BREAST CANCER AWARENESS AND PRACTICE OF BREAST SELF EXAMINATION AMONG RURAL WOMEN IN UMUOWA, ORLU LOCAL GOVERNMENT AREA IMO STATE
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 braest changes are detected early and treatment commenced early enough, the survival rate of breast cancer wii be increased. The purpose of this study was to investigate the breast cancer awareness and practice of Breast Self-Examination (BSE) among women 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
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 an environment where late presentation is predominant there is an urgent need for awareness of breast cancer and its early detection measures. Recommended preventive techniques to reduce breast cancer mortality and morbidity include breast self examination, clinical breast examination and mammography (Doshi et al, 2012). Early diagnosis has a positive effect on the prognosis as well as limits the development of complications and disability (Gwarzo et al, 2009). Changes in the early detection guidelines of the American Cancer Society now recommend that women, beginning in their early 20s should be told about the benefits and limitations of breast self examination. They also recommend that BSE be performed monthly beginning at the age of 20 years and women should undergo a clinical breast examination annually beginning at the age of eighteen years (Salaudeen, Akande, & Musa, 2009). It is an option for women and it is a woman’s best weapon in the fight against breast cancer.This is especially so since nearly 70% of all breast cancer are found through breast self examination and with early detection, quality of life is increased (Gwarzo et al, 2009) and the five year survival rate is 98% (National breast Cancer Foundation, 2012).
An increased awareness among women in general on BSE as a means of detecting breast cancer would most likely result in a high number of women practicing it. If there is increased awareness and improvement in the capacity of women to understand themselves, it will enable them seek medical attention early enough. Awareness can be created by health workers such as nurses and doctors. Newspapers, journals and the internet are also sources where one can read articles written on BSE (Cosgrave, 2009). According to Oluwatosin (2012), women given information on and instruction about BSE and breast cancer by healthcare professionals demonstrated higher knowledge and confidence and tend to practice BSE more than those who receive information from other sources.
Moreover, practicing monthly breast self examination beginning at age 20 can play an important role in early detection of breast cancer resulting in greater chances of cure and less complex treatment (Berman, Kozier & Erb, 2008). According to Atanga, Atashili, Fuh, and Eta, (2012) regular practice of BSE is the corner stone of the fight against breast cancer worldwide, especially for black women because clinical breast examination and mammography might not be accessible to them for economic or other reasons. Though screening mammography is widely practiced in developed countries, it is hardly recommended for those under 30 years because of their dense tissue which makes interpretation of the films difficult (National Breast Cancer Foundation, 2012). Furthermore, BSE is still recommended as a general approach to increasing breast health awareness and thus potentially allow for early detection of any anomalies (Ginsberg, Lauer, Zella, Bacten & Baltussen, 2012). Therefore, BSE becomes particularly important and appropriate.
Based on the fact that a greater percentage of Nigerian women die because of late detection and that awareness on BSE increases the possibility of early presentation and consequently reduces mortality, this study is designed to determine the breast cancer awareness and practice of BSE among women in selected rural communities who constitute the majority of women at risk both for the disease and late presentation.
Statement of problem
Prognosis and survival rates for breast cancer vary greatly depending on the cancer type, stage, treatment and geographical location of the patient (Fasoranti, 2010). Survival rates of breast cancer in the western world are high as eight out of ten women in England diagnosed with breast cancer survive for at least five years. In developing countries, survival rates of breast cancer are much poorer. Lack of awareness of early detection measures and screening for breast cancer is common in developing countries (Hanna & Kangolie, (2010)
Salaudeen, et al (2009) asserted that the black woman usually presents late for treatment of breast cancer with a bigger mass and seems afflicted with a biologically more aggressive tumour. Jebbin and Adotey (2009) reported that many cases of carcinoma of the breast they found in the clinic were advanced, with large tumours and multiple nodal involvements and have poorer clinical and pathological prognostic outcome. Jebbin and Adotey, 2009, believe that if women in Port-Harcourt are knowledgeable about BSE and practice it, this scenario may not be so. Similarly, at the surgical unit of Imo State Teaching Hospital, women with breast cancer are presenting with advanced stages of the disease. As a result of late detection of breast cancer, five women of Umuowa died of breast cancer between March and June, 2010.
