Knowledge And Practice Of Self Breast Examination Among Staff In Augustine University

Project and Seminar Material for Nursing (Science)

Knowledge And Practice Of Self Breast Examination Among Staff In Augustine University


Abstract


The study assessed the Knowledge, And Practice Of Self Breast Examination Among Staff In Augustine University with an aim of preventing breast cancer among women. The study was carried out using a descriptive cross sectional design where 143 respondents were used. These were selected by simple random sampling. Data was collected through self administered interviews and data was analysed by Microsoft excel and Chi-Square Tests.
Majority 81 (56.3%) of the respondents were between 18 and 30 years, 84 (58.7%) were married, 65 (45.7%) had secondary education, 50 (34.8%) were housewives, 118 (82.4%) were Christians and 131 (91.4%) had never had family members who suffered from breast cancer. Respondents had good knowledge about breast self examination because; all of them had ever heard of it where 77 (54.2%) heard from the media. Many rightly knew the signs of breast cancer 106 (73.8%). 112 (78.4%) knew that breast cancer could be detected early enough through physical identification of the signs and symptoms. 110 (77.2%) knew the right age BSE should be carried (above 19 years) and 123(85.8%) knew that it could be done by palpating with the palm and a minimum of three fingers. However, they did not know that it was only for females 82 (57%) and did not know it should be carried out weekly.
Respondents’ practices towards breast self-examination were generally poor. In the first instance few had ever performed BSE. The few; 55 (38.3%) who had ever done it, never did it regularly where 32 (58.6%) of them examined their breasts monthly, 31 (38.9%) had last examined their breasts six months ago and mainly did it in the evening 24 (46.2%).
Despite having good knowledge about BSE, they had negative attitude towards it where they did not believe that could detect breast cancer themselves which deterred their will to perform BSE. The researcher therefore suggests enhancing health education and sensitization to all females about the prevalence of breast cancer and the importance of BSE. Extensive health education campaigns should be provided to the community. Nurses should play role in developing a collaborative care model to provide education to the public.


Chapter One


Introduction

1.1 Background of the Study

Breast self-examination (BSE) is a screening method which involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling to detect early breast cancer. Breast self-examination is a simple, inexpensive, non-invasive procedure which helps a woman to know her breast and allows her to detect changes in the breast; such as breast masses or lumps (Burke et al., 2007).

Breast cancer is among the leading causes of cancer mortality in women worldwide. The incidence of breast cancer is rising more rapidly in population groups that enjoyed a low incidence of the disease (WHO, 2015).

The number of new cases of female breast cancer was 125.0 per 100,000 women per year. The number of deaths was 21.5 per 100,000 women per year. These rates are age-adjusted and based on 2009-2013 cases and deaths. Approximately 12.4% of women will be diagnosed with female breast cancer at some point during their lifetime, based on 2011-2013 data. In 2013, there were an estimated 3,053,450 women living with female breast cancer in the United States. In 2015, an estimated 231,840 new cases of invasive breast cancer will be diagnosed among women, as well as an estimated 60,290 additional cases of in situ breast cancer.

Breast cancer causes 376,000 deaths a year worldwide and about 900,000 women are diagnosed every year with the disease (WHO, 2016). In comparison of China and Europe, China exhibited lower breast cancer mortality rates of 6.6 per 100,000 (Zeng, 2010), while the respective mortality rate in Europe was equal to 16.1 (Ferlay, 2013) in accordance with incidence rates.

Globally, cancer is the top leading causes of death. It was estimated that 8.2 million people died of cancer in 2012 and Prevalence estimates for 2012 show that there were 32.6 million people alive who had had a cancer diagnosed in the previous five years. More than half of all cancers (56.8%) and cancer deaths (64.9%) in 2012 occurred in less developed regions of the world (IARC WHO, 2013).

