CHAPTER ONE
INTRODUCTION
1.1. Background of the Study
The breast is a vital organ of female reproduction and it is perceived by the society as a sign of feminity, womanhood and motherhood. Women breasts are linked with sexual attractiveness, sexual stimulation and feeding of babies. Female gender is usually faced with a lot of health problems among which is breast cancer. Breast cancer emanates from breast tissues, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk, (Surveillance Epidemiology and End Results, 2017). Breast cancer is the most common type of cancer in women both in high income and, in low and middle income countries, Nigeria inclusive, (WHO, 2014).
Cancer of the breast is a major health concern, as it is regarded as the second leading cause of cancer death in women, exceeded only by lung cancer, (Porter, 2018). More than one million new cases of female breast cancer are diagnosed every year which accounted for over 1/3 of the estimated annual 4.7 million cancer diagnosis in females and the second most prevalent tumor after lung cancer in both sexes, (American Cancer Society, 2017). This growing rate necessitates that breast lumps are detected early enough in order to minimize its mortality rate. Cancer of the breast is as well the most prevalent female cancer in both developed and developing countries with 55percent of it occurring in the developing countries, (American Cancer Society, 2017). The occurrence of breast cancer is escalating both in developing and developed countries as a result of the increased life expectancy, urbanization and adoption of western lifestyles, (WHO, 2019). The early detection of breast cancer plays a crucial role in improving breast cancer outcome and survival, (WHO, 2019).
However, there are various ways through which breast lumps are detected and diagnosed, which include the following: mammography, clinical breast examination and breast self-examination. But, for the purpose of this study, breast self-examination will be considered among female undergraduate in Babcock University. Breast Self-Examination is defined as the examination carried out by a female individual to help detect any abnormality within the breasts. It involves visually and manually inspecting the breasts for lumps, bumps and changes in the skin and nipples of the breasts, (Anderson, Anderson & Glanze 2016). Breast self examination should be performed monthly after the age of 20 years; preferably a few days after an individual’s menstrual period when the breasts are least swollen. According to Weber and Kelly (2014), breast self examination is the process through which female gender examine their breasts regularly in order to detect any abnormal swelling or lumps so as to seek immediate medical attention.
Breast self examination is considered an essential tool for the early detection of breast cancer. This is very crucial because prognosis is directly linked with the stage at which the tumour is detected and how localized the lesion is, (Porter, 2018). Early diagnosis usually results in treatment prior to metastasis of the cancerous cells and signifies a better outcome of management. It has been estimated that an effective screening programme may minimize mortality in the screening age group by up to 25percent, (Blamey, Wilson & Patrick, 2011). According to Simsek and Tug (2012), breast self-examination is of benefits to female gender in two ways. Firstly, women will become familiar with both the appearance and the feel of their breasts, and secondly, they will be able to detect any changes as early as possible. Karayurt, Ozmen and Cetinkaya (2016) asserted that, 90percent to 95percent of the times, breast cancer is first noticed by the woman herself during the performance of breast self examination.
In early detection of breast lump, the practice of breast self examination is so germane and essential as this will go a long way in making female gender become breast aware and in the process, discover any abnormality that may exist in their breast. Studies by various researchers in Nigeria found that practice of breast self examination was generally low. For instance, Kayode, Akande and Oshagbemi (2014) reported that despite the positive attitude of respondents to breast self examination, its practice was low. This was corroborated by Balogun and Owoaje (2012), Chioma and Asuzu (2014), Agboola, Deji-Agboola, Oritogun, Musa, Oyebadejo and Ayoade (2015); Gwarzo, Sabitu and Idris (2018), who all agreed that there was low practice of breast self examination among the respondents in Nigeria. This finding is as well same for Swedish women as only 10percent of the women studied practised breast self examination regularly, (Person & Johansson, 2013). Similarly, Haji-Mahmoodi, Montazeri, Jarvandi, Ebrahimi, Haghighat and Harirchi (2016) as well stated that, only 60percent performed breast self examination on a monthly basis, 50percent performed occasionally and 44percent never practised breast self examination.
In similar studies done in United Arab Emirate by Bener, Alwash, Miller, Denic and Dunin, (2015) and in Brazil, by Fidelis and Manalo (2017) it was asserted that the practice of breast self examination was as well commonly low among women. In the light of the scenario sketched above, the American Cancer Society (2017) recommended that woman should begin breast self examination at age 20. However, the American Academy of Pediatrics suggested that girls begin breast self examination at age 14 as this would enable them imbibe the culture of routine performance of breast self examination, (Cromer, Frankel, Hayes & Brown, 2016). Despite the various initiatives by individuals, health practitioners, NGOs and governments through radio/television campaigns and jingles to create awareness and encourage breast self examination practice among women, it has turn out to be necessary to ascertain the current awareness level and practice of breast self examination among female undergraduate in Babcock University. Therefore, based on the above, this study focuses on the awareness and practice of breast self examination among female undergraduate of Babcock University in Ogun State.
1.2. Statement of Research Problem
The issue of breast cancer is of global concern and a very serious disease affecting a lot of women in across the world especially in developing countries (Nigeria inclusive). The rate of breast cancer is increasing in low and middle income countries because of increased life expectancy, urbanization and adoption of western lifestyles (WHO, 2019). However, the practice of breast self examination has been established to empower women, taking responsibility for their own health.
