Breast cancer and breast X ray examination: current knowledge, attitude and practice of female health workers in a three level health care facility in northern Nigeria
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https://www.eduzhai.net Public Health Research 2012, 2(5): 114-119 DOI: 10.5923/j.phr.20120205.01 Breast Cancer and Mammography: Current Knowledge, Attitudes and Practices of Female Health Workers in a Tertiary Health Institution in Northern Nigeria Oche MO*, Ayodele SO, Umar AS Department of Community Health, Usmanu Danfodiyo University, Sokoto, Nigeria Abstract Breast cancer is one of the most common causes of cancer related deaths among women world wide, accounting for 31% of cancers among wo men and 19% of deaths among wo men are due to cancer. Early detection of breast cancer and early presentation for management has been shown to reduce mortality rates. This descriptive cross-sectional study involving 100 female health workers made up of 30 doctors and 70 nurses was carried out at the Usmanu Danfodiyo University Teaching hospital, So koto .The study is aimed at assessing the knowledge of female health workers about breast cancer and their attitude and practice o f mammography. A total of 67% of the study subjects had adequate knowledge of breast cancer and its risk factors with 80% of the female doctors having better knowledge co mpared to the nurses. Majority, (84%) of the respondents were aware of mammog raphy as a way of detecting early cancer o f the breast and only 9% of them had undergone the procedure in the last one year. The commonest reason for not undergoing the procedure was that they were not aware of the procedure being carried out in the study centre. The low mammographic screening rate recorded in the study portrays a bad omen for the fight against cancer of the breast and this reinforces the need for educational intervention to increase the awareness and uptake of mammog raphic screening among the study population. Keywords Breast Cancer, Knowledge, Female Health Workers, Mammography, Nigeria 1. Introduction Breast cancer is one of the most co mmon cause of cancer related deaths among wo men worldwide(1-3) accounting for 31% of cancers among wo men and 19% of deaths among wo men are due to cancer(1). In Nigeria as well as in other parts of the world, Breast cancer remained the most common cancer among wo men and the second leading cause of death(4-7). While breast cancer is one of the commonest reasons for death among wo men, it has been observed that detection and diagnosis at the earlier stage of the disease allo ws wo men variable treat ment options and a greater chance of survival(1) In Nigeria, the burden of the d isease is increasing and mostly at advanced stages with min imal hope of any intervention that will significantly reduce disability and mortality(8). One of the major reasons observed for the late presentation was the lack the access by most women to vital informat ion on the factors that decrease breast cancer ris ks (9 ,1 0) . Aderounmu et al in their study on the knowledge and at titude of women to cancer of the breast in South Western * Corresponding author: firstname.lastname@example.org (Oche MO) Published online at https://www.eduzhai.net Copyright © 2012 Scientific & Academic Publishing. All Rights Reserved Nigeria noted that inadequate knowledge of the disease andthe limited awareness of the risk factors for cancer of the breast contributed significantly to the poor prognosis of breast cancer(11).Early detection of breast cancer and early presentation for management has been shown to reduce mortality rates and it is therefore important that regular screening methods be encouraged among populations(12). Empowering female health workers and creating awareness amongst them could go a long way in enhancing the screening program fo r breast cancer. Breast self examination(BSE), clinical breast examination(CBE) and mammography are the secondary preventive methods used for investigation in early detection of breast cancer(13). According to the A merican Cancer Society(ACS), wo men should know how their breasts feel and report promptly to their health care providers any breast changes. Although ACS does not recommend BSE any longer as breast cancer detection though BSE does not increase survival rate(14), It is still widely pract iced in most developing countries where CBE and mammography are not readily available and accessible to the vast majority of the wo men population. Th is