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Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 17. Published in final edited form as: Afr J Med Med Sci. 2014 September ; 43(Suppl 1): 79–86.

Awareness, knowledge and practices of breast cancer screening measures among female postgraduate students of a Nigerian Federal University: a cross-sectional study Joel Ojo. Aluko1, Mary Funmilayo Ojelade2, C. Olanrewaju Sowunmi3, and O. Abimbola Oluwatosin1

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Joel Ojo. Aluko: [email protected] 1Department 2Clinical

of Nursing, University of Ibadan, Ibadan

Nursing Department, Orthpaedic Specialist Hospital, Igbobi, Lagos State

3Department

of Nursing, Babcock University, Ilisan Remo, Ogun State

Abstract Introduction—Annually, over a million new cases of breast cancer results in about 375,000 deaths worldwide. Recently, the burden of the disease has been on the increase in Nigeria and most cases present in hospitals late when cure becomes elusive. The choice of postgraduate students for this study was as a result of their potential to impact positively on the rest of the population by the virtue of their present or future positions. This forms the basis for this study.

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Methods—This cross-sectional descriptive study recruited 278 female postgraduate students of the University of Ibadan, Nigeria as participants using purposive sampling technique. Data were collected with the aid of a validated structured questionnaire. The research protocol was approved by the UI/UCH Ethical Committee. Both descriptive and inferential statistics were used for data analysis with the aid of Statistical Package of Social Sciences (SPSS) version 16.

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Results—The students’ mean age was 27 years ± 5.1 Std. Most of the postgraduate students were aware of the breast self examination (BSE), clinical breast examination (CBE) and mammography through health workers. Out of 159 respondents that claimed to be practicing BSE, 118 (58.4%) used to practice it occasionally. Out of 53 postgraduate students that had CBE done, 7.4% had CBE done by nurse/midwives. Among the students 11.4% had good knowledge of BSE. Similarly, 33.7% had good knowledge of breast cancer risk factors. Besides, the higher the level of knowledge of breast cancer the more the possibility that postgraduate students will practice BSE (Chi-square = 15.169, df = 4, P-value = 0.004). Conclusion—It is suggested that health workers should reach students within the academic communities with effective breast cancer prevention campaign programmes. Besides, both printed and electronic media should be used for dissemination of health education/information to ensure wider coverage.

Correspondence to: Joel Ojo. Aluko, [email protected].

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Keywords Awareness; Knowledge; Practice; breast cancer; screening measure

Introduction

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Globally, breast cancer has been identified as a leading cause of death globally [1, 2]. There are more than a million new cases of breast cancer resulting in about 375,000 deaths each year, with high mortality rates in developing countries [3]. In Nigeria, breast cancer has been reported to account for 56.6% of all cancer diagnosis between 1995 and 2002 [4]. The burden of the disease has been on the increase and affected women often present late in hospitals when it has reached advance stage [5]. Its cure at this stage becomes seriously compromised; the poor survival rate has been linked to late detection and diagnosis [6]. Cancer is a disease process that begins when an abnormal cells is transformed by the genetic mutation of the cellular Deoxyribonuleicacids (DNA) [7]. Breast cancer is neither painful nor cause any discomfort in its early stage. It usually presents as a painless breast lump. There are diverse risk factors that may affect each woman’s susceptibility to the disease [8]. Studies [9, 10] have shown that screening help save life by detecting breast cancer in its early stages when it is easier to treat. American cancer society’s recommendation for breast cancer screening is suggested to be adopted locally and it includes BSE, CBE and mammography [5, 11]. It is believed that 95% survival rate could be achieved if cancer is diagnosed at an early stage [12].

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Previous studies done in Nigeria [13, 14] have reported high level of awareness but relatively low compliance with the screening modalities. A similar study conducted among female undergraduate of University of Ibadan presented high level of awareness of the three breast cancer screening measure but low level of practice [15].

