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ly
by
t
h
e
l
a
c
k
o
f
e
a
r
l
y
de
t
e
c
t
i
o
n
pr
o
gr
a
m
m
e
,
r
e
s
u
l
t
i
ng
i
n
a
hi
g
h
pr
o
p
o
r
t
i
o
n
o
f
wo
m
e
n
pr
e
s
e
n
t
i
n
g
w
i
t
h
l
a
t
e
-
s
t
a
ge
d
i
s
e
a
s
e
,
a
s
we
ll
a
s
by
t
h
e
l
a
c
k
o
f
a
de
qua
t
e
di
a
g
n
o
s
i
s
a
n
d
t
r
e
a
t
m
e
n
t
f
a
c
i
li
t
i
e
s
[
2]
.
E
s
t
a
bl
i
s
he
d
r
i
s
k
f
a
c
t
o
r
s
o
f
b
r
e
a
s
t
c
a
n
c
e
r
a
r
e
a
f
a
mi
li
a
l
hi
s
t
o
r
y
o
f
b
r
e
a
s
t
c
a
n
c
e
r
,
pr
o
l
o
n
ge
d
e
x
po
s
ur
e
to
e
n
do
ge
n
o
us
e
s
t
r
o
ge
n
s
,
s
uc
h
a
s
e
a
r
ly
m
e
n
a
r
c
he
,
l
a
t
e
m
e
n
o
pa
us
e
,
l
a
t
e
a
ge
a
t
f
i
r
s
t
c
hil
d
bi
r
t
h
,
E
x
o
ge
n
o
us
h
o
r
m
o
n
e
,
Or
a
l
c
o
n
t
r
a
c
e
p
t
i
v
e
a
n
d
h
o
r
m
o
n
e
r
e
p
l
a
c
e
m
e
n
t
t
h
e
r
a
p
y
.
B
r
e
a
s
t
f
e
e
d
i
n
g,
we
i
g
h
t
c
o
n
t
r
o
l
,
phy
s
i
c
a
l
a
c
t
i
vi
t
y
,
a
n
d
a
v
o
i
da
n
c
e
o
f
s
m
o
k
i
ng
a
l
s
o
h
a
v
e
a
pr
ot
e
c
t
i
v
e
e
f
f
e
c
t
[
2
]
.
Al
t
h
o
ugh
r
i
s
k
r
e
duc
t
i
o
n
mi
g
h
t
b
e
a
c
hi
e
ve
d
w
i
t
h
pr
e
v
e
n
t
i
o
n
,
t
h
e
s
e
s
t
r
a
t
e
gi
e
s
c
a
nn
o
t
e
l
i
mi
na
t
e
t
h
e
m
a
j
o
r
i
t
y
o
f
b
r
e
a
s
t
c
a
nc
e
r
s
t
h
a
t
de
v
e
l
o
p
i
n
l
o
w
a
nd
m
i
dd
l
e
i
nc
o
m
e
c
o
un
t
r
i
e
s
.
T
h
e
r
e
f
o
r
e
,
t
h
e
ke
y
s
t
r
a
t
e
g
y
in
r
e
duc
i
n
g
b
r
e
a
s
t
c
a
n
c
e
r
r
e
l
a
t
e
d
m
o
r
t
a
l
i
t
y
,
i
m
pr
o
vi
n
g
b
r
e
a
s
t
c
a
n
c
e
r
o
u
t
c
o
m
e
a
n
d
s
ur
vi
va
l
i
s
s
c
r
e
e
ni
ng
to
e
a
r
l
y
de
t
e
c
t
a
n
d
m
a
n
a
ge
b
r
e
a
s
t
c
a
n
c
e
r
.
T
hi
s
i
s
v
e
r
y
i
m
p
o
r
t
a
n
t
b
e
c
a
us
e
a
n
e
x
c
e
l
l
e
n
t
pr
o
gn
o
s
i
s
i
s
d
i
r
e
c
t
l
y
a
s
s
o
c
i
a
t
e
d
w
i
t
h
t
h
e
s
t
a
ge
a
t
whi
c
h
t
h
e
t
um
o
r
i
s
i
n
i
t
i
a
ll
y
de
t
e
c
ted
a
n
d
h
o
w
l
o
c
a
l
i
z
e
d
t
h
e
l
e
s
i
o
n
i
s
.
