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CHAPTER ONE
Purpose of the Study
The purpose of the study was to explore the level of the knowledge and practice of breast self examination among women of child bearing age in University of Uyo Teaching Hospital of the Uyo Metropolis in the Akwa Ibom state, Nigeria.
CHAPTER TWO
REVIEW OF RELATED LITERATURE
The purpose of the study was to assess the level of knowledge, attitude and practice of breast self-examination among women of child bearing age. For the purpose of this chapter researches, articles, books and journals on BSE were read and literature was reviewed under the following sub-headings because they form the variables of the study. Specifically, the literature was reviewed on;
- The Breast Self-Examination Concept
- Screening Methods for Breast Cancer
- Knowledge on Breast Self-Examination
- Practice of Breast Self-Examination
- Attitude on Breast Self-Examination
- Summary
Screening Methods for Breast Cancer
Breast cancer is by far the most frequent cancer of women (23% of all cancers), with an estimated 1.15 million new cases in 2002, ranking second overall when both sexes are considered together. More than half of the cases are in industrialized countries about, 361,000 in Europe (27.3%) and 230,000 in
North America (31.3%). Incidence rates are high in most of the developed areas (except for Japan, where it is third after colorectal and stomach cancers), with the highest age-standardized incidence in North America (99.4 per 100,000) (Jemal, Clegg & Ward, 2004).
Breast cancer is the most commonly diagnosed cancer and common cause of death in women in the world. Current estimates by International Agency for Research on Cancer (IARC) for the global disease burden of breast cancer in the year 2002, estimates that there were approximately 1.15 million newly diagnosed cases and approximately 411,000 deaths as a result of cancer (Parkin, Bray, Ferlay &Pisani, 2002). Incidence, mortality, and survival rates vary fourfold across the world’s regions because of underlying differences in known risk factors, access to effective treatment, and the influence of organized screening programs (Althuis, Dozier, Anderson, Devesa & Brinton, 2005). Incidence and mortality rates tend to be higher in high-resource countries and lower in lowresource countries. Conversely, fatality rates tend to be higher in low-resource countries (Parkin et al, 2002).
In part, the high incidence in the more affluent world areas is likely because of the presence of screening programmes that detect early invasive cancers, some of which would otherwise have been diagnosed later or not at all
(IARC Handbook on Cancer Prevention, 2002). The incidence is more modest in Eastern Europe, South America, Southern Africa, and Western Asia, but it is still the most common cancer of women in these geographic regions. The rates are low (<30 per 100,000) in most of Africa (with the exception of South Africa) and in most of Asia. The lowest incidence is in Central Africa (ASR, 16.5 per 100,000) (IARC Handbook on Cancer Prevention, 2002).
The observation in many countries world over is that incidence of breast cancer are increasing. Based on current estimates of an average annual increase in incidence ranging from 0.5% to 3% per year, the number of new cases projected to be diagnosed in 2010 is 1.4–1.5 million (Parkin et al., 2002).
In 2002, global summit conference attendees recommended a stepwise process for building the foundation for achieving earlier detection, as follows: promote the empowerment of women to seek and obtain health care; create the infrastructure for the diagnosis and treatment of breast cancer; promote early detection through breast cancer education and awareness. The report also recommended that if resources are adequate, early detection efforts should be expanded to include mammographic screening, since it offers considerably greater potential to reduce the incidence of advanced breast cancer than programs limited to earlier diagnosis of symptomatic breast cancer (Althuis, Dozier, Anderson & Devesa, 2005).
In the United Kingdom, Stockton, Davies, Day and McCann, (1997) found that in the 1980s before the National Breast Screening Programme (NBSP) began, the rate of advanced breast cancer fell dramatically, and it is believed that this down staging was due to increased awareness that resulted from the greater presence of public education messages about early detection. A similar pattern was observed in Yorkshire, where a generalized shift toward a more favourable stage at diagnosis that could not be attributed to screening was observed before a reduction in mortality (Pisani & Forman, 2004).
Over 100,000 women a year in the United States are diagnosed with breast cancer, and the risk increases dramatically with age, with women at age 50 more than twice as likely to have breast cancer as women age 40years(Young, Percy, & Asire, 1981). Breast cancer is reported to be a disease of both the developing and developed worlds. It is the leading type of cancer in women. Among Turkish women, breast cancer represents 24.1% of all cancers seen in women and is the second leading cause of cancer-related deaths and about 2,390 new cases of breast cancer were diagnosed in 1999 in Turkey (Online breast cancer resource, 2005). As age increases the risk of breast cancer increases. Inherited genetic mutations, family history and biopsy-confirmed hyperplasia are primary factors that increase the risk factors of breast cancer (American Cancer Society, 2005).
Early detection and prompt treatment offer the greatest chance of longterm survival (Sadler, Dhanjal, Shah, Ko, Anghel & Harshburger, 2001). Mammography, clinical breast examination and breast self-examination (BSE) are the secondary preventive methods used for screening in the early detection of breast cancer (Fung, 1998). Cancer screening tests play a pivotal role in reducing breast cancer related mortalities (Tang, Solomon & McCracken, 2000). The American Cancer Society (ACS) recommends CBE and mammography in the early detection of breast cancer (Smith, Saslow, Sawyer, Costanza, Evans, Foster, Hendrick, Eyre & Sener, 2003).
