KNOWLEDGE AND PRACTICE OF SCREENING FOR BREAST AND CERVICAL CANCERS AMONG WOMEN IN UYO, AKWA IBOM STATE

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ABSTRACT

The purpose of the study was to investigate the knowledge and practice of screening tests for breast and cervical cancers among women in Uyo. Four specific objectives and corresponding research questions and hypotheses were used in the study. A descriptive cross-sectional design was adopted for the study. A multistage sampling technique was used to select 420 women aged 18 to 50 years from a population of 5,860. The data collected were analyzed using the International Business Machines (IBM), Statistical Package for Social Sciences (SPSS) version 20. 0. Many of the women (66.7%) knew about Breast Self Examination (BSE), few of them (24.5% and 24%) knew Clinical Breast Examination (CBE) and Mammogram respectively and a little over half of them (54.3%) practiced them. A little number of the women (27.3%) knew cervical cancer screening and only 16.7% practiced them. There was a significant association between knowledge of eligible women to be screened and practice of breast cancer screening (x2 17.62; P = 0.00527). There was no significant association between knowledge and practice of breast cancer screening (x2 = 4.93, 10.23, 6.83; P = 0.176995, 0.805028, 0.077625) and cervical cancer screening (x2 = 5.26, 18.71, 6.75; P = 0.153719, 0.22717, 0.080308). There was a significant relationship between women’s age 18 – 28 years and the practice of breast cancer screening (r = 0.59; P = 0.00001) whereas there was no relationship between women’s age 29 -39 years and practice of breast cancer screening (r = – 0.001; 0.99135) and age 40 – 50 years (r = 0.038; P = 0.658129).  Findings also showed relationship between age 18 – 28 years and practice of cervical cancer screening (r = 0.197; P = 0.011983) whereas there was no significant relationship between other age groups and practice of cervical cancer screening with P > 0.05. Adequate health education through women friendly organizations and screening for all women  during regular physician office visit for other health issues are recommended.

TABLE OF CONTENTS

Title
Table of Contents
List of Tables
List of Figures
Abstract

CHAPTER ONE: INTRODUCTION
Background of the Study
Statement of Problem
Purpose of the Study
Specific Objectives
Research Questions
Research Hypotheses
Significance of the Study
Scope of the Study
Operational Definitions of Terms

CHAPTER TWO: LITERATURE REVIEW
Conceptual Review:
Breast Cancer
Breast Cancer Screening
Cervical Cancer
Cervical Cancer Screening
Theoretical Review:
Health Belief Model
Tripartite Theory of Knowledge
Empirical Review
Summary of Literature Review

CHAPTER THREE: RESEARCH METHODS
Research Design
Setting of the Study
Study Population
Sample
Sampling  Procedure
Instrument for Data Collection
Validity of Instrument
Reliability of Instrument
Ethical Consideration
Procedure for Data Collection
Method of Data Analysis

CHAPTER FOUR: PRESENTATION OF RESULT
Demographic Characteristics of  Respondents
Presentation of  Result According to Research Questions
Presentation of  Result According to Hypotheses

CHAPTER FIVE: DISCUSSION
Discussion of Findings
Implication of the Study for Nursing
Limitation of the Study
Recommendations
Suggestion for Further Studies
Conclusion
Summary of the Study
REFERENCES

APPENDICES

CHAPTER ONE
INTRODUCTION
Background to the study
Cancer is the uncontrolled growth of abnormal cells anywhere in the body.  The abnormal cells are termed malignant or misnomer cells (Dugdale, 2010). Cancer is a group of more than 200 diseases characterized by unregulated growth of cells. It can in persons of all ages and all races and is a major health problem in many countries worldwide. It is known to be the most feared of all diseases, feared far more than heart diseases (Seeley, Stephen & Tate, 2010). These authors viewed cancer as synonymous with death, pain, disfigurement and dependency.

 Hippocrates coined the word carcinoma, meaning a tumour that spreads and destroys the host.  However, ancient Egyptians and later Galen described cancer as being crablike in nature because cancerous tumours stick onto the body and prey on the flesh like crabs. They grasp the tissues they invade and cause pain that is throbbing, creeping, gnawing the flesh and resembling the pinching of a crab (Dugdale, 2010).

