Assessment Of Breast Cancer Awareness Among Nigeria Nursing Mothers In Nasarawa State

Assessment Of Breast Cancer Awareness Among Nigeria Nursing Mothers In Nasarawa State

Abstract

A descriptive cross sectional study conducted at Lafia, Nasarawa State to determine the level of awareness of women/nursing mothers about breast cancer, was done by administering interviewer’s schedule to 106 respondents who were nursing mothers.

Demographically, they were young and middle aged mothers, with minimal educational level and low socio-economic status.

Pertaining the knowledge about the risk factors of breast cancer, a good number of mothers did not know the real risk factors that can predispose one to breast cancer. Mothers had little knowledge about clinical features of breast cancer and self-breast examination.

It can be concluded that mothers interviewed had limited knowledge about risk factors, and clinical features of breast cancer.

Mothers do not know that breast cancer affects both men and women.

There is need to uplift the educational and economic status of this people. Also there is need to health educates mothers about breast cancer in the area.

Chapter One

Introduction

1.1 Background of the Study

Breast cancer is an uncontrollable growth that starts in the cells of the breast. It is found mostly in women, but men can get breast cancer, too. Here we will only talk about breast Cancer in women. To understand breast cancer, it’s important to know something about the normal parts of the breasts.

A woman’s breast is made up of glands (called lobules) that make breast milk, ducts, Fats and connective tissues, blood vessels and lymphatic system. Most breast cancers begin in thecells that line the ducts (ductal cancer), some begin in the lobules (lobular cancer), and asmall number starts in other tissue. The lymph system and blood is one of the main ways in which breast cancers can spread. Breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes and metastases to other organs (www.cancer.org).

Breast cancer continues to remain the most lethal malignancy in women across the world. In 2008, approximately 1.4 million women were diagnosed with breast cancer worldwide with corresponding 460000 deaths. Of these, approximately 450000 women were diagnosed with the disease in Europe with a corresponding 140000 deaths, while 68000 women were reportedly diagnosed with the disease in Africa with a corresponding 37000 deaths .A number of studies have suggested that there are epidemiological differences between breast cancers among women in Europe and Africa. Risk factors such as menopause, oral contraceptive use, cigarette smoking, and family history of breast cancer have been shown to have different relations to breast cancer among blacks and whites (J. Ferley at el, 2008).

Globally the cancer burden is on the increase especially in the developing world. WHO estimates that most of this increase will be in the developing countries especially in Sub-Saharan Africa.

In Nigeria available statistics indicate that the incidence of breast cancer has been on the increase. It was 11 per 100, 0002 women in 1961, 22 per 100, 0002 women in 1995 and 36 per 100, 0002 women in 2009.

The 5 –year survival rate is 56% as compared to US with 89% and 76% for Europe. Breast cancer in Nigeria is common in young women with a median age of 41 years(ACS,2007).

Therefore, this research wants to discover the awareness of breast cancer among nursing mothers from (15-49) years. This is in the view of what nursing mothers knows about breast cancer.

1.1.1.0 Types of Breast Cancer

There are many types of breast cancer, but some of them are very rare. Sometimes a Breast tumor can be a mix of these types or a mixture of invasive and in situ cancer.

1. Ductal carcinoma in situ (DCIS).
2. Invasive (or infiltrating) Ductal carcinoma (IDC).
3. Invasive (infiltrating) lobular carcinoma (ILC).
4. Inflammatory breast cancer (IBC).

1.1.1.1 Causes of Breast Cancer

Certain changes in DNA can cause normal breast cells to become cancerous. So far, the causes of most of the DNA mutations that could lead to breast cancer are not known. We do know certain risk factors linked to the disease. It is not yet known just how some of these risk factors cause cells to become cancerous

1. Gender. Being a woman is the main risk for breast cancer.
2. Age. The chance of getting breast cancer goes up as a woman gets older.
3. Genetic risk factors. breast cancers are thought to be linked to inherited changes (mutations) in certain genes.
4. Family history. Breast cancer risk is higher among women whose close blood relatives have this disease.
5. Personal history of breast cancer. A woman with cancer in one breast has a greater chance of getting a new cancer in the other breast.
6. Dense breast tissue. Women with denser breast tissue have a higher risk of breast cancer.
7. Certain benign (not cancer) breast problems. Women who have certain benign breast changes may have an increased risk of breast cancer.
8. Menstrual periods. Women who began having periods early (before age 12) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer.
9. Breast radiation early in life. Women who have had radiation treatment to the chest area (as treatment for another cancer) earlier in life have a greatly increased risk of breast cancer. The risk varies with the patient’s age when she had radiation.
10. Alcohol. The use of alcohol is clearly linked to an increased risk of getting breast cancer.
11. Being overweight or obese. Obesity after menopause is linked to a higher risk of breast cancer.
12. Lack of exercise. Studies show that exercise reduces breast cancer risk. (www.cancer.org).

