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"Tesis ini membahas analisis manajemen program deteksi dini kanker payudara dan kanker leher rahim di Puskesmas Karang Kitri dan Puskesmas Pejuang Kota Bekasi 2022 pada kerangka logic model meliputi input, activities, output dan feedback. Penelitian ini merupakan penelitian kualitatif analitik deskriptif dengan desain studi kasus. Penelitian dilakukan di Puskesmas Karang Kitri dan Puskesmas Pejuang. Hasil penelitian membuktikan bahwa permasalahan pada input dan activities dapat menyebabkan output yang tidak baik diperkuat dengan adanya perbedaan manajemen program yang dilakukan oleh kedua Puskesmas. Perlunya kebijakan daerah, sdm yang terlatih, pembagian tugas dan kordinasi program di internal Puskesmas, anggaran, sarpras dan sistem informasi terintegrasi diperlukan untuk melakukan manajemen program deteksi dini kanker payudara dan kanker leher rahim, mulai dari perencanaan, sosialisasi promosi, pelaksanaan, pencatatan dan pelaporan, pembinaan dan pengawasan serta monitoring evaluasi. Sehingga peningkatan cakupan deteksi dini kanker payudara dan kanker leher rahim dapat tercapai.

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This thesis discusses the analysis of the management program for early detection of breast cancer and cervical cancer in Puskesmas Karang Kitri and Puskesmas Pejuang Bekasi City 2022 in a logical framework model including input, activity, output and feedback. This research is a descriptive analytic qualitative research with a case study design. The research was conducted at the Karang Kitri Health Center and the Pejuang Health Center. The results of the study prove that problems with inputs and activities can lead to poor output which is strengthened by the differences in program management carried out by the two Community Health Centers. The need for regional policies, trained human resources, division of tasks and coordination of programs in the internal health center, budget, infrastructure and integrated information systems are needed to carry out the management of early detection programs for breast cancer and cervical cancer, starting from planning, outreach, promotion, implementation, recording and reporting. coaching and supervision as well as evaluation monitoring. Thus increasing the coverage of early detection of breast cancer and cervical cancer can be achieved."

"Kanker leher rahim berada pada kedua tertinggi yaitu 9.2 per 100.000 penduduk, angka kematian rata-rata 9.0 per 100.000 penduduk. Cilegon belum mencapai target pemeriksaan IVA yang ditentukan, tahun 2019 sampai 2022 mencapai 0.99%; 1.78%, 2.05%, dan 2.35%, sehingga belum mencapai target nasional sebesar 80% dan target SPM kesehatan 100% dengan sasaran 71.139 orang. Tujuan penelitian untuk menganalisis capaian deteksi dini kanker leher rahim di Puskesmas Kota Cilegon 2019-2022. Jenis penelitian merupakan penelitian kualitatif dengan desain studi kasus, dilaksanakan pada bulan April – Mei 2023. Hasil penelitian dari sisi komponen hasil (capaian program) deteksi kanker leher rahim di Kota Cilegon periode 2019-2022 belum mencapai target SPM. Dari sisi komponen struktur, SDM, SOP, pendanaan dan sarana prasarana sudah tersedia, tetapi masih ada sedikit kendala pada ketidakseimbangnya jumlah SDM dan target. Dari sisi komponen proses, setiap puskesmas sudah menjalankan proses perencanaan, pelaksanaan, pencatatan, pelaporan, serta monitoring evaluasi sesuai dengan prosedur. Berbagai upaya telah dilakukan untuk memudahkan akses, sosialisasi aktif dilakukan, pendekatan inovatif serta kerjasama lintas program sudah dilakukan dan kerja sama lintas sektor belum menambahkan capaian deteksi dini kanker leher rahim di Puskesmas se-Kota Cilegon secara signifikan, hal ini disebabkan karena ketidaksamaan persepi tentang penghitungan target, belum maksimalnya kegiatan promosi dan advokasi, pendekatan komunikasi yang belum tepat, penggunaan media yang belum efektif, pemanfaatan yang belum maksimal potensi-potensi yang ada di Kota Cilegon sebagai kota industri, serta masyarakat yang takut diperiksa atau tidak tahu tentang pemeriksaan IV A.

