China faces an alarming increase in breast cancer rates, largely
because of an increase in risk factors associated with changing
lifestyles (Yang et al. 2005). For women 45–49 years, prevalence
was less than 100 per 100 000 in 1999 but is projected to reach
121 in 2010 and 145 per 100 000 by 2020 (Zhen et al. 2001).
Breast is now the most frequently diagnosed cancer in Shanghai,
Beijing, Tianjin and Guangzhou (Gao 1999; Hao et al. 2002; Li
2004; People’s Daily 2003a; Yang et al. 2004; Ying & Zhang 2003).
By 2021, 2.5 million women aged 35–49 years in 2001 are
expected to have breast cancer. China is ‘on the cusp of a breast
cancer epidemic’ (Linos et al. 2008).
In nations with adequate medical resources, mammograms
are the standard screening technique for early detection. In
China, mammograms are available only at a limited number of
urban hospitals. The Chinese government policy is recognized as
the foundation for change, but there is no mandate to provide
free or low-cost mammograms on the mass scale required. In
most cases, the cost must be paid by the individual (Wong &
Gabriel 2000). Recognizing the situation in many low-resource
countries, the World Health Organization (WHO) continues to
recommend breast self-examination (BSE) until more technologically
advanced alternatives are available (World Health
Organization 2002). The WHO’s support for BSE is based on its
estimate that two-thirds of all cancers, including breast cancer,
can be prevented or treated successfully if detected early (World
Health Organization 2005). Its recommendation is based on
research showing that BSE can be associated with finding breast
cancer at a more favourable clinical stage (Foster et al. 1978).
The study reported here started at the first step in examining
the effectiveness of BSE education by asking the following
questions:
1 Does BSE increase after a BSE educational intervention is
delivered in communities of residence by nurses in China?
2 After the intervention, does BSE increase among the women
living in both urban and non-urban areas?
3 In addition to the intervention, do women’s demographic
and/or psychosocial characteristics help predict more frequent
BSE?