THE ENHANCEMENT OF PUBLIC HEALTH THROUGH BREAST SELF-EXAMINATION HEALTH EDUCATION IN WOMEN OF CHILDBEARING AGE

Breast cancer is the cancer disease with the second highest prevalence after cervical cancer in Indonesia in 2013, also the prevalence of breast cancer is around 2.4% in Yogyakarta. Meanwhile in Central Java Province, the prevalence of breast cancer is around 0.5%. The aim of the community service is an effort to improve public health through health education about breast self-examination. The method of the community service is educations people through a classical study, question and answer as well as discussion and simulation. There were findings of 85% abnormalities in the breasts and no self-handlers were treated. The provision of health education to couples of childbearing age can help women to develop knowledge, attitudes, and behaviors in preventing breast cancer with one of the efforts to do self-examination.


Introduction
Cancer is a disease caused by the abnormal growth of cells of body tissues that turn into cancer cells.In its development, these cancer cells can spread to other parts of the body so that it can cause death.One of the things that make it difficult is the lack of awareness from women in understanding breast cancer in order to avoid breast cancer attacks and detect early (Setiati, 2009).
According to GLOBOCAN (IARC) data in 2012, it is known that breast cancer is a cancer with the highest percentage of new cases (after being controlled by age), which is 43.3%, and the percentage of deaths (after being controlled by age) due to breast cancer is 12.9%.Breast cancer is the cancer disease with the second highest prevalence after cervical cancer in Indonesia in 2013, also the prevalence of breast cancer is around 2.4% in Yogyakarta.Meanwhile in Central Java Province, the prevalence of breast cancer is around 0.5%.
Awareness of the importance of understanding about what and how cancer does is very important because early recognition and understanding will be able to detect early every symptom of this disease, so that cancer can be handled early.Since if it has been Vol: 01, No. 02, Oktober 2022, hlm.16-20 detected early, the treatment is effective and efficient so that it is not too dangerous and can even be handled completely (Diananda, 2009) The main problem of breast cancer is irregularity and it is rare to do breast selfexamination correctly.Breast self-examination activities for all women begin from childbearing age, because 85% of breast abnormalities are actually found to be first recognized by sufferers if not treated early.Breast self-examination should be done every time after menstruation (the 10th day from the beginning of menstruation), the examination is carried out every month from the age of 20 years.(Rasjidi, 2010) The high incidence of breast cancer results in not a few breast cancer sufferers which leads to death.If only the signs and symptoms of breast cancer can be found as early as possible, the cure rate will be even higher.One of the efforts that can be done for early detection of breast cancer is to do a breast self-examination (SADARI).In fact, more earlystage breast cancer can be detected and AWARE of it.
Knowledge is one of the factors that affect changes in the behavior of individuals.Health promotion is very important, the simplest of which is with counseling.Counseling aims to increase individual knowledge of early detection habits and healthy living behaviors.So that with early detection, breast cancer can be found and treated quickly and precisely, and the possibility of recovery is greater.
The provision of health education will help women to develop knowledge, attitudes and behaviors in overcoming changes and problems during the climacterium period so that they are able to adapt to various changes and symptoms that occur at that time.In addition, health education is one of the strategies to improve women's behavior and coping in overcoming menopause symptoms (Rotem et al, 2005).
Blaru Village as one of the areas in Pati Regency which is located in the middle of the city, with a distance of about 1 km from the downtown.Data obtained from interviews with the Headman and midwives, that there has never been any counseling on breast cancer, breast self-examination, besides that the average mother does not know the signs of breast cancer symptoms, how to self-examine breasts.
Blaru village has an obligation to participate in community mobilization.This participation is an elaboration of the implementation of the tri dharma of higher education with community service activities for lecturers and / or students.For this reason, we held community service activities in the form of Improving Public Health through Health Education About Breast Self-Examination (SADARI) for Couples of Childbearing Age in Blaru Village, Pati Regency.
To overcome the existing problems in Blaru Village, the community service team can make an effort to improve the role and function of health cadres.Whatcan be done is through providing health education about breast self-examination.Therefore, community service activities with these partners are very appropriate.This is done in order to improve public health through health education about breast self-examination in women of childbearing age.