was further underscored by the reported five year survival of breast cancer in Nigeria to be less than 10% co mpared to 70% in Western Europe and North America(3). Several studies have reported and established a positive association between performance of BSE and early detection of breast cancer (8,15). Health 115 Public Health Research 2012, 2(5): 114-119 workers play a v ital ro le in empowering wo men with the necessary information on the various secondary preventive methods on the early detection of breast cancer. For health workers to be effective in impart ing health education, they must possess the appropriate knowledge, attitude and beliefs concerning the health behaviour being promoted (18). Nurses and other health care workers who are saddled with the responsibility of giving health talks in clinics can now play a vital ro le in patient education about breast cancer screening methods (19). They also play a unique role in alerting the community to the early detection of breast cancer as they are usually the closest contacts with female patients(20,21). However, studies in the USA and South western Nigeria have reported knowledge gaps among physicians and nurses in pro moting breast cancer s creen in g (16, 1 7). Furthermore, studies have shown that the attitude and orientation of health care providers are important determinants of use of breast cancer screening programs(22,23). Several reports about breast cancer in Nigeria have observed very low knowledge about symptoms of cancer of the breast and various screening methods(8,17,24). The paucity of knowledge and attitude on part of health wo rkers could constitute an impediment to institutional frameworks and policies targeted towards sensitization of the wo men populace about breast cancer and mammography. Carrying out annual mammography is considered the most valuable tool for detecting breast cancer in the earliest possible stages, before the cancer has metastasized and when interventions are most effective and least invasive and debilitating(25). Similar studies have not been carried out in this part of the country and considering the increasing rate of cancer of the breast in Nigeria, which formed the basis for this study, aimed at assessing the knowledge of female health workers about breast cancer and their attitude and practice of ma mmography. 2. Methodology The design was a descriptive cross-sectional study carried out amongst female health workers at the Usmanu Danfodiyo University Teaching Hospital So koto, North Western Nigeria. The hospital is one of the referral centres in north –western part of Nigeria and renders preventive, curative and rehabili tative services including Magnetic resonance imaging (M RI), mammography and radiotherapy among others. The Teaching hospital has a 650 bed capacity with a staff strength of over 1,300 including 166 female health workers. A total of 100 female health workers made up of 30 doctors and 70 nurses were selected proportionate to their population fro m the departments of obstetrics and gynaecology, surgery and family med icine who are involved in the day to day patient management. A set of comprehensive, structured pretested and self admin istered questionnaire was administered to the respondents. 3. Instruments and Data Collection The questionnaires sought information on biodata, respondents’ knowledge such as signs and symptoms of cancer of the breast, mode of presentation, risk factors, screening and diagnostic procedures and management options available in the study area, attitude towards cancer of the breast and practice of mammography screening. The questionnaires were sorted out for completeness and data cleaning after which data was entered into and analysed using Epi-info version 3.4(2008). The answers to the knowledge questions were scored and graded with each correct answer to a questions attracting one mark and no marks awarded to a wrong answer. Scores <50 and ≥50% were adjudged inadequate and adequate knowledge respectively. There was cross tabulation of variables with level o f statistical significance set at 95% confidence interval. 