Evaluation of a breast selfexamination (BSE) program in a breast diagnostic clinic

Margaret I. Fitch, Judith McPhail, Edmee Franssen


The purpose of this study was to evaluate the short-term effectiveness of a breast self-examination (BSE) teaching program on women’s knowledge about BSE, proficiency in performing BSE, and motivation to perform BSE. The program was developed for delivery by nurses in a breast diagnostic clinic, a clinic designed to meet the need for expeditious management of breast disease, current information about breast cancer risk, surveillance, and counselling. A convenience sample of 68 women attending the clinic in a regional cancer centre participated in a pre- and five month post-teaching program evaluation. The Toronto Breast Self Examination Instrument was used as the evaluation tool. There were statistically significant changes following the teaching program in the areas of knowledge about the correct technique for performing BSE, proficiency performing BSE, and confidence about finding changes when performing BSE. No significant changes were observed in motivation to practise BSE, although group scores did improve following the education. Participants found the video presentation and the review of BSE information pamphlets by the nurse to be the most helpful components of the BSE teaching program.

Full Text:



Agars, J., & McMurray, A. (1993). An evaluation of comparative

strategies for teaching BSE. Journal of Advanced Nursing, 18,


Alagna, S.W., & Reddy, D.M. (1984). Predictors of proficient

technique and successful lesion detection in BSE. Health

Psychology, 3, 113-127.

Alcoe, S.Y., Gilbey, V.J., McDermot, S.R., & Wallace, D.G.

(1994). The effects of teaching breast self-examination:

Reported confidence and frequency of practice over a sixyear

period. Patient Education and Counselling, 23, 13-

Alonzo, A.A. (1993). Health behaviour: Issues, contradictions and

dilemmas. Social Science Medicine, 37(8), 1019-34.

Baines, C.J. (1997). Reflections on BSE. [Editorial]. Journal of the

National Cancer Institute, 89(5), 339-40.

Baines, C.J., & To, T. (1990). Changes in BSE behaviour achieved by

,835 participants in the Canadian National Breast Screening

Study. Cancer, 66, 570-576.

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of

behavioral change. Psychology Review, 84(2), 191-215.

Brooten, D., & Naylor, M.D. (1995). Nurses’ effect on changing

patient outcomes. Image, 27(2), 95-99.

Budden, L. (1998). Registered nurses’ breast self examination

practice and teaching to female clients. Journal of Community

Health Nursing, 15(2), 101-12.

Champion, V.L. (1989). Effect of knowledge, teaching method,

confidence and social influence on BSE behaviour. Image, 21, 76-

Champion, V.L. (1995). Results of a nurse-delivered intervention on

proficiency and nodule detection with breast self-examination.

Oncology Nursing Forum, 22(5), 8l9-824.

Clarke, V.A., & Savage, S.A. (1999). Breast self-examination

training: A brief review. Cancer Nursing, 22(4), 320-6.

DeMuth, J.S. (1989). Patient teaching in the ambulatory setting.

Nursing Clinics of North America, 24(3), 645-654.

Ferris, L.E., Shamian, J., & Tudiver, F. (1991). The Toronto Breast

Self-Examination Instrument (TBSEI): Its development and

reliability and validity data. Journal of Clinical Epidemiology,

(12), 1309-1317.

Gastrin, G., Miller, B.M., To, T., Aronson, K.J., Wall, C., Hakama,

M., Louhivuori, K., & Pukkala, E. (1994). Incidence and mortality

from breast cancer in the Mama program for breast screening in

Finland, 1973–1986. Cancer, 73(8), 2168-2174.

Gram, I.T., & Slenker, S.E. (1992). Cancer anxiety and attitudes

toward mammography among screening attenders, nonattenders,

and women never invited. American Journal of Public Health,

(2), 249-25l.

Hailey, B.J., Lalor, K.M., Byrne, H.A., & Starling, L.M. (1992). The

effects of self-reinforcement and peer-reinforcement on the

practice of breast self-examination. Health Education Research:

Theory & Practice 7(2), 165-174.

Hall, L.S. (1992). BSE: Use of a visual reminder to increase practice.

American Association of Occupational Health Nurses Journal,

(4), 186-192.

Harvey, B.J., Miller, A.B., Baines, C.J., & Corey, P.N. (1997). Effect

of breast self-examination techniques on the risk of death from

breast cancer. Canadian Medical Association Journal, 157(9),


Harvey, B.J., Miller, A.B., Baines, C.J., & Corey, P.N. (1998). Authors

response to letter to editor. Journal of the Canadian Medical

Association, 158(4), 472.

Katic, M., Lang, S., & Budak, A. (1996). Evaluation of the general

practice program of women education for breast self-examination.

Acta Medical Croatica, 50(4-5), 185-91.

Leight, S.B., & Leslie, N.S. (1998). Development of a competencybased

curriculum for training women in breast self-examination

skills. Journal of American Academy of Nurse Practitioners

(7), 297-302.

Lerman, C., Kash, K., & Stefanek, M. (1994). Younger women at

increased risk for breast cancer: Perceived risk, psychological

well-being, and surveillance behaviour. Journal of the National

Cancer Institute Monographs, 16, 171-176.

Mayer, J.A., & Solomon, L.J. (1992). BSE skill and frequency: A

review. Annals of Behavioral Medicine, 19(3), 189-196.

Morrison, C. (1996). Determining crucial correlates of BSE in older

women with low incomes. Oncology Nursing Forum, 23(1), 83-93.

National Cancer Institute of Canada. [NCIC]. (2000). Canadian

cancer statistics 2000. Toronto, ON: Author.

Nettles-Carlson, B., & Smith, L. (1988). Self-examination in the early

detection of breast cancer: Issues and implications for nursing

practice and research. Health Care for Women International, 9,


Newcomb, P.A., Weiss, N.S., Storer, B.E., Schools, K.D., Young,

B.E., & Voigt, L.F. (199l). Breast self-examination in relation to

the occurrence of advanced breast cancer. Journal of National

Cancer Institute, 83, 260-5.

Spielberger, C.D., Gorsuch, R.L., Lushene, R., Vagg, P.R., & Jacobs,

G.A. (1983). State-trait anxiety inventory (Form Y). Mind

Garden, Palo Alto, CA: Consulting Psychologists Press, Inc.

Street, R.L. Jr., van Order, A., Bramson, R., & Manning, T. (1998).

Preconsultation education promoting breast cancer screening:

Does the choice of media make a difference? Journal of Cancer

Education, 13(3), 152-61.

Strickland, C.J., Feigl, P., Upchurch, C., King, D.K., Pierce, H.I.,

Grevstad, P.K., Bearden, J.D. III, Dawson, M., Loewen, W.C., &

Meyskens, F.L. Jr. (1997). Improving breast self-examination

compliance: A Southwest Oncology Group randomized trial of

three interventions. Preventive Medicine, 26(3), 320-332.

Thomas, D.B., LiGao, D., Self, S.D., Allison, C.J., Tao, T., Mahloch,

J., Ray, R., Qin, Q., Presley, R., & Porter, P. (1997). Randomized

trial of BSE in Shanghai: Methodology and preliminary results.

Journal of the National Cancer Institute, 89(5), 355-364.


  • There are currently no refbacks.