Breast cancer accounts for 45% of all cancer in females aged 25–49 years and 34% of all cancer in the 50–74 year age group in the United Kingdom. The incidence in the age group between 15 and 24 is 3.1 per million of population in the UK (WHO, 2016). In the United States, the probability of developing breast cancer remains at 0.5% for women aged less than 39 years and 3.8% for women aged 40–59 years (WHO, 2016).

According to GLOBOCAN-2012 estimations, there were 14.1 million new cancer cases, 8.2 million cancer deaths and 32.6 million people living with cancer (within 5 years of diagnosis) worldwide, but 57% (8 million) of new cancer cases, 65% (5.3 million) of the cancer deaths and 48% (15.6 million) of the 5-year prevalent cancer cases occurred in the less developed regions (WHO, 2015). With regard to breast cancer (BC), about 1.3 million women are annually diagnosed with the affection worldwide and over 508 000 women died in 2011 from the disease, making it the top women cancer. Although BC is thought to be a disease of the developed world, almost 50% of breast cancer cases and 58% of deaths occur in less developed countries (WHO, 2015). The GLOBOCAN, (2012) reported the incidence of BC in East Africa close to 11.7%, second to cervix cancer with 27.1% estimated 5-year prevalence (IARC, 2015).
In Europe, an average of 20% of breast cancer cases occur in women younger than 50 years; 37% occur at age 50–64 and the remaining cases in women above this age (Europa, 2013)

In Turkey, a study (Karayurt, Ozmen and Cetinkaya, 2008) found low knowledge among adolescent females as to time for BSE (13.2%), frequency of BSE (21.8%) and BSE procedure (26.6%). In Europe a study reported that only 14.8% among students aged 17 to 30 years knew how to perform BSE. Close findings also were found in Malaysia (Zavare et. al., 2011), Yemen and Kuwaiti (Alharbi, Alshammari and Almutairi, 2012)

Another study in Jeddah Saudi Arabia indicated that 39.6% reported ever hearing of BSE, but only 14.4% and 7.1% respectively knew the correct frequency and timing. A study High School and College Students in Mid Western USA (Mafuvadze, Manguvo, He, Whitney and Hyder, 2013) concluded that annual efforts to disseminate breast cancer awareness and the availability of information about the disease, both college and high school students have a poor understanding of BC.

In 2015, approximately 40,290 women are expected to die from breast cancer. Only lung cancer accounts for more cancer deaths in women. In 2015, about 2,350 men will be diagnosed with breast cancer and 440 men will die from the disease. Excluding cancers of the skin, breast cancer is the most common cancer among US women, accounting for 29% of newly diagnosed cancers.

Globally, breast cancer is the most common malignant neoplasm among women (WHO, 2016). Breast cancer causes 376,000 deaths a year worldwide; about 900,000 women are diagnosed every year with the disease (WHO, 2016). Indeed, the incidence of breast cancer is rising more rapidly in population groups that enjoyed a low incidence of the disease (NK et al., 2009). Although the incidence of breast cancer in developing countries is relatively low (Ko et al., 2013), about 50% of all cases of breast cancer are diagnosed in these countries (Haji-Mahmoodi et al., 2012; Sadler et al., 2011).

In 2012, 1.7 million women were diagnosed with breast cancer and there were 6.3 million women alive who had been diagnosed with breast cancer in the previous five years in the world. Breast cancer is the most common cause of death and the most frequently diagnosed cancer among women in 140 of 184 countries worldwide. Incidence rate remains highest in more developed regions, but mortality is relatively much higher in less developed countries due to lack of early detection and access to treatment facilities ((IARC WHO, 2013).

