CHAPTER ONE

INTRODUCTION

 1.1 Background to the Study

Cancer is the uncontrolled growth of abnormal cells anywhere in the body. The abnormal cells are termed malignant or misnomer cells (Dugdale, 2010). Cancer is a group of more than 200 diseases characterized by unregulated growth of cells. It can in persons of all ages and all races and is a major health problem in many countries worldwide. It is known to be the most feared of all diseases, feared far more than heart diseases (Seeley, Stephen & Tate, 2010). These authors viewed cancer as synonymous with death, pain, disfigurement and dependency.

Hippocrates coined the word carcinoma, meaning a tumour that spreads and destroys the host. However, ancient Egyptians and later Galen described cancer as being crablike in nature because cancerous tumours stick onto the body and prey on the flesh like crabs. They grasp the tissues they invade and cause pain that is throbbing, creeping, gnawing the flesh and resembling the pinching of a crab (Dugdale, 2010).

In the females, the most occurring cancers are those affecting the mammary glands ( breast cancer) and those affecting the neck of the uterus (cervical cancer) (Bassey, Ekpe & Abasiatai, 2007; American Cancer Society (ACS), 2009 & Odetola, 2011). Breast cancer is cancer that occurs in the breast tissue. It is a malignant proliferation of epithelial cells that line the ducts or lobules of the breast. It is formed when the processes that control normal cell growth breaks down, enabling a single abnormal cell to multiply at a rapid rate. These new cells tend to destroy an increasing portion of normal breast tissue overtime and may occur metastasize to other parts of the body (Smeltzer, Bare, Hinkle & Cheever, 2010).

Breast cancer is the most frequently diagnosed cancer among women in 140 of 180 countries worldwide (Ferlay, Soerjomataram, Ervik, Rebelo, Parkin & Forman, 2013). In 2007, 1.7 million women were diagnosed with breast cancer and there were already 6.3 million women 15 who were alive with the diagnosis of breast cancer in the previous five years (Ferlay, et. al, 2013). Since 2008 estimates, breast cancer incidence has increased by more than 20% while the mortality has increased by 14% making it to be the most common cause of cancer death among women, with 522,000 deaths in 2012 worldwide (Ferlay, at. al, 2013; Fasoranti, 2013).

Worldwide trends show that developing countries are going through rapid societal and economic changes in an attempt to become industrialized. There is also a shift in the life style of people towards that of industrialized countries, leading to a rise in the burden of cancer especially those associated with reproductive, dietary and hormonal risk factors. Breast cancer incidence and mortality are increasing in most countries of Africa and Asia (International Agency for Research on Cancer (IARC), 2012).Ferlay, et. al (2013) reports that the incidence rate of breast cancer varies in different regions of the world, it remains highest in more developed regions, while its mortality is relatively much higher in less developed countries due to lack of early detection and access to treatment facilities. For instance in Western Europe, breast cancer incidence has reached more than 90 new cases per 100,000 women annually compared with 30 per 100,000 women in East Africa.

Jedy-Agba, Curado, Ogunbiyi, Oga, Falowole, Osubor & Otu (2012) posited that the most common cancers in Nigeria among women are breast cancer 50.8% and cervical cancer 15.7%. The standardized incidence rate of breast cancer from both Abuja Cancer Registry (ABCR) and the Ibadan Cancer Registry (IBCR) in 2012 was 58.3 per 100,000. For IBCR only, it was 52.0 per 100,000 while ABCR had 64.6 per 100,000 (Jedy-Agba, et. al, 2012). According to Odeh, (2012) breast cancer is responsible for about sixteen percent (16%) of all cancer related deaths in Nigeria and is still the number one disease, and leading cancer scourge affecting humans with 25% of cases being reported early while 75% are reported late.

There is no single, specific cause of breast cancer, but a combination of genetic, hormonal and possibly environmental factors may increase the risk of its development. It is not a pathologic entity that develops overnight, it starts with a genetic alteration in a single cell and takes time to divide and double in size. Doubling time varies but breast tumours are often present for several years before they become palpable. For this reason every woman needs to have a clear understanding of her risk factors, warning signs of breast cancer for example, a lump, discharge from nipple and her normal breast size and shape so that any abnormality can be detected at a very early stage. Unfortunately, some women often underestimate their risk of developing breast cancer and are rarely engaged in breast screening programmes and as such seek initial treatment after years of ignoring symptoms.

Screening refers to the examination of individuals or groups of usually asymptomatic people to detect those with high probability of having a given disease, typically by means of inexpensive diagnostic tests (IARC, 2012). Screening tests can often times detect cancer in its earliest stages, long before any actual symptoms can be noticed. There are specific cancer screening tests that are available for women. Each test is highly effective and recommended for all females particularly those for breast cancers. The World Health organization (WHO) in several reports indicated that cancers are largely preventable by effective screening programmes. Considerable reduction in breast cancer incidence and deaths have been achieved in developed nations with symptomatic cytological smear, screening and breast 18 examination programmes organized by the national breast cancer early detection programmes (Elovainio & Miller, 2007).

