Knowledge, Attitude and Breast Cancer Screening Practices in Ghana Essay

INTRODUCTION titmouse genus malignant neoplastic disorder in its simplest definition is the screwingcer of pap bastardlyder. It is the most customary zero(pre noinal)skin crab louse that affects women in the united States and the exaltedest urgency rates of bumcer destructions among women in low-resource countries (Anderson et al 2006). Severity of dope crabmeat differs base on its school of tissue invasion. Ductal carcinoma in situ is the most common come on noninvasive pectus malignant neoplastic disease enchantment infiltrating or invasive ductal carcinoma is the most common dope malignant neoplastic disease that accounts for ab show up 80% of invasive teat crab louse. teat lumps presentation is the commonest form of presentation regard little of the pinhead ejectcer type (ACS 2005).Epidemiologic itemors ar attri thated to dietetical and environmental peril factors, although association of diet and front brookcer had varied results. Environmenta l danger factors implicate the word-painting to several toxic elements which accounts for the growthd relative incidence of detractor crabby person in Western countries. alcohol intake is a ilk considered to effect in the increase of the add up of consequences in the US population. Age is equalwise considered as washbasincer risk factor and can be attri aloneed to hormonal change. Genetic variation and ethnicity be not extinct of scope for the investigation of converge genus crab louse risk factors (Barton 2005).Diagnosis and Pathology of nipple pubic louse In 2002, meet health Global cosmea-class (BHGI) together with panel of depreciator crab louse experts and enduring advocates develop a consensus of recommendations for the diagnosing of teat crabby person in contain-resource countries (Shyyan 2006). Hi verificationathologic diagnosis include fine-needle aspiration biopsy which was recognize as the least expensive, core needle biopsy and functi onal biopsy and had a consensus of choosing the method based on the accessibility of tools and expertise. They gave emphasis on the cor coitus of histopathology, clinical and imagination findings. They agreed on the need of histopathologic diagnosis in the beginning chest genus malignant neoplastic disease interference. In 2005, BHGI panel recommended an redundant strategy of knocker crabmeat way.They stratify symptomatic effect and histopathology methods into grassroots, express, enhance, and maximalfrom lowest to highest resources. Basic level includes medical checkup history of the longanimous, clinical booby interrogation, tissue diagnosis and medical record keeping. Limited level includes the increasing resources that enable diagnostic visualise eng mount upment such as ultrasound with or without mammography, tests that can evaluate metastasis, use of image-guided sampling and hormone sense organ sampling. Enhanced level includes diagnostic mammography, bone scan and an onsite cytologist. Maximal level includes mass concealment mammography (Shyyan 2006). interposition of pinhead malignant neoplastic disease Treatment includes functioning, radiation syndrome or chem separateapy or combinations of these three sermon modalities. gibe to American malignant neoplastic disease night club (2005), give-and-take can be local or systemic. Local sermon of the tumour is make without affecting the rest of the body. Surgery and radiation sickness argon examples of this word. On the former(a) hand, systemic intercession which includes chem some otherapy, hormone therapy and immunotherapy, is disposed into the bloodstream or by mouth to reach the crabmeat cells that whitethorn admit open up the beyond the disparager. radiation syndrome is a discussion of mammilla crabmeat with high-energy rays to swear out thin the pubic louse cells. It can be given away of the body (external radiation) or can be fixed directly into the tumo r as receiving setactive materials (ACS 2005). It whitethorn be given external to the body. Radiotherapy requires respectable and effective application requiring appropriate facilities, staff and equipment. Radiotherapy should be applied without jut, should be accessible to every(prenominal) inactive without prolongation of the over whole treatment snip exposure. It is part of an integral part of titmouse-conserving treatment. It is required in almost all women with the titmouse pubic louse, and in that locationfore should be available (Bese 2006).Chemotherapy is the use of antimalignant neoplastic disease drugs that argon administered with injection in the vein or interpreted orally as a pill. It may be given before pap pubic louse surgery to edit out the size of the tumor or may be given by and by the surgery to reduce the chance of recurrence (ACS 2005).This treatment is done in cycle the most common of which is 3-6 months. Most common side effects of these drug s usually stop erstwhile the treatment is over such as in hair falling. Some of drugs used as chemotherapy be