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Copyright (c) 2023 Shirley Díaz Cárdenas, Adrián Rodríguez Rodríguez
This work is licensed under a Creative Commons Attribution 4.0 International License.
Breast self-examination in students of a public university in the Colombian Caribbean
Corresponding Author(s) : Adrián Rodríguez Rodríguez
arojanor@unicartagena.edu.co
Ciencia e Innovación en Salud,
2023
Abstract
Introduction: Breast self-examination is considered the most relevant, simple and affordable method for the prevention and early diagnosis of breast cancer. Objective: To evaluate knowledge, attitudes and practices on breast self-examination (BSE) in female university students in the health area. Methods: A cross-sectional study was conducted among 400 female students of a public university. An anonymous ad-hoc self-report questionnaire was applied, which included sociodemographic variables and variables related to knowledge, attitudes and practices on BSE. Data were analyzed from proportions, Poisson regression estimating prevalence ratios and associations with 95% confidence interval. Results: 55.7%, 51.0% and 54.5% had adequate knowledge, attitudes and practices regarding WEA, respectively. In multivariate analysis, the model that best explained inadequate knowledge was being adolescents (PR=1.36), rural origin (PR=1.30), studying in programs not related to AEM (PR=1.92) and consuming alcohol (PR=1.28); inadequate attitudes: belonging to programs not related to AEM (PR=1.44) and consuming alcohol (PR=1.48) and inadequate practices with being an adolescent (PR=1.74) and belonging to programs not related to AEM (PR=1.37). Conclusions: Knowledge, attitudes and inadequate practices about AEM in university students are associated with age, origin, alcohol consumption and studying in academic program not related to AEM, offering specific lights to intervene from health promotion..
Keywords
Breast Self-Examination; Health Knowledge, Attitudes, Practice; Students, Health Occupations; Breast Neoplasms.
1.
Díaz Cárdenas S, Rodríguez Rodríguez A, Arrieta-Vergara K. Breast self-examination in students of a public university in the Colombian Caribbean. Ciencia e Innovación en Salud [Internet]. 2023 Mar. 7 [cited 2024 Nov. 13];. Available from: https://revistas.unisimon.edu.co/index.php/innovacionsalud/article/view/5083
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References
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1. Qasim S, Tayyab H, Zulqadar K, Masood S, Qasim TB, Zubair Z. Breast Cancer knowledge and perceived barriers to help seeking among pre-clinical and clinical female medical students of King Edward Medical University, Lahore: a cross-sectional study. BMC Med Educ. 2020; 20(1):222. https://doi.org/10.1186/s12909-020-02132-
2. Sancho H, Colonna M. Épidémiologie des cancers du sein [Breast cancer epidemiology]. Presse Med. 2019; 48(10):1076-1084. https://doi.org/10.1016/j.lpm.2019.09.022
3. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. https://doi:10.3322/caac.21492.
4. Kamińska M, Ciszewski T, Łopacka-Szatan K, Miotła P, Starosławska E. Breast cancer risk factors. Prz Menopauzalny. 2015; 14(3):196-202. https://doi.org/10.5114/pm.2015.54346
5. Picon‐Ruiz M, Pan C, Drews‐Elger K, et al. Interactions between adipocytes and breast cancer cells stimulate cytokine production and drive Src/Sox2/miR‐302b mediated malignant progression. Cancer Res. 2016; 76:491‐504. https://doi.org/10.1158/0008-5472.CAN-15-0927
6. Kilwein TM, Kern SM, Looby A. Interventions for alcohol-related risky sexual behaviors among college students: A systematic review. Psychol Addict Behav. 2017; 31(8):944-950. https://doi: 10.1037/adb0000294
7. Patel AV, Friedenreich CM, Moore SC, Hayes SC, Silver JK, Campbell KL et al. American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control. Med Sci Sports Exerc. 2019; 51(11):2391-2402. https://doi:10.1249/MSS.0000000000002117.
