Response to the letter regarding the practice of breast self-examination and


Department of Reproductive Health and Nutrition, School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia

Mr. editor

I (on behalf of all authors) read Alexandra MacKenzie’s letter on areas for improvement in our previously published article “Breast Self-Examination Practice and Associated Factors in Women Attending the Family Planning Department in the public health facilities of Modjo in southwest Ethiopia ”. Firs I would like to thank Alexandra MacKenzie for her invaluable advice indicating the area of ​​improvement for future researchers. I share some of the points he raised. As he explained, breast cancer is the leading cause of cancer death worldwide and breast self-examination is one of the cheapest methods used for the early detection of breast cancer in women. asymptomatic women in resource-limited settings.1 Unlike clinical breast examination and mammography, BSE is a general approach to increase awareness of breast health allowing early detection of abnormalities.2 Despite its prevalence, breast cancer is not considered a major public health problem at any level of the health system in Ethiopia.3 According to the results of our study, the practice of breast self-examination was low in the study area. Higher education, knowledge of breast self-examination, and a positive attitude toward breast self-examination were significantly associated with the practice of breast self-examination. . To remind the author, each study has an objective and a scope, so the aim of our study was to assess the practice of breast self-examination and associated factors in women attending a family planning service. For this reason, we were tempted to assess the overall practice of our respondents (the women attended the family planning service), the reasons for not practicing and the determining factors for practicing BSE. The first thing, investigating the reasons for the development of a negative attitude was not our field of study. Second, attitudes develop reasonably from the beliefs people have about the object of the attitude or we form beliefs about an object by associating it with certain attributes, i.e. others. objects, characteristics or events. Each belief links the behavior to a certain outcome, or to some other attribute such as the cost incurred by performing the behavior. Since the attributes which come to be related to the behavior are already evaluated positively or negatively, we automatically and simultaneously acquire an attitude towards the behavior.4 Third, several items with the Likert measurement scale measure attitude, which is difficult to assess the reasons for misunderstanding. Another concern of the author was not to investigate traditional and religious barriers. According to a qualitative study conducted by Getachew et al with twelve breast cancer patients using in-depth interviews in urban and rural areas of southern Ethiopia, belief in traditional medicine and religious practices for the treatment, and the lack of social and financial support to seek care in a medical facility were barriers to early diagnosis of breast cancer.5 In this study, women are already developing breast cancer and may worry and intend to see traditional or religious healers rather than going to a health facility due to scarce resources for diagnosing breast cancer. breast.2.6 Here, our study excluded women diagnosed with breast cancer in order to reduce bias. Although not within our scope of study, traditional, cultural, and religious barriers associated with the practice of breast self-examination may require further investigation through qualitative study. The author was also concerned that the selection of study participants in public health facilities is likely to introduce selection bias, as those who already attend a family planning service are naturally more likely to be concerned about their health and have the means to access health care. He tried to review the article from a systematic review and meta-analysis by Yeshitila et al that identified poor health-seeking behaviors and lack of confidence in the health system as barriers. to the practice of BSE in Ethiopia.7 In this study, there is no data showing the association between health-seeking behavior and breast self-examination. The results of this study indicated that women who had a non-formal education, a family history of breast cancer, a good knowledge of breast self-examination and a favorable attitude towards breast self-examination were significantly associated with the practice of breast self-examination. First, our study aimed to assess the practice of animal self-examination and associated factors among women attending the family planning service and generalized on this source population. Second, our study population is looking for a family planning service and not a breast cancer diagnosis which may not be biased. There are no studies showing the association between seeking family planning services and performing breast self-examinations. In addition, the author was concerned about study participants as the use of family planning services in the Oromia region was low, at around 40.7%, and noted that more than a third of women interviewed found family planning unacceptable.8. Thus, by selecting patients from family planning clinics, the authors eliminate a significant proportion of the population who may practice or ignore BSE, which may affect the representativeness of this study. First of all, I want to correct the author that we were selected clients and not patients. Because the main goal of our study participants to visit a health facility was not treating breast cancer, but rather using the family planning service. Second, the usage figure cited here in the Oromia region was for postpartum women only. The participants in our study were women of reproductive age from the general population. Third, although the use of 40.7% is for postpartum women, this figure is higher than the national prevalence of EDHS 2016, which is 35%.9 The last was the question of the validity of the knowledge elements. We tried to validate not only the elements related to knowledge, but also the elements related to attitudes. Finally, I would like to thank the author for his criticisms and possible suggestions for future researchers.


The author declares that there is no conflict of interest in this communication.

The references

1. WHO / World Health Organization. Breast Cancer Fact Sheet; 2020. Available from: Accessed September 27, 2021.

2. Abay M, Tuke G, Zewdie E, Abraha TH, Grum T, Brhane E. Practice of breast self-examination and associated factors in women aged 20-70 attending city public health facilities Adwa, in northern Ethiopia. BMC Resolution Notes. 2018; 11: 622. doi: 10.1186 / s13104-018-3731-9

3. Fajans P, Simmons R, Ghiron L. Helping public sector health systems innovate: the strategic approach to strengthen reproductive health policies and programs. Am J Public health. 2006; 96 (3): 435-440. doi: 10.2105 / AJPH.2004.059907

4. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991; 50 (2): 179-211. doi: 10.1016 / 0749-5978 (91) 90020-T

5. Getachew S, Tesfaw A, Kaba M, et al. Perceived barriers to early diagnosis of breast cancer in southern and southwestern Ethiopia: a qualitative study. BMC Women’s Health. 2020; 20 (1): 1–8. doi: 10.1186 / s12905-020-00909-7

6. Ethiopian FMOH. Disease Prevention and Control Directorate. National cancer control plan 2016-2020.

7. Yeshitila YG, Kassa GM, Gebeyehu S, Memiah P, Desta M. The practice of breast self-examination and its determinants in women in Ethiopia: a systematic review and meta-analysis. PLoS A. 2021; 16 (1): e0245252. doi: 10.1371 / journal.pone.0245252

8. Seifu B, Yilma D, Daba W. Knowledge, use and associated factors of postpartum family planning among women who gave birth in the previous year in Oromia Regional State, Ethiopia. Open Access J Contracept. 2020; 11: 167. doi: 10.2147 / OAJC.S268561

9. (CSA) CSA, ICF. Ethiopia Demographic and Health Survey. Addis Ababa, Ethiopia, and Rockville, Maryland, United States: CSA and ICF; 2016.

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