4. Results Table 1. Age of respondents Age (years) No (%) 25-29 25(25) 30-34 30(30) 35-39 18(18) 40-44 14(14) 45-49 7(7) 50-54 6(6) Mean age = 35.3 ±2.3 Table 2. Respondents’ duration of practice Duration of practice (years) No (%) 0-4 20(20) 5-9 43 (43) 10-14 7(7) 15-19 3(3) 20-24 3(3) ≥25 24(24) Total 100(100) Mean duration of practice=11.9±3.7 Table 3. Source of information about cancer of breast and mammography Source of information No (%) Text books Seminars/workshops 45 (45) 27 (27) Int ern et 16 (16) Medical journals 12 (12) Tot al 100 (100) Oche M O et al.: Breast Cancer and M ammography: Current Knowledge, Attitudes and Practices 116 of Female Health Workers in a Tertiary Health Institution in Northern Nigeria Knowledge Knowledge of Cancer of the breast Age of respondents(yrs) <40 ≥40 Category of health worke rs Doctors Nurses Duration of practice(yrs) <10 ≥10 Table 4. Knowledge of breast cancer Adequate knowledge(≥50%) 67(67%) Inadequate knowledge (≤50%) 33(33%) 49 24 18 9 12 3 55 30 39 24 28 9 Test statistics X2=0.002, df=1, P=0.97 X2=0.75,df= 1 ,P =0 .3 9 X2=1.43,df= 1 ,P =0 .2 3 Source of information Text bo ok s 34 Seminars/workshop 19 Int ern et 9 Medical journals 5 X2=5.95, 11 df=3, 8 P =0 .1 14 (not 7 sign ificant ) 7 Attendance of pre vious training on breast cancer and mammography Yes 9 No 58 4 X2=0.34,df= 1 ,P =0 .8 55 29 (not sign ificant ) Table 5. Knowledge of mammography Variable Knowledge of Cancer of the breast Age of respondents(yrs) <40 ≥40 Category of health worke rs Doctors Nurses Duration of practice(yrs) <10 ≥10 Attendance of pre vious training on bre ast cancer and mammography Yes No Grading of knowledge Adequate knowledge (≥50%) Inadequate knowledge (≤50%) 56(56%) 44(44%) 39 34 17 10 13 2 43 42 42 21 14 23 11 2 56 31 Table 6. Practice of BSE Test statistics X2 =0.392, df =1; P=0.27(not significant) X2 =5.35, df=1, P =0 .0 21 (sign ificant) X2 =6 .7 4,df=1,P =0.009 (significant) X2=1.28, df=1;P=1.28 (not significant) Practice of BSE Age of respondents(yrs) <40 ≥40 Category of health worke rs Doctors Nurses Duration of practice(yrs) <10 ≥10 Attendance of pre vious training on breast cance r andmammography Yes No Yes 54(54%) 35 19 9 47 26 30 13 54 No 46(46%) 28 18 6 38 37 7 0 33 Test statistics P=0.42 (not significant) P=0.021(not significant) P =0 .0 001 (significant) X2 c=5 .7 4 ;df=1 ;P =0 .0 17 (significant) 117 Public Health Research 2012, 2(5): 114-119 Table 7. Reasons for not undergoing mammography Reasons Not aware of the procedure Don’t need it Cannot afford the cost It is only meant for people with cancer of the breast NR Tot al No (%) 69 (69) 14 (14) 5 (5) 3 (3) 9 (9) 100(100) The ages of the respondents ranged from 25-29 years with a mean age of 35.3±2.3 years. A total of 28(28%) respondents were Hausas, 26(26%) Igbos while other tribes constituted 22%. More than half of the respondents were Christians(59%) and married(55%) (Table 1) Most(43%) of the study subjects had practiced for 5-9years, 24% for more than 25 years with a mean duration of practice of 11.9±3.7(Tab le 2) Concerning the source of information about cancer of the breast and mammography, 45% o f the study subjects read it in text books while only 12% got the informat ion fro m med ical journals(Table 3). Out of the hundred respondents , only thirteen of them had attended any in service training on breast cancer and mammography in the last three years. On the knowledge o f breast cancer, 67(67%) of the study subjects had adequate knowledge of the disease and its risk factors with 80% of the female doctors having better knowledge co mpared to the nurses. Age, category of health worker, duration of practice, source of information and attendance of previous training on breast cancer and mammography did not influence the level of knowledge of the respondents significantly(Table 4). A total of 84(84%) of the respondents were aware of mammography as a way of detecting cancer of the breast with more than half (56%) having adequate knowledge about mammography and its ability to detect early cancer of the breast. The category of health workers and duration of practice significantly influenced the knowledge of mammography as the female doctors and health workers that practiced less than ten years had a better knowledge of mammography (Table 5). However, on ly 32(32%) of the health workers were awa re of the procedure be ing carried out in the Hospital. Of the 32 respondents that were aware of the procedure being carried out in the hospital, 15 learnt of it through patients and their relations, hospital staff(10) and hospital management. A total of 54% o f the study subjects do carry out regular self breast examination(BSE). The respondents who practiced more than ten years and those who had attended a previous training on breast cancer and mammog raphy practiced BSE better than the other respondents and this was found to be statistically significant(Table 6) Only 9 o f the respondents had actually undergone mammography with only three of them undergoing the procedure twice. Majority, 69% of the respondents who did not go for ma mmography decla red that they we re unawa re of the procedure being carried out in the hospital while only 5% of them opined that they could not afford the cost of the procedure.