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Most related studies in Nigeria and some part of sub-Saharan Africa [13, 14, 16, 17, 18, 19, 20] had focused on various categories of women but there is still dearth of literature on the issue of breast cancer screening practices among postgraduate students in Nigerian universities. The researchers observed that postgraduate studies are undertaken by graduates and significant proportions of them are already working in one establishment or the other. It is hoped that this category of the Nation’s population could impact positively on the rest of the population. University of Ibadan, which has all the state of the federation as its catchment areas, was considered suitable for this study. Thus, students pursuing higher degrees in the university are more likely to come from various states and ethnic groups within the country. On this premise the study aimed at assessing the awareness, knowledge and practices of breast cancer screening measures among postgraduate students of University of Ibadan, Nigeria.

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Material and methods Design and setting This cross-sectional descriptive study was conducted among female postgraduate students of the University of Ibadan, Ibadan, Nigeria. University of Ibadan was founded in 1948 during the Colonial era by the then Federal Government of Nigeria. The university was located in Ibadan, the headquarters of the then Western Region of the country, now the Oyo State capital. The study focused on the female postgraduate students of the University of Ibadan because they are at risk of coming down with breast cancer like any other women in the larger society yet; there is still a dearth of literature among this category of women. The ancient city is the largest in the West African sub-region. Participants were recruited proportionately for the study from all the female postgraduate halls namely: Obafemi Awolowo hall, Abdulsalam Abubakar hall and Tafawa Balewa hall.

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Instrument and data collection Data was collected using a validated structured questionnaire developed by the researcher. Information elicited from the respondents includes socio-demographic characteristics, knowledge of breast cancer risk factor, knowledge and practice of breast cancer screening. The face and content validity of the instrument were ensured by comparing its items with the previous similar studies and by matching them with the stated research objectives, the adapted version of Social Cognitive Theory and the formulated research hypotheses. Besides, copies of the proposal and the instrument were submitted for expert reviews by UI/UCH Ethical Committee.

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The retrieved questionnaires were organized, coded and analyzed using the statistical package of social sciences (SPSS) version - 21. The frequency and percentages of the respondent’s socio-demographic characteristic are presented in tables and figures. Population and sampling technique

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A study sample of 278 (253 sample size + 10% attrition) female postgraduate students was recruited proportionately across the three postgraduate halls of residents of the university. The selection of the participants was done using simple random technique from the hall registers (sample frames). Only bonafide female postgraduate students whose registrations were found in hall register were included in the study. The sample interval (K) was calculated to be approximately 2 using the statistical formula K = N/n, where K = sample interval, N = total population in the sample frame, n = sample size. Based on the above stated statistical calculation, every second person on the sample frame was selected except male students. The first student was selected from the frame using balloting method. The study protocol was approved by the UI/UCH Ethical Committee. Students were recruited into the study after due written informed consent was obtained from each of them. Statistical analytical methods Both descriptive and inferential statistics were employed for data analysis using Statistical Package of the Social Sciences (SPSS) version 16. The set null-hypothesis was tested by the use of Pearson Chi-square analysis. Level of significance was reported at 5% probability

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level. The knowledge level of the participants on breast cancer risks and screening modalities were measured on a self-structured scale. For each question item on the scale, participants were expected to choose one among the three options (i.e. ‘yes’, ‘no’, ‘I don’t know’). Correct answer attract 1(one) point, while wrong answer attract 0 (zero) point. Participants’ knowledge scores were summed up and categorized as ‘0 – 2 = poor’, ‘3 – 4 = low’ and ‘5 – 9 = good’.

Results A total of 202 questionnaires retrieved were suitable for analysis; putting the response rate at 74 percent. The students’ age ranged between 17 and 48 years; mean age being 27 years ± 5.1 standard deviation. One hundred and sixty-five (81.7%) and 37 (18.3%) of the respondents were single and married, respectively.

