TABLE OF CONTENTS PAGE
Title page                                                                                                                     i
Dedication                                                                                         ii     Â
Certification iii
Approval iv
Acknowledgement                                                                                v     Â
List of tables                                                                                         viii
List of figures                                                                                          ix
Abstract                                                                                              x              Â
CHAPTER ONE: INTRODUCTION
Background to the study 1
Statement of the problem                                                                             5
Purpose and objectives of the study                                                     6
Research questions 7
Significance of the study 7
Scope of the study 9
Operational definition of terms                                                             9
CHAPTER TWO: REVIEW OF RELATED LITERATURE
 Conceptual review                                                                            10
Concept of breast cancer                                                                      10
Types of breast cancer                                                                   18
Staging and grading of breast cancer                                                19
Risk factors for breast cancer                                                                   22
Manifestations of breast cancer                                                         43
Epidemiology of breast cancer                                                                 44
Breast cancer screening guide/early detection practices                    53
Breast self examination: Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 54Â Â Â
Techniques for Performing BSE: Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 56
Factors affecting breast self examination                                60
Clinical breast examination (CBE): 62
Mammography 62
Biopsies 65
Breast ultrasound                                                                          67
Concept of reverend Sisters                                                                     76
Theoretical review                                                                                     81
Health belief model                                                                                        81
Empirical review                                                                                               86
Studies on knowledge of breast cancer and its early detection measures                                                                                                              96
 Summary of reviewed literature                                          102
CHAPTER THREE: RESEARCH METHODS
Research design                                                                                              105
Area of study                                                                                    105
Population of the study                                                                                106 Sample size                                                                                 106
Sampling procedures                                                                     108
Instrument for data collection                                                                       108
Validity of instrument                                                                            108
Reliability of instrument                                                                        109
Ethical considerations                                                                               109
Procedure for data collection                                                               110
Method of data analysis                                                                         110
CHAPTER FOUR: PRESENTATION OF RESULTS Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 108 Â
Summary                                                                             125
CHAPTER FIVE: DISCUSSION OF FINDINGS
   Discussion of major findings                                                          127 Â
  What the reverend sisters know as breast cancer                              127
  What the sisters attribute as risk factors/causes of breast cancer      128
Early warning signs of breast cancer identified by the respondents   129
Reverend sisters knowledge of early detection measures of BCa        130
Early detection measures the respondents know                                  131                       Â
Breast cancer preventive measures respondents know                            132
Respondents’ sources of knowledge on breast cancer                       133
How respondents do breast examination respondents                         134
Factors identified by respondents as militating against their use of                 detection and preventive health behaviours                              136
Conclusion                                                                                137
Implications to the study                                                                  138
Limitations of the study                                                                   139
Recommendations                                                                              140
Suggestion for further studies                                                           141  Â
Summary                                                                                      141
REFERENCESÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 144
APPENDICES
Appendix A: Questionnaire                                                                 149
Appendix B: PPMCC calculation for reliability of instrument               153
Appendix C:Introduction letter from the Department                           156
Appendix C: Ethical Approval letter                                                 157
LIST OF TABLES
Table 1:Number and sample distribution of Sisters from various congregations 107
Table 2: Socio- demographic characteristics of the respondents             112
Table 3: What breast cancer means to the respondents  (n = 324)  113  Â
Table 4: Breast cancer risk factors/causes identified by the respondents 114
Table 5: Early warning signs of BCa identified by respondents 116
Table 6: Breast cancer early detection practices respondents know 118
Table 7: Breast cancer preventive measures respondents know 119
Table 8: Respondents’ sources of information                            120
Table 9: How the respondents do breast examination                          121
 Table 10: When respondents practice breast self-examination           122
Table 11: When respondents do clinical breast examination             123
Table 12: Factors identified by respondents as militating against their use
of detective and preventive health behaviours                          124
LIST OF FIGURES
Figure I: Conceptual model for the study 86
Figure II: Responses on whether women who had prolonged exposure
to ovarian hormone have high risk of developing  breast cancer  115
Figure III: What breast examination means to the respondents              117
ABSTRACT
This study assessed the knowledge of breast cancer and
early detection measures of reverend sisters in Anambra State. Eight objectives
and eight research questions were raised to guide the study. Cross-sectional
descriptive survey design was used. A sample size of 324 respondents was drawn
from an estimated population of 794 sisters of the various congregations living
in communities located in Anambra State through stratified, proportionate and convenient
sampling techniques. Data were collected by administration of a 17-item
self-developed questionnaire through personal contacts by the researcher and 3 research assistants. Data were
analysed descriptively using
frequencies and percentages. Unpaired t-test was used to compare the responses
of the two groups of respondents. There
was significant difference in the knowledge of breast cancer preventive
measures among the respondents. Only 61 (18.8%) of the sisters described breast
cancer as uncontrolled multiplication of breast tissue. As many as 52 (16.0%) of the respondents had no idea
of what breast cancer means. Painless lump was identified by 141 (43.5%)
respondents as the early warning sign of breast cancer. There was no
significant difference in the awareness of early warning signs/symptoms of
breast cancer among the two groups (0.7438>p0.05) and what the two groups knew
as breast examination (0.8608>p0.05). Most popular breast cancer early
detection practices identified was breast self examination. More sisters in the
active group seem to be aware of this than the contemplatives. A good number of them had never done breast
self examination 50 (15.4%) and clinical breast examination 158 (48.8%). As
many as 148 (45.7%) respondents were not aware of where to obtain the services,
and 73 (22.5%) avoided the detection measures because of fear of lumps. Not
being aware of where to obtain the services was a factor to reckon with, while
at the same time, the sisters preferred to live in ignorance for fear of a lump
being detected. Congregations should establish policy guidelines aimed at
promoting adequate and urgent dissemination of all relevant information about breast
cancer; and, integrate breast cancer screening procedures into their curriculum.
