KNOWLEDGE AND PRACTICE OF BREAST CANCER SCREENING AMONG MARKET WOMEN IN ODEDA LOCAL GOVERNMENT AREA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

According to GLOBOCAN, 2008, breast cancer holds the position of being the second most prevalent form of cancer and the fifth leading cause of cancer-related mortality on a global scale. The aforementioned statement highlights the fact that breast cancer is the prevailing form of cancer in the female population, and it holds significant implications as a leading contributor to mortality rates associated with cancer among women. This information is supported by reputable sources such as GLOBOCAN in 2008, the World Health Organisation in 2013, and GLOBOCAN in 2012. Within the context of low- and middle-income countries (LMICs), the issue at hand continues to pose a noteworthy public health obstacle. This is evidenced by the fact that incidence rates have demonstrated an annual growth of up to 5%, leading to a projected influx of over 1 million new cases per year by 2020 (WHO, 2013; GLOBOCAN, 2012; Anderson, Shyyan, Eniu, Smith, Yip & Bese, 2006). It has been observed that there is an increase in the incidence rates of breast cancer in Sub-Saharan Africa, as reported by Forouzanfar et al. in 2011. It is worth noting that in Nigeria, there has been a notable increase in the prevalence of breast cancer.

Specifically, the incidence rate in the years 2009-2010 was recorded at 54.3 per 100,000 individuals. This data indicates a substantial rise, amounting to a 100% increase, over the course of the past decade (Jedy-Agba et al., 2012). Furthermore, it is worth noting that in the majority of developing countries and low resource settings, the diagnosis of breast cancer often occurs at advanced stages of the disease, resulting in a less favourable prognosis and a higher mortality rate when compared to more developed nations (World Health Organisation, 2013). The implementation of screening methods such as routine breast self-examination (BSE), clinical breast examination, and mammography in asymptomatic women plays a crucial role in mitigating the significant morbidity and mortality associated with breast cancer. By facilitating the early detection of breast cancer, these screening measures, as recommended by the World Health Organisation (WHO, 2013), not only expand the range of treatment options accessible to affected women but also enhance their chances of survival (Faronbi & Abolade, 2012). In resource-constrained settings such as Nigeria, the practice of BSE (Breast Self-Examination) is often recommended due to its ease of execution and convenience, as individuals can perform it independently and at no cost. Awareness, knowledge, and attitudes play a pivotal role in the implementation of breast cancer screening methods by women, as well as their subsequent adherence to conventional treatment. This task can be accomplished by individuals regardless of the women's social status or socioeconomic background. Nevertheless, there exists a dearth of information regarding the awareness, knowledge, attitude, and practices pertaining to breast cancer among market women. This knowledge gap is particularly significant considering the prevalent lack of formal education among the majority of market women in Nigeria. Various scholarly investigations have been undertaken to examine the knowledge and attitudes of Nigerian women pertaining to breast cancer and breast self-examination. It is worth noting that these studies have focused on distinct categories of Nigerian women, thereby extending beyond the specific population utilised by the researchers in question (Obaji et al., 2013; Olaogun et al., 2017; Banning and Ahmed, 2013; Gwarzo et al., 2009). Moreover, it is worth noting that there exist certain similarities between the study conducted by Oladimeji et al. in 2015 and the present study.

1.2 Statement of the problem

Breast cancer is the most common cancer, yet early detection can cure 70–80% of cases. If the tumour has spread, current breast cancer treatments are ineffective. Breast cancer is the most frequent cancer in women worldwide and the second most common cancer overall. Over 2 million breast cancer cases were diagnosed in 2018. Breast screening tools include mammography, self-breast examination, and clinical breast examination help detect breast cancer early and improve women's health.

Patient delay in seeking help, making therapy less effective and reducing survival rate, is linked to limited information among women regarding breast cancer symptoms, prevention, risk factors, and treatments. Women have low breast cancer screening participation due to low awareness, according to studies. Low- and middle-income nations without national screening systems have far lower cancer screening awareness and participation. Some studies have found that breast cancer screening for early diagnosis and treatment has increased survival and prevented recurrence and mortality. Early diagnosis relies on mammography, BSE, and CBE. Age, family history, genetics, gender, race, early menarche, late menopause, reproductive history, dense breast tissue, genomic alterations, obesity, alcoholism, radiation exposure, poor breast feeding, and lifestyle are breast cancer risk factors.8 Low breast cancer awareness leads to late diagnosis and high fatality rates. Inconvenient referral paths, insufficient therapy at regional cancer centres, and incomplete treatment regimens also lead to advanced breast cancer detection. In Nigeria, breast cancer incidence and mortality are rising, so cancer literacy is important, especially since the average age of diagnosis is 10 years younger than in Western countries. Assessing public cancer awareness and practice is necessary to create comprehensive and effective health programmes and treatment campaigns for early breast cancer identification.

1.3 Objectives of the study

The purpose of this study is to assess market women’s knowledge and practices regarding breast cancer and breast cancer screening. This category of women was chosen because they hardly take time off their normal daily routine to go for screening. Moreso, getting them aware and improving their knowledge and attitude towards screening could go a long way in reducing the rate of diagnosing breast cancer at advanced stages of the disease, reducing high fatality rate thereby leading to better outcomes. This study seeks to achieve the following objectives:

1. To determine if market women aware of breast cancer and its screening methods.
2. To find out if women know the changes to look out for in their breasts.
3. To find out if women know how often they should do breast self examination.
4. To find out market women’s breast cancer related attitudes.
5. To find out the level of the market women’s breast cancer related knowledge.
6. To find out market women’s breast cancer-related practices.
7. To find out the relationship between age and education with breast cancer-related awareness, knowledge, attitude and practice.

1.4. Research Questions

Specifically, the study seeks to answer the following seven research questions:

Are market women aware of breast cancer and its screening methods?

1. Do women know the changes to look out for in their breasts?
2. Do women know how often they should do breast self examination?
3. What are the market women’s breast and breast cancer related attitudes?
4. What is the level of the market women’s breast cancer related knowledge?
5. What are the market women’s breast cancer-related practices?
6. What is the relationship between age and education with breast cancer-related awareness, knowledge, attitude and practice?

1.5. Significance of the study

The importance of this study is tripartite in nature. First, it benefits women, especially market women who may have attributed less regard to the need for breast screening. Also, this study will inform statutory authorities on the need to expand the awareness of breast screening as a preliminary preventive mechanism. Finally, this study is significant as it contributes to knowledge.

1.6. Scope of the study

The scope of this study will be focused on market women in Osiele and Odeda markets in Odeda local government area of Ogun state.

1.7. Definition of terms

Breast cancer: A malignant tumor that can occur in the lobules or milk-producing glands or in the ducts that connect the lobules to the nipple (ACS, 2017).

Breast cancer screening: Searching for cancer cells before the symptoms are evident, so that it could be easier to treat cancer before spreading. It includes breast self-examination, clinical breast examination, and mammogram (NCI, 2017). The recommended screening by ACS is mammogram (ACS, 2017).

Mammographic utilization: In the context of this study, it means using breast cancer screening services, specifically mammogram (Kwok et al., 2016).