(Table 7). 5. Discussion For health workers to function as effective pro moters of breast cancer control through early detection, they must possess the relevant knowledge as well as appropriate attitude and belief concerning the disease and its early detection(18). The respondents in this study demonstrated good knowledge of cancer of the breast and its risk factors as majority(67%) of them had adequate knowledge of the disease. The high knowledge observed in this study is in agreement with the findings fro m similar studies in Los Angeles, Western Turkey and Ibadan(16,25,26). Ho wever the level of knowledge recorded in our study was higher than the findings fro m other studies where lo wer figures were observed for the knowledge of breast cancer(27,28). Doctors in our study group had a better knowledge as 80% o f them had adequate knowledge of breast cancer wh ich is in consonance with findings fro m similar studies in Benin city and Lagos, Nigeria(27,29). A lthough the female doctors in the study had a better knowledge of breast cancer co mpared to all the other cadre of health workers, this was however found not to be statistically significant(P=0.39). The high knowledge recorded by the female doctors may not be unrelated to the content of their undergraduate curriculum which covered the subject under study. Similarly, the age of respondents(P=0.97) and duration of practice(P= 0.23) d id not have any significant impact on the level of knowledge of the respondents about breast cancer and its risk factors. There was a very high level of awareness(84%) about mammography and its use in early detection of breast cancer amongst the respondents in our study. This is in keep ing with findings fro m the study in Benin city, Nigeria where their subjects equally recorded a very h igh level of awareness(80.7%) about mammography(27). However mo re than half(56%) of the respondents had adequate knowledge of ma mmography and its ability to detect cancer of the breast in the early stages. Although the respondents in this study reported high levels of awareness and knowledge concerning mammography, only 32% o f them were aware of the procedure being carried out in the study area. This underscores the need to enlighten the female health workers on the availability and use of mammography in detecting cancer of the breast at its earliest stages since these group of health workers are the closest to the female patients who are the eventual recip ients of this procedure. The study by Akhigbe and colleagues showed that only 23.7% and 35.9% of their respondents had good and poor knowledge of ma mmography(27). More than half(57%) of the wo men in this study showed positive attitude towards mammog raphy and would advise other women to go for it. The high knowledge and awareness about mammography could have contributed to this positive Oche M O et al.: Breast Cancer and M ammography: Current Knowledge, Attitudes and Practices 118 of Female Health Workers in a Tertiary Health Institution in Northern Nigeria attitude of the respondents. Similar positive attitude to mammography was observed in the study by Bastani et al(18); however the study from Mulago hospital in Ka mpa la showed that all the wo men in their study generally reported negative attitude towards mammography(28). In this study, only 9(9%) of the respondents had actually undergone mammography. Similar lo w level of utilization of mammography was previously reported fro m other centres(17,27,29). In a study carried out at Mulago hospital, Kampala, it was observed that none of their subjects had ever done a mammography and the main reason for this was the high cost of the procedure(28). The low level of ut ilization of mammography amongst our study subjects may not be unrelated to the lack of awareness about mammog raphy being carried out in the study centre in contrast to the non availability of the mammography in some centres(27). The cost of carry ing out a mammography in the study centre is one of the cheapest in the country(less than four thousand naira or
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