Original Research Report Effect of Health Education Regarding Awareness Examination as Early Detection of Breast Cancer on the Knowledge and Attitude of Adolescent Women at the Medan Tuntungan Health Center

: Breast cancer (Carsionama mamae) is cancer that originates from the glands, ducts and supporting tissues of the breast but does not include the skin of the breast. Breast cancer is the second most common cancer affecting Indonesian women and is the number one killer of women in the world (Mangan, 2005). The purpose of this study was to find the effect of education between health education regarding BSE examination and the knowledge and attitudes of young women at the Medan Tuntungan Health Center in 2020. The research method used was quasi-experimental. The population in this study were all young women who lived in the area of the Medan Tuntungan Health Center. Sampling technique with a total sampling of 34 people. The results of statistical tests using the Wilcoxon test, obtained p value = 0.025 (p value <0.05) meaning Ho is rejected, which means that there is an influence between the Health Department on adolescent attitudes about BSE examinations. It is hoped that adolescents can increase their knowledge about BSE examinations and be more concerned with their own health conditions so that they can detect cancer in themselves early.


Introduction
Breast cancer (carsinoma mammae) is cancer that originates from the glands, ducts and supporting tissues of the breast but does not include the skin of the breast. Breast cancer is the second most common cancer that attacks Indonesian women and is the number one killer of women in the world [1] [2] [3] [4] [5] [6].
In the Ministry of Health [7] according to WHO (2013), the incidence of cancer from 2008 to 2012 increased from 12.7 million cases to 14.2 million cases. Cancer is the number 2 cause of death in the world after cardiovascular disease.In 2030 it is estimated that the incidence of cancer will increase to reach 26 million people and as many as 17 million people will die from cancer. Of the various types of cancer in Indonesia, breast cancer ranks first based on data from Globocan with the number of new cases reaching 58,256 cases in 2018. According to the Basic Health Research [8], the incidence of breast cancer in Indonesia is estimated at 61,682 people. Young age does not guarantee safety from breast cancer and the risk of breast cancer increases with age [9] [10]. One of the prevention of breast cancer is breast self-examination (BSE). Apart from mammography, breast self-examination (BSE) is an efficient and effective way to detect breast cancer. Many breast cancer patients with advanced stage conditions just come to the hospital to check because the patient does not feel any changes in the condition of their breasts [11].
To find out the signs of breast cancer at an earlier stage (down staging), a breast self-examination (BSE) is performed [12]. BSE examination helps womenperforming an independent examination without paying for an examination, can increase awareness and alertness of an abnormal lump in the breast.Lack of motivation and feelings of fear when after doing BSE, it turns out that women find an abnormal lump in their breasts are the reasons why women don't do BSE. If an abnormal lump is found in the breast, it helps a woman get treatment as soon as possible before the cancer becomes an advanced stage [13].
Based on the results of a preliminary survey conducted by researchers on women in the working area of the Tuntungan Health Center by interviewing 10 students, it was found that there were 8 people who did not understand BSE examination and 2 people who understood BSE examination. So that the 10 students admitted that they had never practiced BSE so that the young women never did BSE examination.

Methods
This study uses a quasi-experimental research design. with this research design model using one group pretest -post test, namely by giving a pretest (initial observation) before being given an intervention, after being given an intervention, then a posttest (final observation) [14] [15] [16] The study population was all young women who lived in the working area of the Medan Tuntungan Health Center. Sampling is done by using total sampling

Result and Discussion
Based on Table 1, Table 2 and Table 3, the level of knowledge of respondents about BSE examination at the Medan Tuntungan Public Health Center was found in the pre-test the majority were in the sufficient category as many as 18 (52.9%) and the minority in the knowledge with less category as many as 2 people. The results of statistical tests using the Wilcoxon test, obtained p value = 0.025 (p value <0.05) meaning Ho is rejected, which means that there is an influence between the Health Department on adolescent attitudes about BSE examinations.

Respondent's Knowledge before and after the Intervention
According to the researcher's assumption, this can be felt reasonable because the teenagers have not been touched with information related to BSE examinations for themselves. Limited information causes their knowledge to be limited so they do not know about it. The information provided can vary in nature and there are many factors that support the increase in the knowledge of adolescents themselves about BSE examinations. This is in line with Muliana's research on the effect of health education on the knowledge and attitudes of respondents. The results of this study showed that in the pre-test the knowledge of the respondents was categorized as poor, namely 73.8%.

Adolescent Attitudes about BSE Examination in the Working Area of the
MedanTuntungan Health Center before and After the Intervention According to the researcher's assumptions, adolescent attitudes were obtained both before the provision of health education because they had positively received the form of information, but they had not yet put it into a more tangible form so that they had not shown significant changes in action.Still from the research conducted by Muliana, it was found that the results of the study showed that the attitude of adolescents at the time the pre-test was carried out was in the unfavorable category, which was 84.6%.
The results of the research conducted by Dewi [17] regarding the level of anxiety of the husband towards his wife who underwent Sectio Caesarea delivery in the delivery room of RSUD 45 Kuningan used an observational research design with consecutive sampling technique and analysis of univariate and bivariate data with a 2-mean difference test, namely the t-test shows that husbands and wives who give birth by sectiocaesarea have a level of anxiety that is included in the very anxious category with a score of (78.88). The husband's high level of anxiety when waiting for his

Conclusion
From the discussion and the results of the statistical analysis carried out, conclusions and suggestions can be drawn as follows: Health education has an important effect on increasing respondents' knowledge and attitudes about BSE examinations, Respondents' level of knowledge about BSE examinations in Medan The gains obtained in the pre-test are the majority in the quite good category as much as 18 people (52.9%) while in the post-test the majority were in the good category as many as 23 people (67.6%). Respondents' attitudes about BSE examinations at the Medan Tuntungan Health Center in the pre-test showed that the majority had good attitudes as many as 18 people (52, 9%).Adolescent attitudes about BSE examination in the post test showed the majority results were in the good category, namely 23 people (67.6%) and the minority category was sufficient 11 people (32.4%) with the results of the Wilcoxon test statistical test obtained p value = 0.025 (p value < 0.05) means Ho is rejected, meaning that there is an influence between the health education provider on adolescent attitudes about education BSE examination.MedanTuntungan District. Most of the respondents in this study had the act of working mothers in exclusive breastfeeding in the no category, which was 65.6% or 21 people.
The dual role conflict of working mothers in the Baru Ladang Bambu Village, Medan Tuntungan District shows that the level of conflict in the dual role of working mothers in the Baru Ladang Bambu Village, Medan Tuntungan District. In the category. There is a dual role conflict 27 people with a high percentage of 84.4%. From the statistical test between the dual role conflict of working mothers and the action of exclusive breastfeeding in the Baru Ladang Bambu Village, Medan Tuntungan District. The correlation coefficient or r value is -0.420, the probability is 0.020 with a 95% confidence level where p <0.05. This means that there is a relationship between the dual role conflict of working mothers and the action of exclusive breastfeeding in the Baru Ladang Bambu Village, Medan Tuntungan District so that the resulting working hypothesis is accepted