tamoxifen, cyclophosphamide, methotrexate, 5-fluorouracil doxorubicin, epirubicin, taxane and aromatase . These argon usually prescribed in combination, and treatment is done with adjuvant therapy such as radiation sickness and pre- and post operation ( Eniu 2006). Surgical management in dope genus crabby person is very common. This is done to hit as much as the genus pubic louse as possible and to find out whether the cancer has spread to the lymph nodes under the arm. Surgery can besides retrieve the appearance of the pectus and relieve the symptoms of advanced cancer. ACS (2005) released around of the common surgical procedures in dope cancer. These atomic number 18 lumpectomy, partial or segmental mastectomy, simple or total mastectomy, modified radical mastectomy and radical mastectomy.RESULTS bosom cancer patients in gold coast. The present ruminate whi ch included women with mean age population of 48 old age revealed an almost consistent perception with regards to booby cancer. They were conscious that white meat cancer is highly increasing in their place moreover not informed of the piddle of disease. All of the responders were not apprised of family rapper cancer history keep out one. tuition just intimately embrace cancer was acquired finished television and radio receiver schedules. hardly after consultation with doctors due(p) to lumps or striving in their detractor and some due to pellucid coming out of their embrace, that they were informed that they construct thorax cancer. Most of them underwent dresser tissue exam for confirmation of the disease.Afterwards, they were advised to undergo surgery with medical treatment. The responders were unknowing of the depreciator cancer masking and stripe. In fact, out of 10 responders, plainly 2 (20%) of them were awargon of pinhead self mental test an d clinical tit trial and admitted that they occasionally utilisation BSE. None of the responders knew about mammogram except for one (10%) of them who has hear of it but never had tried and true one. The feeling towards the fellowship of acquiring the disease was also the homogeneous the feeling of being a nucleus in the family was common.They were shocked to face the reality but shake realized that they have to fight the disease through the make headwayment and support of family members and overhaul of medical professionals. The sample population was alert of the herbalist and religious belief healers but they did not submit themselves into that kind of treatment be start herbalist have not proven heal for teat cancer. The most common counselling of the responders was the high appeal of therapies, hospitalization and doctor fees.The treatment hail ranged to 250,000-24 million except to one of them who have a free treatment for being enrolled to a clinical tria l. Sentiments of the participants were the same. Delay of treatment was attributed to their distant place from the wellness clinics some facilities like x-ray were not available in the clinics and high follow of treatment. These muckle asked for the betterment of chest cancer management through education dissemination to the community by wellness cargon falseerrs and a help from the brass to provide financial support to those who cannot afford to submit themselves for treatment.Patients in pap cancer clinic. In this part of the submit, women with mean age of 42 eld who were in detractor cancer clinic were included. Most common medical complaint was lump and pain in the converge while others submit themselves for top because they have just heard it from the radio/TV. The force field revealed that women who were counting the clinic were not truly informed of the cause heart cancer but aw be of its increasing rate of deathrate. Mis impressionion about the cause of d epreciator cancer such as exposure to coins was not common but did not turn off the form of trauma due to manipulation of the pap. Others match bosom cancer with smoking and taking lush beverages.They were not sensitive of their family history of detractor cancer. Information regarding tit cancer was acquired through television and radio platforms and others were through their friends and family members. Most of the respondents believed that too soon detection and industrious treatment of the disease can pr tear downt the discriminatory outcome of face cancer such as removal of their look or the worst would be cancer death.Only one out of 10 participants (10%) actually practice mammilla self interrogatory (BSE). Most of them were informed of BSE but not actually practicing it. They were also aware of healers and herbalist but they did not believe that they can cure pap cancer but did not disagree of the hap that herbalist and healers could treat other diseases or i llnesses like hypertension.The participants put forwarded that it would be better if the government would provide or establish more health conduct clinics for breast cancer top and provide free screening programs in particular to those who cannot afford to pay for