E
a
r
l
y
d
i
a
g
n
o
s
i
s
us
ua
l
l
y
r
e
s
u
l
t
s
i
n
s
uc
c
e
s
s
f
u
l
t
r
e
a
t
m
e
n
t
b
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o
r
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m
e
t
a
s
t
a
s
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s
a
nd
s
i
g
ni
f
i
e
s
a
b
e
t
t
e
r
o
u
t
c
o
m
e
[
5]
.
R
e
c
o
m
m
e
n
de
d
pr
e
v
e
n
t
i
v
e
t
e
c
hni
que
s
t
o
r
e
duc
e
b
r
e
a
s
t
c
a
n
c
e
r
m
o
r
bi
d
i
t
y
a
n
d
m
o
r
t
a
l
i
t
y
i
nc
l
ude
b
r
e
a
s
t
s
e
l
f
-
e
x
a
mi
na
t
i
o
n
(
B
S
E
)
,
c
l
i
n
i
c
a
l
b
r
e
a
s
t
e
x
a
mi
na
t
i
o
n
(
C
B
E
)
,
a
n
d
m
a
mm
o
gr
a
p
hy
.
C
B
E
a
n
d
m
a
mm
o
gr
a
phy
r
e
qu
i
r
e
h
o
s
p
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t
a
l
vi
s
i
t
a
n
d
s
pe
c
i
a
li
z
e
d
e
qu
i
p
m
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n
t
a
nd
e
x
pe
r
t
i
s
e
w
h
e
r
e
a
s
B
S
E
i
s
a
n
i
ne
x
pe
ns
i
ve
t
oo
l
t
h
a
t
c
a
n
b
e
c
a
r
r
i
e
d
o
u
t
by
wo
m
e
n
t
h
e
m
s
e
l
ve
s
[
6]
.
E
v
e
n
t
h
o
ugh
B
S
E
i
s
a
s
i
m
p
l
e
,
qu
i
c
k,
a
n
d
c
o
s
t
-
f
r
e
e
pr
o
c
e
dur
e
,
t
h
e
pr
a
c
t
i
c
e
o
f
B
S
E
i
s
l
o
w
a
n
d
v
a
r
i
e
s
i
n
d
i
f
f
e
r
e
n
t
c
o
un
t
r
i
e
s
.
S
e
v
e
r
a
l
r
e
a
s
o
n
s
li
ke
l
a
c
k
o
f
t
i
m
e
,
l
a
c
k
o
f
s
e
l
f
-
c
o
nf
i
de
n
c
e
i
n
t
h
e
i
r
a
bi
li
t
y
t
o
pe
r
f
o
r
m
t
h
e
t
e
c
h
ni
que
c
o
r
r
e
c
t
l
y
,
f
e
a
r
o
f
po
s
s
i
bl
e
d
i
s
c
o
v
e
r
y
o
f
a
l
u
m
p,
a
n
d
e
m
ba
r
r
a
s
s
m
e
n
t
a
s
s
o
c
i
a
t
e
d
w
i
t
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m
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ni
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l
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t
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t
h
e
b
r
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a
s
t
h
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ve
b
e
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n
c
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t
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d
a
s
r
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a
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o
n
s
f
o
r
n
o
t
pr
a
c
t
i
c
i
n
g
B
S
E
[
6]
.
T
h
e
r
e
i
s
e
vi
de
n
c
e
t
ha
t
wo
m
e
n
w
h
o
c
o
r
r
e
c
t
ly
pr
a
c
t
i
c
e
B
S
E
m
o
n
t
hl
y
a
r
e
m
o
r
e
li
ke
ly
t
o
de
t
e
c
t
a
l
u
m
p
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n
t
he
e
a
r
ly
s
t
a
ge
o
f
i
t
s
de
v
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l
o
p
m
e
n
t
,
a
n
d
e
a
r
ly
d
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a
g
n
o
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s
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r
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po
r
t
e
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to
i
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l
u
e
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a
r
l
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t
to
y
i
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l
d
a
b
e
t
t
e
r
s
ur
vi
va
l
r
a
t
e
[
7]
.