There should be free access to screening services in the government health
institutions.
CHAPTER ONE
INTRODUCTION
Background to the study
Breast cancer (BCa) is a malignant tumour that has developed from breast cells, which has no cure at present. However, it can be managed with modern technological tools, and one’s life can be prolonged. In the last four decades, with the introduction of screening programmes that efficiently detect cervical cancer in its early stage, BCa has been seen to overtake cervical cancer in incidence and has become number one neoplasm among women (Okolie, 2012). BCa has therefore become a worldwide major health problem. The vast majority of it occur invasively in women (National Cancer Society [NCS], 2013). It accounts for 16% of all female cancers, and 22% of it are invasive. In both men and women, it accounts for 18.2% of all cancer deaths (NCS, 2013). Adebamowo and Ajayi (2006) corroborate the opinion of NCS and maintain that BCa is the commonest cancer among women in the world and in Nigeria too.
Adebamowo and Ajayi (2006) opine that it has become the commonest malignancy affecting Nigerian women. Also, according to Smeltzer, Bare, Hinkle and Cheever (2010), among the ten leading types of cancers by gender determined on the basis of estimated new cases and deaths in the United States in 2004, BCa accounts for 32% and the highest in female while prostate cancer accounts for 33% in males, which is the highest among them. Some of its common threats to physical wellbeing according to Adejumo and Adejumo (2009) include effects of treatments, recurrence and metastasis, fatigue, arm and shoulder discomfort, as well as lymphedema.
Unfortunately, Nigeria (which is the home country of the reverend sisters that are the focus of this study) remains ill-equipped to deal with the complexities of cancer detection and care as the testing and care facilities are still very few. The prevalence of BCa within the country is 116 per 100,000, and 27,840 new cases were expected to develop in 1999 (Adebamowo & Ajayi, 2006). In 2005, between 7 and 10,000 new cases of BCa developed.
This increasing incidence of BCa in Nigeria is in line with the situations in other developing countries, and even those advanced countries that used to have a low incidence now record high incidence. The relative frequencies of BCa among other female cancers, from Cancer Registries in Nigeria were 35.3% in Ibadan, 28.2% in Ife-Ijesha, 44.5% in Enugu, 17% in Eruwa, 37.5% in Lagos, 20.5% in Zaria and 29.8% in Calabar (Banjo, 2004 ). Similarly, in all the centres, except Calabar and Eruwa, BCa rated first among other cancers.
Further reports showed that majority of cases occurred in premenopausal women, and the mean age of occurrence ranged between 43–50 years across the regions. The youngest age recorded was 16 years, from Lagos (Banjo, 2004). This trend was attributed to several factors such as: the acceptance of fine needle aspiration as an accurate diagnostic evaluation, and increased awareness about BCa and usefulness of breast self-examination (Thomas, 2000).
Several other factors are responsible for this increasing detection, but the most important in the researcher’s view are: increased access to diagnostic facilities;empowerment of women, which is increasing women’s ability to make independent decisions about their own health-care; increasing westernization of dietary products;and physical activity; obstetric and gynaecological factors among others. Conventionally, breast self-examination (BSE) is the easiest and simplest procedure for detecting breast masses because a woman who knows the texture, contour, and feel of her own breasts is far more likely to detect changes that may develop (ACS, 2007).
The above notwithstanding, the American Cancer Society (2010) made the following recommendations: monthly self breast examination (SBE) beginning at the age of 20, from the fifth day of the menstrual cycle to one week following menstruation; clinical breast examination every three (3) years, from age 20 to 40, then annually, beginning at age 40; and mammogram, at age 40, and above annually. Adejumo and Adejumo (2009) recommend that in addition to the above promotive health behaviours, needle aspiration may be performed when ultrasound reveals a suspicious lesion. The researchers advanced that imaging techniques offer new and emerging technologies that aid diagnosis of the disease at its rudimentary stage.
Anecdotal knowledge and experience have revealed that the knowledge of preventive and promotive health behaviours of reverend sisters is highly militated against, probably owing to their life-style, ignorance and fear on their part, and inability of the health team to create adequate awareness. This, may lead to increase in the rate of high sisters mortality, sequel to BCa, as evidenced by the number of deaths (7), recorded by the congregations, which occurred in quick succession. Such deaths would have been averted if the sisters were responsive to preventive health behaviours of early BCa detection practices. Moreover, early detection of BCa will lead to early intervention at an early phase of cancer progression, resulting in improvement in years of survival for the clients/sisters.
There are two categories of reverend sisters, the contemplatives and the active ones. The active reverend sisters are the sisters that live in convents from where they interact and operate with the outside world, committing themselves to some hours of private and community prayers. The conservatives are popularly known as nuns who live in monasteries and take vow of stability, in addition to the vows of chastity, poverty and obedience. They live strict life of enclosure.
There is an urgent need to assess the knowledge of BCa and its preventive health behaviours among the different congregations for early detection and prompt intervention, so as to avert deaths sequel to its occurrence. Okolie (2012) maintains that BCa is now a manageable disease, and attributes this to early diagnosis and advances in surgical techniques, chemotherapy and radiation, with the main thrust being, early diagnosis. The reverend sisters therefore have a role to play in diagnosis by performing monthly breast self examination (BSE), obtaining routine screening, via mammography and seeing a health professional for regular breast examinations, as well as going for ultrasound (though secondary), in order that BCa could be detected early enough for prompt intervention/s, given their nulliparous nature. The researcher’s concern is basically to find out what reverend sisters in Anambra State know about BCa and what they do towards its early detection.
Statement ofProblem