Despite evidence that breast cancer screening reduces morbidity and mortality, Odetola (2011) reports that most women have not undergone regular screening examinations. The major factor which determines people’s participation in screening programmes either in high risk group or in the general population is the awareness which is a motivating factor (Odetola, 2011). This study therefore would assess the women’s knowledge and practices of the various screening tests for breast cancer.

1.1 Statement of Problem

Most people with chronic diseases including cancer in Nigeria prefer to consult traditional healers first, although these healers do not understand the scientific basis of cancer management (Sofulowe & Bennet, 2011). Patients therefore utilize existing facilities in conventional hospitals as a last resort. This practice causes delay in presentation of cancer cases at the hospitals with a large proportion of patients being diagnosed at advanced stages of the disease. Breast cancer are the most commonly diagnosed cancers in women with an increasing morbidity and mortality rate in most developing countries (IARC, 2012; Ferlay, et. al, 2013). Whereas breast and cervical cancer screening have become a success story of cancer prevention in the developed countries (Ferlay, et, al, 2013), Odetola, (2011) reports that most women in her study have not undergone regular screening examinations.

The researcher has also observed nine (9) women die between 2012 and 2013 in the State due to breast cancer. Two of them were seen receiving spiritual care/treatment in a church where they remained till death. May be these and other unknown cases could have been prevented through screening, early detection and appropriate treatment. However, in effort to avail women of screening facilities, the State branch of the Medical Women Association (MWA) offers weekly screening services at their clinic at Uyo for breast cancer in women.

1.3 Justification of the Study

Market women are heterogeneous group of people with different background and therefore likely to represent the general population. Lack of enough data necessitated this study which will form a baseline for subsequent comparison and intervention.

1.4 Research Questions

 i. What is the level of knowledge of breast cancer and screening amongst market women in Ahoada metropolis?

 ii. What is their attitude towards cervical screening?

 iii. What is their practice of cervical cancer screening?

1.5 Aims and Objectives

General Aim

 To assess mammographic screening awareness among female traders in Ahoada metropolis.

Specific Objectives

 i. To assess the level of knowledge of cervical cancer and cervical cancer screen among market women in Ahoada metropolis.

 ii. To determine the attitude of market women in Ahoada metropolis towards breast cancer screening.

iii. To determine the practice of breast cancer screening among market women in Ahoada metropolis.

1.6 Significance of the study

The result of this study will provide information on the awareness of screening tests for breast cancer among female traders in Ahoada. It will also indicate whether the women in Ahoada participate in the screening programmes for breast cancer or not. The study will help to fill the gap in knowledge and practice of breast cancer among women in Ahoada, Rivers State. Findings if utilized will help equip and guide nurses, health planners and other stakeholders in the health sector with the right information to direct health education programmes and campaigns to increase awareness among women on the various screening tests for breast cancer. If the results of the study were put to use, it will help to improve the number of women who present themselves for screening, thus reducing the delays in presentation, diagnosis and treatment of cancer cases. This will generally help to reduce the incidence and mortality rates of breast cancer among women in the State. The findings will also add to the existing literature on knowledge and practice of breast and cervical screening tests, evaluate the success of cancer screening programmes in the state. Finally, the study will serve as a reference material to other researchers on related topics.

 1.7 Scope of the study

 The study was delimited to assess the awareness of screening tests for breast cancer among female traders. It focused on knowledge of various screening tests, knowledge of signs to look for during screening, knowledge of screening centres and the frequency of screening. The study was conducted in Ahoada metropolis and covered all female traders within the age range of 18 and 50 years who were present in the area during the period of the study.

1.8 Operational definitions of terms

Knowledge of breast cancer screening tests

·        Being able to identify the appropriate screening tests for breast and cervical cancer.  - Knowledge of when the tests should be done.

·        Knowledge of likely findings to report for breast cancer for example lump, discharge from the nipple, pain.

·        Practice of breast and cervical cancer screening

·        Having had her breasts examined or screened for signs of breast cancers within the past three years and more than once.

 Screening tests – the screening tests of concern in this study include:

·        Breast self-examination – Examination of the breast by an individual for lumps, changes in size or shape of the breast or any other changes in the breasts or underarm.

·        Clinical breast examination - Examination of breast by medical Doctor or Nurse for signs of cancer. Mammogram – The use of an X-ray machine by a radiographer to check the women’s breasts for abnormal cells or cancer cells or signs

·        Women – adult females within the age of 18 and 50 years who will be found in Uyo municipality during the study.

·        Female Trader; Women trading in commercial areas especially in industrial areas and market area.

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