CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

 The World Health Organization (WHO) has shown that early diagnosis of cancer greatly affects treatment success. The process to early diagnosis is proposed to include education (knowledge) on the disease, encouragement for participation (practice) which is a vital factor that contribute to the acceptance level and early detection procedures and practices that prevent the risk of developing cancer (Who, 2014).  Çapik (2014) reported that in Turkey and many countries, the early diagnostic tests for cancer are not considered among routine screening programs but are performed on an individual basis with recommendations from physicians. 

 In Nigeria, previous work on assessing the level of acceptance which is based on knowledge of the population on cancer was done through the normal Demographic Health Survey (DHS) of 2013 - 2014 without details on specific cancer types including prostate cancer.  In particular, screening for prostate cancer has not achieved desired targets.

 According to the Nigeria Cancer Society (NCS), most Nigeria men shy away from prostate cancer screening due to the way the examination is being done. Therefore, there is a need to equip the public with knowledge on prostate cancer and to create more awareness on prostate cancer screening as was recently reported in the Vanguard News

Cancer is the second leading cause of death at 8% after HIV (23%) in Nigeria (WHO).  Screening tests are not emphasized in Nigeria, with only prostatectomy being the main recommended procedure for treatment. The burden of cancer is increasing, and thus the African Organization for Research and Training in Cancer (AORTIC) has committed to fostering research, education and advocacy on a variety of levels to increase the awareness of cancer in Africa (“Cancer in Africa,” 2011). 

 Although the level of knowledge on prostate cancer is generally high in Nigeria, Oshana region is among the regions which have low percentages of men who have heard of prostate cancer (DHS, 2014).  It is well documented that having adequate knowledge about prostate cancer is also a significant determinant of level of acceptance for screening (Pendleton et al., 2008).  According to Vandamme (2009) a study on acceptance level is conducted to investigate human behaviour on a certain topic for diagnostic purposes, to gain insight into a current situation and to help design appropriate interventions.

Prostate cancer is the most common cancer among Nigerian men and the second most common cause of death from cancer in men worldwide. Prostate cancer is more common in blacks and mixed-race men compared to men of European or of Asian descent. The primary goal of prostate cancer screening is to reduce deaths due to prostate cancer through early detection and prompt management. Men with screen-detected cancer can potentially fall into 1 of 3 categories: Those whose cancer will result in death despite early diagnosis and treatment, those who will have good outcomes in the absence of screening, and those for whom early diagnosis and treatment improves survival. Recommended screening test for prostate cancer is the measurement of serum prostate specific antigen (PSA) levels; other methods of screening such as digital rectal examination or ultrasonography are secondary. There are contradictions in the current guidelines by various medical organizations on screening for prostate cancer. The American Urological Association and the American Cancer Society recommended screening for all men aged 50 years and above with life expectancy more than 10 years and also men aged 40–45 years who are at a high-risk for the condition like African Americans and those with affected first degree relatives. However, the National Cancer Institute and the United States Preventive Service Task Force did not recommend routine screening for prostate cancer in the general population or in at-risk population group such as blacks. This is because evidence shows that PSA-based screening programs result in the detection of many cases of asymptomatic prostate cancer that either will not progress or will progress so slowly that it would have remained asymptomatic for the man's lifetime. The terms "over-diagnosis" or "pseudo-disease" are used to describe both situations.

Routine prostate cancer screening is not a common practice in Nigeria despite the fact that it is the most common cancer in Nigerian men. Awareness of prostate cancer among Nigerian men is poor majority of our patients usually present in the hospital when the disease is already advanced. Previous local studies on prostate cancer highlighted the need to increase awareness and surveillance for the disease. Prevalence of prostate cancer as reported by different researchers across Nigeria is between 2% and 11%. Nigeria ranked first among nine African countries with highest prevalence of the disease. The country is also ranked third among countries with significant death from prostate cancers after the United States and India according to World Health Organization.