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Cervical cancer ranks second highest at 9.2 per 100,000 population, with an average death rate of 9.0 per 100,000 population. Cilegon has not reached the designated target for IVA screenings, with percentages from 2019 to 2022 reaching 0.99%, 1.78%, 2.05%, and 2.35%, thus not achieving the national target of 80% and the health SPM target of 100%, with a target population of 71,139 individuals. The research objective is to analyze the achievement of early detection of cervical cancer at the Cilegon City Health Center from 2019 to 2022. The research design is qualitative with a case study design, conducted in April - May 2023. The research findings indicate that the program's achievement in detecting cervical cancer in Cilegon City from 2019 to 2022 has not reached the SPM target. In terms of structural components, human resources, standard operating procedures, funding, and infrastructure are already available, but there is still a slight obstacle due to the imbalance between the number of human resources and the target. In terms of process components, each health center has implemented planning, implementation, recording, reporting, and monitoring and evaluation processes according to procedures. Efforts have been made to facilitate access, actively promote awareness, employ innovative approaches, and foster cross-program cooperation, but cross-sector collaboration has not significantly improved the early detection of cervical cancer at the Cilegon City Health Center. This is due to discrepancies in perceptions of target calculation, suboptimal promotion and advocacy activities, inappropriate communication approaches, ineffective media usage, underutilization of potential resources in Cilegon as an industrial city, and a population that is either afraid of or unaware of IVA screenings."

"Penderita kanker payudara umumnya terdeteksi dalam kondisi stadium lanjut, sehingga kesempatan untuk sembuh menjadi kecil. Pemeriksaan payudara sendiri (SADARI) merupakan salah satu cara deteksi kanker payudara secara dini, tetapi metode ini belum banyak diterapkan oleh perempuan di Indonesia. Hal ini mungkin saja disebabkan oleh kurangnya pengetahuan dan keyakinan mengenai deteksi dini kanker payudara. Tujuan penelitian ini ialah mengetahui hubungan antara tingkat pengetahuan dan keyakinan dengan perilaku deteksi dini kanker payudara. Desain penelitian yang digunakan ialah cross sectional dengan teknik random sampling pada 102 responden yang merupakan perempuan usia subur di UPT Puskesmas Sukmajaya, Kota Depok. Hasil penelitian menunjukkan bahwa tidak ada hubungan antara tingkat pengetahuan maupun keyakinan dengan perilaku (p=0,490 dan p=0,280, CI 95%). Namun ditemukan hubungan yang signifikan antara pengetahuan dengan keyakinan (p=0,009, CI 95%). Penelitian ini menyarankan diadakannya promosi kesehatan mengenai deteksi dini kanker payudara terutama pada perempuan usia subur.

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Breast cancer patients are generally diagnosed late. Breast self-examination (BSE) is one way to detect breast cancer early, but this method has not been widely adopted by women in Indonesia. This may have been caused by the lack of knowledge and beliefs about early detection of breast cancer.

The purpose of this study was to determine the relationship between the level of knowledge and beliefs with the behavior of breast cancer early detection.

The study design used is cross sectional by random sampling technique, and was conducted on 102 respondents who are women of childbearing age in UPT Puskesmas Sukmajaya, Depok.

The results showed that there is no relation between the level of knowledge and belief to the behavior (p = 0.490 and p = 0.280, 95% CI). However, a significant relationship was found between knowledge and belief (p = 0.009, 95% CI). This study suggests the holding of health promotion into early detection of breast cancer, especially in women of childbearing age."

"Kanker leher rahim menempati posisi ketiga dengan jumlah sebanyak 36.633 kasus dan 21.003 kematian (9,0%) setelah jantung koroner dan kanker payudara di Indonesia. Hal ini mendorong pemerintah menempatkan pencegahan dan penanggulangan kanker leher rahim sebagai salah satu prioritas masalah Kesehatan melalui program deteksi dini IVA. Meski sudah memiliki bukti yang kuat bahwa deteksi dini mampu menurunkan angka kematian akibat kanker leher rahim, namun capaian deteksi dini tetap saja rendah. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan riwayat kunjungan deteksi dini kanker leher rahim pada WUS di Puskesmas Alianyang Pontianak Tahun 2022 berdasarkan teori multistage model of carcinogenesis oleh Armitage dan Doll. Desain studi yang digunakan adalah potong lintang dengan sumber data sekunder dari catatan medis deteksi dini kanker leher rahim dan kanker payudara. Analisis data dilakukan secara bivariat menggunakan uji chi square. Jumlah sampel penelitian adalah 101 WUS. Hasil penelitian menunjukkan bahwa faktor-faktor yang berhubungan dengan riwayat kunjungan deteksi dini kanker leher rahim adalah pendidikan PR = 2,766 (95% CI: 0,698-7,904) dan frekuensi menikah PR = 4,725 (95% CI: 0,727-30,721). Perlu dilakukan peningkatan pengetahuan masyarakat khususnya WUS mengenai deteksi dini kanker leher rahim dan faktor risikonya baik melalui media berbasis internet, media sosial maupun intervensi langsung ke masyarakat.