Among women, breast cancer (BC) is the most common cause of mortality accounting for 16% of cancer deaths in adult women (WHO, 2016). Data from South Africa’s National Cancer Registry (NCR) shows breast cancer as the leading cancer among women. In Ugandan women, breast cancer is third most common cancer following Kaposi’s sarcoma and cervical cancer with incidence rate of 22 per 100,000 women (WHO, 2015). In Nigeria, the incidence of breast cancer has been reported to be 33.6/100,000 (WHO, 2015; Alkhasawneh, Akhu-Zaheya and Suleiman, 2009).
In the year, 2016, an estimated 246,660 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S and at the same time, 61,000 new cases of non-invasive (in situ) breast cancer are also expected. (Breastcancer.org, 2016) But in Asia, Australia had an ASR for breast cancer, at 86.0 per 100,000, in 2012 while China was with 2012 ASRs for incidence and mortality of breast cancer at 22.1 and 5.4 per 100,000 respectively. India’s 2012 ASR was 25.8 per 100,000 while Japan had a markedly lower ASR for breast cancer in 2012 of 51.5 per 100,000 and Singapore had an incidence ASR — 65.7 per 100,000 in 2012. (The Economist, 2016)

Among women in Iran, breast cancer is the commonest cancer comprising 21.4% of all cancers among females (Noroozi et al., 2010) and accounted for approximately one third of the registered female malignancies (Iraqi Cancer Board, 2010).

Although the incidence of breast cancer in developing countries is relatively low (Koet al., 2013), about 50% of all cases of breast cancer are diagnosed in these countries (Haji-Mahmoodi et al., 2012; Sadler et al., 2011). In the developing countries, the literature indicates that breast cancer presents about one decade earlier than in developed countries (Noroozi et al., 2010).

In Nigeria, et al (2009) reported that 97.3% of women had heard of breast cancer and breast self- examination. Indeed, most of the respondents, (85.8%) knew how to perform breast self- examination correctly. 65.4% had a good attitude towards breast self-examination This indicated a high level of awareness of breast cancer and breast self-examination among the respondents. Their attitude towards breast cancer and breast self-examination was fair though the practice was poor (Nk et al., 2009) The prevalence of BSE was 21%.

Among female university students, the percentage of adolescents performing BSE is also low all over the world. The findings among female university nursing students in Angola revealed that only 57.8% were knowledgeable about BC and its screening (Sambanje and Mafuvadze, 2012).

The third most common cause of death after infectious and cardiovascular diseases is cancer with breast cancer contributing to 23.3 % of cancer deaths in Kenya. Among the annual deaths in Kenya, Cancer is estimated to be responsible for 7% of the total annual deaths. (Health in Kenya, 2014). Meanwhile, the early discovery of breast lumps through breast self-examination (BSE) is important for the prevention and early detection of this disease.
In a study carried out in Rwanda, almost 95% of respondents had heard about BC, but less than 25% had sufficient knowledge about BC diagnostic methods, BC risk factors and BSE. More than 74% of interviewed girls never had BSE for breast cancer purpose, and of those who agreed doing BSE, only 4% knew the real timeframe of doing it, consistent with the studies by other researchers worldwide (Ndikubwimana et al., 2016).

In Uganda, the incidence of breast cancer is unknown, although reports show that breast cancer is the third most common cancer among women with an estimate of 56% five-year survival rate. (Gakwaya et al., 2008) This is attributed to breast cancer being an invasive and aggressive disease and is associated with a poorer prognosis in older women. Early detection rates through breast self-examination (BSE) plays an important role in decreasing the morbidity and mortality rates. (Gakwaya et al, 2008)

More so, evidence showed that knowledge and appropriate use of screening methods significantly reduced the mortality rates associated with breast cancer in the United States and the United Kingdom (Jemal, 2009) and little has been done regarding the assessment of knowledge and attitudes towards practice of breast-self-examination among women attending Uganda Cancer Institute which inspired the researcher to do this research study.
Despite the benefits associated with BSE, most of the women (71%) have no idea about mammography or self breast examination (Kiguli-Mulwadde, et al., 2010). More than 80% of women irregularly perform it and many do not even know how to perform it. There is also evidence that women are more likely to perform BSE effectively when taught by physicians or a nurse. The purpose of this study is to assess the Knowledge, And Practice Of Self Breast Examination Among Staff In Augustine University