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Awareness and practice of breast cancer screening among the participants Figure 1 presents the awareness of BSE, CBE and mammography among the participants. Health workers constituted a major source of information on the three primary breast cancer screening measures to the participants (figure 2). Out of 159 respondents that claimed to be practicing BSE, 118 (74.2%) used to practice it occasionally, 26 (16.4%), 14 (8.8%) practiced it monthly and weekly, respectively, while one (0.6%) performed it daily (figure 3).

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Prior to data collection 53 (26.2%) of the postgraduate students had CBE done as follows: 16 (7.9%) had CBE done by nurse/midwives, while 37 (18.3%) were performed by medical doctors (figure 4). Eleven (5.4%) had undergone mammography among the postgraduate students. The eleven students had the mammography done between 2000 and 2011. Three and five of them had it done in 2011 and 2010, respectively; while, the remaining one and two had it done in 2001 and 2000, respectively. Among those who had mammography exposure, seven had it once, while the remaining four were exposed to it twice (figure 5). The forty-three (21.3%) respondents who were not practicing BSE gave reasons for nonpractice. Thirteen (30.2%) and 10 (23.3%) of them reported lack of skill and feeling that BSE is not necessary for non-practice of BSE, respectively but 6 (13.9%) gave no reason (Table 1).

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Among the respondents 23 (11.4%) had good knowledge of BSE (figure 4). Similarly, 68 (33.7%) had good knowledge of breast cancer risk factors (figure 6). Among the postgraduate students, the level of knowledge of breast cancer was found to influence the practice of BSE. Thus, the practice of BSE is more among students who had evidence of knowledge of it than those who had poor knowledge. (chi-square = 11.234, df = 2, p-value = 0.004).

Discussion This study was conducted among postgraduate students. This explains the reason for the mean age of 27 years within the study population. Most Nigerian graduates including

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women return to universities to pursue higher degree in the areas of their interest immediately after their first degree. This is because most graduate women like their male counterparts desire to proceed to pursuing higher degrees, particularly, Master of Science (MSc.) degree before settling down for marriage and child rearing nowadays. This appears to be paradigm shift from most ancient African culture. For instance, in the past, Nigerian society often views a woman as unfulfilled, if she is yet to settle the issue of marriage as at when due irrespective of her educational attainment. It is observed that, most Nigerian children including girls entered university at a very young age and they graduate before 20 years or a little above 20 years nowadays. In addition, this accounts for the larger proportion of the students being single. Awareness and practice of Breast Cancer screening measures

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Majority of the students were aware of BSE, CBE and mammography, almost all the participants had heard about BSE and well above half also reported to have heard of CBE and mammogram. The proportion of the students who had heard of BSE was higher than in CBE; Awareness of mammography was the least. This finding is similar to that of other indigenous and foreign studies [10, 14, 21]. However, the small proportion (13%) of the students that practiced BSE monthly irrespective of whether it was done correctly or not; timely or not was likely to be an indication that the students lack detailed information about the three screening modalities. Although, similar low practice of BSE was recorded among Korean women, who were not university students [22], it could be inferred that most of the students who participated in this current study did not know more than the contextual meaning of the three concepts (i.e. BSE, CBE and mammography). It implies that though, most of the postgraduate students actually heard of the three screening measures from health workers, it appears that this population had not received any training on the practice of breast cancer screening. Thus, the information they claimed to have on the screening measures was inadequate and thus, had not translate into regular, correct and appropriate practices of the preventive measures for early detection of breast cancer. However, the fact that the majority of the participants heard of BSE, CBE and mammography from health workers as observed in this study like previous ones [13, 14] is commendable. However, other methods of communicating health information and education should be explored to improve breast cancer screening practices among postgraduate students. In contrast, similar study conducted among female undergraduate of the same university reported mass media as major source of information of BSE, CBE and mammography to the participants. In this current study, since other media contributed to sources of information on breast cancer screening, such media such as printed and electronic media may be involved to ensure wider coverage. These types of media have been found to be sources of health information including breast cancer screening measures [10, 15]. In this study, approximately one-quarters of the students had had CBE by health workers. This is very small compared with the study conducted in Malaysia among female university students; a situation where more than 70% had undergone CBE [23]. This may be due to the fact that there is no structured program as recommended for developing countries by WHO [24]. However, it may be appropriate to identify factors influencing the performance of CBE on clients by relevant health workers (particularly, nurses and medical doctors) in future