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Cervical cancer occupies the third position with a total of 36,633 cases and 21,003 deaths (9.0%) after coronary heart and breast cancer in Indonesia. This has prompted the government to place prevention and control of cervical cancer as one of the priority health issues through Early Detection using IVA test. Despite of strong evidence that cervical cancer screening results in reducing mortality from the disease, the uptake for cervical screening among Indonesian women remains low. This study aims to determine the factors associated to history of early detection of cervical cancer among women of Reproductive Age in Puskesmas Alianyang Pontianak in 2022 based on the theory of the multistage model of carcinogenesis by Armitage and Doll. This cross-sectional study was conducted using secondary data from medical records of early detection of cervical cancer and breast cancer. Bivariate analysis was performed using the chi square test. The number of research sample was 101 reproductive-aged women. The results showed that the factors associated to history of early detection of cervical cancer were education PR = 2,766 (95% CI: 0,698-7,904) and frequency of marriage PR = 4,725 (95% CI: 0,727-30,721). It is necessary to improve community’s knowledge especially the women in their reproductive age about cervical precancer early detection and related risk factors through internet-based media, social media and direct intervention to the community."

"Kanker payudara menjadi salah satu masalah utama pada kesehatan perempuan di dunia yang kasusnya semakin meningkat setiap tahunnya. Namun data yang didapat dari Unit Layanan Kesehatan Karyawan RS Kanker “Dharmais”, karyawati yang melakukan deteksi dini kanker payudara masih rendah dibanding target dari Unit Layanan Kesehatan Karyawan. Tujuan dari penelitian ini adalah untuk mengetahui faktor-faktor yang mempengaruhi perilaku deteksi dini kanker payudara pada karyawati RS Kanker “Dharmais” Tahun 2013. Penelitian ini bersifat deskriptif analitik dengan rancangan cross-sectional dan pengambilan sampel secara simple random sampling. Data yang dipergunakan diperoleh dari hasil pengisian kuesioner oleh responden wanita yang berusia 30-50 tahun. Jumlah sampel dalam penelitian ini adalah 110 orang. Hasil penelitian menunjukkan karyawati yang pernah melakukan deteksi dini kanker payudara sebanyak 34,5%. Berdasarkan faktor predisposisi, kelompok umur 40-50 tahun sebanyak 51,8%, tingkat pendidikan tinggi sebanyak 80,9%, pekerjaan/unit kerja berisiko tinggi sebanyak 61,8%, berpengetahuan baik sebanyak 72,7%, mempunyai sikap positif sebanyak 51,8%. Berdasarkan faktor pemungkin, fasilitas pelayanan kesehatan sebanyak 90,0% responden menyatakan memadai, sarana dan prasarana sebanyak 95,5% responden menyatakan memadai. Berdasarkan faktor penguat, adanya dukungan keluarga sebanyak 54,5%, adanya dukungan teman/lingkungan kerja sebanyak 76,4% dan adanya dukungan tenaga kesehatan 80,0%. Dari analisis bivariat dengan CI 95% dan p-value < 0,05 didapatkan variabel dukungan keluarga dan dukungan tenaga kesehatan menunjukkan hubungan bermakna dengan perilaku deteksi dini kanker payudara pada karyawati RS Kanker “Dharmais” tahun 2013. Berdasarkan penelitian ini, disarankan mengadakan sosialisasi kembali dan penyuluhan pentingnya deteksi dini kanker bagi karyawati secara berkala dan mengadakan program kerjasama antar satuan kerja terkait untuk lebih meningkatkan dan mengembangkan program deteksi dini kanker bagi seluruh karyawan terutama k

