CHAPTER ONE

INTRODUCTION

Background of the Study

Breast cancer is a global health concern and a leading cause of morbidity and mortality among all the cancers that affect women. In 2008, it was estimated that the prevalence of breast cancer among women aged 15 years and above in Sub-Saharan Africa was 23.5 per 100,000 women (World Health Organization,  2015).

The term cancer was derived from the observation by Hippocrates in 400 B.C. that the veins radiating from a breast cancer resembled the legs of crab, hence referred to as “karkinoma” in Greek and cancer in Latin. Breast cancer has been identified as a major public health problem in both developed and developing nations because of its high incidence-prevalence, the over-burdened health system and direct medical expenditure (Blair, 2014). Global statistics shows that the annual incidence of breast cancer is increasing and this is occurring more rapidly in countries with a low incidence rate of breast cancer.

Breast cancer is characterized by the uncontrolled growth of abnormal cells in the milk producing glands of the breast or in the passages (ducts) that deliver milk to the nipples. Breast cancer is the most common cancer and the leading cause of cancer death among women which accounts for 23% of all female cancers globally (Walter, 2015).

Worldwide, an estimated 1.7 million women were diagnosed with breast cancer and about 522,000 women died from breast cancer in 2012. Between 2008 and 2012, breast cancer incidence rate has increased by more than 20%, while mortality has increased by 14%. Breast cancer is also a leading cause of cancer death in the less developed countries of the world  (International Agency for Research on Cancer, 2016).

In Saudi Arabia, the percentage of death from breast cancer is 19.8 % in age of 45 years (Jemal, 2006). Although breast cancer usually develops after the age of 45 years, the age of onset is decreasing, and more young women than ever are affected. Young women's cancers are generally more aggressive and result in lower survival rates, making early detection even more important (Rosenberg, 2015).

African women; in comparison with their low incidence of cancer disproportionately bear a high cancer mortality rates (Fregene, 2015). It has been estimated that by the year 2020, approximately 70% of new cancer cases will occur among individuals in developing countries and population groups that have previously enjoyed low incidence, with a substantial fraction likely to be breast malignancies (WHO, 2018).

This is complicated by late presentation that generally characterise cancer diagnosis among Nigerian and other African women, with about 70-90% presenting late, hence diminishing survival probabilities compounded by exorbitant cost (Combs, 2015). The peak age of breast cancer in Nigeria is about ten years earlier than the experience of many western women. This could be attributed to increasing adoption of western life style and diet compounded by poor knowledge and attitude related to cancer issues.

Cancer is not a single disease, but is many different diseases that all share common biological and pathological characteristics. In most Western societies, cancer is a leading cause of death. The disease may develop in any body tissue or organ and over hundred different types of cancer can occur in adults. Cancer also occurs in children and may even be present at birth (Wilson, 2014).

Breast cancer can’t be prevented but early detection of it can reduce its spread. Breast cancer is an abnormal growth of cells which tend to proliferate in an uncontrollable way and in some cases spread around the breast region of a woman. In other words, breast cells. Breast cancer is the most common cause of cancer related death among women worldwide, breast cancer account for 31% of cancer among women and 19% of the death among women are due to cancer (Dermirkiran, 2012). Breast self examination is a step by step approach that a woman can use to look and check her breast for any abnormal growth or lump. (Ertem, 2013).

Breast Cancer awareness and attitude has been described as a common denominator to Several factors determining the stage at which patients with breast cancer present to the hospital. There are reports suggesting that factors related to women’s knowledge and beliefs about breast cancer and its management may contribute significantly to medical help-seeking behaviours (Okobia, 2016).

One potentially important strategy in reducing breast cancer mortality is the use of screening to achieve earlier detection of cancer. Early diagnosis usually results in treatment before metastasis and signifies a better outcome of management (Parkin, 2017).

`The three screening methods recommended for breast cancer include breast-self-examination (BSE), clinical breast examination (CBE) and mammography. It is important to adequately motivate women to regularly carry out BSE so as to curtail the increasing mortality rate from breast cancer (Hacksaw, 2017). In fact, regular BSE has been suggested as part of overall health promotion concept. The practice of BSE can help women to know the structure and composition of their normal breast thereby enhancing their sensitivity to detect any abnormality at the earliest time. BSE once a month contributes to a woman’s heightened awareness of what is normal for her. Promotion of self-care, an attitude fostered early in life, may pay lifelong dividends (Larkin, 2018).

American Cancer Society recommends as an option breast awareness and BSE for early detection of breast cancer. It benefits women in two ways: women become familiar with both the appearance and the feel of their breasts and detect any changes in their breasts as early as possible (American Cancer Society, 2015). BSE makes women more "breast aware", which in turn may lead to an earlier diagnosis of breast cancer (Siahpush, 2016). The rationale behind extending BSE practice as a screening test is the fact that breast cancer is frequently detected by women themselves without any other symptoms (Levshin, 2018).

