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ORIGINAL ARTICLE
Year : 2017  |  Volume : 13  |  Issue : 2  |  Page : 268-275

Breast cancer screening practices amongst female tertiary health worker in Nnewi


1 Department of Surgery, Anambra State University Teaching Hospital, Awka, Anambra State, Nigeria
2 Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
3 Department of Pharmacology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Anambra State, Nigeria
4 Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

Date of Web Publication23-Jun-2017

Correspondence Address:
Chimezie Innocent Madubogwu
Department of Surgery, Anambra State University Teaching Hospital, Awka, Anambra State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.188433

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 > Abstract 

Background: Breast cancer in Nigeria and other developing countries is characterized by late presentation and poor outcome due to ignorance, superstition, self-denial, fear of mastectomy, and unavailability of treatment facilities. The mortality of breast cancer in Western world is decreasing due to early detection and better management.
Objective: This study aims at accessing the knowledge, attitude, and practice of breast cancer screening among female tertiary health workers.
Materials and Methods: A cross-sectional descriptive study carried out using a structured, pretested, self-administered questionnaire to assess the knowledge, attitudes, and practice of breast cancer and screening methods among female health workers.
Results: The mean age of respondents was 31.70 ± 7.62 years. The level of awareness of breast cancer screening methods was high: 158 (98.75%), 127 (79.4%), and 144 (90.0%) for breast self-examination (BSE), clinical breast examination (CBE), and mammography, respectively. However, only 47 (35.9%), 36 (22.5%), and 3 (1.9%) correctly practiced BSE, CBE, and mammography, respectively. The level of education and occupation showed significant correlations with the knowledge and practice of breast cancer screening methods.
Conclusion: Breast cancer screening still needs to be promoted to improve the attitude and practice among both health workers and general population.

Keywords: Breast cancer screening methods, knowledge, mammography, practice


How to cite this article:
Madubogwu CI, Egwuonwu AO, Madubogwu NU, Njelita IA. Breast cancer screening practices amongst female tertiary health worker in Nnewi. J Can Res Ther 2017;13:268-75

How to cite this URL:
Madubogwu CI, Egwuonwu AO, Madubogwu NU, Njelita IA. Breast cancer screening practices amongst female tertiary health worker in Nnewi. J Can Res Ther [serial online] 2017 [cited 2022 Nov 26];13:268-75. Available from: https://www.cancerjournal.net/text.asp?2017/13/2/268/188433


 > Introduction Top


A wide range of diseases can affect the breast ranging from benign to malignant varieties. Benign breast diseases are commoner than the malignant ones.[1],[2] Breast cancer, however, is the most common malignancy affecting women in many parts of the world.[1],[3],[4],[5] In 2004, approximately 1.5 million new cases were diagnosed worldwide.[1] In Britain, 1 in 12 women will develop breast cancer in their lifetime.[1],[3] Breast cancer is the leading cause of cancer deaths in women.[6] In Western world, breast cancer accounts for 3–5% of all deaths in women and in developing countries for 1–3%.[1] The incidence in Nigeria is yet to be determined but ranges from 3.5% to 13.5% in hospital-based reports.[7] Breast cancer in Nigeria and other developing countries is characterized by late presentation and poor outcome due to ignorance, superstition, self-denial, fear of mastectomy, and unavailability of treatment facilities.[5],[8],[9] Breast cancer presents a decade earlier in Nigerian women and indeed other African women with worse biological behavior and poor prognosis.[10],[11],[12],[13],[14],[15] African women enjoy a lower incidence of breast cancer than their Caucasian counterpart; however, incidence is increasing.[11],[16] The mortality of breast cancer in Western world is decreasing due to early detection and better management.[5],[17],[18]

The diagnosis of breast diseases can be achieved like in other clinical conditions using: history, physical examination, and investigation which include cytological or histological confirmation. Patients with breast lesions may complain of breast pain, breast lump, nipple discharge, nipple retraction, eczema or dermatitis of the areolar area (in Paget's disease), lymphedema of the breast and/or arm and features of metastasis in cases of advanced malignant breast diseases with pulmonary symptoms of cough or dyspnea; axillary lymphadenopathy; osseous deposits with bone pain and swelling; hepatomegaly and ascites. Breast lump which is one of the most common presentation of breast lesion can be detected by means of: breast self-examination (BSE), clinical breast examination (CBE), and mammography. Early detection and prompt treatment offer the greatest chance of long-term survival in patients with breast cancer.[19],[20] Mammography, CBE, and BSE are the secondary preventive methods used for screening in the early detection of breast cancer.[19] Cancer screening tests play a pivotal role in reducing breast cancer-related mortalities.[19] The American Cancer Society (ACS) recommends CBE and mammography in the early detection of breast cancer.[21] According to ACS recommendations, women should know how their breasts normally feel and report any breast changes promptly to their health care providers. BSE is an option for women starting from the early 20s.[19],[21],[22],[23] Beginning in their 20s, women should be told about the benefits and limitations of BSE. The importance of prompt reporting of any new breast symptom to a health professional should be emphasized. Women who choose to do BSE should receive instruction and have their technique reviewed on the occasion of a periodic health examination.

