PREDICTIVE FACTORS OF BREAST CANCER SCREENING BEHAVIOURS AMONG WOMEN IN NNEWI NORTH LOCAL GOVERNMENT AREA ANAMBRA STATE

CHAPTER ONE
INTRODUCTION
Background to the study
Cancer is a group of diseases that cause cells in the body to change and grow out of control. Most types of cancer cells eventually form a lump or mass called a tumour, and are named after the part of the body where the tumour originates (American Cancer Society (ACS), 2012). Breast cancer begins in the breast tissue.
Breast cancer is the most common cancer in women worldwide, with nearly 1.7 million new cases diagnosed in 2012 (World Cancer Research Fund (WCRF) International, 2013). In United States, breast cancer accounts for 29% of newly diagnosed cancers (ACS, 2013). One in 8 women in the United States will develop breast cancer in her life time (ACS, 2013). Also, ACS (2011), stated that breast cancer incidence death rates increase with age. In their opinion, 95% of new cases and 97% of breast cancer deaths occurred in women 40years of age and older.
In Africa, breast cancer is second (after lung cancer) leading cause of death among African women (Courage to Dare Foundation, 2013). By the year 2020, one million cases of breast cancer are expected yearly in African countries (Courage to Dare Foundation, 2013).In a Ghanaian Teaching Hospital in 2012, breast cancer accounted for 29.3% of all cancers (Tagoe, Yarney, Kenu, Amanhyia, Enchill & Obeng, 2014).
Studies from Nigeria indicate that breast cancer has been the most common female malignancy in areas of western and Eastern Nigeria (Anyanwu, 2008), Breast cancer incidence had risen at least four times over the decade and accounted for 40% of women cancers in 2010 (Adepoju, 2012 ). In the South-Western geopolitical zone of Nigeria, cancer of the breast was the leading malignancy among women (Ogunbiyi, Fabowale & Ladipo, 2010). In North central geopolitical zone (Ilorin),breast cancer  constituted  22.41%  of  new  cancer cases registered in 5 years and accounted for 35.41% of all cancers in women (Afolayan, Ibrahim & Ayilara, 2012).
It is disheartening that breast cancer is responsible for about 450,000 females deaths per annum worldwide (WCRF, 2014). Whereas the deaths could be avoided or reduced if people accept they   are at risk, believe that screening is an effective tool against breast cancer, and utilize the available opportunities of breast screening, stay free from breast cancer, be healthy and alive.
Unlike other cancers, breast cancer lends itself to earlier diagnosis and subsequently more successful treatment. Early detection of breast cancer is a major determinant of reduction of its morbidity and mortality. A 95% survival could be achieved if breast cancer is detected early (Tavafian, Hasani, Teamur & Zare, 2009). According to WHO (2009) two components of early detection have been shown to reduce cancer mortality viz: education to help women recognize early signs of cancer and seek prompt medical attention; then screening to identify early cancer or pre-cancerous lesions before signs are recognizable.ACS (2012), is of the opinion that women should be familiar with how their breasts normally feel, and report any breast changes promptly to their health care providers, because 95% of breast cancers in advanced stages and 65% of breast cancers in primary stages are detected by  women through Breast Self Examination (BSE). ACS (2013) recommends that women receive an annual mammogram beginning at age 40. Women in their 20s and 30s should have a CBE by a health professional every 3 years. Women who are at high risk for breast cancer should have magnetic resonance imaging (MRI) and a mammogram every year beginning at 30 years of age. BSE practice is a gateway to health promotion behaviour that provides women with knowledge and attitude that set the stage for clinical breast examination and mammography screening later in life (Avei, 2008). Furthermore, early detection of breast cancer has been facilitated by several technological innovations. Magnetic resonance imaging (MRI) has been reported to detect almost all cancers at an early stage when used along with mammography (ACS, 2012). Acknowledging the importance of early detection, several countries have adopted breast cancer screening programmes as part of their cancer control strategies (Farid, Sadat & Dahlui, 2014).
In Nigeria, there is yet to be a national organized early detection programme but mammography has become more available in more centres in the last two years (Oluwatosin, 2010). Even at that, most persons utilizing mammography are referred cases with breast lesions and symptoms. Again in Nigeria late presentation has been reported over decades till date. Egwuonwu, Anyanwu, Nwofor and Ame (2012) reported that Nigerian women                                                                                          with breast cancer are still diagnosed at advanced stages of the disease when little or no benefit can be derived from any therapy. Odemwingie (2014) stated that 30 Nigerian women die every day from breast cancer. Adisa (2013), reported that 52% of Nigerian women presented with stage iv breast cancer between 1991-2005.  This is indeed a worrisome trend that demands evidence based attention to reduce the burden of breast cancer in Nigeria. Identifying and understanding factors that predict the breast cancer screening behaviours are primary to instituting measures to increase screening thereby enhancing early detection of the disease and reducing mortality from breast cancer.
Predictive factors of breast cancer screening behaviour are those factors that are more likely to motivate the women to engage in the screening exercise and adhere to the practice throughout one’s life time, in order to detect cancer early if it starts developing. Such factors include level of education, knowledge of signs and symptoms of breast cancer and risk factors, parity of the women, age, family history of breast cancer, place of residence, association with health worker and benefits derived from breast screening, all these are the focus of the study.
 
