ABSTRACT
Breast cancer is said to be the commonest cancer and the most lethal malignancy in women across the world. Most of the cases are brought late to the hospital when the conditions are severe with multiple nodal involvements and poorer clinical pathological prognostic outcome. If breast changes are detected early and treatment commenced early enough, the survival rate of breast cancer will be increased. The purpose of this study was to investigate the breast cancer awareness amongst women of child bearing age in Umuowa Orlu L.G.A. of Imo State. The research design for the study was descriptive survey. Umuowa was purposively selected for the study. Proportionate sampling method was used to draw three hundred and forty nine (349) women in the ten villages in Umuowa. Systematic sampling technique was used to the reach the respondents in the villages. A validated questionnaire which served as an interview schedule was used for data collection. Data derived from the questionnaire were analyzed descriptively using frequencies and percentages. Chi Square and Spearman’s Rank analysis were used to test for relationships between demographic data, breast cancer awareness and practice of BSE. The study revealed that the awareness of breast cancer and BSE among the women were low. The major source of information was healthcare providers. Majority of the women had inadequate practice of BSE despite the fact that a little above half (51.95) practiced BSE. Age, educational attainment and parity were associated with the practice of BSE. This implied that with increase in age and parity, the practice of BSE reduced while it increased with educational attainment. There were negative relationships between age, parity and awareness of BSE. This implied that BSE awareness increased as age and parity reduced. A positive relationship was established between BSE awareness and educational attainment. Findings further revealed that there is a positive relationship between breast cancer awareness and practice of BSE. Based on these findings, it was recommended that healthcare providers should embark on directed and focused health education awareness campaign to enhance the awareness of breast cancer. The importance of BSE as a key factor in the early detection of breast cancer should be stressed with special emphasis on regular practice of BSE and the proper steps of BSE.
CHAPTER ONE
INTRODUCTION
1.1 Background to the study
Breast cancer is the commonest cancer as it continues to remain the most lethal malignancy in women across the world (Doshi, Reddy, Karunakar & Kulkarani, 2012). It constitutes a major public health issue globally with over one million new cases diagnosed annually, resulting in over 400,000 annual deaths and about 4.4 million women living with the disease (Globocan, 2008; Ganiy and Ganiyu, 2012). Breast cancer is the leading cancer among women but it can also appear in men (Tara, Agrawal & Agrawal, 2008). Although breast cancer is 100 times more common in women than in men, although men tend to have poorer outcomes due to delay in diagnosis (Fasoranti, 2010).
Although breast cancer incidence rates are higher in industrialized countries, recent trends show that the largest increase in risk is occurring in developing countries. There is thus a geographical variation in the incidence of breast cancer with higher incidence in Europe and America compared to Asia and Africa (Otunne, 2008). According to Beiki, Hall, Ekbom and Moradi (2012), the incidence ranks highest in high income countries, with the exception of Japan. In Canada, for example, 19,000 new cases are diagnosed each year and 5, 300 Canadian women die from the diseases annually.
Breast cancer is now the commonest cancer affecting women in Nigeria. In Nigeria, the number of women at risk of breast cancer increased steadily from approximately 24.5 million in 1990 to approximately 40 million in 2010 and is projected to rise to over 50 million by 2020 (Akarolo- Anthony, Ogundiran & Adebamowo, 2010). Statistics from the Ministry of Health Nigeria showed that breast cancer had risen at least four times over the decade and accounted for 40 percent of women cancers (Onyebuchi, 2012). In the present scenario, roughly 1 in 26 women are expected to be diagnosed with breast cancer in their life time, majority of cases occurring in pre-menopausal women (Dosh et al, 2010).
According to Salaudeen, Akande and Musa (2009) studies from various ethnic populations have reported the demographic profile of breast cancer especially from the Western and Northern parts of the country. A review of breast biopsies in the Lagos University Teaching Hospital showed 34 percent of all breast biopsies done over a 10-year period to be malignant. They also asserted that a report from Zaria described the mean age of presentation of breast cancer as 42 years with 30 percent occurring in women less than 25 years of age. Furthermore, at University College Hospital, Ibadan, 74 percent of breast cancer patients were pre-menopausal. A ten year review of breast cancer in Eastern Nigeria revealed that patients with breast cancer constituted 30 percent of all patients with breast disease and that 69 percent of these patients were pre-menopausal (Oluwatosin, 2010).
