INTRODUCTION

Breast cancer is the most frequent cancer that occurs among women worldwide, and the second leading cause of death, claiming the lives of thousands of women each year and affecting countries at all levels of development¹. About 1.67 million new cases were diagnosed and 0.522 million deaths from breast cancer occurred in 2012¹. Although breast cancer is rare in men, it has been estimated that 2470 men were diagnosed with breast cancer worldwide and approximately 460 die each year². The prevalence is rising in most countries and is estimated to rise further over the next 20 years despite current efforts to prevent the disease³.The increased incidence is not surprising since there has been, in most countries, an increase in the number of women with major breast cancer risk factors. The risk factors for breast cancer include advancing age⁴, family history of breast cancer, early menarche, late menopause and the use of hormonal replacement therapy (HRT) with combined estrogen and progesterone⁵, late age of first pregnancy, few pregnancies, and short or no periods of breastfeeding. Other risk factors that could be implicated in the burden of breast cancer are obesity, alcohol consumption, and inactivity⁶.

The control of breast cancer in most developing countries including Nigeria and Cameroon is under the auspices of national control programs promoted by the World Health Organization and this involves educating and screening young women for clinical manifestations of breast cancer⁶. The earlier breast cancer is detected, the better the effectiveness of the treatment and the likelihood of survival. Breast cancer screening methods include BSE, Clinical Breast examination (CBE) and mammography, and these are usually done in combination⁷. Among these methods, mammography is the only one that has been proven to be effective, but the method is only cost-effective and feasible in countries with good health infrastructure^4,8. BSE is the recommended method in developing countries because it is easy, convenient, private, safe and requires no specific equipment⁹. Its purpose is to make women familiar with both the appearance and feel of their breasts as early as possible, so that they will be able to easily detect changes in their breast. Several studies have revealed that a positive association exists between the performance of BSE and detection of breast cancer, as most of the early breast tumor detections have been self-discovered^10,11.

BSE for the early detection of breast cancer is not often done by many women. Studies^12,13 affirm only 17% and 12% of women, respectively, were observed to perform BSE monthly. Such an observation has equally been noted among health personnel. For instance, a study conducted among nurses and midwives reported only 14% compliance¹⁴. As a result, most cases of breast cancer in women are diagnosed at an advanced stage due to late presentation. Although BSE is a simple, quick and cost-free procedure, it appears that many women either perform it incorrectly or not at all.

Early diagnosis of breast cancer has been clearly shown to reduce mortality and improve survival⁸. Combined results from randomized screening trials suggest that mammography reduces the risk of dying from breast cancer by 15–20%, and studies of modern mammography screening programs in Europe found that the risk of death from breast cancer was reduced by more than one-third¹⁵. Thus, knowledge and practice of breast cancer preventive measures and screening is therefore critical in the reduction of breast cancer morbidity and mortality.

However, poor awareness and knowledge about breast cancer symptoms and screening methods have been previously reported by several different studies¹⁶. To plan critically needed breast cancer awareness and education programs that optimally address Nigerian women civil servants, healthcare professionals and planners must know the women’s current level of understanding. Therefore, this cross-sectional study in State Secretariat, Ibadan, was performed to explore public knowledge of breast self-examination (BSE) and mammogram amongst women workers in Oyo State.

METHODS

RESULTS

The 204 women who participated in the study had their questionnaires checked to ensure completion before retrieval. The return rate was 100%.

Of the respondents, 40.7% were in the age group 20–32 years (Table 1). Ethnic Yorubas represented the majority in the study consisting of 131 women (64.2%), while the least were 12 Hausas (5.9%). The majority (88.2%) had university education, while others (11.8%) were only diploma holders.

DISCUSSION

The high level of knowledge demonstrated by the respondents is in agreement with studies in similar settings^18,19, as well as in Turkey²⁰. However, this level of knowledge is in contrast to other studies conducted in Turkey, where the majority of the women had little knowledge²¹, and among minorities in the United State^22,23. Poor knowledge of the risk factors was also noted by studies in Nigeria²⁴ and in the Middle East^25-27.

Health workers and family members were the major sources of information on screening and knowledge of breast cancer according to researchers in similar settings^28-30 while social media have also been identified as sources³¹. This view is also held by studies in developed countries^32,33. However, information from family members and friends could be unreliable, thereby leading to fears and poor compliance. It is therefore important that oncology related health workers be trained in giving information to clients in various settings. This will be more correct, increase knowledge, improve use and reduce morbidity.

The fact that majority of the respondents were aware of the value of BSE in early detection of breast cancer and as a non-invasive procedure is in the right direction, in line with results from another study³⁴, but in contrast with a study in a different setting³³. Similarly, the participants’ knowledge of the value of mammography was supported by other studies. A Nigerian study noted that poor knowledge among their participants about mammography being an early detection measure²⁴ was due to the fact that it was not readily available in a rural setting³⁴. This could be attributed to the socioeconomic condition experienced in the countryside, especially among rural dwellers, where there is poor access, geographically and financially. Most of the rural dwellers are farmers with poor educational background that reduces their ability to access relevant information³¹. Also poor access roads prevent the sale of farm produce resulting in limited income, which further compounds the issue of knowledge about and travelling for a mammography. Improving accessibility to the rural areas could improve flow of information and increase knowledge of the value of a mammogram.

Findings from this study revealed low utilization of BSE and mammogram despite the high level of knowledge, in line with other studies^23,30. However, an earlier study in the region found higher proportions of the practice of BSE but poor adherence to the process^28,32. This could be attributed to increased awareness over the years, which led to more exposure but with no corresponding level of utilization. This suggests that the issue of wider utilization requires more than awareness and should be addressed by examining other sociocultural factors.

Among factors that constituted barriers were views of low risk and fear of having abnormal results; this has been corroborated by findings that views of not being at risk, fear, and anxiety of abnormal results are major barriers³⁵. Also, the reported issue of not having enough time could be attributed to the long waiting experienced in most federal and state centers that offer screening services. The implication of this is that follow-up appointments should be streamlined in order to reduce waiting time and enhance compliance.

The issue of clinical and risk factors being significantly linked to respondents’ knowledge and educational level is in line with other studies^36,37. A woman with a higher level of education is more likely to report promptly to the hospital for proper examination if any symptom suggestive of cancer is seen or felt; although earlier studies^37,39 reported that educated women often forget to practise BSE.

CONCLUSIONS

Findings from this study demonstrate that although the majority of the respondents had adequate knowledge of BSE and mammogram, the level of utilization of these methods was still low. More so, a significant association was found between knowledge, level of education and use of BSE and mammogram. Identified barriers to wider utilization of the screening methods, were time, fears of the result of the screening, and other sociocultural factors, and these should be taken into account when designing interventions. This may reduce the barriers, facilitate wider utilization and ultimately lead to a decrease in the morbidity and mortality rate of breast cancer.

In as much as there are strategies in place for increasing awareness and sensitization about breast cancer screening, measures should also be in place to educate, motivate and encourage women to practise BSE and mammogram as preventive measures for the early detection of breast cancer.

Midwives should reinforce the need to practise these screening measures among women. Governments and other stake holders should provide support to facilitate the education of women and provide adequate information about preventive screening for breast cancer. Efforts should be directed to making mammogram more accessible, available and affordable for all, especially in rural areas.