1.2 Statement of the Problem

Breast cancer is the most common cancer causing the largest burden of cancer deaths in women worldwide. It is a global health problem of both developing and developed countries (WHO 2016). Among women, breast cancer (BC) is the most common cause of mortality accounting for 16% of cancer deaths in adult women (IARC-WHO 2012). Breast cancer is major health threat in Rwanda too. According to Globocan 2012), breast cancer accounts for 8.7% of cancer related mortality in Nigeria. Awareness and health seeking practices have been shown to be poor in many developing countries including Rwanda, necessitating the need for proper awareness programs (Montazeri et al. 2012; Khokhar 2014).This leads to a situation where most women with breast cancer are diagnosed in late stages due to lack of awareness on early detection and barriers to health services. A situation that can be reverted if adequate public health programmes are put in place. Although breast cancer awareness programs are being carried out throughout Nigeria, these have not primarily targeted rural women. We conducted this study to evaluate the knowledge and practices related to breast cancer prevention methods, among female in Augustine University.


1.3 Objective of the Study

The study assessed the Knowledge, And Practice Of Self Breast Examination among Staff In Augustine University. Specifically, the study aims:

  1. To assess the level of knowledge about breast self-examination among Staff In Augustine University.
  2. To examine the attitudes towards breast self-examination among Staff In Augustine University.
  3. To assess the practice of breast self-examination among Staff In Augustine University.

1.4 Research Question

  1. What is the level of knowledge about breast self-examination among Staff In Augustine University?
  2. What are the attitudes towards breast self-examination among Staff In Augustine University?
  3. To assess the practice of breast self-examination among Staff In Augustine University?

1.5 Significance of the Study

The study findings will help decision makers in designing strategies for raising awareness and practice regarding breast cancer prevention Staff In Augustine University. Furthermore, this study opened gates for future research, especially investigating for factors related to poor knowledge and practice with regards to breast cancer prevention Staff In Augustine University.

Information on knowledge and attitudes towards practices of BSE among women aged 20 to 25 years Staff In Augustine University will be presented from the study.

Findings will create awareness to the health professionals about the level of knowledge and the women’s attitudes towards practicing BSE thereby improving the quality of patient care through educating the patients and the community about BSE.

The results of this study will also provide the data that will be used by Ministry of health and NGOs to identify he educational needs of women as far as BSE is concerned and prevention of late presentation of breast cancer.

Findings will also provide the future scholars and researches with information regarding data on Knowledge, attitude towards practice of self-breast examination among women.


1.6 Scope of the Study

As a cross sectional study, a cause and effect relationship cannot be established to identify actual predictor. The study was focused on only reproductive age women and didn’t include older for whom concerns about breast cancer may be greater.


1.7 Limitation of the Study

This study is limited to a small sample size used in this study limited generalizing the study findings to the entire population of women in the state since all Staff In Augustine University did not have the same characteristics as those in other part of the country. In the limitation on research work of this magnitude or nature can be carried out without limitation. Hence, during the course, certain constraints were encountered.

Cost:

The cost of thorough research is not what can be afforded by a student. The prices of materials needed for this work has gone up and transport fee has also gone up.

Time:

The time was one of the limitations in the process of carrying out this research work.

Scarcity of Literature:

The research encountered some problems in collection of literature especially on the bank History and operations. This are hindered the smooth running of this work.


1.8 Definition of terms

Knowledge:

A familiarity, awareness, or understanding of someone or something, such as facts, information, descriptions, or skills, which is acquired through experience or education by perceiving, discovering, or learning (Oxford dictionary 2011

Practice:

The actual application or use of an idea, belief, or method, as opposed to theories relating to it (Oxford dictionary 2011).

