Assessment of Knowledge and
Practice of Breast Self-Examination among Women of Reproductive Age in the
Molyko Community, Buea
Department: Nursing
No of Pages: 62
Project Code: NS11
References: Yes
Cost: 5,000XAF
Cameroonian
: $15 for International students
ABSTRACT
Breast
cancer is a major health problem in the world. It is the most common cancer in
women and is equally the leading cause of cancer death in women. However, in
controversy, breast self-examination (BSE) remains a useful tool in early
diagnosis of breast cancer. This study aimed to evaluate knowledge and practice
of breast self-examination among women of reproductive age in the Molyko
Community, Buea.
A
cross sectional study design was used, where by a convenient sampling technique
was used to recruit participants for the studies. A structured
self-administered questionnaire was utilized to collect data.
Data
were entered in to excel 2013 and analysed. A total of 100 participants,
majority of the participants were within the age group 20-30 (67.3%) and had
heard about breast cancer (87.9%) with 74.2% knowing what it is and
demonstrated sufficient knowledge on its risk factors and sign/symptoms.
A
majority (52%) had adequate knowledge on breast cancer. With respect to Breast
self- examination (BSE), 73.7% had earlier heard of it with the main source of
information being health practitioners (61%) and media (25.6%). Only 34.1%)
knew correctly that BSE should be done monthly with about half of them
correctly citing 20 years and above as the appropriate age to perform BSE.
The
participants had adequate knowledge on BSE with knowledge being found to have a
link with age (p=0.0001), region of origin (p=0.0047) and educational level
(p=0.0005). Despite the high level of knowledge only 54.1%, had ever practiced
BSE with only 27.3% knowing correctly the appropriate time within the month to
carry out the practice.
Overall,
participants had poor practice of BSE. Knowledge also, was found to have a link
with practice (p=0.00005). Conclusion: Majority of the women had adequate
knowledge on breast cancer, BSE though with poor practice.
Increasing
the number of health campaigns and seminars, training of more health
practitioners to be BSE educators and maximizing the media as a useful platform
in disseminating health talks more on the practice of BSE will improve BSE
practice.
CHAPTER ONE
INTRODUCTION
1.1 Background
Breast
cancer (BC) is a major global health concern and a prominent reason of
mortality among females. It is the most frequent cancer among women globally,
impacting 2.1 million women each year, and is predicted to grow to
approximately 3.2 million new cases per year by2050 (Hortobagyi et al., 2005).
Breast
cancer is 100 times more common in women than in men (Mieszskowski et al,
2006). World Health Organization (WHO) in 2020 reported that breast cancer had
the leading incidence rate with 2.26
million new cases. Worldwide, breast cancer is the second most frequent cancer
and the fifth cause of cancer (WHO, 2022).
It
is the most common cancer to affect women and it is second only to lung cancer
as the principal cause of cancer-related deaths among women (GLOBOCAN, 2021).
In low- and middle-income countries (LMICs), it remains a significant public
health challenge as incidence rates have been shown to increase yearly by as
much as 5% (Ferlay et al., 2015).
According
to WHO 2018 report, the prevalence of breast cancer is increasing in developing nations as a result of a rising number of senior
citizens and lifestyle related breast cancer risk factors like eating unhealthy
foods, obesity, and using harmful substances.
Moreover,
the occurrence is mounting in the unindustrialized nations as a result of the
rising lifespan, urbanization, and embracing of western lifestyles. In
Cameroon, the incidence of BC is higher than the world’s average; estimated at
2625 per 100,000 women with a resultant high
mortality (Bray et al., 2008)
According
to the American Cancer Society (2020) BC is a disease in which cells in breast
tissue change and divide uncontrolled, typically resulting in a lump or mass.
Most breast cancers begin in the lobules (milk glands) or in the ducts that
connect the lobules to the nipple. Breast cancer typically has no symptoms when
the tumour is small, and most easily treated, which is why screening is
important for early detection.
The
most common physical sign is a painless lump.
BC can manifest at late stages in several signs ranging from pain, skin
changes, breast lump, abnormal breast discharges, nipple retraction and changes
in breast size to subclinical forms where no mass can be palpated (American
Cancer Society, 2016).
Lifestyle
related breast cancer risk factors like eating unhealthy foods, obesity, and
using harmful substances predisposes women in developing breast cancer
according to WHO 2018 report. Some of the known risk factors for breast cancer
can be modified by individual behavior to lower risk and others require
societal or systemic changes. (White et al, 2020).
Historically, ductal carcinoma in situ (DCIS)
and lobular carcinoma in situ (LCIS), also known as lobular neoplasia, were
considered the two main types of in situ breast cancer. However, LCIS is
generally believed to be a benign condition associated with increased breast
cancer risk, but without the potential to progress to invasive cancer (American
Cancer Society, 2020).
Breast cancer is the most frequently diagnosed
cancer in women worldwide with 2.26 million new cases in 2020 (Siegal et al.,
2019). Stage at diagnosis is one of the most important factors affecting
prognosis. Although early detection remains the cornerstone of breast cancer
control to improve outcome and survival, in low- and middle-income countries
breast cancer is diagnosed in very late stages.
Because
of poor access to diagnosis and treatment, women in low- and middle-income countries
generally have much poorer outcomes as well. In sub-Saharan Africa only 32% of
women that are still alive five years after a breast cancer diagnosis, compared
with 81% in the United States (Pace et al., 2016).
The
American Cancer Society recommends that women should be familiar with how their
breasts normally feel via breast self-examination (BSE) and report any breast
changes promptly to their health care providers. In addition, the Breast Health
Global Initiative (BHGI) guideline for low and middle-income countries suggests
BSE as the first step in preventing breast cancer (Anderson et al., 2003).