8. Celik S, Tasdemir N, Sancak H, Demirel M, Akman O, Kara M. Breast cancer awareness among Turkish nursing students. Asian Pac J Cancer Prev. 2014; 15(20):8941-8946. https://doi.org/10.7314/apjcp.2014.15.20.8941
9. Pashayan N, et al. Personalized early detection and prevention of breast cancer: ENVISION consensus statement. Nature reviews. Clinical oncology. 2020; 17(11) 687-705. https://doi:10.1038/s41571-020-0388-9
10. Kıssal A, Kartal B, Çetin Ö. The Determination of Knowledge, Applications and Health Beliefs of Third- and Fourth-Grade Nursing Students Regarding Breast Self-Exam. J Breast Health. 2017; 13(1):10-15. https://doi.org/10.5152/tjbh.2016.3207
11. Ministerio de Salud y Protección Social, Instituto Nacional de Cancerología ESE – Manual para la detección temprana de cáncer de mama 2015. https://www.cancer.gov.co/files/libros/archivos/,Manual
12. Kıssal A, Kartal B. Effects of Health Belief Model-Based Education on Health Beliefs and Breast Self-Examination in Nursing Students. Asia Pac J Oncol Nurs. 2019; 6(4):403-410. https://doi.org/10.4103/apjon.apjon_17_19
13. Heena H, Durrani S, Riaz M, AlFayyad I, Tabasim R, Parvez G, et al. Knowledge, attitudes, and practices related to breast cancer screening among female health care professionals: a cross sectional study. BMC Womens Health. 2019; 19(1):122. https://doi:10.1186/s12905-019-0819-x.
14. Abera H, Mengistu D, Bedaso A. Effectiveness of planned teaching intervention onknowledge and practice of breast self-examination among first year midwifery students. Palos One. 2017; 12(9): e0184636. https://doi:10.1371/journal.pone.0184636
15. Yılmaz M, Durmuş T. Health Beliefs and Breast Cancer Screening Behavior among a Group of Female Health Professionals in Turkey. J Breast Health. 2016; 12(1):18-24. https://doi:10.5152/tjbh.2015.2715.
16. Ahmadian M, Carmack S, Samah AA, Kreps G, Saidu MB. Psychosocial Predictors of Breast Self-Examination among Female Students in Malaysia: A Study to Assess the Roles of Body Image, Self-efficacy and Perceived Barriers. Asian Pac J Cancer Prev. 2016; 17(3):1277-84. https://doi:10.7314/apjcp.2016.17.3.1277.
17. Gençtürk N, Demirezen E, Ay F. Health Beliefs of Midwifery Students at Istanbul University about Breast Cancer and Breast Self-Examination Acknowledgements. J Cancer Educ. 2017; 32(4):784-789. https://doi:10.1007/s13187-016-1014-5
18. Departamento Administrativo Distrital De Salud. Perfil epidemiologico del distrito de Cartagena año-2018. Cartagena: Alcaldía mayor de Cartagena; 2019. https://www.dadiscartagena.gov.co/images/docs/saludpublica/vigilancia/d2018/asis_cartagena_2018.pdf
19. Hernández-Escolar J, Castillo-Ávila IY, Consuegra-Mayor C, Mejía-Chávez G. Conocimientos, actitudes y prácticas sobre autoexamen de mamas en universitarias del área de la salud. Cartagena (Colombia). Arch Med (Manizales) 2019; 19(2):227-37. https://doi.org/10.30554/archmed.19.2.2788.2019
20. Mesa-Gutierrez D, Velandia-Gonzalez D, Quemba-Mesa M. Autoexamen de seno: conocimientos, actitudes y prácticas en mujeres de una institución de educación superior. Revista Investigación En Salud. 2019; 6(1) 72-87. https://doi.org/10.24267/23897325.407
