ATTITUDE AND PRACTICES OF BREAST SELF EXAMINATION AMONG FEMALE UNDERGRADUATE STUDENTS OF TERTIARY INSTITUTIONS

1.0 Introduction

1.1 Background Of The Study

Breast cancer remains a major health problem all over the world, affecting women in both the developing and developed countries. The incidence of breast cancer is even growing in regions of the world (such as Asia and Africa) that had a low incidence of the disease in the past. Based on studies during 1975 − 1990, Asia and Africa have experienced a more rapid rise in the annual incidence rate of breast cancer than that of North America and Europe (Shirazi, Champeau, & Talebi, 2006). According to Jayadevan, Jayakumary, Manda and Merlin (2010), the incidence of breast cancer is increasing in most countries of Asia and Africa. Isara and Ojedokun (2011) observed that breast cancer is a public health problem that is increasing throughout the world especially in developing countries, including Nigeria.

Breast cancer is the leading type of cancer in women. It is and still remains one of the cancers affecting all age groups of women worldwide. Lesccynska, Krajewska and Leszczynski (2004) stated that globally, breast cancer is the most common malignant neoplasm among women. Continuing, they stated that globally, over one million new cases of breast cancer among females are detected each year. According to American Cancer Society (ACS) (2009), National Cancer Institute estimated that one in eight women born today will be diagnosed with breast cancer at some time in her life. This is a dramatic increase from the rate in 1977, when the rate was one in fourteen women (George, 2000).

Breast cancer is a significant cause of cancer deaths among women all over the world, including women in Nigeria. Adebamowo and Ajayi (2000) stated that breast cancer is the second principal cause of cancer deaths among women in the world as well as in Nigeria. Continuing they reported that the prevalence rate of breast cancer according to a study in Nigeria was 116 per 100,000 and 27,840 cases occurred in 1999. The report further stated that Nigerian women usually present with advanced stages of the disease at which time little or no benefit can be derived in the form of therapy. Sasco (2001) reported that in Nigeria, over 100,000 women develop breast cancer annually with majority of patients arriving medical centres at a late stage, thus resulting in a high mortality rate. Muanya (2014) stated that according to National Cancer Control Programme report, breast cancer incidence in Nigeria has gone up at least four times over the decade and in 2010, it accounted for 40 per cent of women cancers.

Breast cancer incidence is growing faster in age groups (between 36 and 44 years) that had a low incidence of the disease. The incidence of breast cancer among younger women (16- 35years) seems to be increasing also. Vorobiof, Sitas and Vorobiof (2001) reported that there has been an alarming increase in the incidence of breast cancer among young women since, 1998.

Over the years, people had the belief that breast cancer is an older woman’s disease, therefore, the primary focus has been on prevention, detection and treatment of breast cancer for women who are 50 years and older. However recent reports have shown that in Nigerian Communities, the disease can strike well at a younger age. A report in Nigeria showed that the peak age of incidence was 42.6years and 12 per cent of cases occurred before the age of 30years (Adebamowo & Ajayi, 2000). Banjo (2004) reported that in Nigeria the youngest age of breast cancer incidence recorded was 16 years from Lagos. Salaudeen, Akande and Musa (2009) stated that in Nigeria, studies from various ethnic populations have reported the demographic profile of breast cancer especially from the Western and Northern parts of the country. According these authors, a review of breast biopsies in the Lagos University Teaching Hospital showed 34 per cent of all breast biopsies done over a 10-year period to be malignant. A report from Zaria described the mean age at presentation of breast cancer as 42 years with 30 per cent occurring in women less than 25 years of age. At University College Hospital, Ibadan, 74 percent of breast cancer patients were pre-menopausal.

A ten year review of breast cancer in Eastern Nigeria, which Imo State is part of, revealed that patients with breast cancer constituted 30 per cent of all patients with breast disease and that 69% of these patients were pre-menopausal (Anyanwu, 2000). According to Isara and Ojedokun (2011) more young Nigerian women are being exposed to breast cancer risk factors (apart from genetic or family) such as alcohol, tobacco, obesity, late age at first pregnancy (> 30 years) due to education and late marriages. They may also be exposed to breast cancer due to inadequate knowledge of breast cancer risk factors and other breast cancer issues.