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studies. Forty-three of the postgraduate students studied gave reasons for non-practice of BSE. The reasons given were similar to those given by participants in previous studies [10, 13], which include lack of skill to perform BSE, fear of detecting cancer and forgetfulness). Besides, it is anticipated that health campaign that features effective teaching and practical training including demonstration will improve BSE practice and utilization of mammography among participants. Knowledge of BSE among participants

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From the findings, the percentages of postgraduate students that had good knowledge were very small for BSE (11%) and breast cancer risk factors (34%). However, the level of knowledge of breast cancer was found to influence the practice of BSE in this study. Thus, the better the level of knowledge the more likely the students are likely to carry out BSE for the purpose of early detection of BSE. This agrees with the study done among female high school student in Turkey [10]. In this current study, the larger percentage of the postgraduate student who had poor or low knowledge of breast cancer risks and screening measure might be responsible for low practice of BSE among the study population.

Conclusion

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Results from this study show that though, the level of awareness of the three screening modalities under study, the breast cancer screening information received so far were inadequate. This might have impact greatly on the level of knowledge. Level of awareness did not translate into either knowledge or practice of the breast cancer screening modalities. Therefore, it is suggested that health workers should reach people within academic communities with effective breast cancer prevention campaign programmes. It may be necessary to explore other methods of communicating health information and education on breast cancer screening measures to university students. In addition, future studies capable of identifying factors influencing performance of CBE by nurses, midwives and medical doctors may be necessary. Replication of this study in other Nigerian tertiary institution may be necessary for the purpose of possible future generalization.

Acknowledgment Data analysis and writing of this paper was supported by the Medical Education Partnership Initiative in Nigeria (MEPIN) project funded by Fogarty International Center, the Office of AIDS Research, and the National Human Genome Research Institute of the National Institute of Health, The Health Resources and Services Administration (HRSA) and the Office of the US Global AIDS Coordinator under Award Number R24TW008878. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations.