More so, majority of women present with advanced stages of the disease at which time little or no benefits is derived from any form of therapy. The 5- year survival rate of breast cancer is over 85% with early detection whereas later detection decreased the survival rate to 56% (Dosh et al, 2010; Fasoranti, 2010). The low survival rates of breast cancer in less developed countries can be attributed to lack of early detection as well as inadequate diagnosis and treatment facilities. Oluwatosin (2012) asserted that late presentation of breast cancer patients suggests that women in Nigeria have poor knowledge of the disease. Chiejina (2011) also noted that what is more worrisome in a country like Nigeria with over 140 million people is that the detection of the disease is usually late. For women to present early, they need to be “Breast aware” and must be able to recognize symptoms of breast cancer through routine practice. Late presentation of patients at advanced stages is thus the cause of breast cancer death in Nigerian women, as 80 percent of breast cancer patients in Nigeria are said to die because of late detection (Otunne, 2008)
In Developing Countries, the rise in breast cancer incidence as shown by trends has resulted mostly from the adoption of lifestyles typical of industrialized countries due to the rapid societal and economic changes. This in turn has caused a rise in the burden of cancers like breast cancer (IARC, 2013). Though this carcinoma is thought to be a disease of the developed world, almost 50% of breast cancer cases and 58% of the deaths occur in less developed countries (WHO, 2014). It has also been estimated that the number of new cases is expected to be as high as 15 million with most of the cases (60%) occurring in developing countries (Shatha et al, 2012).
According to Coleman et al (2008), the survival rate for breast cancer varies worldwide, ranging from 80% or over in developed countries to less than 40% in less developed countries. Lack of early detection programmes resulting in a high proportion of women presenting late stage of disease, as well as lack of adequate facilities for diagnosis and treatment, has been the major causes of the low survival rates in developing countries.
In Nigeria, carcinoma of the breast is the third most common cancer in women only exceeded by cervical cancer and Kaposi’s sarcoma (Gakwaya et.al, 2008). Breast cancer is on the rise in Nigeria, projected at a 4.5% annual increase in ASR (age standardized incident rate) from 2006 (Parkin et.al, 2006). Much as mass screening campaigns are a necessity, the use of mammography is not readily available in most sub Saharan countries such as Nigeria. This is mainly attributed to the scarcity of resources for health care (Galukande et al, 2010).
Furthermore, mammography is not an appropriate screening technique for women younger than 35 years due to the density of their breast tissue which makes visualization of the lesions present difficult and results unreliable (Parkin et al, 2006). This leaves CBE and BSE as available options.
Breast self examination is definitely an appealing screening method primarily because it has no financial cost and it can be privately conducted by a woman (Hackshaw, 2003). Studies that have been conducted suggest that such women are more likely to detect breast tumors themselves and present these in earlier stages which in turn increase their survival rate (IARC, 2002).
1.2 Problem Statement
In order to prevent Breast cancer and curb mortality arising from the disease, strategies such as use of screening methods to achieve earlier detection of this carcinoma need to be adopted by health systems worldwide.
Over the past three decades, the incidence rate of breast cancer in Nigeria has increased from 11 per 100,000 to 39.2 per 100,000 (IARC, 2002) particularly in Imo where incident rates have been on the rise since 1960s (Wabinga et.al, 1969-1997). This alarming statistic has been a result primarily of the adoption of western lifestyles such as smoking, excessive alcohol consumption eating fatty foods, and a lack of physical exercise amongst women of child bearing age in Imo. Furthermore, the low frequency and level of awareness about breast cancer screening coupled with the attitudes of women towards breast cancer has contributed significantly to the rise in incidence and mortality of breast cancer.
