The development of clinical breast examination by nurses for breast cancer screening at Ubon Ratchathani Cancer hospital



development of breast examination, breast cancer screening, registered nurses


              The purposes of this research and development were to study, develop, and evaluate a clinical breast examination (CBE) for breast cancer screening at the Ubon Ratchathani Cancer Hospital, Thailand. The study was divided into two phases. In the first phase, a situation analysis was conducted via two surgeons and 33 registered nurses by using questionnaires and a semi-structured interview. The second phase comprised developing the CBE prototype, implementation, and efficiency evaluation for the CBE model via 44 registered nurses, one physician. The CBE was performed with 44 female volunteers at the Hospital’s Outpatient Department. The data were collected using a questionnaire about the knowledge, attitude, skills, and satisfaction. Then, the data were analyzed by conducting content analysis, descriptive statistics, and a paired t test. In addition, a kappa statistic was used to test the diagnostic agreement, sensitivity, specificity, positive predictive value, and negative predictive value.

              The results of this research were as follows: In the first phase, the CBE model was unclear, and nurses did not have any competency about breast examination. Thus, this problem resulted in developing more details of the practice algorithms and reporting documentation. The CBE model consisted of five issues: 1) CBE training program, 2) CBE handbooks, 3) an innovative artificial breast model, 4) a video teaching how to conduct a breast examination, and 5) the format of the documentation of the interpretation and reporting of specific CBE findings. The results found that knowledge, attitudes, and skills of CBE practices scores were a statistically significant increased (p<0.05). The satisfaction of the service was at the highest level (mean=4.54). The quality of the CBE between the physician and specialist nurses was at a good agreement. (Cohen’s Kappa coefficient was 0.64 (95% CI= 0.19-1.00). The corresponding sensitivity values were 50% (95%CI=6.76-93.20), specificity values were 100% (95%CI=91.20-100.00), positive predictive value was 100% (95% CI=15.80-100.00), and the negative predictive value was 95.2% (95% CI=83.80-99.40), respectively.

             These findings suggested that a CBE model should be applied in the practice of screening for breast cancer in the health service system. Furthermore, this may enhance the nursing role in increasing the confidence of the competency and increasing the effectiveness of early breast cancer detection.


Download data is not yet available.


Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68:394–424.

International Agency for Research on Cancer. Globocan 2012 [Online] 2013 [cited 2018 Aug 6]. Available from: /fact_sheets_population.aspx.

Imsamran W, Pattatang A, Supaattagorn P, Chiawiriyabunya I, Namthaisong K, Wongsena M, et al. Cancer in Thailand Vol.IX, 2013-2015.Bangkok: New Thammada Press (Thailand) Co., Ltd.; 2018. p.7. (in Thai).

Ubonratchathani Cancer Hospital. Hospital based cancer registry 2018. Ubonratchathani Thailand. n.p.; 2018. (in Thai).

Lertsanguansinchai P. Breast cancer. In: Lorvidhaya V,Thepmongkol P,Phomratanapongse P, Tesavibul C, Editors. Manual of radiation oncology. 3rd Edition. Bangkok: Chulalongkorn University; 2001. p. 133-64. (in Thai).

Vlastos G, Verkooijen HM. Minimally invasive approaches for diagnosis and treatment of early-stage breast cancer. Oncologist. 2007; 12(1): 1-10.

National Cancer Institute, Department of Medical Service Ministry of Public Health.Cancer service plan 2018-2023. Bangkok, Thailand. n.p.; 2018.(in Thai)

Ministry of Public Health Thailand. Health Data Center (HDC) [Online] 2020 [cited 2018 July.14]. Available from: reports/page.php?cat_id=59acae7a68f02c8e2c0cb88dfc6df3b3

Laoitthi P, Parinyanitikul N. Breast cancer: epidemiology, prevention and screening recommendations. Chulalongkorn Medical Journal. 2016; 60(5): 497 – 507. (in Thai).

Alba LH, Diaz S, Gamboa O, Poveda C, Henao A, Perry F, et al. Accuracy of mammography and clinical breast examination in the implementation of breast cancer screening programs in Colombia. Prev Med. 2018; 115:19-25.

Ohta K, Kasahara Y, Tanaka F, Maeda H. Is clinical breast examination effective in Japan? Consideration from the age-specific performance of breast cancer screening combining mammography with clinical breast examination. Breast cancer. 2016; 23(2):183-9.

Romanoff A, Constant TH, Johnson KM, Guadiamos MC, Vega AMB, Zunt J, et al. Association of previous clinical breast examination with reduced delays and earlier-stage breast cancer diagnosis among women in Peru. JAMA Oncol. 2017; 3(11): 1563-1567.

Pongthavornkamol K, Watthayu N, Khuhaprema T. Breast cancer prevention and screening system in Thailand in health practitioners’ perspectives. Thai Cancer Journal 2019; 39(3): 77-92. (in Thai).

International Agency for Research on Cancer, World Health Organization. IARC handbooks of cancer prevention: breast cancer screening. Lyon, France: n.p.; 2016.p.149-152.

International Labour Organization. Competency-based training (CBT): an introductory manual for practitioners. Beirut, Lebanon: ILO Regional Office for Arab States; 2020. p.17-85.

Noe RA. Employee training and development .5th Edition. New York: McGraw Hill; 2010.

Caceres BA. King's theory of goal attainment: exploring functional status. Nurs Sci Q. 2015; 28(2):151-5.

Wongpanarak N. King’s theory: concepts and application in nursing. Journal of nurses’ association of Thailand, north-eastern division. 2013; 31(4):16-25. (in Thai)

Luptrawan S. The efficiency of screening nurses in breast examination. Ramathibodi Nursing Journal. 2000; 6(2):133-41. (in Thai).

Ahmad F, Stewart DE. Predictors of clinical breast examination among South Asian immigrant women. J Immigr Health. 2004; 6(3):119-26.

Angarita FA, Price B, Castelo M, Tawil M, Ayala JC, Torregrossa L. Improving the competency of medical students in clinical breast examination through a standardized simulation and multimedia-based curriculum. Breast Cancer Res Treat. 2019; 173(2); 439–45.

Gutnik L, Lee C, Msosa V, Moses A, Stanley C, Mzumara S, et al. Clinical breast examination screening by trained laywomen in Malawi integrated with other health services. J Surg Res 2016; 204(1):61-7.

Nassif J, Sleiman AK, Nassar AH, Naamani S, Sharara-Chami R. Hybrid simulation in teaching clinical breast examination to medical students. J Cancer Educ. 2019; 34(1): 194-200.

Zafar A. Clinical breast examination; the diagnostic accuracy in palpable breast lumps. Professional Med J. 2014; 21(6):1147-52.

Sankaranarayanan R, Ramadas K, Thara S, Muwonge R, Prabhakar J, Augustine P, et al. Clinical breast examination: preliminary results from a cluster randomized controlled trial in India. J Natl Cancer Inst. 2011; 103(19):1476-80.

Fenton JJ, Rolnick SJ, Harris EL, Barton MB, Barlow WE, Reisch LM, et al. Specificity of clinical breast examination in community practice. J Gen Intern Med. 2007; 22(3):332-7.





Research Articles