Statement of Problem
Globally, the devastation that befalls women diagnosed of breast cancer remains inestimable (Olowokere, Onibokun & Oluwatosin, 2012). Early detection remains a major effective approach to combat the disease (Olowokere, Onibokun & Oluwatosin, 2012). Several studies have indicated that community-based breast cancer screening, executed for an appropriate age range at appropriate intervals and with quality assurance in every step, has decreased breast cancer mortality in women by 30% (Dunder, Ozyurt & Erdurak, 2011).
Bello, Olugbenga, Oguntola, Adeoti and Ojemakinde (2011), reported that good knowledge of breast cancer screening among female nurses does not imply better screening rates in South-western Nigeria. In their study, only 55.6% of female nurses practiced BSE and 22.9% had undergone mammography. Again, early diagnosis is only possible when the women avail themselves voluntarily to the screening services before symptoms are noticed.
Despite health education efforts to enlighten women on breast health awareness including the awareness of different screening methods available, the increasing incidence of breast cancer and presentation at an advanced stage are still challenges to healthcare professionals in Nnewi, North Local Government Area. Previous records (2009-2012) from cancer registry Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi showed that one thousand, two hundred and eleven (1,211) women were affected by breast cancer. Information from the mammography unit in NAUTH, Nnewi revealed that in 2012 only 45 women presented themselves for mammography ,  and only 6 out of this number voluntarily came for screening, 39 were referred cases. In 2013, 92 women were screened. The increase was as a result of awareness sponsored programme. Even at that only 40 of the women came for routine screening, others were referred cases. Also, in 2014, limited number of women (30) availed themselves for mammography and only 3 women actually came for routine screening. The low rate at which women in Nnewi North L.GA. respond  to breast cancer screening  mammography stimulated the researcher to ponder on  the possible reasons; by asking what are the factors that predict their behaviour to the breast cancer screening tests?
 
Purpose of the Study
The purpose of this study was to investigate the predictive factors of breast cancer screening behaviours of women in Nnewi North L.G.A of Anambra State.
Specific objectives were to:

1. Ascertain the level of knowledge of breast cancer screening methods among women in Nnewi North L.G.A.
2. Ascertain the level of knowledge of risk factors and early indications of breast cancer among women in Nnewi North L.G.A.
3. Determine breast cancer screening practices/behaviour among women in Nnewi North L.G.A.
4. Determine the factors that predict breast self examination (BSE) screening behaviour among women in Nnewi North L.G.A.
5. Determine the factors that predict clinical breast examination (CBE) screening behaviour among women in Nnewi North L.G.A.
6. Determine the factors that predict mammography screening behaviour of women in Nnewi North L.G.A.