21. Manrique FG et al. Factores asociados a la correcta práctica del autoexamen de mama en mujeres de Tunja (Colombia). Invest. Educ. enferm. 2012; 30(1) 18-27. http://www.scielo.org.co/scielo.php?pid=S012053072012000100003&script=sci_abstract
22. Ramos-Águila YC, Marimón-Torres ER, Crespo-González C, Junco-Sena B, Valiente-Morejón W. Cáncer de mama, su caracterización epidemiológica. Rev Ciencias Médicas. 2015; 19(4): 619-629. http://www.revcmpinar.sld.cu/index.php/publicaciones/article/view/2134
23. Kulakci H, Ayyildiz TK, Yildirim N, Ozturk O, Topan AK, Tasdemir N. Effects of Breast Cancer Fatalism on Breast Cancer Awareness among Nursing Students in Turkey. Asian Pac J Cancer Prev. 2015; 16(8):3565-3572. https://doi:10.7314/apjcp.2015.16.8.3565
24. Akhtari-Zavare M, Latiff LA, Juni MH, Said SM, Ismail IZ. Knowledge of Female Undergraduate Students on Breast Cancer and Breast Self-examination in Klang Valley, Malaysia. Asian Pac J Cancer Prev. 2015; 16(15):6231-6235. https://doi:10.7314/apjcp.2015.16.15.6231
25. George SM et al. Development of a multigenerational digital lifestyle intervention for women cancer survivors and their families. Psychooncology. 2020; 29(1):182-194. https://doi.org/10.1002/pon.5236
26. Kalliguddi S, Sharma S, Gore CA. Conocimiento, actitud y práctica del autoexamen de mamas entre mujeres profesionales de TI en Silicon Valley, India. J Family Med Prim Care. 2019; 8 (2): 568-572. https://doi: 10.4103 / jfmpc. jfmpc_315_18
27. Nde FP, Assob JC, Kwenti TE, Njunda AL, Tainenbe TR. Knowledge, attitude and practice of breast self-examination among female undergraduate students in the University of Buea. BMC Res Notes. 2015; 8:43. https://doi.org/10.1186/s13104-015-1004-4
28. lshahrani M, Alhammam SYM, Al Munyif HAS, Alwadei AMA, Alwadei AMA, Alzamanan SSM et al. Knowledge, Attitudes, and Practices of Breast Cancer Screening Methods Among Female Patients in Primary Healthcare Centers in Najran, Saudi Arabia. J Cancer Educ. 2019; 34(6):1167-1172. https://doi:10.1007/s13187-018-1423-8.
29. Dadzi R, Adam A. Assessment of knowledge and practice of breast self-examination among reproductive age women in Akatsi South district of Volta region of Ghana. PLoS One. 2019; 14(12): e0226925. https://doi:10.1371/journal.pone.0226925
30. Didarloo A, Nabilou B, Khalkhali HR. Psychosocial predictors of breast self-examination behavior among female students: an application of the health belief model using logistic regression. BMC Public Health. 2017; 17(1): 861.https://doi.org/10.1186/s12889-017-4880-9
31. Kim EM, Lee H, Kim JG, Ho TV, Huong NTT, Mai TTN et al. Using the Stage-Based Approaches to Predict Breast Self-Examination Among Rural Vietnamese Women. Asia Pac J Public Health. 2019; 31(4):325-334. https://doi: 10.1177/1010539519849326.
32. Shield KD, Soerjomataram I, Rehm J. Alcohol Use and Breast Cancer: A Critical Review. Alcohol Clin Exp Res. 2016; 40(6):1166-81. https://doi.org/10.1111/acer.13071
33. Bastias EM, Stiepovich J. Una revision de los estilos de vida de estudiantes universitarios iberoamericanos. Cienc. enferm. 2014; 20(2):93-101. http://dx.doi.org/10.4067/S0717-95532014000200010.
