ASSESSMENT OF KNOWLEDGE AND PRACTICE OF BREAST SELF-EXAMINATION AMONG WOMEN OF REPRODUCTIVE AGE IN THE MOLYKO COMMUNITY, BUEA

Abstract

Background: 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. Though 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. Methods: 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 analyzed. Results: Of the 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 tumor 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). c 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 tumor 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. But 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 world average; estimated at 2625 per 100,000 women with 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. Research Questions

1. What knowledge do women of reproductive age in the Molyko Community have on breast cancer?
2. What knowledge do women of reproductive age in the Molyko Community have on breast self-examination?
3. What practices are undertaken regarding breast self-examination among women of reproductive age in the Molyko Community?