HEALTH SEEKING BEHAVIOUR AND PRESENTATION OF BREAST CANCER AMONG WOMEN VISITING THE CAPE COAST TEACHING HOSPITAL

ABSTRACT
Breast cancer has been identified as a leading malignancy and one of the most common causes of hospital admission among women. According to hospital records at the Cape Coast Teaching Hospital most women visiting the breast clinic delay their presentation of breast cancer symptoms. This study therefore examined the health seeking behaviour and late presentation among patients with breast cancer visiting the Cape Coast Teaching Hospital. A descriptive quantitative study was employed. Convenient sampling method was used with the inclusion criteria of women who had been diagnosed with self-detected cancer or cancer detected through mammogram or clinical breast examination with stage II to stage IV breast cancer. A questionnaire was used to assess the demographics characteristics, barriers to seeking early care for breast symptoms, factors influencing health seeking behaviour, and breast cancer related knowledge. Health records of respondents were also used to assess the date of presentation at the clinic, and the duration of symptoms. The questionnaire was found to have adequate reliability with a Cronbach alpha value of 0.0839. The study found that the respondents had poor health-seeking behaviour. Delayed presentation of breast cancer was found not to be associated with educational level, income, marital status nor religion. However it was associated (X2=11.411: p=0.044) with older age. The study concluded that the willingness of women to screen for breast cancer influences time of presentation. The study therefore recommended that education is required for the relatively older women on breast cancer to avoid delayed presentation.

CHAPTER ONE
INTRODUCTION
Background to the Study
Breast cancer is a major public health problem in both high income and low income countries (Parkin, Bray, Ferlay & Pisani, 2005) and the most common cause of cancer deaths in women worldwide (Tsu, Jeronimo & Anderson, 2012). Breast cancer has approximately 500000 annual deaths (Unger-Saldaña, 2014), the highest incidence rates occurring in the most developed regions of the world, with 74.1 new cases per 100000 women in comparison to 31.3 new cases per 100,000 observed in less developed regions. However, the mortality rate is actually higher in developing countries (Unger-Saldana, & Infante-Castañeda, 2009). It is estimated that by 2030, the global burden is expected to grow to 21.4 million new cancer cases and 13.2 million cancer deaths (American Cancer Society, 2011).

Breast cancer is the second most frequent cancer in African and among sub-Saharan African women with an incidence of 15-53 per 100,000 women (Mbuka-Ongona, & Tumbo, 2013). Trend analysis of breast cancer indicates a rise by 50-100% in the prevalence in the last 20 years (Fregene & Newman, 2005; Easton, 2005). Breast cancer presents in a more aggressive form in African women than that of women from European origin (Fregene & Newman, 2005; Easton, 2005). Furthermore, the case-fatality rate tends to be higher, largely due to patients presenting with more advanced stages. About 90% of patients with breast cancer disease in Africa and sub-Saharan Africa present with stage III or IV disease, a median tumour size of 10 cm, and palpable nodal metastasis (Kanavos, 2006). Breast cancer is the leading malignancy in Ghana. It accounts for 15.4% of all malignancies and appears to be on the increase (Clegg- lamptey & Hodasi, 2007). The pattern of the disease can be so advanced that even optimal western therapy may offer minimal survival benefit (Gilani, Khurram, Mazhar, Mir, Ali, Tariq, & Malik, 2010). This implies that majority of breast cancer deaths occur in developing countries and these cancers are detected at later stages where much cannot be done to address the problem.
Breast cancer can occur in men but it most commonly occurs in women (Okobia, Bunker, Okonofua, & Osime, 2006). Breast cancer presents most commonly as a painless breast lump and a smaller proportion with non-lump symptoms. For women to present early to hospital they need to be breast aware; they must be able to recognize symptoms of breast cancer (Okobia, et al., 2006). An estimated 20%–30% of women will wait at least 3 months from first detection before seeking help for breast cancer symptoms despite extensive measures to promote early detection of breast cancer. In breast cancer literature, delayed presentation is defined as a delay of more than 3 months from the self-detection of a new breast cancer symptom until presentation to a health care provider. Women with delayed presentation often have larger tumours and metastases (Heisey, Clemons, Granek, Fergus, Hum, Lord, McCready, & Fitzgerald, 2011). At this stage little or no benefit is derived from any form of therapy leading to poorer long-term survival (Sharma, Costas, Shulman, & Meara, 2012).

Breast cancer delay is not only associated with a reduced survival time; the longer the delay, the more likely for the patient to present with large tumours and regional lymph node involvement. Delayed presentation conveys a greater risk of needing more aggressive treatments. Hence, the longer the delay, the more likely it is for a woman to require mastectomy instead of conservative surgery as well as more toxic or extended adjuvant treatment. Women diagnosed with advanced disease have also been shown to have psychological morbidity which strongly impacts their quality of life (Unger-Saldaña, 2014).
There is evidence-based research to show that one-third of all cancers are preventable and a further one-third, if diagnosed early, is potentially curable (Al-Naggar, Al-Naggar, Bobryshev, Chen & Assabri, 2011). Therefore early detection and treatment of cancers can drastically reduce mortality rates.

Statement of the Problem
In Ghana, breast cancer has been identified as a leading malignancy and one of the most common causes of hospital admission among women (Clegg- Lamptey & Hodasi, 2007). The age of developing breast cancer among Ghanaians is relatively younger compared to that of European countries. The average age is between 40-49 years compared to 60 years in the United States of America (USA) (Opoku, Benwell &, Yarney, 2012). Late presentations have been observed as the hallmark of breast cancer in Ghanaian women where over 60% of patients report with either stage III or IV of the disease (Opoku, et al., 2012). It has been reported that 57% of those who present with breast cancer have advanced cancers with average tumour size of about 6x7 cm (Clegg- Lamptey & Hodasi, 2007). On the average, women report at least eight months after first noticing a change in their breasts (Clegg-Lamptey & Hodasi, 2007). This makes the 5-year survival rate of breast cancer in Ghana less than 25%, compared with 70% in Western Europe and North America. Studies have shown that one–third of breast cancers is curable when diagnosed early (Unger-Saldaña, 2014). However, most women in Ghana present late resulting in poorer long term survival (Clegg- Lamptey & Hodasi, 2007; Opoku, et al., 2012). Understanding the factors that influence patient delay in seeking help for breast changes is a prerequisite for development of strategies to prevent late reporting of breast cancer symptoms to the hospital (Okobia, et al, 2006).

A number of studies on delayed presentations has been done worldwide (Unger-Saldaña, 2014, Heisey, et al., 2011, Sharma, et al., 2012) and one study done in Ghana by Clegg Lamptey et al. (2007) at the Korle-Bu Teaching Hospital but from the literature search there appears to be no study from the Cape Coast Teaching Hospital. This makes it quite difficult to know the reason(s) why women with breast cancer delay presentation to the hospital as well as the health seeking behaviour of women with breast cancer visiting the hospital. Data from this study in addition to data from Clegg Lamptey’s study will provide a better understanding of problems facing women with breast cancer in the country.

This study therefore, sought to find the health seeking behaviour and late presentation of breast cancer from the perspectives of women visiting the Breast Clinic at Cape Coast Teaching Hospital.

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Item Type: Ghanaian Project Material  |  Attribute: 125 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH110 ($20)  |  Delivery: Within 30Mins.
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