TABLE OF CONTENTS

Title page                                                                                                                    i

Approval page                                                                                                 ii

Dedication                                                                                                                  iii

Acknowledgment                                                                                                       iv

Table of contents                                                                                                        v

List of tables                                                                                                               vi

Abstract                                                                                                                      vii

CHAPTER ONE: INTRODUCTION

Background of the study                                                                                            1

Statement of problem                                                                                                 5

Purpose of study                                                                                                         6

Objectives of the study                                                                                               6

Research Questions                                                                                                     6

Hypothesis                                                                                                                  7

Significant of the Study                                                                                             7

Scope of the Study                                                                                                     8

Operational Definition of Terms                                                                    9

CHAPTER TWO: LITERATURE REVIEW

Conceptual Review                                                                                       10

The Normal Breast                                                                                    10

Concept of Breast Cancer                                                                             12

Risk Factors for Breast Cancer                                                                14

Diagnosis of Breast Cancer                                                                           20

Concept of Breast Self-Examination                                                             23

Awareness on Breast Self-Examination                                                          23

Sources of Information on Breast Cancer and Breast Self-Examination                   28

Practice of Breast Self-Examination                                                                30

Empirical Review                                                                                     39

Summary of Literature Review                                                                  49

CHAPTER THREE: RESEARCH METHODS

Research Design                                                                                                         52

Area of Study                                                                                                             52

Population of Study                                                                                53

Sample                                                                                                                        53

Criteria for Inclusion                                                                                 53

Sampling Technique                                                                                        54

Instrument for data collection                                                                 55

Instrument validity                                                                                           56

Reliability of the instrument                                                                           57

Ethical consideration                                                                                  57

Procedure for data collection                                                                     58

Method of Data Analysis                                                                                59

CHAPTER FOUR:  DATA PRESENTATION AND ANALYSIS

Presentation’s Demographic                                                                       60

Presentation of Result According to Research Question                   61

Summary of Findings                                                                                   91

CHAPTER FIVE: DISCUSSION OF FINDINGS

Discussion of Major Findings                                                                         94

Implication of the Study                                                                              113

Limitation of the Study                                                                                114

Suggestions for Further Studies                                                                  114

Summary                                                                                                    114

Conclusion                                                                                                      117

Recommendation                                                                                           120

References                                                                                               121

Appendix                                                                                                   126

LIST OF TABLES

Table 1: Showing the number of Women in Each Village and Their Sample Size     44

Table 2: Demographic Characteristics of Respondent                           60       

Table 3: Awareness of Breast Cancer among Women in Umuowa Orlu LGA          62

Table 4: Awareness of Breast Cancer among Women in the various Communities in Umuowa Orlu LGA          66                                           

Table 5: Awareness of BSE among Women in Umuowa Orlu LGA             68                               

Table 6: Awareness of BSE among Women in the Various Communities Umuowa             Orlu LGA                                                                                                       70

Table 7: Source of Information on Breast Cancer and BSE Awareness                    72

Table 8: Frequency of Practice of BSE                                                       75

Table 9: Procedure Observed in Practicing BSE                    76

Table 10: Detection of Changes during BSE                                              78

Table 11: Practice of BSE among Women in the Various Communities     79

Table 12: Cross-Tabulation of Age and Practice of BSE                             81

Table 13: Tests Statistic of Hypothesis One                                       82

Table 14: Cross Tabulation of Educational Attainment and Practice of BSE            82

Table 15: Tests Statistics of Hypothesis Two                                                 83

Table 16: Cross-tabulation of Parity and Practice of BSE                                         84

Table 17: Tests Statistics of Hypothesis Three                                        85

Table 18: Cross- tabulation of Age Range BSE Awareness                    86

Table 19: Tests Statistics of Hypothesis Four                                                 87

Table 20: Cross- tabulation of Educational Attainment and BSE Awareness           87

Table 21: Tests Statistics of Hypothesis Five                                                 88

Table 22: Cross- tabulation of Parity and BSE Awareness               88

Table 23: Tests Statistics of Hypothesis Six                                        89