The ACS no longer recommends BSE as there are reliable data that breast cancer detection through BSE does not increase survival rates.[21],[24] However, BSE seems to be an important viable optional substitute available in rural areas where access to CBE and mammography is difficult and might still detect breast cancer early enough for treatment which can be offered to prolong women's lives and reduce suffering. For younger women, BSE training and adherence is a gateway health promotion behavior. It provides women with the knowledge that sets the stage for adherence to CBE and mammography screening guidelines later in life. For average-risk asymptomatic women in their 20s and 30s, it is recommended that CBE be part of a periodic health examination, preferably at least every 3 years.[21],[24] The examination should include BSE instruction for the purpose of gaining familiarity with breast composition. Information should be provided about the benefits and limitations of CBE and BSE, and it should be emphasized that breast cancer risk is very low for women in their 20s and gradually increases with age. The importance of prompt reporting of any new symptoms to a health professional also should be emphasized. Asymptomatic women aged 40 and over should continue to receive CBE as part of a periodic health examination, preferably annually.[21],[24] Beginning at age of 40 years, discussion during CBE should include information about screening mammography. For average-risk women, aged 40 and younger, earlier detection of palpable tumors identified by CBE can lead to earlier therapy. After age 40, when mammography is recommended, CBE is regarded as an adjunct to mammography.[24] There may be some benefit to performing the CBE shortly before the mammogram.[24]

The underlying premise for breast cancer screening is that it allows for the detection of breast cancers before they become palpable. Breast cancer is a progressive disease, and small tumors are more likely to be early stage disease, have a better prognosis, and are more successfully treated. The efficacy of breast cancer screening has been demonstrated in randomized controlled trials and observational studies;[21] thus, most organizations that issue recommendations endorse regular mammography as an important part of preventive care.[21] However, while it is true that screen-detected breast cancers are associated with reduced morbidity and mortality, the majority of women who participate in screening will not develop breast cancer in their lifetime.[21] Screening also will not benefit all women who are diagnosed with breast cancer, and it leads to harms in women who undergo biopsy for abnormalities that are not breast cancer, as well as those who are overtreated for ductal carcinoma in situ that might have been nonprogressive.[21] Thus, in addition to benefits, limitations of screening and harms associated with screening should be discussed with women before embarking on screening program.

Female health workers play very important role in patients' health education, especially with regard to breast cancer and screening. Even when female health workers are not directly involved in referring patients for breast cancer screening, they play an important role in creating an environment supportive of screening behaviors by offering positive role models.[25] It has also been observed that for health workers to be effective as educators they must possess the appropriate knowledge, attitude, and beliefs concerning the health behavior being promoted.[25] This study, therefore, aims at accessing the knowledge, attitude, and practice of breast cancer screening among female tertiary health workers.


 > Materials and Methods Top


Study design

This is a descriptive cross-sectional study carried out among female health workers at a University Teaching Hospital.

Study population

The study population is made up of all the female employees of the Teaching Hospital above the age of 20 years.

Sampling procedures

A nonprobability (convenience) sampling procedure was used to obtain the requisite sample size. Total sampling of all the female workers who gave their consent for the study was done.

Instruments and data collection

A structured, pretested, self-administered questionnaire was the tool for data collection. A verbal informed consent was obtained from all respondents. Information was collected on sociodemographic characteristics, knowledge of breast cancer, knowledge and practice of BSE, CBE, and mammography [Questionnaire [Additional file 1]].

Data analysis

The questionnaires were sorted out for completeness and data cleaning after which data were entered into and analyzed using Statistical Package for Social Sciences (SPSS) version 17 (SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc., USA). There was cross-tabulation of variables with level of statistical significance set at 95% confidence interval.


 > Results Top


A total of 200 questionnaires were administered and 182 were retrieved giving a response rate of 91%. Of the 182 questionnaires retrieved, only 160 were found adequate for analysis.