34. Mirmoammadi A, Parsa P, Khodakarami B, Roshanaei G. Effect of Consultation on Adherence to Clinical Breast Examination and Mammography in Iranian Women: A Randomized Control Trial. Asian Pac J Cancer Prev. 2018; 19(12):3443-3449. https://doi.org/10.31557/APJCP.2018.19.12.3443
35. Hwang JJ, Donnelly TT, Ewashen C, McKiel E, Raffin S, Kinch J. Sociocultural Influences on Arab Women's Participation in Breast Cancer Screening in Qatar. Qual Health Res. 2017; 27(5):714-726. https://doi:10.1177/10497323156
References
1. Qasim S, Tayyab H, Zulqadar K, Masood S, Qasim TB, Zubair Z. Breast Cancer knowledge and perceived barriers to help seeking among pre-clinical and clinical female medical students of King Edward Medical University, Lahore: a cross-sectional study. BMC Med Educ. 2020; 20(1):222. https://doi.org/10.1186/s12909-020-02132-
2. Sancho H, Colonna M. Épidémiologie des cancers du sein [Breast cancer epidemiology]. Presse Med. 2019; 48(10):1076-1084. https://doi.org/10.1016/j.lpm.2019.09.022
3. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. https://doi:10.3322/caac.21492.
4. Kamińska M, Ciszewski T, Łopacka-Szatan K, Miotła P, Starosławska E. Breast cancer risk factors. Prz Menopauzalny. 2015; 14(3):196-202. https://doi.org/10.5114/pm.2015.54346
5. Picon‐Ruiz M, Pan C, Drews‐Elger K, et al. Interactions between adipocytes and breast cancer cells stimulate cytokine production and drive Src/Sox2/miR‐302b mediated malignant progression. Cancer Res. 2016; 76:491‐504. https://doi.org/10.1158/0008-5472.CAN-15-0927
6. Kilwein TM, Kern SM, Looby A. Interventions for alcohol-related risky sexual behaviors among college students: A systematic review. Psychol Addict Behav. 2017; 31(8):944-950. https://doi: 10.1037/adb0000294
7. Patel AV, Friedenreich CM, Moore SC, Hayes SC, Silver JK, Campbell KL et al. American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control. Med Sci Sports Exerc. 2019; 51(11):2391-2402. https://doi:10.1249/MSS.0000000000002117.
8. Celik S, Tasdemir N, Sancak H, Demirel M, Akman O, Kara M. Breast cancer awareness among Turkish nursing students. Asian Pac J Cancer Prev. 2014; 15(20):8941-8946. https://doi.org/10.7314/apjcp.2014.15.20.8941
9. Pashayan N, et al. Personalized early detection and prevention of breast cancer: ENVISION consensus statement. Nature reviews. Clinical oncology. 2020; 17(11) 687-705. https://doi:10.1038/s41571-020-0388-9
10. Kıssal A, Kartal B, Çetin Ö. The Determination of Knowledge, Applications and Health Beliefs of Third- and Fourth-Grade Nursing Students Regarding Breast Self-Exam. J Breast Health. 2017; 13(1):10-15. https://doi.org/10.5152/tjbh.2016.3207
11. Ministerio de Salud y Protección Social, Instituto Nacional de Cancerología ESE – Manual para la detección temprana de cáncer de mama 2015. https://www.cancer.gov.co/files/libros/archivos/,Manual
12. Kıssal A, Kartal B. Effects of Health Belief Model-Based Education on Health Beliefs and Breast Self-Examination in Nursing Students. Asia Pac J Oncol Nurs. 2019; 6(4):403-410. https://doi.org/10.4103/apjon.apjon_17_19
13. Heena H, Durrani S, Riaz M, AlFayyad I, Tabasim R, Parvez G, et al. Knowledge, attitudes, and practices related to breast cancer screening among female health care professionals: a cross sectional study. BMC Womens Health. 2019; 19(1):122. https://doi:10.1186/s12905-019-0819-x.