 1.2 STATEMENT OF THE PROBLEM

Globally, 32.5 million people diagnosed with cancer within the 5 years previously were alive at the end of 2012.(Ferlay,2012). 8.2 million deaths and 14.1 million new cases are recorded annually but 70% will be in developing countries.(Ferlay,2012) The World Health Organization (WHO) reported that 12.5% of all deaths are attributable to cancer and if the trend continues, it is estimated that by 2020, 16 million new cases will be diagnosed per annum out of which 70% will be in developing countries.(WHO,2005). Cancer is the second most common cause of death in developed countries following cardiovascular disease, as population aging continues in many countries, cancer will remain a major health problem worldwide as elderly peoples are most susceptible to cancer.(WHO,2012) The percentage increase in cancer in many African countries is higher than in developed countries this can be attributed to lack of awareness about the risk factors and changes in lifestyle(Akinkugbe,2012) GLOBOCAN burden rises to 14.1 million new cases and 8.2 million cancer deaths in 2012 compared with 12.7 million new cases and 7.6 million cancer deaths in 2008 (Jedy,2015). The most common cancer diagnosed worldwide is lung (1.8 million, 13%), breast (1.7 million 11.9%), and colorectal (1.4 million, 9.7%) while the most common cause of cancer deaths were lung (1.6 million, 19.4%), liver (0.8 million, 9.1%), and stomach (0.7 million, 8.8%) due to growth and aging of the global population.(Jedy,2012) A projection of 19.3 million new cancer cases per year for 2025 has been predicted by GLOBOCAN2012 (Jedy,2012).

Prostate cancer accounts for 44.8 per 100,000 of all cancers among men in Nigeria. It also accounts for 21.2 per 100,000 of overall cancer incidence and 21.5 per 100,000 of all cancer mortalities among adult men. Namibia has a 5-year prevalence rate of 28 per 100,000 (Ferlay et al., 2015). The Cancer Association of Namibia has projected that one in eight men (1/8) in Namibia will develop prostate cancer during their lifetime, with most men being diagnosed after the age of 50. Statistics from CAN also show that prostate cancer has been on the increase with 126 and 311 cases reported in 2006 and 2012 respectively (Haidula, 2014).

Although the 2013 DHS of Nigeria reported 64 percent of men who have heard of prostate cancer, there is no documented data whether their knowledge influences their uptake for testing. The number of men who were tested was less than half of those who were reported to have knowledge. Furthermore, there was no information on when and how men obtained knowledge on prostate cancer heard about it. For instance, was it by the onset of illness or symptoms, or through some other source? Moreover, the sources of information on prostate cancer among men who receive services at the IHO had not been previously assessed. Availability of such information may help public health workers to design Information, Education and Communication (IEC) materials for men through appropriate media to address the identified gap of knowledge.

1.3 PURPOSE OF THE STUDY \SPECIFIC OBJECTIVES

 The purpose of the study was to determine the level of acceptance of prostate cancer screening exercise among adult male in Elele in Rivers state.

 1.4 OBJECTIVES OF THE STUDY

1.To determine the knowledge of prostate cancer amongst adult male in Elele, Rivers state

2.To determine the acceptance of prostate cancer amongst male in Elele, Rivers state

3.To identify ways of improving prostate cancer screening among male in Elele, Rivers state. 

1.5 RESEARCH QUESTIONS

1.What is the knowledge of prostate cancer amongst adult men in Elele, Rivers state?

2.To what extent does men in Elele, Rivers state accept prostate cancer screening exercise

3.What are the ways of improving prostate cancer screening amongst men in Elele, Rivers state? 

1.6 SIGNIFICANCE OF THE STUDY

 The results from this study will create baseline data which help to develop appropriate preventative measures and awareness programs. Furthermore, this study will also help identify possible reasons for the late reporting of men for prostate cancer screening and aid to inform the public on the need for early-seeking behaviour through screening. 

Previous research conducted on other cancer types such as breast cancer have confirmed that various awareness-creations campaigns have led to an increase in early detection and treatment leading to a decrease in the burden of disease due to morbidity mortality (Yip et al., 2008).  Therefore, an increase in awareness among men at risk of prostate cancer may result in early detection, reduction in mortality and morbidity and subsequent and disease burden. 

 Moreover, the study findings will provide data on the knowledge levels, acceptance and screening practices towards early detection of prostate cancer which can be used as a basis for subsequent academic research.  The need for a cancer registry or a reliable source of information with all cancer records including the history of the patient, date diagnosed, treatment, follow-up, outcome and so forth is needed greatly in Nigeria.

The research will also help medical practitioners especially nurses in creating awareness of the fatal disease among adult male so as to reduce the risk and increase their acceptance level.

1.7 DEFINITION OF CONCEPTS

The main concepts related to this study are defined:

Knowledge of prostate cancer: Knowledge of prostate cancer is defined as having information on prostate cancer.  Information include what the signs and symptoms are, prevention and treatment modalities for prostate cancer

Acceptance of prostate cancer: Acceptance in human psychology is a person's assent to the reality of a situation, recognizing a process or condition (often a negative or uncomfortable situation) without attempting to change it or protest it.

Improving prostate cancer screening:

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