Knowledge And Practice Of Breast Self Examination Among Women Of Child Bearing Age

INTRODUCTION
1.1 Background to the Study
Screening for early detection and diagnosis of diseases and health conditions is an important public health principle. Breast self-examination (BSE) is a process whereby women examine their breasts regularly to detect any abnormal swelling or lumps in order to seek prompt attention. Breast cancer according to a 2016 cross sectional study is the most common cancer in women both in the developed and developing countries with nearly 1.7 million new cases diagnosed each year which accounts 12% of new cancer cases and 25% of all cancers in women. Cancer is a major cause of death globally with over 8.2% deaths in 2012 (MC Guire S. & World Cancer Report 2014, Adv. Nutr. 2016). According to study, breast cancer is the leading cancer among women globally, claiming the lives of over thousands of women each year and affecting countries at all levels of modernizations (Bilimoria KY, Stewart AK, Winchester DP, & Ko CY, 2008). Breast self examination is a screening technique used in detecting early breast cancer which involves the woman herself looking at the mirror in a bid to feel each breast for possible lumps and distortions or swelling (Ferlay J, Soerjomataram I, & Ervik M et al, 2012).
In United States, over 230,000 women are estimated to have been diagnosed with cancer and 40,000 will die (American Cancer Society, 2016). Also in France the breast cancer at risk population increased from19 million in 1990 women to 21 million in 2010 (Akarolo-Anthony S.N, Ogundiran T.O & Adebamowo C.A, 2010). In Uganda, breast cancer have a five-year survival rate of 56% and incidence of 22:100,000 (Alkhasawneh I.M, Akhu-Zaheya L.M, Suleiman S.M. 2009). In Nigeria the incidence of breast cancer was reported to be 33.6/100,000 (Odusanya O.O., 2001).
Worldwide as well as in Nigeria, breast cancer has been reported as the most common cancer in women and the second leading cause of death. It has been observed that women of African-American Descent present in later stages of the disease with poorer outcomes than their Caucasian counterparts. This same trend has been reported among Nigerian women. Meanwhile, early discovery of breast lumps through breast self-examination (BSE) is important for the prevention and early detection of this disease. The American Cancer Society and the National Cancer Institute recommends periodical mammograms, Clinical Breast Examination and monthly BSE to detect breast cancer at an early stage. Studies from developed countries show that attitude and orientation of health care providers are important determinants of use of breast screening programs. For health workers to be effective and efficient as health educators, they must possess the appropriate knowledge, attitude and beliefs as regard the health behavior being promoted. Various risk factors have been implicated in the causative of breast cancer and these include; increasing age, hormone, replacement therapy (HRT), high-dietary fat, excessive alcohol consumption, smoking and family history among others.
A good knowledge of these risk factors by the health workers is very important in order to be well informed to teach others in their communities. Nevertheless, the practice of these screening methods is dependent on the awareness about breast cancer. If the knowledge is poor among those who are regarded as health role models, there will be difficulty promoting these life saving methods in the community. The purpose of BSE is to increase familiarity with breast, to detect presence of lump as stated above. Self-examination of the breast each month between the seventh (7th) and tenth (10th) day of the menstrual cycle is the simplest yet extremely way to detect breast cancer at the early stages of growth-the breast self-examination (BSE) involves palpation of the breast for lumps with the tips of the hand. The woman would be in the erect position, either sitting or standing and lying down. It has been observed that women can detect 95 % of breast cancers and 65% of early minimal breast cancers through BSE. As well stated above, effective management of breast cancer depends largely on its early detection through periodic mammograms. There have been overwhelming barriers to screening and treatment of cancer in developing countries. However, majority of the cancer patients present themselves late for treatments especially when little or nothing could be done often at times due to ignorance. This owes to the lack of knowledge regarding the risk factors, symptoms, screening methods and treatments associated with different cancers.
In Nigeria, the cost of breast cancer screening through mammography is very high and requires a specific manpower resource which makes it not very attainable. Breast self-examination remains the cheapest, non-invasive and simple to follow the procedure as it requires no special skill and material. This is an effective screening method for breast cancer that only takes five minutes to apply. The control of breast cancer in most developing countries including Nigeria is under the auspices of National Council Programs promoted by the WHO and this involves educating and screening women 15-49 years of age for signs of breast cancer. Control of cancer including breast cancer is through the organization of periodic screening campaign which are often not very effective since they are organized in only the major urban centers. In studies performed by Godazandeh & Nafissi et al. only 17 % and 12% of women respectively were observed to perform Breast self –examination (BSE) monthly. In a study, only 14% of nurses and midwifes were observed to regularly perform BSE. As a result, most cases of women diagnosed with breast cancer are usually in an advanced stage of the disease.
A study in Turkey indicated that breast cancer is the second leading cause of cancer related deaths among Turkish women. In Nigeria, cancer of the breast has overtaken carcinoma of the cervix in hospital incidence. A preliminary survey report from population based epidemiological study in Nigeria showed the prevalence of breast cancer to be 116 cases per 100,000 women per year. Awareness of risk factors and early warning signs of the disease among different groups were below average. BSE is an important, cheap and easy method for early diagnosis of breast cancer. Early diagnosis of breast cancer has a positive effect on the prognosis as well as limits the development of complications and disability. In a study conducted by Philip et al. 54 % of 304 patients with newly diagnosed BC claimed to practice BSE. It was found that those who performed BSE had reported their symptoms to health personnel sooner than the other subjects. In addition, in a meta-analysis of 12 studies including the study mentioned above, evidenced there the good benefit of practicing BSE.