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Breast cancer is one of the major health problems in the world of women whose cases is increasing every year. However, the data obtained from the Employee Health Services Unit RS Kanker “Dharmais”, an employee of the early detection of breast cancer is still low compared to the target of Employee Health Services Unit. The purpose of this study was to determine the factors that influence the behavior of early detection of breast cancer in the RS Kanker “Dharmais” (One of the specialized Cancer Hospital in Indonesia) in 2013. This research is a descriptive analytic cross-sectional design and sampling by simple random sampling. Used data obtained from the questionnaires by the female respondents aged 30-50 years. The number of samples in this study was 110 people. The results showed that the employee had the early detection of breast cancer as much as 34.5%. Based on predisposing factors, age group 40-50 years as much as 51.8%, higher levels of education as much as 80.9%, employment / work at non-high risk units as much as 61.8%, 72.7% much better knowledgeable, having a positive attitude as much as 51, 8%. By enabling factors, health care facilities as much as 90.0% of respondents said adequate, facilities and infrastructure as much as 95.5% of respondents said adequate. By reinforcing factors, family support as much as 54.5%, the support of friends / work environment as much as 76.4% and the 80.0% support health workers. From bivariate analysis with 95% CI and p-value <0.05 was obtained variable family support and support health workers showed a significant correlation with the behavior of early detection of breast cancer in the Cancer Hospital employee "Dharmais" in 2013. Based on this study, it is recommended holding back socialization and education for the importance of early detection of cancer and conduct regular employee cooperation programs between units of work related to further improve and develop the cancer early detection program for all employees, especially women’s employee, such as creating a time-table schedule for early cancer detection in order to facilitate the working time employee with cancer early detection services."

"Rendahnya kesadaran melakukan deteksi dini kanker payudara dan serviks adalah penyebab tingginya angka pasien kanker yang datang dengan stadium parah. Penelitian ini bertujuan untuk mendapatkan gambaran kesadaran melakukan deteksi dini kanker payudara dan kanker serviks pada perempuan usia subur. Studi survei-deskriptif kepada 400 perempuan usia subur berusia 26 sampai 50 tahun di Jakarta Timur secara online dengan menggunakan teknik convenience sampling. Alat ukur yang digunakan adalah kuesioner African Women Awareness of Cancer (AWACAN) breast and cervical cancer tool. Hasil penelitian dengan analisis univariat didapatkan pengetahuan yang baik, sikap yang positif, dan praktikyang baik dalam deteksi dini kanker payudara dan serviks. Diharapkan bahwa pemberi asuhan keperawatan melakukan program edukasi dan sosialisasi melibatkan suami, serta perempuan usia subur yang belum menikah untuk meningkatkan kesadaran melakukan praktik deteksi dini kanker payudara dan kanker serviks.

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The low awareness of early detection of breast and cervical cancer is the cause of the high number of cancer patients who come with a severe stage. This study aims to get a picture of awareness of early detection of breast cancer and cervical cancer in women of childbearing age. An online survey-descriptive study of 400 women of Fertile age aged 26 to 50 years in East Jakarta using a convenience sampling technique. The measuring instrument used was the African Women Awareness of Cancer (AWACAN) questionnaire, breast and cervical cancer tool. The results of the study with univariate analysis obtained good knowledge, positive attitudes, and good practice in early detection of breast and cervical cancer. It is hoped that nursing care providers carry out educational and socialization programs involving husbands and women of childbearing age who are not married to raise awareness of early detection practices for breast cancer and cervical cancer."