According to Dr. Fred Okuku; an oncologist based at the Nigeria Cancer Institute in Mulago National Referral hospital, there is a steady increase in the number of Nigerians suffering from various forms of cancer, breast cancer being the second commonest form amongst women. In the last three years alone, he said the number of cancer patients had shot up from 1200 to 2800 with 60% of patients presenting advanced stages of disease. This, he attributed to the poor health seeking culture of Nigerians especially in terms of acquiring knowledge concerning cancers such as breast cancer. A large proportion of the people who turn up at the institute are henceforth diagnosed with stage four cancer which is a late stage as far as cancer management is concerned (The Observer Newspaper, 16th February 2013).
Though there are some organizations such as the National Breast Cancer Foundation (NBCF) in place, not much has been done in regard to Breast cancer concerning women in Imo and Nigeria at large. This is evidenced by the limited data which has been documented about breast cancer in Nigeria generally.
If the situation remain this way, Nigeria is likely to experience an exponential increase in the incidence and mortality arising from breast cancer.
1.3 General Objective
To assess the knowledge, Attitudes and awareness amongst women of child bearing age in Umuowa, Imo state
Specific Objectives
• To assess the knowledge of Breast cancer amongst women of child bearing age in Umuowa
• To assess the Attitude of women towards breast self examination
• To assess the practice of these women towards breast self examination.
1.4 RESEARCH QUESTIONS
1. How knowledgeable are the women in Umuowa about Breast cancer?
2. What are the attitudes of women in Umuowa towards Breast self examination?
What is the practice of breast self examination amongst women of child bearing age in Umuowa?
1.5 JUSTIFICATION OF STUDY
Nigeria is a developing country that is still plagued by communicable infections such as Malaria, HIV/AIDs etc. Most of the limited resources in the health sector therefore are used in combating such diseases. Inevitably, there is lack of enough resources to purchase screening equipment for mammography or setting up a number of screening facilities to ease access to these services. Under such circumstances, BSE is the best alternatives for early detection of breast cancer seeing as it is done at no cost.
Women in Nigeria have a fundamental role to play within various communities and the country at large; so much that their health status affects the health of their children, family and community. In addition to their role as wives, mothers, and primary care givers for their families, they take on important positions within the social and economical lives of their community (Wong P, 2003)
Medical advances have shown that one-third of all cancers breast cancer inclusive, are preventable and a further one third, if diagnosed sufficiently early, is potentially curable. This observation demands that cancer control should be of increasing priority in the health care programs of developing countries (Milaat, 2000). In a bid to reduce the incidence of mortality from breast cancer there is need for an effective screening program.
This study therefore sought to determine the women’s awareness of Breast cancer, as well as their attitude and practice of BSE. Findings from this research can aid in the creation of appropriate health interventions materials to improve the awareness and practice level of BSE among Nigerian women. Additionally, findings can also provide information on BSE for governmental health officials and other nongovernmental organizations which are working particularly on breast cancer to raise awareness amongst women about breast cancer and the role of BSE in breast cancer prevention and control. This, in turn will curtail the increasing incidence rate and mortality of breast cancer in Imo and eventually Nigeria as a whole. Furthermore, the data obtained from this study can be utilized as reference in future research as there is inadequate Nigerian Literature pertaining to BSE available.
1.6 Study Limitations
First of all, the source of data for this study was based on self-report of respondents and provided no validation of information obtained with any objective source. Secondly, some respondents were not willing to take part in this study and others were not at their places of residence at the time of the study.
1.7 Operational Definitions
Breast Cancer: Breast cancer is defined as the malignant proliferation of cells in the breast tissue.
Screening: Screening is the process by which unrecognized disease or defects are identified early, using tests which can be applied rapidly and on to large numbers of people.
Breast Self Examination: This is a screening method used in an attempt to detect breast cancer early. It involves the woman herself looking at and feeling each breast for possible lumps, distortions or swellings.
Knowledge of Breast Self Examination: Knowledge about breast self examination refers to having information about breast self examination.
Practice of Breast Self Examination: Practice of Breast Self Examination is defined as the process of palpating of one’s own breast at least once a month.
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