14. Abera H, Mengistu D, Bedaso A. Effectiveness of planned teaching intervention onknowledge and practice of breast self-examination among first year midwifery students. Palos One. 2017; 12(9): e0184636. https://doi:10.1371/journal.pone.0184636
15. Yılmaz M, Durmuş T. Health Beliefs and Breast Cancer Screening Behavior among a Group of Female Health Professionals in Turkey. J Breast Health. 2016; 12(1):18-24. https://doi:10.5152/tjbh.2015.2715.
16. Ahmadian M, Carmack S, Samah AA, Kreps G, Saidu MB. Psychosocial Predictors of Breast Self-Examination among Female Students in Malaysia: A Study to Assess the Roles of Body Image, Self-efficacy and Perceived Barriers. Asian Pac J Cancer Prev. 2016; 17(3):1277-84. https://doi:10.7314/apjcp.2016.17.3.1277.
17. Gençtürk N, Demirezen E, Ay F. Health Beliefs of Midwifery Students at Istanbul University about Breast Cancer and Breast Self-Examination Acknowledgements. J Cancer Educ. 2017; 32(4):784-789. https://doi:10.1007/s13187-016-1014-5
18. Departamento Administrativo Distrital De Salud. Perfil epidemiologico del distrito de Cartagena año-2018. Cartagena: Alcaldía mayor de Cartagena; 2019. https://www.dadiscartagena.gov.co/images/docs/saludpublica/vigilancia/d2018/asis_cartagena_2018.pdf
19. Hernández-Escolar J, Castillo-Ávila IY, Consuegra-Mayor C, Mejía-Chávez G. Conocimientos, actitudes y prácticas sobre autoexamen de mamas en universitarias del área de la salud. Cartagena (Colombia). Arch Med (Manizales) 2019; 19(2):227-37. https://doi.org/10.30554/archmed.19.2.2788.2019
20. Mesa-Gutierrez D, Velandia-Gonzalez D, Quemba-Mesa M. Autoexamen de seno: conocimientos, actitudes y prácticas en mujeres de una institución de educación superior. Revista Investigación En Salud. 2019; 6(1) 72-87. https://doi.org/10.24267/23897325.407
21. Manrique FG et al. Factores asociados a la correcta práctica del autoexamen de mama en mujeres de Tunja (Colombia). Invest. Educ. enferm. 2012; 30(1) 18-27. http://www.scielo.org.co/scielo.php?pid=S012053072012000100003&script=sci_abstract
22. Ramos-Águila YC, Marimón-Torres ER, Crespo-González C, Junco-Sena B, Valiente-Morejón W. Cáncer de mama, su caracterización epidemiológica. Rev Ciencias Médicas. 2015; 19(4): 619-629. http://www.revcmpinar.sld.cu/index.php/publicaciones/article/view/2134
23. Kulakci H, Ayyildiz TK, Yildirim N, Ozturk O, Topan AK, Tasdemir N. Effects of Breast Cancer Fatalism on Breast Cancer Awareness among Nursing Students in Turkey. Asian Pac J Cancer Prev. 2015; 16(8):3565-3572. https://doi:10.7314/apjcp.2015.16.8.3565
24. Akhtari-Zavare M, Latiff LA, Juni MH, Said SM, Ismail IZ. Knowledge of Female Undergraduate Students on Breast Cancer and Breast Self-examination in Klang Valley, Malaysia. Asian Pac J Cancer Prev. 2015; 16(15):6231-6235. https://doi:10.7314/apjcp.2015.16.15.6231
25. George SM et al. Development of a multigenerational digital lifestyle intervention for women cancer survivors and their families. Psychooncology. 2020; 29(1):182-194. https://doi.org/10.1002/pon.5236
26. Kalliguddi S, Sharma S, Gore CA. Conocimiento, actitud y práctica del autoexamen de mamas entre mujeres profesionales de TI en Silicon Valley, India. J Family Med Prim Care. 2019; 8 (2): 568-572. https://doi: 10.4103 / jfmpc. jfmpc_315_18
27. Nde FP, Assob JC, Kwenti TE, Njunda AL, Tainenbe TR. Knowledge, attitude and practice of breast self-examination among female undergraduate students in the University of Buea. BMC Res Notes. 2015; 8:43. https://doi.org/10.1186/s13104-015-1004-4
28. lshahrani M, Alhammam SYM, Al Munyif HAS, Alwadei AMA, Alwadei AMA, Alzamanan SSM et al. Knowledge, Attitudes, and Practices of Breast Cancer Screening Methods Among Female Patients in Primary Healthcare Centers in Najran, Saudi Arabia. J Cancer Educ. 2019; 34(6):1167-1172. https://doi:10.1007/s13187-018-1423-8.