1.2 Statement of the Problem
Breast cancer is the leading type of cancer in women both in the developed and developing countries with nearly1.7 million new cases diagnosed in 2012. It is also the leading cause of cancer death in women between ages 15-54 years. Every thirteen minutes a woman dies from it, a new case of breast cancer is diagnosed. The incidence and mortality of breast cancer are increasing in Africa and Asia.
According to the International Agency for Research on Cancer, over 67,000 new cancer cases were diagnosed in Ethiopia in 2018, and almost 48,000 people died from the disease that same year. Dr. Paul Mainuka, acting WHO Representative to Ethiopia said on the occasion of Cancer Center on World Cancer day said, “Cancer is becoming a major public health challenge responsible for over 8 million deaths annually worldwide. In Africa, 715,000 new cancer cases and 542,000 cancer deaths in 2018”.Breast self-examination is an important viable optional substitute available for identifying breast tumors at an early stage, where access to clinical breast examination (CBE) and mammograms is difficult. Studies in medicine have shown that one-third of all cancers are predictable and a further one-third if diagnosed sufficiently early is potentially curable.

1.3 Research aims and objectives
General Objective
To evaluate the knowledge, and practice of Breast Self-Examination among women of child bearing age in Umuchieze, Umunneochi Local Government Area Abia State.

Specific Objective
1. To estimate the proportion of women who are aware of breast self- examination.
2. To identify reasons of respondents to non-practice of breast self-examination.
3. To estimate the proportion of women who practice breast self-examination.
4. To estimate the frequency of practice of breast self-examination amongst the women.

1.4 Research Questions
1. What is the knowledge of breast self-examination among the women?
2. What are the reasons of the respondents to non-practice of breast self-examination?
3. What is their level of practice of breast self-examination?
4. How often do women practice breast self-examination

1.5 Scope of the Study
The study was carried out in Umuchieze, Umunneochi Local Government Area of Abia State. The study centered on women of child bearing age with total population of 500 (from The National Population Commission in conjuction with UNICEF, Umunneochi local government area, Abia State). It made use of questionnaire.

1.6 Significance of the Study
The research study is conducted to promote BSE among women of reproductive age 15-49 years of age in Umunneochi. It will help to discover and correct wrong beliefs about BSE among women in Umunneochi. A clear knowledge and understanding of the problem would help health workers, governmental and non-governmental agencies to formulate policies to promote BSE. It would also broaden the knowledge of medical students and knowledge of teenagers who wish to update themselves intellectually.

1.7 Justification for the Study
This study will help women of child bearing age in Umuchieze get acquainted to their breast as to be able to detect breast tumors. It will serve as a coverage tool for both the women and health workers to build a relationship based on trust.

1.8 Operational definitions
Knowledge: According to Cambridge Dictionary is understanding of or information about a subject that you get by experience or study, either known by one person or by people generally. According to Wikipedia knowledge is a familiarity, awareness, or understanding of someone or something such as facts or objects. It refers to a theoretical or practical understanding of a subject. It can be implicit or explicit, formal or informal, systematic or particular (American English, 2010).
Attitude: According to Cambridge Dictionary is a feeling about something or someone, or way of behaving. It is according to Wikipedia a psychological construct, a mental and emotional entity that inheres in, or characterizes a person.
Practice: According to Cambridge Dictionary is action rather than thought or ideas. It is the actual application or use of an idea, belief, or method as opposed to theories relating to it.
Women: The term women are sometimes used for female humans regardless of age, as in phrases such as “women’s right”.
Breast Cancer: A cancer that forms in the cells of breast, treatable by a medical professional, requires a medical diagnosis. Lab tests or imaging always needed.
Breast Lumps: Non-cancerous changes that give a breast a lumpy or rope-like texture.
Screening: Is a strategy used to look for as- yet-unrecognized conditions or risk-markers. This testing can be applied to individuals or to a whole population.
Breast Self-Examination: Is a process whereby women examine their breasts regularly to detect any abnormal swelling or lumps in order to seek prompt attention.