| BackgroundData from the National Central Cancer Registry Database in China shows that about 249,000 new cases were diagnosed in China in 2011.Breast cancer has become the most common cancer for Chinese female,which incidence is increasing year by year and tend to be younger over the last decade.There is grim situation of breast cancer prevention in China.Survival of breast cancer depends on stage of diagnosis as well as histological and molecular subtypes.Survival rates are highest for early stages of diagnosis(99%)versus late stages(26%).Since the inconspicuous early symptom and sign of breast cancer,early screening and prevention are important strategies to improve its prognosis.Previous study has reported that most of the women in our country had poor awareness of cancer prevention and insufficient knowledge about breast cancer.Most of them lack of the awareness of early screening for breast disease.Medical university female personnel and students as a group are responsible for providing accurate and professional health information to the general population,whose knowledge,attitude and screening behaviors are significant to the early prevention of breast cancer.Breast health education for medical university female should be the key target with respect to increasing the awareness of the general population.In addition,identifying women at high risk of breast cancer using risk assessment model is of great significance to early screening of breast cancer.In view of literature about risk assessment models for breast cancer,a series of studies have been carried out abroad,and several risk prediction models have been established,among which Gail model is the most widely used model.Previous studies showed that Gail model is mainly applied to white people,and it is reported that the Gail model has poor applicability and sensitivity in other races and regions.It is difficult to establish a unified risk assessment model in China due to the large population,imbalance of regional economic development and disequilibrium of regional health resources distribution.Therefore,in order to do a good job in the breast cancer screening,there is necessity to establish breast cancer risk assessment model for the region,then providing the basis for breast cancer screening and early intervention,as well as regional data for establishing a further risk assessment model of breast cancer in our country.Objective1.To explore the early prevention situation and influence factors for breast cancer of female personnel and college students in a medical university.2.To identify main risk factors and protective factors of breast cancer among female in Guangdong province.3.To preliminarily establish a risk factor assessment model based on population characteristics of this region,providing a basis for early screening of breast cancer and the definition of high risk population.Contents and methodsThere are two parts in this study:1.The current situation of knowledge attitude and practice(KAP)for prevention of female breast cancer.A total of 600 female personnel and 900 female university students from a medical university were recruited with convenience sampling and randomized cluster sampling method,respectively.Descriptive statistics(means,standard deviation,frequencies,and percentage)were used to describe the current situation of KAP for breast cancer prevention.The influence factors of knowledge and practices were analyzed by the Chi-square test and multivariable logistic regression analysis.2.Study on risk factors of female breast cancer in Guangdong.A hospital-based case-control study was conducted to investigate the risk factors of breast cancer with a total of 362 newly pathologically diagnosed breast cancer patients and 362 healthy women frequency matched(± 2 years old).Multiple logistic regression was used to estimate odd ratios and 95%confidence intervals(CI)for factors associated with breast cancer and establish a risk assessment model of breast cancer.Using the ROC curve,Youden index,and Fisher discriminant analysis to evaluate the effectiveness of the model.Results1 Part ⅠKnowledge of breast cancer prevention.The correct answer rate of breast cancer prevention among female personnel and college students was 72.5%and 65.5%,respectively,while pass rate was 81.8%and 45.3%,respectively.Multivariable logistic regression analysis showed that major,grade,education,history of breast benign disease,breast cancer knowledge health education,ways of breast health knowledge approaching and prevention practices scores were main factors that affected the awareness of breast cancer prevention in medical college female.Attitudes of breast cancer prevention.The overwhelming majority(98.0%)recognized the importance of breast cancer prevention.About breast self-examination(BSE),94.1%agreed that it was a worthwhile thing to do,but only 56.6%of female personnel and 41.0%of female college students agreed to be able to do it correctly.It was worth noting that about 20%of women in medical university still had difficulty in obtaining breast health knowledge.Practices of breast cancer prevention.The pass rate of breast cancer prevention practices among female personnel and college students was 71.6%and 36.2%,respectively.Age,education,major,marital status,history of benign breast disease,breast cancer knowledge health education,ways of breast health knowledge approaching and knowledge scores were main factors that affected the practices of breast cancer prevention in medical college female.2 Part ⅡMultivariable logistic stepwise regression analysis showed that risk factors associated with breast cancer including:early menarche(<12 years old)X1,long menstrual years(≥35 years)X2,high frequency of abortion(three times or more)X3(3),breastfeeding X4,family history of breast cancer X5,depression X6,stay up late X7,were bra to sleep X8,high-fat diet X9(1),and high intake of fresh fruit and vegetables X10,fat meat X11,and greasy food X12.Among those,breastfeeding and high intake of fresh fruit and vegetables were protective factors for breast cancer.The risk assessment model for breast cancer established in this study was as following:Y=24*X1+14*X2+24*X3(3)-12*X4+38*X6+25*X6+14*X7+12*X8+10*X9(1)-16*X10+23*X12+13*X13Results about evaluation of diagnosis effectiveness of the risk assessment model showed that the area under the ROC curve was 0.785,with a 95%confidence interval of(0.752-0.819).The comparison between area under the curve(AUC)and 0.5(AUC=0.5,mean that there was no diagnostic value)showed that the difference was statistically significant(P<0.001).Youden index was adopted to define the optimal cut-off point of high and low risk of breast cancer.20.500 points was the best critical score of high risk population.Fisher discriminant analysis results showed that the sensitivity and specificity of the model were 66.9%and 79.3%,respectively.Conclusions(1)The awareness of breast cancer prevention in medical college female was not balanced.This study points to the insufficient knowledge about risk factors and screening methods of breast cancer and the low practice of breast screening method among female at a medical university.Although the positive attitude in prevention was found among female personnel and college students,most of them lack the perception of their own susceptibility on breast cancer.The awareness of breast health care needs to be enhanced.Grade,education level,specialty,history of breast benign disease,breast cancer knowledge health education and ways of breast health knowledge approaching are the common factors influencing the distribution of knowledge and practices for breast cancer prevention.Ages and marital status may also affect breast cancer prevention practices of the female personnel.Mutual influence factors were observed between knowledge and practices.(2)The results showed that risk factors associated with breast cancer including:early menarche(<12 years old),long menstrual years(≥35 years),high frequency of abortion(three times or more),breastfeeding,family history of breast cancer,depression,stay up late,wear bra to sleep,high-fat diet and high intake of fresh fruit and vegetables,fat meat,and greasy food.Among those,breastfeeding and high intake of fresh fruit and vegetables were protective factors for breast cancer.(3)The risk assessment model preliminarily established in this study had certain practical value which might be used in the population prevention and intervention of breast cancer for screening high risk population in this region.However,the source of data is limited,extrapolating of this model has certain limitations which should be further verified and improved by prospective cohort study and follow-up. |
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