29. Dadzi R, Adam A. Assessment of knowledge and practice of breast self-examination among reproductive age women in Akatsi South district of Volta region of Ghana. PLoS One. 2019; 14(12): e0226925. https://doi:10.1371/journal.pone.0226925
30. Didarloo A, Nabilou B, Khalkhali HR. Psychosocial predictors of breast self-examination behavior among female students: an application of the health belief model using logistic regression. BMC Public Health. 2017; 17(1): 861.https://doi.org/10.1186/s12889-017-4880-9
31. Kim EM, Lee H, Kim JG, Ho TV, Huong NTT, Mai TTN et al. Using the Stage-Based Approaches to Predict Breast Self-Examination Among Rural Vietnamese Women. Asia Pac J Public Health. 2019; 31(4):325-334. https://doi: 10.1177/1010539519849326.
32. Shield KD, Soerjomataram I, Rehm J. Alcohol Use and Breast Cancer: A Critical Review. Alcohol Clin Exp Res. 2016; 40(6):1166-81. https://doi.org/10.1111/acer.13071
33. Bastias EM, Stiepovich J. Una revision de los estilos de vida de estudiantes universitarios iberoamericanos. Cienc. enferm. 2014; 20(2):93-101. http://dx.doi.org/10.4067/S0717-95532014000200010.
34. Mirmoammadi A, Parsa P, Khodakarami B, Roshanaei G. Effect of Consultation on Adherence to Clinical Breast Examination and Mammography in Iranian Women: A Randomized Control Trial. Asian Pac J Cancer Prev. 2018; 19(12):3443-3449. https://doi.org/10.31557/APJCP.2018.19.12.3443
35. Hwang JJ, Donnelly TT, Ewashen C, McKiel E, Raffin S, Kinch J. Sociocultural Influences on Arab Women's Participation in Breast Cancer Screening in Qatar. Qual Health Res. 2017; 27(5):714-726. https://doi:10.1177/10497323156
2. Sancho H, Colonna M. Épidémiologie des cancers du sein [Breast cancer epidemiology]. Presse Med. 2019; 48(10):1076-1084. https://doi.org/10.1016/j.lpm.2019.09.022
3. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. https://doi:10.3322/caac.21492.
4. Kamińska M, Ciszewski T, Łopacka-Szatan K, Miotła P, Starosławska E. Breast cancer risk factors. Prz Menopauzalny. 2015; 14(3):196-202. https://doi.org/10.5114/pm.2015.54346
5. Picon‐Ruiz M, Pan C, Drews‐Elger K, et al. Interactions between adipocytes and breast cancer cells stimulate cytokine production and drive Src/Sox2/miR‐302b mediated malignant progression. Cancer Res. 2016; 76:491‐504. https://doi.org/10.1158/0008-5472.CAN-15-0927
6. Kilwein TM, Kern SM, Looby A. Interventions for alcohol-related risky sexual behaviors among college students: A systematic review. Psychol Addict Behav. 2017; 31(8):944-950. https://doi: 10.1037/adb0000294
7. Patel AV, Friedenreich CM, Moore SC, Hayes SC, Silver JK, Campbell KL et al. American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control. Med Sci Sports Exerc. 2019; 51(11):2391-2402. https://doi:10.1249/MSS.0000000000002117.