Table 24: Cross-tabulation of Breast Cancer and Practice of BSE            90

Table 25: Chi- Square Tests                                                                        90

LIST OF FIGURE

Figure One: Model of the Study on Breast Cancer Awareness and BSE                  37

ABSTRACT

Breast cancer is said to be the commonest cancer and the most lethal malignancy in women across the world. Most of the cases are brought late to the hospital when the conditions are severe with multiple nodal involvements and poorer clinical pathological prognostic outcome. If braest changes are detected early and treatment commenced early enough, the survival rate of breast cancer wii be increased. The purpose of this study was to investigate the breast cancer awareness and practice of Breast Self-Examination (BSE) among women in Umuowa Orlu L.G.A. of Imo State. The research design for the study was descriptive survey. Umuowa was purposively selected for the study. Proportionate sampling method was used to draw three hundred and forty nine (349) women in the ten villages in Umuowa. Systematic sampling technique was used to the reach the respondents in the villages. A validated questionnaire which served as an interview schedule was used for data collection. Data derived from the questionnaire were analyzed descriptively using frequencies and percentages. Chi Square and Spearman’s Rank analysis were used to test for relationships between demographic data, breast cancer awareness and practice of BSE. The study revealed that the awareness of breast cancer and BSE among the women were low. The major source of information was healthcare providers. Majority of the women had inadequate practice of BSE despite the fact that a little above half (51.95) practiced BSE. Age, educational attainment and parity were associated with the practice of BSE. This implied that with increase in age and parity, the practice of BSE reduced while it increased with educational attainment. There were negative relationships between age, parity and awareness of BSE. This implied that BSE awareness increased as age and parity reduced. A positive relationship was established between BSE awareness and educational attainment. Findings further revealed that there is a positive relationship between breast cancer awareness and practice of BSE. Based on these findings, it was recommended that healthcare providers should embark on directed and focused health education awareness campaign to enhance the awareness of breast cancer. The importance of BSE as a key factor in the early detection of breast cancer should be stressed with special emphasis on regular practice of BSE and the proper steps of BSE.

CHAPTER ONE

INTRODUCTION

Background to the study

Breast cancer is the commonest cancer as it continues to remain the most lethal malignancy in women across the world (Doshi, Reddy, Karunakar & Kulkarani, 2012). It constitutes a major public health issue globally with over one million new cases diagnosed annually, resulting in over 400,000 annual deaths and about 4.4 million women living with the disease (Globocan, 2008; Ganiy and Ganiyu, 2012). Breast cancer is the leading cancer among women but it can also appear in men (Tara, Agrawal & Agrawal, 2008). Although breast cancer is 100 times more common in women than in men, although men tend to have poorer outcomes due to delay in diagnosis (Fasoranti, 2010).

Although breast cancer incidence rates are higher in industrialized countries, recent           trends show that the largest increase in risk is occurring in developing countries. There is thus a geographical variation in the incidence of breast cancer with higher incidence in Europe and America compared to Asia and Africa (Otunne, 2008). According to Beiki, Hall, Ekbom and Moradi (2012), the incidence ranks highest in high income countries, with the exception of Japan. In Canada, for example, 19,000 new cases are diagnosed each year and 5, 300 Canadian women die from the diseases annually.

Breast cancer is now the commonest cancer affecting women in Nigeria. In Nigeria, the number of women at risk of breast cancer increased steadily from approximately 24.5 million in 1990 to approximately 40 million in 2010 and is projected to rise to over 50 million by 2020 (Akarolo- Anthony, Ogundiran & Adebamowo, 2010). Statistics from the Ministry of Health Nigeria showed that breast cancer had risen at least four times over the decade and accounted for 40 percent of women cancers (Onyebuchi, 2012). In the present scenario, roughly 1 in 26 women are expected to be diagnosed with breast cancer in their life time, majority of cases occurring in pre-menopausal women (Dosh et al, 2010).