He
a
l
t
h
e
duc
a
t
i
o
n
a
n
d
c
o
m
m
u
ni
c
a
t
i
o
n
h
a
v
e
b
e
e
n
f
o
un
d
to
pr
o
m
o
t
e
h
e
a
l
t
h
s
e
e
k
i
ng
be
h
a
vi
o
r
a
l
c
h
a
n
ge
w
i
t
h
s
u
f
f
i
c
i
e
n
t
ut
i
li
z
a
t
i
o
n
a
n
d
c
o
m
p
l
i
a
nc
e
t
o
b
r
e
a
s
t
c
a
n
c
e
r
pr
e
v
e
n
t
i
o
n
a
n
d
s
c
r
e
e
ni
ng
s
t
r
a
t
e
gi
e
s
.
Ho
w
e
v
e
r
,
n
o
pr
e
vi
o
us
r
e
s
e
a
r
c
h
w
a
s
do
n
e
i
n
t
h
e
s
t
udy
a
r
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a
a
n
d
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wa
r
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s
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a
b
o
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b
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t
c
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r
a
m
o
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g
E
t
hi
o
p
i
a
n
wo
m
e
n
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s
n
o
t
we
l
l
do
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u
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t
e
d.
T
hi
s
pa
p
e
r
,
t
h
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r
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o
r
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a
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to
a
s
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f
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o
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dge
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d
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tt
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t
ude
to
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lf
b
r
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a
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a
m
i
na
t
i
o
n
.
2.
M
E
T
HO
D
AN
D
M
AT
E
RI
AL
S
2.
1.
S
t
u
d
y
Ar
e
a
an
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iod
Th
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2013
in
M
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r
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t
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m
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t
s
6
,
340
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r
e
f
e
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s
[8
]
,
[
9]
.
T
h
e
uni
ve
r
s
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y
h
a
s
t
w
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l
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t
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m
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ly
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r
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e
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t
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pul
a
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f
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2.
2.
S
t
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d
e
s
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an
d
S
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r
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p
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de
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t
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.
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pul
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a
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t
h
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id
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
S
N
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2252
-
8806
I
J
P
HS
V
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3.
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s
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)
2.95(
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
P
HS
I
S
S
N:
2252
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8806
A
w
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d
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gul
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ude
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t
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ke
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l
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Uni
ve
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s
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t
y
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gr
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y
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n
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t
hi
o
p
i
a
,
2013
(
n
=
760)
S
ig
ns
a
nd S
y
mpt
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ms
of
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r
e
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s
t
C
a
nc
e
r
C
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r
r
e
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t
r
e
s
p
o
ns
e
N
umbe
r
%
L
u
mp i
n t
h
e
br
e
a
s
t
578
76.10%
D
is
c
ha
r
ge
f
r
o
m t
h
e
br
e
a
s
t
451
59.30%
P
a
in
o
r
s
o
r
e
n
e
s
s
i
n t
he
br
e
a
s
t
601
79.10%
C
ha
nge
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n t
he
s
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z
e
of
t
h
e
br
e
a
s
t
408
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l
or
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ti
o
n /
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mpl
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g
of
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he
b
r
e
a
s
t
299
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U
lc
e
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ti
o
n
of
t
h
e
br
e
a
s
t
384
50.50%
W
e
ig
ht
l
o
s
s
211
27.80%
C
ha
nge
s
i
n t
he
s
ha
pe
of
t
h
e
br
e
a
s
t
292
38.40%
I
nve
r
s
i
o
n/
pul
l
in
g i
n
of
ni
ppl
e
237
31.20%
S
w
e
ll
in
g
or
e
nl
a
r
g
e
m
e
nt
of
t
he
b
r
e
a
s
t
441
58.00%
L
u
mp unde
r
a
r
mpi
t
316
41.60%
3.
4.
K
n
owl
e
d
ge
of
e
ar
l
y
d
e
t
e
c
t
ion
m
e
as
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r
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of
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t
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c
e
r
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m
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e
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a
g
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o
s
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s
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C
B
E
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s
t
h
e
m
o
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t
c
o
m
m
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n
m
e
a
n
s
o
f
de
t
e
c
t
i
n
g
b
r
e
a
s
t
c
a
n
c
e
r
,
m
e
n
t
i
o
n
e
d
by
654
(
86.
10%
)
o
f
t
h
e
pa
r
t
i
c
i
pa
n
t
s
,
f
o
l
l
o
we
d
by
S
B
E
a
n
d
u
l
t
r
a
s
o
un
d
452
(
59.
5%
)
.
R
e
ga
r
d
i
n
g
t
h
e
i
r
pr
a
c
t
i
c
e
,
315
(
41.
