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Chapter 1


1.1 Background of the study

Breast cancer is the most frequent cancer among women and the top cancer in women both in the developed and the developing world (WHO, 2017). Breast cancer affects women all around the world, but the majority (69%) of all breast cancer deaths occur in developing countries. The Malaysian National Cancer Registry (MNCR) Report 2007-2011 identified breast cancer as the most common cancers among Malaysian citizens and it occurs to women more than men. Based on the age-specific incidence rate, breast cancer commonly happened to women at age of 25-59 and the highest incidence of breast cancer happened at the age of 55 with 100,000 women (MNCR, 2016).  In view of race in Malaysia, Chinese are (41.5%) more likely to have breast cancer followed by Indian (37.1%) and Malay (27.2%). The percentage of breast cancer detected at stage I and II was 56.9% (MNCR, 2016). According to this report, breast cancer becomes the most concern to each woman in the country. Every woman has the possibility to get breast cancer and it needs more attention from woman and people surrounding in order to prevent this silent killer disease. In order to prevent this, citizens need to have the right knowledge about breast cancer and positive attitude towards breast cancer screening as it can prevent late diagnosed. Apart from that, practice of breast self examination that can be perform individually also play a role in early detection of breast cancer symptom.

Early detection or screening of breast cancer means a person who does not have any symptom of breast cancer yet undergo test or exams that can be performed in hospital or at home. Test that can be performed in hospital include mammogram and clinical breast examination (CBE), while at home is breast self-examination (BSE). In 2015, American Cancer Society has developed latest breast cancer screening guideline for women 40-55 years old and above. The guidelines explained that women at these ages (40-55 years old and above) should start screening with mammogram every year. In addition to that, they are also encourages to do clinical breast examination (CBE) and breast self-examination (BSE). These two also can be performed or applied by women at young age of 20 years old or girls that reach puberty and could be helpful if women are familiar with their breast normally look and feel. If any abnormalities detected, they can report to the health care provider right away for further investigation.


1.2 Problem Statement

Breast cancer is the top cancer in women and women at age 55 comprise the highest incidence in Malaysia (MNCR, 2016). As cancer is the silent killer, most of the patients being diagnosed of breast cancer at late stage and prognosis for the disease to be cured is low as the cancer might be large and already metastasis to other organ (Campbell, 2014). Women regardless of age need to have knowledge about breast cancer which includes the sign and symptoms, risk factors and type of breast cancer screening as this disease keep increasing yearly. Women at young age need to have early exposure about breast cancer as this disease can be prevent and treat easily when the symptoms of cancer are found early. As younger generations especially youth are equipped with good knowledge about breast cancer, Malaysia in the future could have a great reduction of breast cancer diseases.

However, a good knowledge must be accompanied by good attitude towards health-seeking behavior. People will have great prognosis when the diseases is being detected in early stage especially a cancer diseases as the cancer still small and not spread yet. Having good health-seeking behavior by getting breast cancer screening regularly could save their lives. Breast cancer screenings have many types which include mammography, CBE and BSE. People with lack of breast cancer knowledge might have fatalistic belief regarding breast cancer screening. Embarrassment, fear of cancer diagnosis and cost are common barriers that hinder them from do breast cancer screening (Parsa et al., 2008).

One of the simplest and easiest breast cancer screening methods is breast-self examination. Even though there were not many research that support the effectiveness of this screening, breast mass of 65% of breast cancer cases were identified by BSE before mammography was used (Sreedharan, Muttappallymyalil, Venkatramana, & Thomas, 2010). BSE can be done by individual at home and it could be useful for those who are shy to go and see health care provider. Regularly perform on every month on the same date for pregnant and menopause women and few days after period ends for other women. Regularly examine own breast will easily detect and notice any abnormalities which differ from breast normally look and feel.

Reflecting to the evidence had been presented in MNCR Report 2007-2011, breast cancer has been a great phenomenon in our country since a few years before (MNCR, 2016). This issue becomes more tragic when the case keep increasing by years. This is due to the lack of knowledge and awareness about this disease. People pay less attention and will not realize the visible changes happened to their body and later on will be shocked when they have been diagnosed to have the breast cancer. Thus, further research need to be done in order to assess the knowledge of breast cancer among women in this country as well as the attitude towards breast cancer screening and practice of breast self-examination as one of the screening method.


1.3 Significance of study

This study is important to Malaysia as breast cancer one of the common cancer in the country especially in women. By doing this research, knowledge level regarding breast cancer of women especially younger generation in Malaysia will be one of indicator of breast cancer awareness in Malaysia. Massive health promotion and prevention by mass media will play a vital role in spreading the knowledge regarding breast cancer. Citizens will pay more attention when this promotion is spread throughout the country and health care provider need to play their role in educate their patient by informing about the importance and benefits of breast cancer knowledge in their life. At the end of this study, researcher is able to know of to what extend the breast cancer disease is clearly understand by the citizens.


1.4 Research Question

  1. What is the level of knowledge on breast cancer among female students of IIUM Kuantan?
  2. Is there a relationship between knowledge of breast cancer and attitude towards breast cancer screening among female students of IIUM Kuantan?
  3. Is practice of Breast Self-Examination among female students of IIUM Kuantan associated with knowledge of breast cancer?


1.5 Research Objective

1.5.1 General Objective

To determine the knowledge level of breast cancer, attitudes towards breast cancer screening and practice of breast self-examination among female students of IIUM Kuantan.

1.5.2 Specific Objective

  1. To assess the knowledge level of breast cancer among female students of IIUM Kuantan.
  2. To determine the relationship between knowledge of breast cancer and attitudes towards breast cancer screening among female students in IIUM Kuantan.
  3. To investigate the association regarding knowledge of breast cancer with practice of breast self-examination (BSE) among female students of IIUM Kuantan.



1.6 Hypothesis

1.6.1 Hypothesis 1

There is no significant difference between knowledge of breast cancer and attitude towards breast cancer screening among female student in IIUM Kuantan.

1.6.2 Hypothesis 2

There is an association regarding knowledge of breast cancer with practice of breast self-examination among female students of IIUM Kuantan.


1.7 Definition of Term

Breast Cancer: Referring to cells that spread through breast to lymph nodes or other parts of body. Most often begins with cells in the milk-producing ducts.

Breast cancer screening: Checking a women’s breast for cancer before there are signs or symptoms of the diseases.

Breast self-examination (BSE): One type of breast cancer screening. This technique allows an individual to examine his/her breast tissue for any physical or visual changes.

Youth: Person between 15-24 years old (Ministry of Education, 2003). But in this study it comprise of undergraduate student from age 19-24 years old.

Attitude: It refers to behavior of people towards breast cancer screening.

Knowledge: It refers to knowledge of breast cancer.



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