"Insidensi kanker payudara terus meningkat secara global setiap tahun. Di negara berpendapatan menengah ke bawah, meningkatnya insidensi ini diikuti dengan meningkatnya angka kematian akibat kanker payudara yang disebabkan oleh keterlambatan diagnosis yang sering terjadi, sehingga pengobatan dan perawatan kanker payudara tidak lagi efektif dilakukan. Pada penelitian ini dilakukan analisis metode peningkatan deteksi dini terencana kanker payudara yang telah dilakukan di beberapa negara berpendapatan menengah ke bawah dengan menggunakan systematic review. Systematic review dilakukan dengan melakukan identifikasi literatur dari Google scholar, ProQuest, ScienceDirect, Scopus, dan Pubmed dengan menggunakan kata kunci improve, early detection, screening, breast cancer, low middle-income countries, dan LMIC, lalu dilakukan pencarian lanjutan dengan teknik snowball dari literatur yang sudah didapatkan. Kriteria inklusi pada pencarian literatur adalah artikel full text berbahasa Inggris yang diterbitkan pada tahun 2010 – Juni tahun 2020 dan memiliki lokasi studi di negara berpendapatan menengah ke bawah. Sebelas artikel didapatkan dari pencarian dan proses seleksi menggunakan diagram alir PRISMA. Ditemukan 5 jenis program dalam upaya peningkatan deteksi dini kanker payudara di negara berpendapatan menengah ke bawah, yaitu program skrining berbasis populasi, program skrining oportunistik, program peningkatan pengetahuan dan kesadaran, program pengalihan tugas, dan pelaksanaan program nasional deteksi dini kanker payudara. Program-program tersebut diketahui berhasil meningkatkan deteksi dini kanker payudara pada latar negara berpendapatan menengah ke bawah. Program peningkatan pengetahuan dan kesadaran, dan program pengalihan tugas dinilai sebagai program yang paling sesuai untuk dilaksanakan di negara berpendapatan menengah ke bawah. Meski begitu, perlu dilakukan pilot studi dan evaluasi biaya untuk melihat keefektifan program deteksi dini ini.

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Incidence of breast cancer keeps increasing globally every year, and in low-and middle-income countries it followed by increased mortality rate. This phenomenon could be associated with late-stage diagnosis that made treatments no longer effective. This study aimed to analyse methods to increase early detection for breast cancer that has been done in several low-and middle-income countries by using systematic review. Systematic review was carried out by identifying literatures from online databases such as Google scholar, ProQuest, ScienceDirect, Scopus, and Pubmed using “improve”, “early detection”, “screening”, “breast cancer”, “low middle-income countries", and “LMIC” as keywords, and followed by manually searching literatures using snowball technique from the literatures that had been identified earlier. Inclusion criterias in this study were English full text that were published between 2010 – June 2020 with low-and middle-income countries setting. Eleven articles were obtained using PRISMA flow diagram and 5 types of programs were found to increase early detection for breast cancer in low-and middle-income countries; population-based screening program, oportunistic screening program, program to improve knowledge and awareness about breast cancer and early detection, task shifting program, and implementation of national breast cancer early detection program. These programs were known to be able to improve early detection in their respective study location. Improving knowledge and awareness, and task shifting program were the most suitable program to be executed in low-and middle-income countries setting. These countries shall do some pilot studies and cost evaluation to identify and analyse the effectivity of these programs before implementing it widely."

"Deteksi dini kanker payudara sangat penting dilakukan bagi wanita berisiko, khususnya Pemeriksaan Payudara Sendiri (SADARI). Pemeriksaan ini secara rutin dilakukan untuk mendeteksi adanya kelainan atau benjolan sejak awal. Penelitian ini bertujuan menganalisis faktor-faktor yang mempengaruhi deteksi dini kanker payudara pada wanita berisiko kanker payudara. Desain yang digunakan Crossectional dengan 135 responden yang teknik concecutive sampling. Hasil penelitian menunjukan ada hubungan yang signifikan antara pengetahuan tanda dan gejala, pengetahuan deteksi dini, pendidikan, riwayat operasi, dimana faktor yang dominan yaitu variabel pengetahuan tanda dan gejala (p< 0,05;OR=0.095 C.I: 0.013-0,687). Faktor-faktor tersebut dapat dijadiakan salah satu eviden base dalam mengidentifikasi masalah dalam usaha mencegah terjadinya kanker payudara pada wanita berisiko kanker payudara.

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Early detection for breast cancer is very important for the high-risk women especially Self Breast Examination (BSE). This examination is done routinely detects the unusual changes or lumps. This research aims to identify the factors influencing early detection of breast cancer in women at risk for breast cancer. Cross sectional design to 135 respondents that were selected by consecutive sampling. The results show that there is significant correlation between the knowledge about signs and symptoms, knowledge about early detection, knowledge about surgery records by which the dominant factor is the knowledge about signs and symptoms (p< 0,05;OR=0.095 C.I: 0.013-0,687). These factors can be presented as an evidence base in identifying problems in an effort to prevent breast cancer in high-risk women for breast cancer."