40%
)
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f
t
h
e
pa
r
t
i
c
i
pa
n
t
s
r
e
po
r
t
e
d
t
h
a
t
t
h
e
y
k
n
o
w
h
o
w
to
pe
r
f
o
r
m
s
e
lf
-
b
r
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a
s
t
e
x
a
mi
na
t
i
o
n
a
n
d
a
s
m
a
ll
n
u
m
be
r
96
(
12.
60%
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f
t
h
e
p
a
r
t
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c
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pa
n
t
s
r
e
s
po
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d
t
h
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t
t
h
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y
k
n
o
w
t
h
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r
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o
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de
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ge
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o
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t
a
r
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f
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b
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t
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mi
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t
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o
n
.
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im
il
a
r
ly
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a
s
m
a
ll
n
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m
be
r
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f
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pa
r
t
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p
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s
c
o
r
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ly
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bl
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n
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r
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a
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ur
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o
f
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r
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s
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n
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e
r
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m
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n
g
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n
de
r
gr
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dua
t
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r
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m
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l
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ude
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t
s
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ke
l
l
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U
ni
ve
r
s
i
t
y
,
T
i
gr
a
y
r
e
g
i
o
n,
E
t
h
i
o
p
i
a
,
2013
(
n
=
760)
Q
ue
s
ti
o
ns
C
o
r
r
e
c
t
r
e
s
p
o
ns
e
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umbe
r
%
P
a
th
o
l
o
gi
c
a
l
e
x
a
mi
na
ti
o
n (
F
in
e
N
e
e
dl
e
A
s
pi
r
a
ti
o
n C
y
t
o
l
o
g
y
)
290
38.20%
S
e
l
f
B
r
e
a
s
t
E
x
a
mi
na
ti
o
n (
S
B
E
)
452
59.50%
C
li
ni
c
a
l
B
r
e
a
s
t
E
x
a
mi
na
ti
o
n
(
C
B
E
)
654
86.10%
M
a
mm
o
gr
a
ph
y
298
39.20%
U
lt
r
a
s
o
und
452
59.50%
D
o
y
ou kn
o
w
t
h
e
r
e
c
omm
e
nd
e
d a
g
e
t
o
s
ta
r
t
S
B
E
?
96
12.60%
D
o
y
ou kn
o
w
h
o
w
t
o
p
e
r
f
o
r
m S
B
E
?
315
41.40%
D
o
y
ou kn
o
w
h
o
w
of
t
e
n S
B
E
s
h
o
ul
d b
e
d
o
ne
?
145
19.10%
H
o
w
of
t
e
n S
B
E
s
h
o
ul
d b
e
d
o
n
e
?
(
M
o
nt
hl
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62
17.70%
H
o
w
of
t
e
n C
B
E
s
ho
ul
d
b
e
d
o
n
e
?
(
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n
c
e
in
a
y
e
a
r
)
312
42.10%
K
n
o
w
t
h
e
r
e
c
omm
e
nd
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d a
g
e
t
o
s
ta
r
t
ma
mm
o
gr
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ph
y
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x
a
mi
na
ti
on (
A
t
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1.70%
W
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t
h
r
e
ga
r
d
to
t
h
e
kn
o
w
l
e
dge
s
c
o
r
e
,
1.
4%
,
3.
6
%
a
n
d
22.
1%
o
f
t
h
e
pa
r
t
i
c
i
p
a
n
t
s
we
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d
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ng
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0%
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n
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h
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r
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s
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t
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ly
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n
d
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7%
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f
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h
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c
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pa
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F
i
gur
e
1.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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I
J
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5
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3
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be
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201
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:
213
–
221
218
F
i
gur
e
1
.
Kn
o
w
l
e
dg
e
s
c
o
r
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o
n
r
i
s
k
f
a
c
t
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f
d
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g
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d
s
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a
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d
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pt
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s
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f
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a
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t
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a
n
c
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r
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n
g
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de
r
gr
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t
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gul
a
r
f
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m
a
l
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t
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s
,
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e
ke
l
l
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U
ni
ve
r
s
i
t
y
,
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gr
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r
e
g
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n
,
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t
hi
o
p
i
a
,
2013
(
n
=
760)
3.
5.
At
t
it
u
d
e
of
u
n
d
e
r
gr
ad
u
at
e
r
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gu
l
a
r
f
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m
a
l
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t
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d
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n
t
s
t
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d
s
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r
e
as
t
Cance
r
M
o
s
t
424
(
55
.