Breast Cancer:

Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumour that can often be seen on an x-ray or felt as a lump. The tumour is malignant (cancer) if the cells can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. Breast cancer occurs almost entirely in women, but men can get breast cancer, too (American Cancer Society 2016).


1.9 Organizations of the Study

The chapter one consist of the introductory part of the study which includes the study background, the statement of the research problem, the study objective and scope of the study.

The second chapter is a critical review of other literatures relevant to the study and its objectives including the theoretical framework for the study. While the third chapter is methods of data collection, sampling and data analysis used in conducting the study. The fourth chapter centres around the research findings including an analysis of how it relates to previous findings. The fifth chapter consists of the summary of findings, conclusion and recommendations base on the study objectives.


Chapter Five


Conclusions and Recommendations

5.0 Introduction

This chapter includes; the major findings of the study and the suggested solutions to the problems found in the study


5.1 Conclusion

Majority of the respondents were between 18 and 30 years, married, had secondary education, were housewives, were Christians, had never had family members who suffered from breast cancer.

5.1.1 Findings on the knowledge on breast self examination

All the respondents had ever heard of breast self examination where they got the information from the media. Breast cancer was not common in the area. There was good awareness of the signs of breast cancer where; dimpling, puckering, or bulging of the skin were the commonest known signs. They knew that breast cancer could be detected early enough through physical identification of the signs and symptoms were aware that carrying out BSE would improve one’s chances of surviving cancer since cancer would be detected early. They knew that BSE should be carried out by people above 19 years when palpating with the palm and a minimum of three fingers.

5.1.2 Findings on the attitudes towards breast self-examination

There was negative attitudes towards breast self-examination because they perceived BSE as a sex abuse action and obscene, could never know whether they had breast cancer through BSE and didn’t believe that BSE helps in prevention of breast carcinoma. However, some believed that BSE can easily be done, couldn’t get breast cancer which makes BSE unnecessary, causes no physical harm and BSE may not necessarily lead to a positive cancer test.

5.1.3 Practices towards breast self-examination

Respondents’ practices towards breast self-examination were generally poor. In the first instance few had ever performed BSE. The few, who had ever done it, never did it regularly and by the time of the study they had taken long without examining them. They never did it at a right time as majority did it in the evening. However, they did not examine their breasts regularly and had taken long and never did not at a right time despite examining their breasts infront of a mirror.


5.2 Recommendations

5.2.1 Findings on the knowledge on breast self examination
  1. Breast cancer being uncommon in the area does mean its non existence. Therefore the government should enhance health education and sensitization about self examination its occurrence so that more people are made aware of it with not costs incurred.
  2. The health care providers should thoroughly educate females on how to perform breast self examination. This would help them to achieve reliable results when they perform it.
  3. The public should know that breast self examination is only for females with breasts and should self breast examination is for everyone even if healthy at the moment.
  4. Breast self examination should at least be done weekly or anytime one may feel or notice any unusual chance on the breasts.
5.2.2 Findings on the attitudes towards breast self-examination
  1. Women should refrain from the belief that breast self examination is obscene. It is part of a medical process that if done by an individual herself in privacy would not lead to embarrassment.
  2. Women and community member should know that if breast self examination is done through the right procedures, can help one to know whether they have breast cancer.
  3. All community members should seek the right knowledge about breast self examination. This would help them to know when they should start the practice, the right time when it should be done, places where to do it from and how to do it.
  4. All females should know that, breast self examination does not necessarily lead to a positive cancer test. It just helps one to identify any abnormalities that could be lead to cancer.
  5. Proper breast self examination is not harmful to the individual
5.2.3 Practices towards breast self-examination
  1. All women should carry out breast self examination most especially when they feel any unusual occurrence among them breasts.
  2. All females should regularly self examine their breasts even if they feel healthy. This should be done at least once every week.
  3. Breast self examination should be done in the morning when one is lying on the bed.
  4. They should also self examine their breasts infront of a mirror so that they view all its parts.

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