In Turkey, The Ministry of Health recommends BSE to increase awareness of breast cancer (Turkish Ministry of Health, 2016). Although there were a lot of studies about knowledge of breast cancer and practice of BSE in female university students (Buddem, 2015). There were few studies about the knowledge of breast cancer and practice of BSE in the age group of 14–19 years (Ludwick,  2016).

Medical advances have shown that one-third of all cancers are preventable and a further one third, if diagnosed sufficiently early, is potentially curable. This observation demands that cancer control should be of increasing priority in the health care programs of developing countries (WHO, 2017). In a bid to reduce the incidence of mortality from breast cancer there is need for an effective screening program. Empowering female health workers and creating awareness amongst them could go a long way in enhancing the screening program for breast cancer. Prevention or identification of breast cancer at an early stage is of paramount importance in saving lives as well as improving the quality of life (Rao, 2015).

Based on the identified problem, this study seek to assess the knowledge and practice of breast self examination in detection of breast cancer among students in Emirate College of Health Science and Technology Kano.

Statement of Problem

Nigerian women usually present with advanced stages of the disease at which time little or no benefit can be derived in form of therapy. Further reports show that majority of cases occurred in pre-menopausal women and the mean age of occurrence ranged between 43-50 years across regions in Nigeria and the youngest age recorded was 16 years from Lagos (Banjo, 2014).

A recent report from Northern Nigeria reported that 99% late presentation (American Cancer Society, 2018). This paradoxical trend of both growing awareness and persisting late presentation coupled with reports suggesting other competing drivers of late presentation question the “theory of poor awareness” as the foremost driver of the persistent late presentations. Furthermore, BSE continues to be recommended by health care practitioners because it is free, painless and easy to practice. It was asserted by (Kayode 2015) that despite the advent of modern screening methods, more than 90% of cases of cancers of the breast are detected by women themselves, stressing the importance of breast self-examination.

Studies like Dermirkiran et al (2014), Waugh (2016) has shown that the percentage of women who know how to perform breast self – examination is very low and that pose a point of concern in the health sector. Yet breast self – examination is cost effective and an alternative for early detection of breast cancer. In Emirate College of Health Science and Technology Kano, most of the students in the College who are above the age of 20 and therefore may be prone to breast cancer. Hence, the needs to carry out the research on the knowledge and practice of breast self examination in detection of breast cancer among students in Emirate College of Health Science and Technology Kano has necessitated the researcher for the choice of above definitions.

Purpose of the Study

The purpose of the study is to determine the knowledge and practice of self breast examination in detection of breast cancer among students in Emirate College of Health Science and Technology Kano. Specifically, it seeks to:

i.                   Determine the level of knowledge of Self Breast Examination in detection of breast cancer among students in Emirate College of Health Science and Technology Kano.

ii.                 Ascertain the methods used in Self Breast Examination among students in Emirate College of Health Science and Technology Kano.

iii.              Find out the practice of Self Breast Examination in detection of breast cancer among students in Emirate College of Health Science and Technology Kano.

iv.              Ascertain the strategies that could be adopted to improve the practice of Self breast examination in detection of breast cancer among students in the study area.

Significance of the Study

The finding from this research study will be of immense benefit to the students, government, society, health workers, Academician and humanity. The result shall serve as a reference point for both government and the state. The findings would provide the scientific basis for health workers and breast self examination in detection of breast cancer among females generally.

The study would serve as a programme support to the entire humanity and answer to the call for more research for measure to prevent breast cancer among female students,

The finding from this research study would be of immense benefit to the society. The result shall serve as reference point for both local government area, state and the country as a whole  for the purpose of formulating policies that will address the low level of awareness of breast self examination.

The finding would provide the scientific basis for the academicians. The knowledge and practice of breast self examination help in early detection of any abnormalities may be cancer or not and may likely be cured at early stage (onset) and lead to attainment of good health and happy living among the community.

1.5     Research Questions

i.                   What is the level of knowledge of Self Breast Examination among students in Emirate College of Health Science and Technology Kano?

ii.       What are the methods used in Self Breast Examination among students in

          Emirate College of Health Science and Technology Kano?

iii.      What is the practice of Self Breast Examination among students in Emirate  

              College of Health Science and Technology Kano?

iv.  What strategies could be adopted to curb the practice of self breast examination

      among students in Emirate College of Health Science and Technology Kano?

Scope of the Study

This study is centered on the knowledge and practice of self breast examination in detection of breast cancer among students in Emirate College of Health Science and Technology Kano. Specifically, the study is restricted to the knowledge of breast self examination, method of breast self examination, practice of self breast examination and the strategies to be adopted to improve the practice of self breast examination among students in Emirate College of Health Science and Technology Kano.   

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