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3. Wilson CM, Tobin S, Young RC. The Exploding Worldwide Cancer Burden: The Impact of Cancer on Women. Intl. J. Gynecol Cancer. 2004; 14:1–11. 4. Madaguw EN, Joaquim KA, Bassir O. Contamination of fermented Nigeria beverages by Carcinogenic nitrosamines. Tropical Geog. Med. 2004; 31:283–289. 5. Okobia MN, Bunker CH, Okonofua FE, Osime U. Knowledge, attitude and practice of Nigerian women towards breast cancer: A cross-sectional study. World. J. Surg Oncology. 2006; 411:1477– 7819. 6. Oluwatosin OA, Oladepo O. Knowledge of breast cancer and its early detection measures among rural women in Akinyele Local Government Area, Ibadan, Nigeria. BMC Cancer. 2006:271. [PubMed: 17125524] 7. Suzanne, CS.; Brenda, GB.; Janice, LH.; Kerry, HC. Textbook of Medical-Surgical Nursing. 12th Edition. Lippincott Williams and Wilkins: Waters Kluwer Health; 2010. Brunner and suddarth’s. 8. Akpinar YY, Baykan Z, Nacar M, Gun I, Cetinkay F. Knowledge, attitude about breast cancer and practice of breast screening among female health care professionals: a study from Turkey. Asian pacific J. cancer prev. 2011; 12:3063–3068. 9. Smith R, Saslow D, Sawyer K, et al. American Cancer Society guidelines for Breast Screening: Update 2007 CA. Cancer J. Clinical. 2007; 53(3):141–169. 10. Karayurt O, Ozmen D, Cetinkaya AC. Awareness of breast cancer risk factors and practice of breast self examination among high students in Turkey. BMC Public Health. 2008; 8:359. [PubMed: 18928520] 11. America Cancer Society. Breast Cancer Facts and Figure. 2008 http://www.cancerorg/ downloads/SIT/CAF2005Brfacspdf2005pdf. 12. Jarvandi S, Montazeri A, Harichi I, Kazemnej IA. Beliefs and behaviours of Iranian Teachers toward Early Detection of Breast and Breast Self Examination. Public Health. 2002; 116:245–249. [PubMed: 12087485] 13. Oluwole OC. Awareness, knowledge and practice of breast self examination amongst female health workers in a Nigerian community. Sudan JMS. 2008; 3(2):99–103. 14. Oche MO, Ayodele SO, Umar AS. Breast cancer and mammography: Current knowledge, attitudes and practices of female health workers in a tertiary health institution in Northern Nigeria. Public Health Research. 2012; 2(5):114–119. 15. Adejumo PO, Aluko JO, Oluwatosin OA. Awareness of breast cancer screening among female undergraduate students of University of Ibadan, Nigeria. Afr. J. Psych. study of social issues. 2008; 11(1&2):161–173. 16. Balogun M, Owoaje E, et al. Knowledge and practice of breast self-examination among female traders in ibadan, nigeria. Annals of Ibadan Postgraduate Medicine. 2007; 3(2):52–56. 17. Ezem BU. Awareness and uptake of cervical cancer screening in owerri, south-eastern nigeria. Annals of African Medicine. 2007; 6(3):94–98. [PubMed: 18240495] 18. Hadi MA, Hassali MA, Shafie AA, Awaisu A. Evaluation of breast cancer awareness among female university students in malaysia. Pharmacy Practice. 2010; 8(1):29–34. [PubMed: 25152790] 19. Ibrahim NA, Odusanya OO. Knowledge of risk factors, beliefs and practices of female healthcare professionals towards breast cancer in a tertiary institution in lagos, nigeria. BMC Cancer. 2009; 9(1):76. [PubMed: 19261179] 20. Sreedharan J, Muttappallymyalil J, Venkatramana M, Thomas M. Breast self-examination: Knowledge and practice among nurses in united arab emirates. Asian Pac J Cancer Prev. 2010; 11(3):651–654. [PubMed: 21039031] 21. Yoo B, Choi KS, Jung K, Jun JK. Awareness and practice of breast self-examination among Korean women: results from nationwide survey. Asian. Pacific J. Cancer Prev. 13:123–125. 22. Hadi MA, Hassali MA, Shafie AA, Awaisu A. Evaluation of breast cancer awareness among female university students in Malaysia. Pharm Practice (Internet). 2010; 8(1):29–34. 23. Oluwatosin OA. Primary health care nurses’ knowledge, practice and client teaching of early detection measures of breast cancer in Ibadan. BMC Nursing. 2012; 11(22) http:// www.biomedcentral.com/1472-6955/11/22.

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Awareness of breast cancer screening measures among UI postgraduate students

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Major sources of information of breast cancer screening measures

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Frequency of BSE practice among UI postgraduate students

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Health personnel that performed CBE on 53 UI postgraduate students

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Practice of breast cancer screening measures among participants

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Level of knowledge of breast cancer and screening among participants

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Table 1

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Factors contributing to non-practice of BSE among UI postgraduate students Contributing factors

Frequency

Percentage

Lack of skill to do BSE

13

30.2

Felt BSE is not necessary

10

23.3

Believed they cannot have breast cancer

14

32.6

No given reason

6

13.9

Total

43

100

Author Manuscript Author Manuscript Author Manuscript Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 17.

Awareness, knowledge and practices of breast cancer screening measures among female postgraduate students of a Nigerian Federal University: a cross-sectional study.

Annually, over a million new cases of breast cancer results in about 375,000 deaths worldwide. Recently, the burden of the disease has been on the inc...
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