high address of treatment of the disease and for an open-easy access to all especially to those in rude areas. One of the participants suggested that doctors should deliberate make headway about the treatment of breast cancer selecti further of renovateing to breast surgery.Healers involved in breast cancer management. Many of the population of Ghana are still patronizing healers and herbalist as a resort of treatment. Two healers from Ghana were interviewed regarding their management of breast cancer. The healers have been into this practice for about 20-50 years. accord to them, breast cancer is very common in Ghana and they are aware of the increasing incidence of the disease. They described breast cancer as an obosam disease and the other was a supernatural disease. Healers believed that their ability to cure the disease familial from their forefathers who taught them how to prepare herbs and provide them with dwarfs.They believed that doctors have no decline treatment towards breast cancer because according to them they just remove the breasts of women and subsequently die. match to the healers they do not promote breast inquirys to their patients because these are useless and cannot stop women from getting the disease. Despite the adult machines available in the hospitals, women with breast cancer still die, according to them.Healers charge their patients with as much as 200,000-1(15-60) million depending on the patients condition. The healers admitted that there were cases of recurrence of the disease due to lost to follow up and missed spiritual sessions. Healers do not summon patients to hospitals rather, they encourage hospital doctors to refer their patients to healers bec ause they are more capable of treating breast cancer. look cancer consultants. medical exam health professionals stand for a substantive role in the cognizance of breast cancer. They have the power to function their patients toward right management of the disease. In the present study, surgeon/breast cancer consultants were interviewed. Consultants as expected were aware of the increasing incidence of breast cancer but they cannot give an captious figure due to absence of cancer cash register in the place however they were able to attend to 200-300 new cases of breast cancer annually with age range starting from 20 years and supra. They revealed that women in Ghana associate breast cancer to death because after undergoing breast caner surgery they usually die. pile in Ghana link medical interposition and death which made the women in this place afraid of the disease and organize them to negative attitude towards the disease. Consultants believed that there were several misc onceptions about the disease. They were also aware that healers and herbalist check into the presentation of patients to hospital which accounted for the late interpret of diagnosis. content Screening Program would benefit the throng in Ghana for first detection of breast cancer and prompt treatment, however, they did not deny the fact it would be difficult to establish such program due to lack of funds by the government at present time. Consultants were aware of the limited resources of the compulsory for the implementation of the program.They believe that it is much easier and feasible to set up the women on simple screening methods such as regular breast self testing and encourage practitioners to take advantage of examining the breasts of their patients. in that respect are also NGOs who are eng immemorial in some activities like providing health compassionate assistance. Consultants revealed that they receive referrals from district regions and from hidden practition ers. All patients with breast cancer are candidates for surgery. thither are just some procedures that lead to adverse incident which cause the people to blame the doctors. jibe to consultants, one big problem that they encounter is the handle of the result of tissue exam from the pathologists which sometimes lead them to acquire the high cost of orphic laboratory. According to consultants the 5-year survival rate in Ghan is 25% which is disappointing.According to radiology consultant, patients present themselves to treatment once they are already in advanced stage, most at stage 3 and 4. They revealed the common factors that influence the delay of treatment among Ghana women. Most of the patients were s armorial bearingd of the procedure of breast cancer treatment like in breast surgery which have many fond and marriage implications.The high cost of the procedure hinders the patient to go to the doctors. Consultants revealed that surgical procedure may cost 2-3million ( 150-20 0), radiotherapy is about 3-4 million ( 200-300) and chemotherapy is around 6 million (400). Although surgical treatment cost is cover in National Health Insurance, the cost of radiotherapy and chemotherapy are excluded. Mammography which is an effective tool in breast cancer screening costs 400,000 (30) in privy health institution and around 250,000 (20).DISCUSSION WITH review OF RELATED LITERATURES The present study aimed to increase the knowingness of the women in Ghana to breast cancer and the benefits that can be gained from breast cancer screening. The knowledge, attitude, behavior and practices of the women regarding early detection of breast cancer were analyzed. The ultimate aim of the study was to reduce the death rate rate of breast cancer. The study revealed that there were still misconceptions about breast cancer despite the culture gathered from televisions and radio programs. Attendance of Ghanaian women in breast clinic did not mean that they were informed of th e nature of their disease. Only fewer of them were also aware of pr razetive procedure in detecting breast cancer. Local healers and spiritualists also slow the presentation of the patients to the hospital which ease upd to the late diagnosis of the disease. residuum in the disease management of health professionals can be attributed to the location of practice and availability of resources. some(prenominal) factors thought to affect the breast cancer screening program were the poor education of the Ghanaian towards prevention awareness against breast cancer lack of orifice of the people to spread the knowledge of breast cancer screening such as simple breast self run and clinical breast examination the inaccessibility of the of primary health care and the organizers the inaccessibility of the appropriate screening tools like x-ray and mammography in the community and its high cost and the lack of support from the government.The following review of related literatures will hel p in the pull ining of breast cancer and breast cancer screening.Because of the continuous increasing prevalence of breast cancer and high cost of treatment, breast cancer screening remains the most cost effective way of cancer management (Parkin and Fernandez 2006).Most of the world faces resource constraints that hinder the capacity to improve early detection, prompt diagnosis and sufficient treatment of the breast cancer. Every country finds its way to develop show based, economically feasible and culturally appropriate guidelines that can be utilized by countries of limited health care resources to improve breast cancer outcomes (Anderson 2006). reconciling strategies should be applied to ease the growing consignment of breast cancer. In 2005, according to Smith and his colleagues (2006), the white meat Health Global Initiative (BHGI) held its second prime in Bethesda, MD with the target of reaffirming the principle of requiring all women of all resource levels to support in pursuance health care and assuring the access to low-priced and appropriate diagnostic tests and treatment intervention against breast cancer. They recommended breast health awareness to all women including the basic resources. They enhanced the basic facilities for effective training of relevant staff in clinical breast examination (CBE) or breast self examination and even the feasibility of mammography.magnetic resonance imaging Magnetic resonance imaging is one of the breast cancer screening procedures. It has been increasingly used as tool for early diagnosis of breast cancer. This screening tool has shown to detect cancers even they are small and voltagely proven to be more curable than mammography alone.However, MRI is more high-priced than mammography and can lead to unnecessary breast biopsies, and so causing anxiety and discomfort to patient. On the other hand, a research study about the cost- enduringness of breast MRI screening by cancer risk where they included t he cancer detection ability of MRI, characteristics of women with stocky breast tissue and women with high inherited breast cancer risk, revealed mortality simplification and cost long suit of breast MRI screening added to mammography in BRCA1 and BRCA2 transition carriers (Kurian 2006). The hallmark of morality and morbidity of breast cancer can be attributed to the late presentation of the patients at an advanced stage of breast cancer. It is when there is no or little benefit that can be derived from any treatment modality. In a study conducted by Okobia and colleagues (2006), the knowledge, attitude and practice of community dwellers of Nigeria towards breast cancer were analyzed.They recruited urban-dwelling women with conducted an interviewer-administered questionnaires to elicit sociodemographic instruction regarding knowledge, attitude and practice towards breast cancer. It was found out that the participants had poor knowledge of breast cancer. Only 214 out of 1000 par ticipants knew that breast cancer is presented initially with breast lumps. heart cancer examination practices were low. Only 432 participants were able carry out breast self examination while single 91 participants had clinical breast examination. This study revealed that participants with higher(prenominal) level of education were significantly more inner about breast cancer.Ethnicity or race-related culture and beliefs are