Otunne (2008) acknowledged that following hospital records in Nigeria breast cancer is truly an epidemic among women, as it was estimated that 211,000 new cases of invasive breast cancer was diagnosed in 2007 and 43, 3000 patients died of this disease in Nigeria. Tara, et al (2008) noted that the earlier a woman is diagnosed of breast cancer, the better her chances of survival. Since there is increased mortality in Nigeria due to late detection and late presentation, one begins to wonder if women are aware of breast cancer and if they practice BSE. This study is therefore set to empirically ascertain the breast cancer awareness and practice of BSE among women in Umuowa community.
Purpose of study
The main purpose of this study is to investigate the Breast cancer awareness and practice of breast self examination among women in Umuowa Orlu L.G.A in Imo State.
Specifically the objectives are to:
- Assess breast cancer awareness among women in Umuowa Orlu L.G.A.
- Determine the BSE awareness among the rural women in Umuowa Orlu L.G.A.
- Identify the sources of information on breast cancer awareness and BSE in Umuowa Orlu.
- Determine the practice of BSE among the rural women Umuowa Orlu L.G A.
5 Determine the relationship between socio-demographic characteristics of these women and their cancer awareness and practice of BSE.
- Determine the relationship between breast cancer awareness and practice of BSE.
Research Questions
- How aware are the women of Umuowa Orlu L.G.A. of breast cancer?
- How aware are the women of Umuowa Orlu L.G.A. of BSE?
- What are the women’s sources of information on breast cancer and BSE in Umuowa Orlu L.G.A?
- How do the women of Umuowa Orlu L.G.A. practice BSE?
- What relationship is there between socio-demographic characteristics and cancer awareness and practice of BSE among women in Umuowa Orlu L.G.A.?
6 What is the relationship between breast cancer awareness and practice of BSE among women of Umuowa community?
Hypotheses
- There is no significant relationship between socio-demographic characteristics and practice of BSE among women of Umuowa.
- There is no significant relationship between socio-demographic characteristics and awareness of BSE among the women of Umuowa.
- There is no significant relationship between respondents’ awareness of breast cancer and their practice of BSE.
Significance of the Study
The findings of this study will help to provide information on breast cancer awareness and practice of BSE among women in rural communities of Umuowa of Imo State. If the information obtained indicate that the women have poor awareness of breast cancer and do not practice BSE or do not do so adequately, it will sensitize health workers to the needs of the women and health-educate them accordingly. This will help in the delivering of focused and directed health talks to the women in the rural areas on the meaning of BSE, meaning of breast cancer and the proper steps used in BSE. This will in turn increase attention to and practice of BSE among rural women.
When the findings of this study come to the awareness of other Government Health Agencies, it will assist them in devicing the means through other sources of information such as television, radio etc to ensure increased awareness on breast cancer and BSE in rural communities. Through these media, the women will be made to know the importance of early reporting of breast changes to their healthcare providers thereby creating room for early diagnosis of breast cancer for better clinical and prognostic outcomes.
It is expected that when the above measures are adequately implemented, the breast cancer and BSE awareness will be increased among these women. This in effect will ensure regular and accurate performance of BSE and consequently early detection of abnormalities. Decrease in late detection and presentation will lead to reduction of maternal morbidity and mortality rate due to breast cancer which will in turn contribute to the achievement of millennium development goal four.
The information obtained from this study may be of help to other researchers interested in working in this field as it will serve as a reference material for further research.
Scope of the Study
This study will be delimited to women between the age of 20 – 70 who are resident in the rural community of Umuowa irrespective of their level of education, occupation and social status. It is also delimited specifically to their awareness of BSE, breast cancer awareness, sources of information and practice of BSE.
Operational definition of terms
- Breast Self Examination: An individual examining her breasts to look and feel for abnormal changes such as lump, discharge, swelling, pain.
- Breast cancer Awareness: In this study means if the women have heard of breast cancer, seen cases of breast cancer, how it is detected and how it presents. It will also mean awareness of those risk factors that could predispose one to breast cancer such as
- a) Behavior or actions of a person e.g. smoking, alcohol, high fat diet, nulliparity, late first pregnancy.
- b) Factors within the person; e.g. Presence of previous cancer, age, breast biopsies, breast cancer among first-degree relatives.
- c) Environmental factors e.g. radiation and environmental pollutants.
- Awareness of BSE: awareness will denote if the women have heard of breast self examination, its purpose, timing and things to watch out for.
- Sources of Information on Breast cancer and BSE: For this study, sources of information include health workers, friends, religious leaders, traditional leaders, newspaper, radio, televisions, poster, magazine, library and journals.
- Practice of Breast Self Examination: for this study means whether it is done, its frequency, accuracy of procedure. It will also include the reasons for not practicing
- Demographic Factors: The demographic factors referred to in this study are parity, age and educational level.