1.1.1.2 Signs and Symptoms of Breast Cancer

The most common sign of breast cancer is a new lump or mass. Other signs of breast cancer include the following.

1. Swelling of part or the entire breast.
2. Skin irritation or dimpling.
3. Breast pain.
4. Nipple pain or the nipple turning inward.
5. Redness, scaliness, or thickening of the nipple or breast skin.
6. A nipple discharge other than breast milk. (www.cancer.org).

1.2 Problem Statement

Breast cancer is a leading cause of death among women in West Africa with approximately 30000 new cases in 2008 and more than 16000 deaths. The incidence appears to be significantly lower in Eastern Africa with approximately 18000 new cases and a corresponding 10000 deaths during the same year. In Western Europe, the incidence is five times higher than that in West Africa. Furthermore, approximately 40000 deaths from breast cancer were recorded in 2008. The incidence is similar in Central and Eastern Europe with approximately 115000 new cases and more than 47000 deaths in 2008. (J.Ferly at el, 2008).In Nigeria, available statistics indicates that the incidence of breast cancer has been on the increase. However some organization like Nigeria women’s cancer support organization (UWOCASO) has already been set in order to create women’s awareness about breast cancer but this is still a challenge to most of the illiterate women and those in remote areas.

Therefore, the research will answer a fundamental question; to what extent do nursing mothers in Lafia, Nasarawa State knows about breast cancer occurrence.

1.3 Purpose of the Study

The purpose of this study was to determine the level of awareness of breast cancer among nursing mothers in Nasarawa State.

1.4.0 Study Objectives

1.4.1 General Objectives

To determine the level of awareness of breast cancer among nursing mothers in Lafia, Nasarawa State.

1.4.2 Specific Objectives

1. To determine the level of awareness of the women on associated risk factors of breast cancer.
2. To assess for the knowledge of Self Breast Examination among nursing mothers.
3. To assess awareness of women on the possible signs and symptoms of breast cancer.

1.5 Research Questions

Are nursing mothers in Nasarawa State aware of the risk factors, and signs and symptoms of breast cancer, and know about self-breast examination?

1.6 Scope of the Study

Questionnaires were used in getting information from nursing mothers in Lafia, Nasarawa State.

1.7 Justifications

Breast cancer has been a problem all over the world, as in Africa 68000 women were diagnosed with breast cancer as per 2008 report.

In Nigeria available statistics indicate that the incidence of breast cancer has been on the increase.

However, in Nigeria, women’s awareness to breast cancer is still unknown. A number of studies have been done but none have been done to determine the level of women’s awareness to breast cancer. I have designed a study to find out the level of awareness of nursing mothers in Lafia, Nasarawa State about breast cancer.

1.7 Organization of the Study

This proposal is organized into three chapters. Chapter one is on the general introduction and it consist of background to the study, statement of research problems, objectives of the study, significance of the study, research hypothesis, scope of the study and outline of the study.

Chapter two focuses on review of literature while chapter three contains the methodology. Chapter four is presentation of result and discussions while chapter five is the summary, conclusions and recommendations.

Chapter Five

Discussions, Conclusion and Recommendation

5.1. Introduction

This chapter entails the discussion, conclusion and recommendation of the findings. More emphasis has been put on the participants’ knowledge about breast cancer.

5.2. Discussion

5.2.1. Demographic Characteristics

The research subjects were nursing mothers from 15 to 49 years old from Lafia, Nasarawa State. They all participated on their own, however, others were unable to read and write, so special attentions were paid to them like reading and interpretation of the questionnaire.