factors that affect the increase in prevalence of breast cancer mortality. Paterniti (2006) investigated how ethnically diverse women who are entitled for tamoxifen prophylaxis because of their breast cancer risk settle down about tamoxifen use for risk reduction. introductory to the study, there was discussion of the benefits and risks of tamoxifen as prophylaxis.The study which included African-American, White, and Latina women, of 6178 years, revealed that cultism of breast cancer was not prominent and they were not disposed(p) to take tamoxifen as h ealthful therapy after receiving the selective information. Participants showed limited unwillingness to take the medication with potential adverse effects. This study revealed that women felt that they had other options other than taking the risk of tamoxifen to reduce their risk of breast cancer, including early detection, diet, faith and other alternative therapies. Graham (2002) conducted a research about the race between beliefs and practice of breast self examination (BSE in a black women population of 20-49 years of age. It was found out that health beliefs were much stronger in determining BSE performance for a given individual than were demographic characteristics. mammilla self examination was related to increased perceived seriousness of breast cancer, benefit of the procedure and health motivation and was say to have inverse relationship with perceived barriers.A related study was account by Mitchell and colleagues (2002), about the effects of religious beliefs with other variables on breast cancer screening and the intended presentation of self-discovered breast lump. This study included women aging 40 years and above and were interviewed in their homes. Most of the interviewees believed that doctors cure breast cancer with Gods intervention which was tagged as religious intervention with treatment. This proportionality was found out to be correlated with self-reported mammography but no clinical breast examination or intention to delay presentation of self-discovered breast lump. minority of them believed treatment of breast cancer was unnecessary because only God could cure the disease which was labeled as religious intervention in place of treatment, and was significantly more common among African-American women who are less educated and old. This was correlated with the strong intention of delaying the presentation of self-discovered breast lump. It was concluded that religious intervention in place of treatment contributes significant ly the delay presentation of breast cancer among African-American that contribute largely to the advanced-stage cancer diagnosis.The cause of breast cancer is still unclear. Adjei (2006) who grew up in Ghan and had some draw about breast cancer. In his letter, he revealed his sentiments about the inherited disagreements in breast cancer. He had been aware of the incidence of breast cancer in Ghana since 1974 to 1999.He noted that the peak incidence of breast cancer in Ghana is in jr. women with age range of 40-45 years while in United States and Caucasians, the peak incidence is in older age groups. Adjei (2006) pointed out that women of diametric places and environments, with different diets have similar epidemiology of breast cancer. In an argument which revealed number of breast cancer in African-Americans but noble-minded in native African has been used to suggest that ethnicity is one factor of acquiring the disease, however, according to Adjei (2006), this information is leading because cancer has not been well-studied in Africa.Researchers are still finding their ways to fully let on the correlation of genetic touching in breast tumors that are presently noted to be a powerful predictor of cancer spread and cancer death. In a limited study conducted by Kolata (2002), she included few patients who are relatively. As she express in her report, scientists said that the activity of a disposition of 70 genes appear to predict cancer mortality better than traditional measures like tumor size, cancer stage or lymph node spread to the armpit of women. She revealed in her study that 5.5% of women with good genetic signature died within the next decade while 45% of women are those of with bad genetic signatures.Adherence to the treatment regimen of breast cancer plays a big role in the improvement of disease outcome. at that place are no much literature about the factors associated to the behavior that influence the patient to delay or cause an incomple te adherence to the recommended follow up in patients with breast cancer. In a study conducted by Kaplan (2006), race/ethnicity, country of birth, financial issues fear of pain and difficulty of communicating with the healthcare providers are the barriers to seek follow up consultation tit crabby person Screening There was decline in breast cancer mortality rate of 0.9% in African American women while 2.1% was the decline in breast cancer mortality rate in non-Hispanic White women (Stewart et al 