الفهرس 
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Abstract
Breast cancer (BC) is the most common malignant tumor diagnosed in women in all over the world; yet its incidence differs from one region to another. Globally more than million cases occur annually. Many older women are unaware of their increased breast cancer risk, and have little knowledge about early breast cancer symptoms, and have comorbidities which may hinder participation in breast cancer screening, so older women are being diagnosed with breast cancer at more advanced stages of the disease.
Breast cancer does not strike older women alone but the whole family unit and community. Despite considerable social changes, women continue to be the focus of family life. The only way to decrease mortality and morbidity from breast cancer is to detect the disease early through screening activities. Early detection remains the cornerstone of breast cancer control that requires early diagnosis in symptomatic women and regular screening in asymptomatic women. Despite the effectiveness of breast cancer screening behaviors in reducing mortality, research findings indicate that screening rates remain low. Several factors could influence older females’ breast cancer screening participation such as sociocultural, religious, demographic, environmental, and psychological factors. Therefore, seeking breast cancer screening among female older adults is vitally important in achieving breast cancer control goals and improving female older adults’ health related quality of life.
The study aimed to identify the factors associated with seeking breast cancer screening among female older adults.
Design: A descriptive design will be followed in this study.
Setting: This study was carried out in Alexandria health insurance clinics (Gamal Abdel Nasser hospital) and the Alexandria ophthalmology general hospital clinics (Farouk hospital) in Alexandria, Egypt.
Subjects: Subjects of this study comprised 270 female older adults attending the above mentioned settings. All female older adults aged 60 years old and above and able to communicate effectively.
Tools of the study: In order to collect the necessary data, four tools were used by the researcher based on relevant literature.
Tool I: Female older adult’s socio-demographic and clinical data structured interview schedule:
Part one: It included items related to socio demographic characteristics of the study subjects such as age, sex, marital status, level of education, source of income and job before retirement
Part two: It included medical health history as the presence of medical problems and family history of tumor, previously female older adults’ history of breast cancer and screening data as type of breast cancer screening and pattern of performing breast cancer screening.
Tool II: Female older adults ‘knowledge about breast cancer screening (BCKT)
This tool translated by the researcher and includes 19 questions, 18 questions focus on general information about breast cancer (e.g. early signs and symptoms), and one item is related to breast health practices (e.g. when and how breast self-examinations should be performed).
Tool III: Female older adults’ beliefs about breast cancer screening (RSBBSMS).
This tool translated by the researcher and includes 58 questions about 11 items related to perceived confidence to perform BSE, 5 questions related to perceived susceptibility, 7 questions related to perceived seriousness, 5 questions related to perceived benefits of mammogram, 6 questions related perceived benefits of BSE, 11 questions related to perceived barriers of mammogram, 6 questions related to perceived barriers of BSE and 7 questions related to perceived health motivation.
Tool IIII: Female older adults’ worry about breast cancer.
This tool translated by the researcher and includes questions about anxiety or worry related to breast cancer.
The main results obtained were as follows:
• The age of the study subjects ranged from 60 to 78 years. 75.2 % of study subjects were married.
• 34.4% had middle and above middle education,33.3% had university and more education, 18.2% had basic education, and only 14.1% of the study subjects were illiterate or read and write
• Pension was the major source of income, 66.7% of study subjects reported that income is enough.
• The majorities (57.4%) of study subjects were employees and 37.5% were housewives.
• The majority (88.4%) of study subjects had family history of malignant tumor.
• 57.9% of study subjects had family history of breast cancer while 12.6% of study subjects had previous history of breast cancer.
• The majority (97.2%) of studied subjects performed BSE while 46.0% of them performed mammogram and 54.0% of studied subjects performed breast cancer screening on irregular manner.
• 46.7% of studied subjects had fair overall knowledge about breast cancer screening while 57.0% of them had moderate worry of getting breast cancer.
• The majority (86.7%) of the studied subjects had high perceived confidence to perform BSE, 74.8% of them had high perceived of health motivation, 66.3% of them had high perceived benefits of mammogram, and 52.6% of them had high perceived barriers of mammogram. However, the majority of the studied subjects (85.4%) had high perceived seriousness of breast cancer and the majority of the studied subjects (80.0%) had high perceived BSE benefits.
• A positive significant relation was found between financial status and performance of breast cancer screening (p= 0.003*).
• A positive significant relation was found between previous job before retirement and performance of breast cancer screening (p= 0.001*).
• A positive significant relation was found among a previous family history of tumor, family history of breast cancer, and previously female older adults’ breast cancer and performance of breast cancer screening (p= 0.001*).
• A positive significant relation was found between availability and accessibility of medical care services and performance of breast cancer screening (p= 0.001*).
• A positive significant relation was found among perceived confidence to perform BSE, perceived susceptibility, perceived seriousness, perceived benefits of mammogram, perceived benefits of BSE and the performance of breast cancer screening (p= 0.001*).
• A positive significant relation was found among knowledge about breast cancer screening, worry of getting breast cancer and performance of breast cancer screening (p= 0.001*).
• A negative significant relation was found between perceived barriers of mammogram, perceived barriers of BSE, and performance of breast cancer screening (p= 0.001*).
Conclusion:
It can be concluded from the findings of the present study that factors associated with seeking breast cancer screening among female older adults receded in four major factors which are overall knowledge and beliefs regarding breast cancer screening such as perceived barriers of mammogram and BSE, perceived susceptibility and seriousness of breast cancer, worry of getting breast cancer and sociodemographic characteristics of the studied subjects. The majority of the study subjects performed BSE, while nearly half of the studied subjects performed mammogram. As well, moderate worry of getting breast cancer reported by more than half of the studied subjects, while about half of the present study subjects had fair overall knowledge about breast cancer screening.
A positive significant correlation was also found among financial status, previous job before retirement, knowledge about breast cancer screening, worry of getting breast cancer and performance of breast cancer screening. Furthermore, a positive significant correlation was found among perceived confidence to perform BSE, susceptibility, seriousness, benefits of mammogram, benefits of BSE and the performance of breast cancer screening. Moreover, a negative significant correlation was found among perceived barriers of BSE and mammogram and performance of breast cancer screening.
The main recommendations are:
1. Faculty members of the gerontological nursing department are required to include breast cancer screening methods and its barriers among female older adults in gerontological nursing curriculum.
2. Health education sessions for female older adults who attend the outpatient clinics should be conducted on regular basis and provided by gerontological nurses. The sessions should include theoretical and practical sessions. The theoretical sessions should cover breast cancer risk factors, its management, and preventive screening methods. Intervention strategies should focus on teaching and motivating female older adults to perform breast cancer screening methods and how to make BSE on a monthly habit using of breast models and videotapes.
3. Raising awareness of the public about breast cancer, its management and breast cancer screening measures in order to prevent and detect breast cancer early through mass media.
4. Encouragement of governmental and private organization/agencies to allocate funds to carry out breast cancer screening methods such as clinical breast examination and mammogram in low cost manner.