  In the females, the most occurring cancers are those affecting the mammary glands ( breast cancer) and those affecting the neck of the uterus (cervical cancer) (Bassey, Ekpe & Abasiatai, 2007; American Cancer Society (ACS), 2009 & Odetola, 2011). Breast cancer is cancer that occurs in the breast tissue. It is a malignant proliferation of epithelial cells that line the ducts or lobules of the breast. It is formed when the processes that control normal cell growth breaks down, enabling a single abnormal cell to multiply at a rapid rate. These new cells tend to destroy an increasing portion of normal breast tissue overtime and may occur metastasize to other parts of the body (Smeltzer, Bare, Hinkle & Cheever, 2010).
Breast cancer is the most frequently diagnosed cancer among women in 140 of 180 countries worldwide (Ferlay, Soerjomataram, Ervik, Rebelo, Parkin & Forman, 2013). In 2007, 1.7 million women were diagnosed with breast cancer and there were already 6.3 million women who were alive with the diagnosis of breast cancer in the previous five years (Ferlay, et. al, 2013). Since 2008 estimates, breast cancer incidence has increased by more than 20% while the mortality has increased by 14% making it to be the most common cause of cancer death among women,  with 522,000 deaths in 2012 worldwide (Ferlay, at. al, 2013; Fasoranti, 2013).

Worldwide trends show that developing countries are going through rapid societal and economic changes in an attempt to become industrialized. There is also a shift in the life style of people towards that of industrialized countries, leading to a rise in the burden of cancer especially those associated with reproductive, dietary and hormonal risk factors. Breast cancer incidence and mortality are increasing in most countries of Africa and Asia (International Agency for Research on Cancer (IARC), 2012).Ferlay, et. al (2013) reports that the incidence rate of breast cancer varies in different regions of the world,  it remains highest in more developed regions, while its mortality is relatively much higher in less developed  countries due to lack of early detection  and access to treatment facilities. For instance in Western Europe, breast cancer incidence has reached more than 90 new cases per 100,000 women annually compared with 30 per 100,000 women in East Africa.

Jedy-Agba, Curado, Ogunbiyi, Oga, Falowole, Osubor & Otu (2012) posited that the most common cancers in Nigeria among women are breast cancer 50.8% and cervical cancer 15.7%. The standardized incidence rate of breast cancer from both Abuja Cancer Registry (ABCR) and the Ibadan Cancer Registry (IBCR) in 2012 was 58.3 per 100,000. For IBCR only, it was 52.0 per 100,000 while ABCR had 64.6 per 100,000 (Jedy-Agba, et. al, 2012). According to Odeh, (2012) breast cancer is responsible for about sixteen percent (16%) of all cancer related deaths in Nigeria and is still the number one disease, and leading cancer scourge affecting humans with 25% of cases being reported early while 75% are reported late.

There is no single, specific cause of breast cancer, but a combination of genetic, hormonal and possibly environmental factors may increase the risk of its development. It is not a pathologic entity that develops overnight, it starts with a genetic alteration in a single cell and takes time to divide and double in size. Doubling time varies but breast tumours are often present for several years before they become palpable. For this reason every woman needs to have a clear understanding of her risk factors, warning signs of breast cancer for example, a lump, discharge from nipple and her normal breast size and shape so that any abnormality can be detected at a very early stage. Unfortunately, some women often underestimate their risk of developing breast cancer and are rarely engaged in breast screening programmes and as such seek initial treatment after years of ignoring symptoms.

Similarly, cervical cancer is a disorder of cell growth and behaviour. It is malignant and predominantly squamous cell cancer caused by the Human Papilloma virus (HPV). It usually begins in cells on the surface of the cervix and over time can invade more deeply into the cervix and nearby tissues (Kumar, et. al, 2007). HPV infection and a number of factors help to increase the risk of cervical cancer (Campbell, 2006).

Cervical cancer is the second most common and fifth deadliest cancer in women worldwide. It affects 16 per 100,000 women per year and kills about 9 per 100,000 per year (WHO, 2009). Approximately, 80% of cervical cancers occur in developing country (WHO, 2009). Data from the new cervical cancer crisis card launched globally put the annual total death count from the five top ranked countries at 137,817. Nigeria and 49 other countries were selected to provide a snapshot of the world and Nigeria ranked 10th with cervical cancer mortality rate of 22.9 deaths per 100,000 with a total of 9,659 deaths recorded every year. The annual incidence of cervical cancer in Nigeria is confirmed at 14,000 with about 26 women losing their lives every day (Ogundipe, 2013). A five year review in University College Hospital, Ibadan Cancer Registry.... 

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