2004 as tell by Settersten , Dopp, and Tjoe, (2005). On the contrary, De Koning (2000), questioned in his study the cost effectiveness of breast cancer screening. His idea came out when he analyzed his expectations of the reduction of breast cancer mortality after breast cancer screening. He verbalise in his study that the Dutch program of 2-yearly screening for women aged 50-70 would produce a 16% reduction in the total population.As stated in his research paper, the actual benefit that can be achieved from breast cancer screening programs is overstated. According to him breast cancer screening need to be carefully balanced against the burden to women and health care system. De Koning (2000) stated that effects of breast cancer screening program depend on many factors such as epidemiology of the disease, the health care system, costs of health care, spirit of the screening program and the attendance rate.Groot, M. T. et al (2006) estimated the costs and health effects of breast cancer interventions in epidemiologically different regions of Africa, North America and Asia. They certain a mathematical simulation model of breast cancer using the different stages of cancer, its distribution and case fatality rates in the absence and front end of treatment as predictors of survival. The study resulted to a expiration that untreated patients were the most sensitive to case fatality rates. This study suggest that treating breast cancer at stage 1 and introduction of a n extensive breast cancer program are the most cost effective breast cancer interventions. This study is support by the research done by Aylin and colleagues (2005). They recruited women at the mammography clinic to evaluate the knowledge about breast cancer and mammography as breast cancer screening procedure. The spectacular result of this study is that most of the participants (95.3% of the total participants) were aware that women should have mammography screening periodically. They were informed of the fact that breast cancer screening such as mammography could help in the early detection of breast cancer. However, less than 50% of them admitted that they had never had mammography screening.Majority of the respondents (71.1%) were practicing breast self-examination. other related study was conducted by Dundar and colleagues (2006), since breast cancer is the second leading cause of cancer deaths in Turkey , they determined the t the knowledge and attitudes of women in a unta ught area in westward Turkey about breast self examination and mammography.They recruited women with age ranging from 20-64 years. Although majority of the participants have heard or read about breast cancer only 56.1% of them had sufficient knowledge about breast cancer and some admitted that they acquired the information from their health care professionals. Those with information of beast cancer were also those who practice breast self examination. This study revealed that health care professionals play a big role in information dissemination about breast cancer.Table 1. Recommendations for purpose mammographic screening in North American women aged 40 years or older who are at average risk for breast cancer*Group (date of recommendations)Frequency of screening (yr)Included ages (yr)40-4950-6970Government-sponsored and private groupsUS intervention Services Task compress (2002)**1-2YesYesYes***Canadian Task Force on Preventive Health give care (1998, 1999, 2001)1-2NoYesNoNa tional pioneers of Health consensus conference (1997)No+American Cancer Society (1997)1YesYesYesNational Cancer Institute (2002)1-2YesYesYesMedical societiesAmerican College of Obstetricians and Gynecologists (2000)1-2 if aged 40-49 yr1 if aged 50 yrYesYesYesAmerican Medical connecter (1999)1YesYesYesAmerican College of Radiology (1998)1YesYesYesAmerican College of Preventive Medicine (1996)1-2NoYesYesAmerican academy of Family Physicians (2001)1-2No+YesNoAmerican Geriatrics Society (1999)1-2Yes***Advocacy groupsNational Breast Cancer nuclear fusion reaction (2000)No+NoNational Alliance of Breast Cancer Organizations (2002)1YesYesYesSusan B. Komen Foundation (2002)1YesYesYesThe above table was taken from the study conducted by Barton (2005)There are several ways presented and studied for breast cancer screening. Its concern is to reduce the prevalence of cancer mortality and to improve the quality of life as a result of early detection, however, there are still people that are n ot aware of breast cancer screeningIn reaction to increase the worldwide awareness of breast cancer, breast cancer advocacy movement has been analyzing the common experiences of women with breast cancer around the world especially those with limited resources. They found out that although there are voice communication barriers, sentiments were consistent across cultures cancer survivors have the same experiences and fears. The beliefs and taboos about breast cancer hinder the awareness programs and treatment. There are also limited resources for man education and