"ABSTRAKLatar Belakang: Berbagai registrasi kanker menunjukkan proporsi pasien kanker payudara usia muda yang lebih tinggi di negara Asia. Tingginya proporsi kanker payudara usia muda perlu mendapat perhatian khusus karena populasi pasien ini membutuhkan pendekatan klinis yang berbeda terkait perangai biologis yang lebih ganas, prognosis yang lebih buruk, serta terkait dampak psikososial yang lebih besar untuk wanita usia muda. Penelitian ini bertujuan mencari karakteristik payudara usia muda di Indonesia serta hubungannya dengan kesintasan.Metode Penelitian: Penelitian ini merupakan studi analisis kesintasan dengan sampel penelitian pasien usia muda dengan diagnosis kanker payudara yang telah dibuktikan secara histopatologis sejak Januari 2008-Agustus 2015 dan menjalani terapi operasi dan/atau kemoterapi dan/atau radiasi di RSCM. Data didapatkan dari penelusuran rekam medis serta wawancara pasien.Hasil Penelitian: Didapatkan bahwa 35 pasien kanker payudara di RSCM berusia

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ABSTRACTBackground: Various cancer registrations and reports had confirmed the higher proportion of young women with breast cancer in Asian countries. This mandates special attention for clinician since this group of patients need different management approach, especially regarding the more aggressive biological behaviour, worse prognosis and the escalating psychosocial burden that young women endures. We conducted a study to describe the clinicopathological characteristics of young age breast cancer in Indonesia and its relation with overall survival. Methods: This is a survival analysis study using samples all young age women with histologically-proven cancer diagnosis that underwent treatment surgery and/or chemotherapy and/or radiation therapy since January 2008-August 2015. Data were collected from both medical records and interview. Results: Young age women comprises 35 of total breast cancer patients, with the majority of cases were in the locally advanced stage, histologic type NST, grade 2, no lymphovascular invasion, positive hormone receptors, negative HER2 status, high Ki-67 and Luminal B subtype. The 5-year overall survival rates were 64 ; variables that showed statistically significant corelation was tumor size, nodal status, metastatic status and clinical stage. Histologic type NST, grade 2, positive lymphovascular invasion, high Ki-67 and positive HER2 were related to survival, but this corelation was not statistically significant. Conclusion: The 5-year overall survival rates of young age breast cancer at RSCM was 64 , much lower that reported figures from literatures and other countries rsquo; reports. Clinical stage was the only variable with statistically significant corelation. Luminal B subtype was observed the most, but the worst survival was found in the HER2 subtype group. "

"Kanker payudara banyak diderita perempuan. Penelitian ini bertujuan menggambarkan pengetahuan dan perilaku mencari pelayanan kesehatan pasien kanker payudara dengan desain penelitian deskriptif sederhana. Responden berjumlah 80 orang secara non probability convenience sampling. Mayoritas responden berpengetahuan baik tentang pengetahuan umum, faktor risiko, tanda gejala, skrining serta perawatan, sedangkan mengenai pengobatan masih kurang. Respon awal saat menyadari perubahan payudara diantaranya tidak bertindak, bercerita, mencari pelayanan kesehatan, melakukan pengobatan alternatif, dan herbal. Keterlambatan pemeriksaan dialami sebagian besar responden. Suami menjadi pilihan terbanyak saat diskusi awal. Dokter bedah dan fasilitas kesehatan pemerintah menjadi pilihan terbanyak saat pemeriksaan awal. Perawat perlu meningkatkan edukasi kanker payudara pada perempuan dan pasien kanker payudara.

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Breast cancer occurs to many women. This study aimed to describe the knowledge and health care seeking behavior of breast cancer patients with simple descriptive research design. The respondents were 80 who are chosen by non probability convenience sampling. Majority of respondents have good knowledge about the general knowledge, the risk factors, the signs and symptoms, the screening and nursing care, but they lack about the treatment. The initial responses when there were changes in their breast included no action, telling somebody, seeking health care, getting alternative medicine and herbal. The delayed diagnosis experienced by most of the respondents. The husband became the largest selected person for the initial discussion. The surgeons and the government?s health facilities were chosen by most respondents at the first examination. Nurses need to improve the education provision about breast cancer to women and the breast cancer patients."