This was basing on the study that reviews some of the epidemiological similarities and differences in breast cancer between white European women and black African women. Majority of women in Europe are postmenopausal when they present with breast cancer; however, the peak incidence among African women is in the premenopausal period. (R.M.Mayberry at el,1993).

Concerning the participants’ level of education in the study area, at least the majority of them had formal education, with 46% in primary level, 24.5% in tertiary level, 22.6% in secondary level and 8.6% who never attained any educational level. In this case most of the mothers stop at primary and secondary level and others never attained any educational level. When these mothers were asked about their level of education, they reported that most of them were raised up from a poor family background that can’t support their education on addition to the previous political insurgency of the Lord’s resistance army (LRA) in Northern Nigeria. This is most likely to become a predisposing factor to low level of awareness of breast cancer in the study population. On addition to that, this mothers has little knowledge about the utilization of health services in their catchment areas and always the traditional healers are taken as the first priority and they report to the health units after the complication has arises. Furthermore, the 24.5% of the women who attained tertiary education has some little knowledge about breast cancer because most of them had a chance to get the information from different media sources.

Pertaining the participants’ addresses, people from the rural areas dominated the exercises 68%.This is because they were easily approachable on explanation of the study purpose. 32% were from the urban and periurban areas. These were few because the majority of them were busy with their daily routine businesses. This study was seeking to compare the knowledge of women about breast cancer from rural area and urban centers. In this matter, there were no differences in the knowledge of women in the two localities, because the majority of the participants had almost the same level of education.

5.2.2. Participants’ Level of Awareness About Breast Cancer

The study revealed that an overwhelming majority, 95% of the participants had ever heard about breast cancer. When asked about the source of their information, the majority of the participants reported that they heard about breast cancer from more than one source of information. The leading source of information where most of the participants heard about breast cancer was from local radio stations (Fm) and televisions, followed by news papers and VHT, this makes up 83% of the participants’ source of information. This implies that most of the mothers in the study area are making proper use of those communication media. The local radio stations (Fm) contributes a lot in giving verbal information in local languages about health related issues which favours even the unlearned mothers compared to the news papers which only favours those who can read and write and only people in urban centers. However, there are also a quite number of people 17% who also reported that, they heard about breast cancer from the health facilities, friends and they also witnessed from those who are already victims and the treated ones who developed complications. By seeing it physically, this made most of the participants to become aware about the existence of breast cancer.

5.2.3 Participants’ Knowledge About the People and the Part of the Body Affected by the Breast Cancer

As it was seen earlier, the majority of the participants 73% reported that breast cancer occurs only in female breast mean while on the other hand, 23% of the participants said breast cancer occurs in both male and female breast. The 23% of the respondents are in line with the American cancer society. In this case breast cancer affects both male and female breast because both breast has the same compartment. 4% of the respondents reported that they have no idea where the breast cancer occurs exactly whether in female, male and female breast or in the cervix. However, none of the respondent reported breast cancer to occur in the cervix. For this matter more health talk show in local radio stations and other medias has to be put in place in order to create more knowledge about breast cancer occurrence if only 23% knows that breast cancer affects both male and female breast and 77% of the respondents does not know that breast cancer also occurs in male apart from female.

5.2.4. Participants’ Knowledge About the Risk Factors that can Predispose a Person to Breast Cancer

The study revealed that the majority of the participants were able to give at least more than one risk factor that can predispose one to breast cancer. 69% of the participant said that, our life style like smoking, alcoholism can probably predispose one to breast cancer. Furthermore, on addition to the life style, they also reported that breast cancer can also run in families. The majority of the respondents 69% had some knowledge about the risk factor of breast cancer according to the American cancer society, breast cancer occurs as a result of the damage to the DNA of the cell. The above risk factors mentioned by the respondents smoking and alcoholism are believed to be the ones responsible for the cell DNA damage and these damaged cell DNA can be inherited in the affected family line.(www.cancer.org). This is also in line with the respondents’ opinion that breast cancer can run in families. However, 31% of the respondents reported that they have no idea about the risk factors that can predispose an individual to breast cancer.

They said “Breast cancer is as a result of witch craft” in the community by the evil people. In this matter more emphasis has to be put in creating the awareness of women about the risk factors that can predispose one to breast cancer.