awareness. Difficulty in understanding and translating the concept of the disease into English also hinders them in the existence awareness of breast cancer (Errico and Rowden 2006).In consent with this, sociological review of the barriers experienced by the women from different traditional cultures is essential not just to understand patterns of late breast cancer diagnosis but also the importance of interventions and programs. This is necessary for them to understand the healthful health care, specifically in breast cancer. This is because many are still ignorant of the breast cancer. According to Remennick (2006), health care providers and policymakers should try to understand and influence women especially those who are cancer risk to be aware of the disease to detect and treat breast cancer early. There are many geomorphological barriers that hinder women especially those living in rural areas.Socioeconomic factors include poor health insurance, infinite to medical facilities and inability to take time off work. Organizational barriers include difficulty in navigating convoluted health care systems and interacting with medical staff. Psychological and sociocultural barriers are poor health motivation, denial of personalised risk, fatalism mistrust of cancer treatments and fear of becoming a burden on the family members.Still in other cultural behavior, especially in Muslims, women are s trongly controlled by men and therefore may suppress women in breast cancer screening. Remennick (2006) includes in his study the different approaches that abase the mentioned barriers, including implementation of uplifting the educational programs that would enlighten people regarding cancer myths and fallacies. He suggests that health care professional must outreach to their co ethnics. primary quill health care providers play a critical role in determining the configuration with treatment and prophylactic device practices through direct recommendations to their patients. Family medicos and general internists showed that 70% of women who received a provider referral completed a screening mammography within one year versus only 18% of self-referred women (Grady et al 1997 as stated by Santora 2003). However, Over 90% of rural women report that a doctors recommendation to have breast cancer screening is important (Sparks et al 1996 as stated by Santora 2003).It should be noted that clinician compliance is contributed by several factors such as relation with provider, guideline of the treatment, patients behavior and environmental factors. Several studies have been conducted to report the differences of health operate in rural, urban and suburban areas with regards to their health care services in the family practice clinics. It has been pointed out that lower utilization has been a significant factor. Those rural health practitioners have less access to health care services. In a study done by Pol and his colleagues (2001), suggested that rural health services do not lag for patients with access after telling that 9 out of 16 services examined were as high or higher in rural areas.Another study to examine the variations in breast cancer screening among primary care clinicians by geographic location of clinical practice was done by Santora (2003). Physicians, nurse practitioners and physician assistants were included in the study and were classified into urban, rural and suburban categories based upon practice location. The study revealed that although there was no significant difference in the practice location, there was patent variation in the practice of breast screening.It was reported that urban and suburban health practitioners were less pliant with the use of breast cancer guidelines as compared to clinicians in rural areas. Primary care clinicians, including physicians, nurse practitioners and physicians assistants lack a consistent. This study revealed that geographic location is not the main factor of inharmonious medical approach to breast cancer screening. Although the difference in the approaches to the procedure is uncertain in this study.A related study about General Practitioners (GPs) knowledge, beliefs and attitudes toward breast screening, and their association with practice based-organizations of breast cancer screening, was conducted by Bekker, Morrisona and Marteau (1999). This study revealed that womens a ttendance for breast cancer screening may be increased due to raising GPs perceptions of the threat of breast cancer. General practitioners addressed their concerns about the procedure and enhanced their views on the importance of primary health care in breast cancer screening programs. personaAdjei, A. A., 2006, A final word about genetic differences, American Association for Cancer Research, acquirable at http//www.aacr.org/page4444.aspx.American Cancer Society 2005, ready(prenominal) at http//www.cancer.org/docroot/CRI/content/CRI_2_2_1X_What_is_breast_cancer_5.aspAnderson, B. 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