BSE
is an easy, expedient, non-invasive and no-cost way to check out women’s own
breasts to find any changes in their breasts that can be an early symptom of
breast cancer in the initial phase when the condition can be treated with
successful outcome and thus increasing survival rate from breast cancer.
BSE aids women by making them conversant about
how their breasts should look and feel thus leading to ‘breast awareness’ and
also enable them to identify changes in their breasts in the initial stage. It
can be performed on a regular basis, at any age and is suitable for low
resource countries (Hussain et al., 2013).
Though
still clouded in controversy, breast self-examination still has an important
role to play in the early detection of breast cancer in resource-constraint
settings where routine clinical breast examination and mammography may not be
feasible.
BSE
is important for enabling women become familiar with the feel and appearance of
their breast; and help them easily and quickly detect any changes that occur.
It has also been shown to improve breast health awareness and thus potentially
allow for early detection of breast anomalies (Suh et al., 2012).
The
American Cancer Society (2016) also recommends that women from the age of 20
years onwards should be educated on the benefits of performing BSE monthly. Although
inappropriate or inaccurate BSE enactment may produce both false positives and
false negatives for women, BSE is still regarded as a legitimate and realistic
alternative for early breast cancer screening in women (Yip et al., 2007).
In
order to perform BSE, the individual needs to possess the knowledge and skill
on doing so. Women who perform BSE correctly monthly are more likely to detect
a lump in the early stage of its tumour development, which is critical for
successful treatment and survival.
BC
treatment is multidisciplinary, combining locoregional and systemic therapies.
One of the major challenges for BC treatment is its heterogenous nature, which
determines the therapeutic options (Polyak, 2011).
According
to Ganesh et al., (2010), BC can be managed using the following therapies;
chemotherapy, gene therapy, non-drug therapies such as surgery and
radiotherapy. Also, Darby et al., (2011), says that breast conserving therapy
which is an operation to remove the cancerous cells while avoiding mastectomy,
according to multiple randomized clinical trials with follow- up of up to
20years have demonstrated that, is safer and has survival outcomes equivalent
to mastectomy in stage i and iv breast cancer.
Complications
of breast cancer can arise from the different treatment regimen for example;
surgical complications include permanent scarring, infection, pain. (Fadi et
al., 2021). Worth noting that, mammography screening is not a practical
approach to pursue breast cancer prevention due to its high costs for the
health system and individual women (in terms of out-of-pocket costs).
1.2 Problem Statement
The
emergence of breast disease and subsequent development of cancer appears to be
more aggressive in young women compared to its progression in older women
(Ameer et al, 2014). Delay in diagnosis and seeking proper treatment from the
primary symptomatic detection of breast cancer lowers the level of successful
treatment outcome and thus decreased survival length.
However,
most breast cancer patients are diagnosed in developing countries, including
Cameroon at an advanced stage due to a lack of understanding and inadequate
knowledge. In Cameroon, the incidence of breast cancer is higher than the
worlds average; estimated at 2625 per 100,000 women with a resultant high
mortality (Bray et al., 2013).
The
overall survival at 5 and 10 years for breast cancer in Cameroon is estimated
to be 30% and 13.2% respectively and is much lower than that of patients in
some developed countries, which is between 90% and 82% respectively at 5 and 10
years (Ngowa et al., 2015). In this regard, women need to be "breast aware"
by being able to identify the risk factors and symptoms of breast cancer as
well as risk reduction strategies(Carlson et al, 2017).
Generous
commitment to public education about breast cancer screening and detection
types, including the timely diagnosis, would save quite a lot of women’s lives.
However, there is evidence that comprehensive knowledge of BSE is still low in
many developing countries.
For
example, in a survey of 790 female household representatives in Southwest
Cameroon, only 25% demonstrated adequate knowledge of BSE and only 15% of those
with knowledge reported practicing BSE (Azemfac et al., 2019).
In
a similar study carried out among female undergraduate students in the
University of Buea, the main reason for not performing BSE as cited by the
respondents was the lack of knowledge. It’s against this backdrop that the
researcher sought to assess the knowledge and practice of breast
self-examination among women of reproductive age in the Molyko Community.
1.3 Rationale
Breast
cancer (BC) is a major global health concern and a prominent reason of
mortality among females. Although early detection remains the cornerstone of
breast cancer control to improve outcome and survival, in low- and
middle-income countries breast cancer is diagnosed in very late stages.
In
addition, what accounts or this is the act that most women are not conversant
about how their breasts should look and feel thus leading to ‘breast
unawareness’ and also making it difficult for them to identify changes in their
breasts in the initial stage of the cancer development. BSE, which is a
screening tool in the early detection of breast cancer and its practice, which
enables women to become ‘breast aware is not duly optimized by women.
This
is supported by recent studies carried out in Cameroon by Azemfac et al.,
(2019) where only 25% demonstrated adequate knowledge on BSE and only 15% of
those with knowledge reported practicing BSE. In a similar study carried out
among female undergraduate students in the University of Buea, the main reason
for not performing BSE as cited by the respondents was the lack of knowledge.
It
is against this backdrop that the researcher sought to assess the knowledge and
practice of breast self-examination among women of reproductive age in the
Molyko Community.
1.4. Research Objectives
1.4.1. General objective
- To assess the Knowledge and Practice of Breast Self-Examination among Women of Reproductive Age in the Molyko Community, Buea.
1.4.2 Specific objectives
- To assess the knowledge of breast cancer among women of reproductive age in the Molyko Community.
- To assess the knowledge of breast self-examination among women of reproductive age in the Molyko Community.
- To examine the practice of breast self-examination among women of reproductive age in the Molyko Community.