5.2. 5. Participants’ Knowledge About Clinical Presentation of Breast Cancer

It was clear that 89% of the respondents were able to correctly enumerate at least more than one clinical presentation of breast cancer like presence of new breast lamp/mass, breast pain, and nipple discharge other than breast milk. This is in line with the American cancer society for the clinical presentation of breast cancer. This knowledge was due to adequate dissemination of information about breast cancer in local radio stations and other media sources. 11% of the respondents admitted that they have no idea or any knowledge about the presentation of breast cancer in an individual. In this case more intervention has to be taken in the way of creating more awareness about breast cancer presentation on different Medias like local radio stations in local languages.

5.2.6. Participants’ Knowledge About Self Breast Examination

The study demonstrated that 54.7% of the respondents have ever done self breast examination and they were able to give out the features of an abnormal breast on doing self breast examination like breast pain, swelling of the breast and the presence of the new breast lamp or mass. Self breast examination is very important because it helps a mother or a woman to detect any abnormal changes in her breast on examination. 45.3% of the respondents reported that they have never done self breast examination however; they were able to point out the features of an abnormal breast as stated above. In this case much effort has to be put in to train mothers on how to do self breast examination in their daily life.

Furthermore, pertaining the features of an abnormal breast on doing self breast examination, 96% of the respondents were able to identify more than one feature of an abnormal breast like breast pain, swelling and presence of new breast lamp or mass on doing self breast examination. This implies that the majority of the respondents have knowledge about the abnormal features of a breast and proper utilization of health units and communication Medias. 4% of the respondents have no idea about the features of an abnormal breast on doing self breast examination. This implies that the coverage of communication Medias like local radio stations has to be extended to those areas such that people are able to hear more health talks on the local radio stations.

5.2.7. Participants’ Knowledge About Early Breast Cancer Diagnosis and Treatment that Will Lead to Quick Improvement

As seen earlier in chapter four, 98% of the respondents reported that according to their own opinion and other media sources, when one gets breast cancer and reports to the health units early and treatment is initiated in time, the prognosis will be good. This is in line with the American cancer society about breast cancer that “Early diagnosis and treatment” of breast cancer has a good prognosis. When these respondents were asked about their source of information about early breast cancer diagnosis and treatment, they had more than one source of information like hospital/ health units, local radio stations/television and VHT. This in total makes up 91.5% of the respondents and 8.5% of the respondents heard it from other sources like from friends and those who have ever suffered from breast cancer and reported to the health units as early as possible for treatment. However, 2% of the respondents reported that they have no idea about early breast cancer diagnosis and treatment that will lead to good prognosis. They reported that they lack enough information about that and all the time they are occupied with domestic work. In this case more communication services and health units have to be extended to these areas such that people get enough information about breast cancer in order for it not to become a challenge to the community and hence there was need for this research to be done.

5.3 Conclusion

Basing on the findings of the study, the following can be concluded;

1. Demographically, the majority of the participants were women of age group 15 to 25 and 26 to 35 years from rural areas with minimal educational level hence low knowledge about breast cancer.
2. Regarding the knowledge, the majority of the participants (95%) had heard about breast cancer except a few participants (5%) who had never heard about breast cancer.
3. Communication Medias are being utilized by the study population. The leading source of information where participants heard about breast cancer is radios or televisions and seeing it from the victims diagnosed with.
4. The majority of the participants know the risk factors of breast cancer and its clinical presentation in an individual except a few numbers of the participants who does not know.
5. Half of the participants have been doing self breast examination and knows the features of abnormal breast.
6. The majority of the mother knows that the prognosis for early breast cancer diagnosis and treatment is good.
7. Breast cancer is already in the study population and the

5.4. Recommendations

As signified by the findings of the study, the following recommendations were made.

1. The government should help improve the standard of living of the women especially those in remote areas who always have inadequate access to information.
2. The government should introduce routine free breast screening mammograms to the mothers and extend their services to the remote areas.
3. There is need to train more health workers including the VHT in order to disseminates health related information about breast cancer in the community during health education.
4. Organizations which are already in place has to be strengthened like Reproductive health that educates mothers about their health related issues and Nigeria women’s cancer support organization (UWOCASO) that fights hard in creating awareness about breast cancer.
5. The government has to boosts girl child education in the study area in order for them to become future mothers with adequate knowledge about breast cancer and their health related problems.
6. More research and information is needed on this subject because there is no related research about it in the study area and the population.

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