Abstract
Background: Breast cancer is the most common malignancy affecting women, and second cause of cancer death in the world, with more than one million cases occurring worldwide annually. The chance of a woman having invasive breast cancer some time during her life is about 1 in 8. The chance of dying from breast cancer is about 1 in 35. In Nigeria, breast cancer is second most common cancer (23.4%), after Cervix uteri (45.8%). The five year breast cancer survival is 39% for advanced disease and 74% for early disease, with overall survival of 56%. This poor prognosis in Nigerians is most probably due to patients seeking medical attention, and presenting at late stage IV of the cancer; factors responsible for this late stage presentation are not systematically spelt out.
Objective: To determine the awareness of breast cancer risk factor and early detection methods, and associated factors among female health care professionals working in Yaba hospital
Methodology: A cross-sectional study, which was carried out in Yaba National Referral Hospital from January to March 2023. A total of 405 nurses where interviewed using simple random sampling with proportional allocation to size of departments. The awareness of breast cancer risk factors and early detection awareness were categorized into good or poor on the basis of twelve key items.
Results: The awareness of breast cancer risk factors among female health care professionals working in Yaba national referral and teaching hospital was low (09%). Awareness was increasingly associated with working experience, having cared for a breast cancer patient and continued education (OR= 2.20, 95% CI = 1.02-4.71), (OR= 5.49, 95% CI = 2.08-14.48), and (OR= 1.99, 95% CI = 0.79-5.02) respectively.
The awareness of mammography among female health care professionals working in Yaba national referral and teaching hospital was low (25.4%). Awareness was increasingly associated with age, gender, marital status, experience, occupation, educational level, having cared for a breast cancer patient (OR= 1.91, 95% CI = 1.12- 3.26) and continued education.
Conclusion: The awareness of mammography was generally low among female health care professionals working in Yaba national referral and teaching hospital were low. The age, gender, marital status, working experience, occupation, having cared for a breast cancer patient and continued education had a positive influence on the awareness of breast cancer risk factors.
These results provide important baseline information and may be used to develop tailored breast cancer education programs, increase primary and secondary prevention efforts, and evaluate the effectiveness of prevention programs.
CHAPTER ONE
INTRODUCTION
1.1 Background of study
Breast cancer is the most common malignancy affecting women, and second cause of cancer death; the sixth cause of death from disease in women of all ages, with more than one million cases occurring worldwide annually. Affluent societies carry the greatest risk, with incidence rates of greater than 80 per 100,000 populations per year [1]. The chance of a woman having invasive breast cancer some time during her life is about 1 in 8, and the chance of dying from breast cancer is about 1 in 35 [2,3].
In North America, Western Europe and Australia, breast cancer mortality rates have declined, mainly due to improvements in early detection and treatment, and high breast cancer awareness levels in the population, surveys and national screening programs. Five year breast cancer survival rates are higher than 70% in most developed countries and less than 40% for most developing countries; mainly due to low awareness levels, lack of access to early diagnosis and treatment options [1].
In Nigeria breast cancer trends were declining and frequency of hospital attendance has risen, reduced late presentation and this was attributed to several factors; increased awareness about breast cancer, improved early detection methods and usefulness of breast self examination [3,4,5].
The most pragmatic solution to early detection and prevention lies in breast cancer education of women to be able to judge their risk and take relevant measures. The important resources of dissemination of breast cancer knowledge to women are the health-care professionals, educational institutions and media. Among the healthcare professionals, female nurses/midwifes comprise the group most suited for this purpose because of their numbers, frequent contact with patients and values [6]. In Nigeria, the largest numbers of clinical/medical staffs are nurses/midwifes, constituting 75.85% of the total staff, of which, a substantial number of nurses are female and according to the local government staffing levels for district health services, the nurses/midwifes are distributed up to least health center II [7] and it is also known that culturally, women patients are reluctant to go to male health care providers for problems such as breast diseases [8].
In Nigeria, there are no studies which have been carried out to assess the awareness of breast cancer risk factors, and early detection measures among female health care professionals. In an environment where there is no established national screening program for breast cancer, it is pertinent to assess the knowledge of breast cancer risk factors, and its early detection measures. National campaigns on cancer prevention and treatment is going on, but to effect these, and in view of the expanded roles female health care professionals are expected to play in breast care, and embarking on improved breast cancer services and national prevention programs, it is important to assess health care professionals’ knowledge of breast cancer and early detection awareness. This study will be conducted among nurses working in Yaba National referral hospital, Nigeria, to determine their awareness of breast cancer and early detection and associated factors.