 > Discussion Top


Studies have been done on knowledge, attitude, and practice of breast cancer screening in Nigeria.[9],[20],[23],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35] A majority of the respondents in this study belong to the younger population. Eighty percent are below the age of 40 years with total age mean of 31.70 ± 7.62 years [Table 1]. This is lower than the age means of 35.3 ± 2.3 years and 40 ± 6.42 years in similar studies.[30],[32] Higher number completed their tertiary education, 139 (86.9%) with Nurses and Doctors making up the majority; 40.0% and 29.4%, respectively. Virtually all the respondents, 158 (98.75%) have heard of breast cancer. Large number probably because of nature of their profession heard it through lectures, books, hospital, and then media [Table 2].
Table 1: Sociodemographic data of respondents

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Table 2: Respondents' knowledge of breast cancer

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Almost all the respondents are aware of BSE, 158 (98.75%) and less number practiced it, 131 (81.9%). The majority of the subjects, 143 (89.4%) have been taught how to do BSE by their teacher, doctor, or nurse. Large number of the respondents have an idea when BSE should be started, 128 (80.0%) but only 93 (58.1%) knew that BSE should be done monthly. Furthermore, only 88 (55.0%) of the cases knew the best time to do BSE with 31 (19.4%) stating that it is best during menstrual flow and 41 (25.6%) having no idea on the best time to do BSE [Table 3]. Reasonable number of the respondents claim they do BSE, 131 (81.9%) but only 47 (35.9%) did it monthly and more respondents, 58 (44.3%) did it occasionally [Table 4]. Another 24 (15.0%) and 35 (21.9%) of the respondents stated that BSE is done using ultrasound and mammography, respectively. Greater number of respondents with higher educational level showed better practice of BSE (P = 0.006) [Table 5].
Table 3: Respondents' knowledge of breast self-examination

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Table 4: Respondents' practice of breast self-examination

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Table 5: Association between some characteristics of respondents and their practice of breast self-examination

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Awareness of CBE is also generally high among the respondents, 127 (79.4%). However, only 122 (79.4%) knew that CBE could be used for detection of breast cancer. Most of the respondents do not know how CBE is done as 30 (18.8%) thought it is done using ultrasound, 47 (29.4%) thought CBE is done using mammography machine and another 35 (21.9%) have no idea [Table 6]. Furthermore, only 36 (22.5%) of the cases recognized that CBE should be done yearly while the rest have other incorrect responses [Table 6]. More doctors than nurses and other health workers are aware of CBE (P = 0.008). The better awareness may be related to higher knowledge of breast cancer by doctors as noted in similar studies.[25],[30] The high knowledge recorded by the female doctors may not be unrelated to the content of their undergraduate curriculum which covered the subject under study.[30] Educational level in this study, however, did not significantly affect awareness and practice of CBE [Table 7].
Table 6: Respondents' knowledge and practice of clinical breast examination

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Table 7: Association between some characteristic of respondents and if they have ever heard of clinical breast examination

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The level of awareness of mammography was generally high among respondents, 144 (90.0%). Only 138 (86.3%) knew that mammography could be used as a tool for early detection of breast cancer. In addition, 67 (41.9%) of the respondents noted that mammography should be commenced from the age of 40 years and above while the rest responded inappropriately [Table 8]. Similarly, only 64 (40.0%) of the respondents knew that mammography should be done yearly. The level of education and occupation showed statistically significant correlation with the level of awareness of mammography, P: 0.020 and 0.000, respectively [Table 9]. This level of awareness of mammography is higher than 80.7% and 84% obtained by Akhigbe in Benin and Oche in Sokoto, respectively.[25],[30] However, the level of practice of mammography was very poor, only 3 (1.9%) of the respondents have ever done mammography. This corresponds to the findings in most other studies in Nigeria.[9],[20],[23],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35] The finding in this study can, however, be explained by the younger population with age mean of 31.70 ± 7.62 years who are still below the age that will benefit from mammography. Worrisome is the fact that the only three persons that ever did mammography were below the age of 30 years and the 32 persons above the age of 40, none ever did mammography [Table 10].
Table 8: Respondents' knowledge and use of mammography

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Table 9: Association between some characteristics of respondents and if they have ever heard of mammography

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Table 10: Association between some characteristics of respondents and if they have ever done mammography

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 > Conclusion Top


This finding impacts negatively on the success of breast cancer screening in Nigeria because for female health workers to serve as educators as well as role models they must believe in this particular course. Mammography which is still the gold standard of breast cancer screening still needs to be promoted to improve the attitude and practice among both the health workers and then the general population.

Recommendations

  1. Conferences and seminars should be organized regularly for health workers on breast cancer and other topical health issues to adequately equip them to function as role models
  2. Health education and talks on breast cancer and other common health conditions should be provided to the general public through schools and other mass media.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]


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