5%
)
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f
t
h
e
pa
r
t
i
c
i
pa
n
t
s
b
e
li
e
v
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d
t
h
a
t
b
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e
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s
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c
a
n
c
e
r
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s
n
o
t
c
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a
bl
e
d
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s
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a
s
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,
a
n
d
465
(
63.
8%
)
b
e
l
i
e
ve
d
t
h
a
t
l
o
n
g
t
i
m
e
s
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va
l
(
>
5
y
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r
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f
t
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ng
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t
y
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f
t
h
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r
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c
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pa
n
t
s
606
(
79.
7%
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r
e
pl
i
e
d
t
h
a
t
t
h
e
y
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d
c
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to
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f
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pe
d
b
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whil
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nl
y
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(
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50%
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a
t
t
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y
wo
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l
d
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gr
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a
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to
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y
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e
d
ne
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s
s
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r
y
(
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a
bl
e
5)
.
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a
j
o
r
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t
y
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f
t
h
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pa
r
t
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c
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p
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n
t
s
,
612
(
80.
5
%
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,
r
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pl
i
e
d
t
h
a
t
t
h
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y
wo
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d
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ll
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tor
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m
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s
t
,
whil
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148
(
19.
5%
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h
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y
w
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n
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a
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w
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m
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l
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to
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to
e
x
a
m
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ne
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r
b
r
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s
t
.
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a
r
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pa
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s
we
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a
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ke
d
a
b
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t
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pe
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ly
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(
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t
h
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ve
d
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i
s
k.
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hil
e
a
n
o
t
h
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r
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a
i
d
t
h
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t
t
h
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y
a
r
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o
t
a
t
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ng
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a
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t
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a
n
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t
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wn
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n
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a
bl
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5.
T
a
bl
e
5
.
A
tt
i
t
ude
to
wa
r
ds
b
r
e
a
s
t
c
a
n
c
e
r
a
m
o
n
g
u
n
d
e
r
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a
dua
t
e
r
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gul
a
r
f
e
m
a
l
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s
t
ude
n
t
s
,
M
e
ke
l
l
e
Uni
ve
r
s
i
t
y
,
T
i
gr
a
y
r
e
g
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o
n
,
E
t
h
i
o
p
i
a
,
2013
(
n
=
760)
A
tt
it
ude
qu
e
s
ti
o
ns
N
umbe
r
%
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e
li
e
ve
br
e
a
s
t
c
a
n
c
e
r
i
s
a
c
u
r
a
bl
e
di
s
e
a
s
e
Y
e
s
336
44.20%
No
424
55.80%
B
e
li
e
ve
L
ong ti
m
e
s
ur
v
i
v
a
l
(
>
5
y
e
a
r
)
a
f
t
e
r
br
e
a
s
t
c
a
n
c
e
r
i
s
r
a
r
e
Y
e
s
275
36.20%
No
465
63.80%
C
o
ns
ul
t
t
o
a
doc
t
or
Y
e
s
606
79.70%
No
26
3.40%
D
o
n'
t
kn
o
w
128
16.80%
A
gr
e
e
t
o
p
e
r
f
or
m M
a
s
te
c
t
o
m
y
Y
e
s
285
37.50%
No
119
15.70%
D
o
n'
t
kn
o
w
356
46.80%
A
ll
o
w
ma
l
e
d
o
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[5
]
D
.
M.
Park
in
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“
Can
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o
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(
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)
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p
p
.
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1
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5
5
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1
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9
4
.
[6
]
K
ara
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rt
O
.
,
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z
me
n
D
.
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C
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.
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,
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M
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h
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l
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[7
]
Pe
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ro
-
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as
W
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,
Mi
k
h
ai
l
B
.
I.
,
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l
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p
.
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]
Me
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:
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[9
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ad
emi
c
.
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0
]
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,
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Can
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.
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1
]
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o
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2
]
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3
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4
]
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.
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P
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v
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l
.
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p
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5
]
O
k
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p
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.
[1
6
]
W.
A
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M
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p
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7
]
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O
.
A
.
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O
.
,
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M
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.
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8
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M
.
N
.
Sa
m
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[1
9
]
U.
M.
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w
arzo
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.
Sab
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S.
H
.
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ri
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0
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F.
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.
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p
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1
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R
.
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-
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ar,
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