1.2 Statement Of The Problem

Breast cancer which affects mostly females is a disease that its fatality can be forestalled when detected early. This is because early-stage detection can prompt effective treatment of breast cancer before its progression. It can curb the greatest challenge of late presentation and improve the chances of survival from the disease. However, early-stage detection of breast cancer requires females to know about breast cancer and practice BSE.

Breast cancer was previously known to be a disease of adult females (45 years and above). But recently, this has become a myth, because the incidence of the disease in young female age groups such as 16 to 35 years abound. In fact, reports have it now that breast cancer incidence is growing faster in young females who used to have a low incidence of the disease, and that these young females have the lowest survival rates because they detect and present themselves for treatment late. Female undergraduates belong to the age group of young females that now suffer from breast cancer. Therefore, they should know about breast cancer and practice BSE. The knowledge of breast cancer can help them while growing up, to prevent breast cancer early. The practice of BSE can help them to detect breast cancer and present for breast cancer treatment early, when something meaningful can be done about it.

Despite the fact that female undergraduates could be affected by breast cancer, and the need for them to know about breast cancer and practice BSE, few research studies have ascertained their knowledge of breast cancer and practice of BSE. While numerous research studies have investigated breast cancer-related knowledge and BSE practice of older adult women− those who are age 45 and above, studies that have presented female undergraduates (16-35 years) are few in Nigeria and virtually nonexistent, to the best knowledge of the researcher, in Imo State.

Thus, Imo state, still lack documented data on the knowledge of breast cancer and practice of breast self-examination among female undergraduates. This situation therefore poses a question of: what is the knowledge of breast cancer and practice of BSE among female undergraduates in higher institutions in Imo State? These were the task of the present study. Again, no study to the best knowledge of the researcher, has ever determined the BSE enhancement strategies for female undergraduates.

Furthermore, this creates a question of: what BSE enhancement strategies can be proffered for female undergraduates in higher institutions in Imo State, if they are found wanting in the practice of BSE? By addressing this topic among female undergraduates in higher institutions in Imo State, this research study is attempting to fill this void.

1.3 Purpose Of The Study

The purpose of the study was to ascertain the knowledge of breast cancer, practice of breast self-examination and BSE enhancement strategies among female undergraduates of higher institutions in Imo State.

The specific purposes of the study were to determine the:

1. Level of knowledge of breast cancer among female undergraduates in higher institutions in Imo State;
2. Proportion of female undergraduates in higher institutions in Imo State that practice BSE;
3. Level of knowledge of breast cancer among female undergraduates in Imo State according to age;
4. Level of knowledge of breast cancer among female undergraduates in Imo State according to marital status;

1.4 Research Questions

The following research questions were formulated to guide the study:

1. What is the level of knowledge of breast cancer among female undergraduates of higher institutions in Imo State?
2. What proportion of female undergraduates in higher institutions in Imo State practice BSE?
3. What is the level of knowledge of breast cancer among female undergraduates in higher institutions in Imo State according to age?
4. What is the level of knowledge of breast cancer among female undergraduates in higher institutions in Imo State according to marital status?

1.5 Significance Of The Study

The data generated from the study of knowledge of breast cancer, practice of breast self-examination and BSE enhancement strategies of female undergraduates of higher institutions in Imo State will form a base line survey to develop future intervention programmes on breast cancer and BSE. The results of this study provided useful data that may be used by health institutions in Imo State and other states in Nigeria to formulate health education programmes focusing on breast cancer and BSE that target female undergraduate students.

The findings will add to the pool of available data in the fields of health education and provide future researchers the background for further research work. The data generated on the female undergraduates’ level of knowledge of breast cancer may be beneficial to public health educators, school health educators, health care professionals and health organizations, since it may make them see the need to carry out breast cancer education-based programmes at the different settings where female undergraduates could be reached, to optimize their level of knowledge on concept of breast cancer, breast cancer risk factors, signs and symptoms and preventive measures.

1.6 Scope Of The Study

The study was delimited to Imo State. It was delimited only to female undergraduates on regular programmes in higher institutions in Imo State which are Imo State University, Owerri; Federal University of Technology, Owerri and Alvan Ikoku Federal University of Education, Owerri. The study covered only level of knowledge regarding concept of breast cancer concept, breast cancer risk factors, signs and symptoms and preventive measures.