1.2 Problem Statement
Breast cancer is second most common cancers in Nigeria (ASR 23.4 per 100,000), after Cervix uteri (ASR 45.8 per 100,000) [3,9]., and the prognosis for most Nigerians patients is poor, most seeking medical attention and presenting late at stage IV of the cancer (58% poorly differentiated, 33% moderately differentiated and 9% well differentiated [10] and this could explain the poor 5-year survival of 56% [11].
Health care professionals constitute 75.85% of the medical care professionals (HSSP II, 2007), the level of breast cancer risk factors and early detection awareness is not known and in view of the expanded roles female health care professionals are expected to play in for National campaigns on breast cancer prevention and treatment, breast care, and embarking on improved breast cancer services and national prevention programs, and the helping role of nurses in promoting healthy behaviors in communities [6]. It’s thus important to assess female health care professionals’ awareness of breast cancer risk factors, and early detection.
1.3 Research Question
I. What is the awareness level for breast cancer risk factors among female health care professionals working in Yaba national referral hospital?
II. What factors are associated with the breast cancer risk factors awareness?
III. What is the Knowledge, attitude and uptake of mammography among female health care professionals working in Yaba national referral hospital?
IV. What factors are associated with the awareness of mammography?
1.4 Study Objectives General objective
The aim of this study is to determine awareness of mammography among female health care professionals working in Yaba hospital.
Specific objectives
I. To determine the awareness level for breast cancer risk factors among female health care professionals working in Yaba national referral hospital?
II. To determine what factors are associated with the breast cancer risk factors awareness?
III. To determine what is the Knowledge, attitude and uptake of mammography among female health care professionals working in Yaba national referral hospital?
IV. To determine what factors are associated with the awareness of mammography?
1.5 Study Justification
Nigeria has reaffirmed its commitment to achieving the MDGs, through the national health policy, universal delivery of national minimum health care package; cluster 4: prevention and control of non-communicable diseases/conditions with targets of increasing community awareness on non-communicable diseases/conditions to 80%, and integration of prevention and management in the functions of 100% of health centers 4 [7,11,12]. The national health policy has not stated clearly national guidelines for breast cancer awareness, screening, and community intervention, including the role that can be played by health workers in community awareness and early detection. There is an urgent need for awareness of breast cancer and its early detection measures. Similarly, baseline reports on current level of knowledge would be vital to an effective awareness program, hence the need for these studies assessing level of awareness of mammography in the nurses and population.
Health care professionals constitute 75.85% of the medical staff, and have an important role in the education of women in our country because they are more frequently in contact with patients (are distributed all over, up to the last level health centre II). It’s also known that the natural helping role of nurses in promoting healthy behaviors in communities, women feel those more closely to ask something about the symptoms and screening of sex specific cancers such as breast cancer and gynecological cancers and thus, they can constitute a model of health promotion for women, despite of the absence of a role on a regular education program [6,7,11].
This study will include midwives, because they are in continuous contact with mothers, who are in risk group of getting breast cancer, and hence will be an important source of information for the mothers and expectant mothers during pre and post antenatal visits.
1.6 Study Significance
This study will be a baseline for Yaba hospital management and nursing/midwives schools, to help develop curriculum, continued training programs for nurses in relation to breast cancer. This study will also act as a baseline for policy makers as Nigeria reaffirms its commitment to achieving MDG, through universal delivery of national minimum health care package; cluster 4: prevention and control of non-communicable diseases/conditions with targets of increasing community awareness on non- communicable diseases/conditions to 80%, and integration of prevention and management in the functions of 100% of health centers 4, hence develop national training program for female health care professionals, as a tool to disseminate information to the general population for awareness, early detection and management at early stages of the cancer.
1.7 Limitations of the study
Different scholars have used different measurement or categorization scale of awareness level and hence our scale of measurement could be varying since there was no standard scale of measure.
There was also limitation of small numbers in each cell of sub categories during bivariate and multivariate analysis, resulting into high value OR. This is because some variables where removed on the way, during the analysis, coupled with categorization of the remaining variables into subgroups
Since the study was carried out in the national referral hospital, there is possibility of selection bias, as this does not represent what happens in other health centers.
No record of number and characteristics of people that refused to participate in the study.
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