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present with late advanced breast cancers and this is reflected in the fact that women in England have poor survival outcomes compared to the rest of Europe.1


Various campaigns and national


cancer plans have had the same remit of encouraging early detection of cancer by raising public awareness. However, even with all the publicity and celebrities such as singers Kylie Minogue and Anastasia advocating early detection, women in general are still not breast aware.1,6


Furthermore, it has been reported that a


worrying 43 % of black British women never examine their breasts and at least 32% know nothing about breast cancer.7 The NHS Breast Screening Programme (NHSBSP) introduced


in 1988 has led to many more women being diagnosed with breast cancer, as well as a general health promotion message to


BOX 2. FIVE-POINT AWARENESS CODE


1. Knowing what is normal. 2. Looking and feeling the breast. 3. Knowing what changes to look for. 4. What to do if a change is found. 5. Informing women about screening.13


be breast aware. The current uptake of screening is around 75%, with the optimum uptake being 80%.8 The programme currently invites women from age 50 to 70 years (as this is when women are at the highest risk). Very soon, the programme will be expand- ed to include women aged 47-73. Younger women therefore have to rely on breast self-examination and breast awareness, and there is still confusion amongst women as to what ‘breast awareness’ is and how to properly self-examine. Many women fear finding something wrong with their breasts.


Primary care nurses therefore have a huge role to play in the education and support of such women in demonstrating how to be breast aware and encouraging them to attend screening. After many years of confusion and Sir Donald Acheson (the then-retir- ing chief medical officer) implying in 1991 that breast self-exami- nation (BSE) was ineffective, a systematic review found that breast self-examination does not improve mortality from breast cancer and should not be advocated as a standalone screening tool.9 Two randomised controlled studies from Russia and China did not show BSE to be beneficial when compared to no screening, and in fact it may cause more harm psychologically by leading to biopsies for benign conditions. Therefore, systematic BSE was abandoned in the UK in 1991 and breast awareness became the preferred behaviour.


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