According to Salaudeen, Akande and Musa (2009) studies from various ethnic populations have reported the demographic profile of breast cancer especially from the Western and Northern parts of the country. A review of breast biopsies in the Lagos University Teaching Hospital showed 34 percent of all breast biopsies done over a 10-year period to be malignant. They also asserted that a report from Zaria described the mean age of presentation of breast cancer as 42 years with 30 percent occurring in women less than 25 years of age. Furthermore, at University College Hospital, Ibadan, 74 percent of breast cancer patients were pre-menopausal. A ten year review of breast cancer in Eastern Nigeria revealed that patients with breast cancer constituted 30 percent of all patients with breast disease and that 69 percent of these patients were pre-menopausal (Oluwatosin, 2010). 

 More so, majority of women present with advanced stages of the disease at which time little or no benefits is derived from any form of therapy. The 5- year survival rate of breast cancer is over 85% with early detection whereas later detection decreased the survival rate to 56% (Dosh et al, 2010; Fasoranti, 2010). The low survival rates of breast cancer in less developed countries can be attributed to lack of early detection as well as inadequate diagnosis and treatment facilities. Oluwatosin (2012) asserted that late presentation of breast cancer patients suggests that women in Nigeria have poor knowledge of the disease. Chiejina (2011) also noted that what is more worrisome in a country like Nigeria with over 140 million people is that the detection of the disease is usually late. For women to present early, they need to be “Breast aware” and must be able to recognize symptoms of breast cancer through routine practice. Late presentation of patients at advanced stages is thus the cause of breast cancer death in Nigerian women, as 80 percent of breast cancer patients in Nigeria are said to die because of late detection (Otunne, 2008)

In an environment where late presentation is predominant there is an urgent need for awareness of breast cancer and its early detection measures. Recommended preventive techniques to reduce breast cancer mortality and morbidity include breast self examination, clinical breast examination and mammography (Doshi et al, 2012). Early diagnosis has a positive effect on the prognosis as well as limits the development of complications and disability (Gwarzo et al, 2009). Changes in the early detection guidelines of the American Cancer Society now recommend that women, beginning in their early 20s should be told about the benefits and limitations of breast self examination. They also recommend that BSE be performed monthly beginning at the age of 20 years and women should undergo a clinical breast examination annually beginning at the age of eighteen years (Salaudeen, Akande, & Musa, 2009). It is an option for women and it is a woman’s best weapon in the fight against breast cancer.This is especially so since nearly 70% of all breast cancer are found through breast self examination and with early detection, quality of life is increased (Gwarzo et al, 2009) and the five year survival rate is 98% (National breast Cancer Foundation, 2012).

An increased awareness among women in general on BSE as a means of detecting breast cancer would most likely result in a high number of women practicing it. If there is increased awareness and improvement in the capacity of women to understand themselves, it will enable them seek medical attention early enough. Awareness can be created by health workers such as nurses and doctors. Newspapers, journals and the internet are also sources where one can read articles written on BSE (Cosgrave, 2009). According to Oluwatosin (2012), women given information on and instruction about BSE and breast cancer by healthcare professionals demonstrated higher knowledge and confidence and tend to practice BSE more than those who receive information from other sources. 

Moreover, practicing monthly breast self examination beginning at age 20 can play an important role in early detection of breast cancer resulting in greater chances of cure and less complex treatment (Berman, Kozier & Erb, 2008). According to Atanga, Atashili, Fuh, and Eta, (2012) regular practice of BSE is the corner stone of the fight against breast cancer worldwide, especially for black women because clinical breast examination and mammography might not be accessible to them for economic or other reasons. Though screening mammography is widely practiced in developed countries, it is hardly recommended for those under 30 years because of their dense tissue which makes interpretation of the films difficult (National Breast Cancer Foundation, 2012). Furthermore, BSE is still recommended as a general approach to increasing breast health awareness and thus potentially allow for early detection of any anomalies (Ginsberg, Lauer, Zella, Bacten & Baltussen, 2012). Therefore, BSE becomes particularly important and appropriate.

Based on the fact that a greater percentage of Nigerian women die because of late detection and that awareness on BSE increases the possibility of early presentation and consequently reduces mortality, this study is designed to determine the breast cancer awareness and practice of BSE among women in selected rural communities who constitute the majority of women at risk both for the disease and late presentation.

Statement of problem