2000 Jan-Feb;42(1):17-25.
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).
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.
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.
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.
制定一项有效策略，向12至47岁的墨西哥女性宣传乳腺癌（BC）知识，并培训她们进行乳房自我检查（BSE）。
1996年4月至1998年7月期间，在墨西哥莫雷洛斯州库埃纳瓦卡设计并评估了两种不同的BSE教学策略。这些策略包括教学材料，并基于参与本研究第一阶段的女性的意见。两种策略都包括发放一份传单和播放一段视频。第一种策略由负责主持课程的公共卫生护士实施。第二种策略由一位乳腺癌幸存者进行讲解。第二种策略还包括幻灯片和硅胶乳房模型。然后将这两种策略与第三种策略进行比较，第三种策略是由一名初级护理护士发放传单并播放视频，依据的是卫生部发布的指导方针。总共对149名女性进行了培训。她们被随机分配到这三种策略中的任何一种。通过评估培训前后女性对乳腺癌和乳房自我检查的知识变化，以及她们在自然尺寸硅胶乳房上识别最多肿块数量的能力，来确定教学策略的有效性。统计分析包括学生t检验、方差分析、McNemar卡方检验、Pearson卡方检验和多元线性回归。
采用所有三种策略后，女性对乳腺癌和乳房自我检查的知识以及她们检测肿块的能力均提高了约30%。尽管在培训开始时，每20名女性中只有1人能够在硅胶模型中识别出3个以上的肿块，但到培训结束时，每10名女性中有3至4人能够做到，p值<0.05。一些因素决定了女性对乳房自我检查和乳腺癌信息的学习，以及她们识别肿块的能力。
所评估的任何一种策略用于教授乳房自我检查，都可以纳入一个综合项目，以对墨西哥女性进行乳腺癌预防和早期检测教育。正确且每月进行乳房自我检查，与从发现可疑体征到寻求医疗护理（如要求进行临床乳房检查，这在乳腺癌存在时需要识别小肿瘤）之间所经过的时间减少有关。