8. Celik S, Tasdemir N, Sancak H, Demirel M, Akman O, Kara M. Breast cancer awareness among Turkish nursing students. Asian Pac J Cancer Prev. 2014; 15(20):8941-8946. https://doi.org/10.7314/apjcp.2014.15.20.8941
9. Pashayan N, et al. Personalized early detection and prevention of breast cancer: ENVISION consensus statement. Nature reviews. Clinical oncology. 2020; 17(11) 687-705. https://doi:10.1038/s41571-020-0388-9
10. Kıssal A, Kartal B, Çetin Ö. The Determination of Knowledge, Applications and Health Beliefs of Third- and Fourth-Grade Nursing Students Regarding Breast Self-Exam. J Breast Health. 2017; 13(1):10-15. https://doi.org/10.5152/tjbh.2016.3207
11. Ministerio de Salud y Protección Social, Instituto Nacional de Cancerología ESE – Manual para la detección temprana de cáncer de mama 2015. https://www.cancer.gov.co/files/libros/archivos/,Manual
12. Kıssal A, Kartal B. Effects of Health Belief Model-Based Education on Health Beliefs and Breast Self-Examination in Nursing Students. Asia Pac J Oncol Nurs. 2019; 6(4):403-410. https://doi.org/10.4103/apjon.apjon_17_19
13. Heena H, Durrani S, Riaz M, AlFayyad I, Tabasim R, Parvez G, et al. Knowledge, attitudes, and practices related to breast cancer screening among female health care professionals: a cross sectional study. BMC Womens Health. 2019; 19(1):122. https://doi:10.1186/s12905-019-0819-x.
14. Abera H, Mengistu D, Bedaso A. Effectiveness of planned teaching intervention onknowledge and practice of breast self-examination among first year midwifery students. Palos One. 2017; 12(9): e0184636. https://doi:10.1371/journal.pone.0184636
15. Yılmaz M, Durmuş T. Health Beliefs and Breast Cancer Screening Behavior among a Group of Female Health Professionals in Turkey. J Breast Health. 2016; 12(1):18-24. https://doi:10.5152/tjbh.2015.2715.
16. Ahmadian M, Carmack S, Samah AA, Kreps G, Saidu MB. Psychosocial Predictors of Breast Self-Examination among Female Students in Malaysia: A Study to Assess the Roles of Body Image, Self-efficacy and Perceived Barriers. Asian Pac J Cancer Prev. 2016; 17(3):1277-84. https://doi:10.7314/apjcp.2016.17.3.1277.
17. Gençtürk N, Demirezen E, Ay F. Health Beliefs of Midwifery Students at Istanbul University about Breast Cancer and Breast Self-Examination Acknowledgements. J Cancer Educ. 2017; 32(4):784-789. https://doi:10.1007/s13187-016-1014-5
18. Departamento Administrativo Distrital De Salud. Perfil epidemiologico del distrito de Cartagena año-2018. Cartagena: Alcaldía mayor de Cartagena; 2019. https://www.dadiscartagena.gov.co/images/docs/saludpublica/vigilancia/d2018/asis_cartagena_2018.pdf
19. Hernández-Escolar J, Castillo-Ávila IY, Consuegra-Mayor C, Mejía-Chávez G. Conocimientos, actitudes y prácticas sobre autoexamen de mamas en universitarias del área de la salud. Cartagena (Colombia). Arch Med (Manizales) 2019; 19(2):227-37. https://doi.org/10.30554/archmed.19.2.2788.2019
20. Mesa-Gutierrez D, Velandia-Gonzalez D, Quemba-Mesa M. Autoexamen de seno: conocimientos, actitudes y prácticas en mujeres de una institución de educación superior. Revista Investigación En Salud. 2019; 6(1) 72-87. https://doi.org/10.24267/23897325.407
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