Despite the benefits of regular breast self examination, a small number of women actually and regularly practice it. In fact, a majority do not even know the correct ways to do a breast self examination, (Stamler, Thomas, & Lafreniere, 2017). A study on cancer awareness in Nigeria by Uche (2015) revealed that, out of 460 respondents only 32percent were aware that breast lump is a warning sign of cancer, 58.5percent were not aware of the warning signs, only 9.8percent were aware of methods for detecting cancer and 50percent did not know that cancer was curable when detected early.
In Abakaliki, South Eastern part of Nigeria, study by Obaji, Elom, Agwu, Nwigwe, Ezeonu, and Umeora, (2016) established that, out of 238 market women only 38.9percent have heard of breast self examination, and just 23.9percent have been taught on how to perform breast self examination, while only one person 0.4percent was aware of the correct frequency of breast self examination, and as well did it regularly. In another survey among female university students from 20 European countries, 54percent of women reported as never having practiced breast self examination and 8percent practiced monthly (Wardle, Steptoe, & Smith, 2015), and in a study in Korea (Shin, Park & Kim, 2016) 27percent of students reported engaging in breast self examination.
Studies among female university students in low and middle income and emerging economy countries showed that in Egypt, 1.3percent monthly breast self examination (Boulos & Ghali, 2014), in Malaysia 36.7percent to 55.4percent had practiced breast self examination (Al-Naggar, Al-Naggar, Bobryshev, Chen, & Assabri, 2015; Akhtari-Zavare, Juni, Said, & Ismail, 2017), in Nigeria, 19.0percent monthly breast self examination (Gwarzo, Sabitu, & Idris, 2018), in the United Arab Emirates (UAE), 22.7percent practiced breast self examination, 3percent monthly BSE (Al-Sharbatti, Shaikh, Mathew, & Salman Al-Biate, 2013), and in Yemen, 17.4percent breast self examination practice (Ahmed, 2017).
In this regard, it can be seen that various factors, such as lack of awareness and knowledge of breast self examination and poor attitudes towards breast self examination could be identified as barriers to breast self examination. Therefore, the various studies examined showed that, there is a low level of awareness and a poor practice of breast self examination among women.
Thus, prompted the need to examine the level of awareness of female undergraduate of Babcock University breast self examination and how it influences their practice.
1.3. Research Objectives
The main objective of the study is to examine the awareness and practice of breast self-examination among female undergraduate in Babcock University. The specific objectives are to;
- assess the awareness level of breast self-examination among female undergraduate in Babcock University.
- examine the practice level of breast self examination among female undergraduate of Babcock University
- identify the attitude of female undergraduate of Babcock University on breast self examination
1.4. Research Questions
The following research questions are posed for the study
- What is the awareness level of female undergraduate of Babcock University on breast self examination?
- What is practice level of breast self examination among female undergraduate of Babcock University?
- What is the attitude of female undergraduate of Babcock University on breast self examination?
1.5. Scope of the Study
The study examined the awareness and practice of breast self awareness among female undergraduate of Babcock University, Ogun State. This study will be carried out among female undergraduate of Babcock University aged 20 years and above. The reason for this age group is because of their understanding of the subject matter and to find out how they have been practicing breast self examination. This study is focused on identifying female undergraduate level of knowledge and awareness of early warning signs and symptoms of breast cancer and breast self-examination, and their practice of breast self examination.
1.6. Significance of the Study
It is hoped that the findings of this study will be of beneficial to Health Officers in order to review nursing curricula and plan education strategies and campaigns that focus on identified areas of knowledge deficit.
Furthermore, this study is significance to University clinic by gaining knowledge on the areas they need to improve and emphasise in giving health education about breast cancer and the importance of breast self examination. Since, early detection implies early intervention thereby minimizing the rate of people undergoing surgery and chemotherapy because of late presentation.
The findings of this study will add to the existing knowledge base for the nursing profession. Nurses should be equipped to educate patients on breast self examination and screening which will lead to increased patient attendance, awareness, knowledge, and practice.
In addition, it is hoped that this study will improve female undergraduate of Babcock self-awareness by educating them and promoting breast self examination for their own personal breast health care.
1.7. Methodology
This study is based on a quantitative approach in order to quantify data and generalise results from a sample of the population of interest. A quantitative approach is used to measure the incidence of various perceptions in a chosen sample. This method was chosen because it offered the researcher control and precision, and data will be analysed using statistical techniques. Data for the study is gathered using a self-structured questionnaire that will be administered female undergraduate of Babcock University aged 20 years and above, in order to elicit their responses and opinion on their awareness and practice of breast self examination.
1.8. Operational Definition of Terms
In this study, the following key terms below are used and defined as used in the study.
Knowledge: refers to female undergraduate information and skills obtained through experience or education on breast self examination.
Breast Cancer: is a malignant neoplastic disease of the breast tissue among female undergraduate.
Breast self-examination: is the skill of examination done by female undergraduate to familiarise themselves with the way their breasts feel.
Knowledge of breast self examination: referred to the female undergraduate knowledge of the practice of breast self examination.
Breast self examination practice: referred to female undergraduate actual performance of breast self examination
