TABLE OF CONTENTS
Title page i
Approval page ii
Dedication iii
Acknowledgment iv
Table of contents v
List of tables vi
Abstract vii
CHAPTER ONE: INTRODUCTION
Background of the study 1
Statement of problem 5
Purpose of study 6
Objectives of the study 6
Research Questions 6
Hypothesis 7
Significant of the Study 7
Scope of the Study 8
Operational Definition of Terms 9
CHAPTER TWO: LITERATURE REVIEW
Conceptual Review 10
The Normal Breast 10
Concept of Breast Cancer 12
Risk Factors for Breast Cancer 14
Diagnosis of Breast Cancer 20
Concept of Breast Self-Examination 23
Awareness on Breast Self-Examination 23
Sources of Information on Breast Cancer and Breast Self-Examination 28
Practice of Breast Self-Examination 30
Empirical Review 39
Summary of Literature Review 49
CHAPTER THREE: RESEARCH METHODS
Research Design 52
Area of Study 52
Population of Study 53
Sample 53
Criteria for Inclusion 53
Sampling Technique 54
Instrument for data collection 55
Instrument validity 56
Reliability of the instrument 57
Ethical consideration 57
Procedure for data collection 58
Method of Data Analysis 59
CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
Presentation’s Demographic 60
Presentation of Result According to Research Question 61
Summary of Findings 91
CHAPTER FIVE: DISCUSSION OF FINDINGS
Discussion of Major Findings 94
Implication of the Study 113
Limitation of the Study 114
Suggestions for Further Studies 114
Summary 114
Conclusion 117
Recommendation 120
References 121
Appendix 126
LIST OF TABLES
Table 1: Showing the number of Women in Each Village and Their Sample Size 44
Table 2: Demographic Characteristics of Respondent 60
Table 3: Awareness of Breast Cancer among Women in Umuowa Orlu LGA 62
Table 4: Awareness of Breast Cancer among Women in the various Communities in Umuowa Orlu LGA 66
Table 5: Awareness of BSE among Women in Umuowa Orlu LGA 68
Table 6: Awareness of BSE among Women in the Various Communities Umuowa Orlu LGA 70
Table 7: Source of Information on Breast Cancer and BSE Awareness 72
Table 8: Frequency of Practice of BSE 75
Table 9: Procedure Observed in Practicing BSE 76
Table 10: Detection of Changes during BSE 78
Table 11: Practice of BSE among Women in the Various Communities 79
Table 12: Cross-Tabulation of Age and Practice of BSE 81
Table 13: Tests Statistic of Hypothesis One 82
Table 14: Cross Tabulation of Educational Attainment and Practice of BSE 82
Table 15: Tests Statistics of Hypothesis Two 83
Table 16: Cross-tabulation of Parity and Practice of BSE 84
Table 17: Tests Statistics of Hypothesis Three 85
Table 18: Cross- tabulation of Age Range BSE Awareness 86
Table 19: Tests Statistics of Hypothesis Four 87
Table 20: Cross- tabulation of Educational Attainment and BSE Awareness 87
Table 21: Tests Statistics of Hypothesis Five 88
Table 22: Cross- tabulation of Parity and BSE Awareness 88
Table 23: Tests Statistics of Hypothesis Six 89
Table 24: Cross-tabulation of Breast Cancer and Practice of BSE 90
Table 25: Chi- Square Tests 90
LIST OF FIGURE
Figure One: Model of the Study on Breast Cancer Awareness and BSE 37
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