In low-income countries, early breast cancer constitutes only 30% of the entire breast cancer load compared to 70–80% in the developed nations (Chopra, 2001). Consequently, 5-year survival rates in developing countries range between 10% and 40% compared with over 70% in developed nations (Okobia & Osime, 2001).
In recent decades, the early detection of breast cancer has been accomplished by physical examination by a clinician (CBE), by the woman herself, or by mammography. Standardization of mammography practices enacted by the Mammography Quality Standards Act has led to improved mammography quality (Saslow, Hannan, Osuch, Alciati, Baines & Barton, 2004).
In trials that demonstrated the effectiveness of mammography in decreasing breast cancer mortality, screening was performed every 12 to 33 months. The evidence indicates that a large proportion of the benefit of screening mammography is maintained by biennial screening, and changing from annual to biennial screening is likely to reduce the harms of mammography screening by nearly half. At the same time, benefit may be reduced when extending the interval beyond 24 months. Screening for high risk individuals by BSE or CBE was maintained at once a month and quarterly for low risk individuals (Saslow et al., 2004).
CHAPTER THREE
METHODOLOGY
The purpose of the study was to assess the level of knowledge, attitude and practice of breast self-examination among women of child bearing age. This chapter elaborates on the methods used to conduct the study. It contains research design, population, sample and sampling procedure, instrument, data collection procedure, and analysis procedures.
Research Design
The study is a descriptive design that collects information on the knowledge; attitude and practice of breast self-examination among women of child bearing age in Uyo Metropolis in the Western Region. Gay (1987) stresses that a descriptive survey method is useful for investigating a variety of educational problems including assessment of attitudes, opinions and demographics.
CHAPTER FOUR
RESULTS AND DISCUSSIONS
The purpose of the study was to explore the level of knowledge, attitude and practice of breast self- examination among women of child bearing age in University of Uyo Teaching Hospital of the Uyo Metropolis in the Akwa Ibom state, Nigeria.
It would be realised that some of the responses presented in the tables did not add up to the total number of respondents (126). This is because some of the respondents did not respond to some of the questions. The presentation was in line with the way the research questions were formed. The arrangement was first general and later separated to represent the details of the different ranks used in the study. The second part of chapter four involved a discussion of all the findings.
CHAPTER FIVE
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
Summary
The purpose of the study was to assess the level of knowledge, attitude and practice of breast self-examination among women of child bearing age in University of Uyo Teaching Hospital, Uyo Metropolis in the Akwa Ibom state, Nigeria. This chapter presents the summary, conclusions and recommendations of the study. Suggestions for further research have also been covered.
Overview of the Study
For the purpose of this chapter researches, articles, books and journals on BSE were read and literature was reviewed under the following sub-headings because they form the variables of the study.
- Screening Methods for Breast Cancer
- Knowledge on Breast Self- Examination
- Practice of Breast Self-Examination
- Attitude on Breast Self-Examination
Five research questions were formulated to guide the study. The descriptive design was used to conduct the study. The accessible population consisted of 229 women of child bearing age attending the regional hospital in the Uyo
Metropolis where the sample population was selected (Western Regional Health Directorate, 2013). A sample size of 130 nurses was considered representative enough for the study. The purposive sampling method was used to select the category to be used for the study. The nurses who were chosen for the study have had not less than three years standing experiences. The instrument for the data collection was a researcher-developed questionnaire. For socio-demographic data such as age group, religion and sex (items 1-5), summary tables of frequency counts and percentage scores were used to present the demographic characteristics of the respondents. Research questions one to three were analysed using frequency counts and percentages to report on the knowledge, attitude and practices of nurses on BSE. Also, chi-square test of independence was used to analyse the research questions since data collected was in the ordinal scale of measurement in view of the fact that the groups are in ranks.
Key Findings
- Virtually all respondents had knowledge on breast self- examination. Most respondents had a singular source of information on BSE .About 40% of the auxiliary had the source from the television which is not encouraging.
- Generally a high level of positive attitude towards breast self- examination was observed .
- Nurses practice on breast self-examination was encouraging but Observation showed that most respondents were of the opinion that breast self-examination was for females only but males also perform BSE to detect cancer.
- The knowledge level of the nurses was not significantly dependent on the category of various nurses
Conclusions
The knowledge of the women of child bearing age in the present study was satisfactory. The nurses knew the importance of BSE and were concerned about its practice except that some did not know that men also perform Breast self-examination
Recommendations
- The finding that some of the nurses did not practice BSE suggests that there is a need for continuing nursing education programmes.
- Emphasis should be laid on BSE in undergraduate and postgraduate courses and other certificate awarding nursing training schools as they are mostly involved in patient care and education.
- The mass media should be used to disseminate information on BSE to enhance effectiveness particularly among the study group who has been found to be well educated enough for adequate impact.
- Health workers should intensify health education on the importance of BSE when they come in contact with the populace especially during antenatal and immunization clinic sessions.
Suggestions for Further Research
This study looked at the level of knowledge, attitude and practice of breast self-examination among women of child bearing age in the University of Uyo Teaching Hospital in the Uyo Metropolis. Further research could be conducted to cover an expanse population, also male nurses should be included in the study.
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