Methods of Implementation
The model of this community service is a guidance participation, which prioritizes participation from the community to participate or involve in the activities carried out.
Meanwhile, the methods used in this community service activity include: a. Classical b.Q&A/ discussion c.Simulation

A. Results
This community service activity goes through several stages including: 1) Survey Phase This stage is carried out by surveying or reviewing service sites, identifying problems and needs of partners as well as knowledge of couples of childbearing-age about breast cancer and Self-Breast Examination (SADARI) to support the program.This community service was held at the Blaru Village Hall, Pati Regency.The data obtained that mothers until now have never had a breast check to detect cancer and only 20% of mothers who do breast care themselves even though the techniques and treatment steps do not know in detail.Based on this data, we involve the Head of Blaru Village, Pati Regency as our partner in the implementation of community service at the Blaru Village Hall, Pati Regency.

2)
Implementation Phase After the survey stage is completed, the next step is to hold a meeting with posyandu cadres to convey a plan of service activities, providing health education information about breast self-examination (SADARI) in couples of childbearing age.
The implementation of community service was being held at the Blaru village hall on Thursday, January 26, 2017 started at 08.00 a.m.The total number of participants was 24 women of childbearing age.Community service activities provide counseling materials about breast self-examination (SADARI).From the material presented, mothers enthusiastically asked about the symptoms of breast cancer symptoms, and how to overcome, and how to practice breast self-examination (SADARI).
At the end of the meeting, an evaluation was carried out by giving questions to the audience and asking the audience to practice breast self-care (SADARI).

3)
Monitoring and Evaluation Phase Monitoring was carried out according to the schedule that has been made after carrying out the service activities.Evaluation of the final results of this activity was carried out at the end of the service activity by providing questions and asking the audience to practice breast care themselves (SADARI).The questions given were able to be answered by almost all audiences correctly and the 4 audiences were able to practice breast care themselves correctly.

B. Discussion
From the results of the implementation of community service in the form of efforts to improve public health through health education about breast selfexamination, it shows that the respondents understand and is able to practice how to do breast self-examination.This is in accordance with the results of a study by Ni Nyoman, et al in 2014 entitled knowledge of women of childbearing age about breast self-examination showed that some or 63 respondents (51.6%) had sufficient knowledge, 52 respondents (42.6%) had good knowledge, and 7 respondents (5.8%) had less knowledge about breast self-examination.
The behavior of women of childbearing age in doing SADARI can also be influenced by the knowledge possessed by women of childbearing age.Women with good knowledge and awareness by 60% have higher alertness, because they know more about the causes of ca mammae, signs and symptoms and prevention of camammae.So it is more permissible to do SADARI in everyday life, because they have concerns if they know the symptoms of ca mammae late that occur in their body and eventually the ca-mammae will be difficult to treat.
The attempt that can be done to increase knowledge to understand the importance of doing SADARI as an effort to early detect breast cancer is to provide health education through maternal and child health posyandu which is carried out regularly.In addition, it can also be done by distributing leaflets about SADARI which contains ways to do SADARI properly and correctly, the right time to do SADARI, and the benefits that can be felt by women of childbearing age by doing SADARI, namely early detection of breast cancer.
The formation of attitudes according to Azwar in Notoatmodjo ( 2014) is influenced by several factors, one of which is personal experience, which must leave a strong impression.Therefore, attitudes will be easier to form if the personal experience occurs in situations involving emotional factors.This is the cause of the relationship between the attitudes and behavior of breast self-examination (SADARI).This is in line with Wahyuni's research (2015) entitled The Relationship between Knowledge Level and Attitude towards the Implementation of SADARI in Housewives in Jati Village stated that the attitude of respondents towards SADARI was obtained by 50% of respondents had a positive attitude towards SADARI, namely as many as 24 respondents.The formation of attitudes can be influenced by several important components, namely knowledge, thoughts, beliefs, and emotions.

Figure 1 .
Figure 1.activity of community service Figure 1, 2 and 3 showed photo documenter of service community activity