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CHAPTER ONE INTRODUCTION

1.1    Background to the study

 

Breast cancer (BCa) is a malignant tumour that has developed from breast cells, which has no cure at present. However, it can be managed with modern  technological tools,  and one’s life can be prolonged. In the last four decades, with the introduction of screening programmes that efficiently detect cervical cancer in its early stage, BCa has been seen to overtake cervical cancer in incidence and has become  number  one neoplasm among women (Okolie, 2012). BCa has therefore become a worldwide major health problem. The vast majority of it occur invasively in women (National Cancer Society [NCS], 2013). It accounts for 16% of all female cancers, and 22% of it are invasive. In both men and women, it accounts for 18.2% of all cancer deaths (NCS, 2013). Adebamowo and Ajayi (2006)  corroborate the opinion  of NCS  and maintain  that BCa is the commonest cancer among women in the world and in Nigeria too.

Adebamowo and Ajayi (2006) opine that it has become the commonest malignancy affecting Nigerian women. Also, according to Smeltzer, Bare, Hinkle and Cheever (2010), among the ten leading types of cancers by gender determined on the basis of estimated new cases and deaths in the United States in 2004, BCa accounts for 32% and the highest in female while prostate cancer accounts for 33% in males, which is the highest among them. Some of its common threats to physical wellbeing according to Adejumo and Adejumo (2009) include effects of treatments, recurrence and metastasis, fatigue, arm and shoulder discomfort, as well as lymphedema.

Unfortunately, Nigeria (which is the home country of the female students that are the focus of this study) remains ill-equipped to deal with the complexities of cancer

 

detection and care as the testing and care facilities are still very few. The prevalence of BCa within the country is 116 per 100,000, and 27,840 new cases were expected to develop in 1999 (Adebamowo & Ajayi, 2006). In 2005, between 7 and 10,000  new  cases of BCa developed.

This increasing incidence of BCa in Nigeria is in line with the situations in other developing countries, and even those advanced countries that used to have a low incidence now record high incidence. The relative frequencies of BCa among other female cancers, from Cancer Registries in Nigeria were 35.3% in Ibadan, 28.2% in Ife- Ijesha, 44.5% in Enugu, 17% in Eruwa, 37.5% in Lagos, 20.5% in Zaria and 29.8% in Calabar (Banjo, 2004 ). Similarly, in all the centres, except Calabar and Eruwa, BCa  rated first among other cancers.

Further reports showed that majority of cases occurred in premenopausal women, and the mean age of occurrence ranged between 43–50 years across the regions. The  youngest age recorded was 16 years, from Lagos (Banjo, 2004). This trend  was attributed to several factors such as: the acceptance of fine needle aspiration as an accurate diagnostic evaluation, and increased awareness about BCa and usefulness of breast self-examination (Thomas, 2000).

Several other factors are responsible for this increasing detection, but the most  important in the researcher’s view are: increased access to diagnostic facilities;empowerment of women, which is increasing women’s ability to make independent decisions about their own health-care; increasing westernization of dietary products;and physical activity; obstetric and gynaecological factors among others. Conventionally, breast self-examination (BSE) is the easiest and simplest procedure for

 

detecting breast masses because a woman who knows the texture, contour, and feel of  her own breasts is far more likely to detect changes that may develop (ACS, 2007).

The above notwithstanding, the American Cancer Society (2010) made the following recommendations: monthly self breast examination (SBE) beginning at the age of 20, from the fifth day of the menstrual cycle to one week following menstruation; clinical breast examination every three (3) years, from age 20 to 40, then annually, beginning at age 40; and mammogram, at age 40, and above annually. Adejumo  and  Adejumo  (2009) recommend that in addition to the above promotive health behaviours, needle aspiration may be performed when ultrasound reveals a suspicious lesion. The researchers advanced that imaging techniques offer new and emerging technologies that aid diagnosis of the disease at its rudimentary stage.

 

Anecdotal knowledge and experience have revealed that the knowledge of preventive and promotive health behaviours of female students is highly  militated  against,  probably owing to their life-style, ignorance and fear on their part, and inability of the health team to create adequate awareness. This, may lead to increase in the rate of high female students mortality. Such deaths would have been averted if the female students were responsive to preventive health behaviours of early BCa detection practices. Moreover, early detection of BCa will lead to early intervention  at  an early phase of cancer progression, resulting in improvement in years of survival for the clients/female students.

There is an urgent need to assess the knowledge, management, causes, and perception of BCa and its preventive health behaviours among female students for early detection and prompt intervention, so as to avert deaths sequel to its occurrence. Okolie (2012) maintains that BCa is now a manageable disease, and attributes this to early diagnosis and advances in surgical techniques, chemotherapy and radiation, with the main thrust being, early diagnosis. The female students therefore have a role to play in diagnosis by performing monthly breast self examination (BSE), obtaining routine screening, via mammography and seeing a health professional for regular breast examinations, as well as going for ultrasound (though secondary), in order that BCa could be detected early enough for prompt intervention.

 

1.2    Statement ofProblem

 

BCa is ranked the second most frequent to cervical cancer in Africa, and Nigeria has a double rise in the incidence (Adejumo & Adejumo, 2009). Taire (2010) estimates that between 7,000 and 10,000 new cases were detected in Nigeria in 2005, and that BCa caused 502,000 deaths (7% all of cancer deaths; almost 1% of all deaths) worldwide the same year.According to WHO (2005) report in Nigeria, approximately 89,000 people died from cancer in 2005, and 54,000 of them were under the age of 70.

Anecdotal information based on observation has revealed an alarming trend in incidence of BCa among female students,  with high  morbidity and mortality rates.  In the three hospitals commonly used by these female students, there have been records of many female students with the complaints of breast changes–tenderness, irregularities in size and contour, shrinking, irregular swelling, visible veins, retraction of the nipple(s), and/or discharges from the breast who were diagnosed of BCa in their various stages.   Most  of  the  cases  were  detected through routine clinical breast examination, as the female students fall within the category  of  professionals socialized into high tolerance for discomforts, including pains. At times, this works against them because pains which are obvious indicators of BCa, and which would have compelled one for early detection of the disorder  is  glossed over,  giving rise to late detection of BCa. Where the culture of pondering things over in one’s heart without complaining prevails, there is need for greater emphasis for early detection of diseases, including BCa, through BSE; CBE; and mammography.

It is against the above backdrop therefore, that this study is on the causes, management and perception of breast cancer among female students of faculty of social science in Delta State University.

 

 

1.3    Purpose of the study

 

The main purpose of the study is to assess the causes, management and perception of breast cancer among female students of faculty of social science in Delta State University. The specific objectives include to:

1. Ascertain the knowledge level of female students about breast cancer, its causes/risk factors and detection measures.
2. Ascertain how BCa can be prevented or managed as perceived by the female students.
3. Identify female students’ sources of knowledge on BCa.
4. Identify the factors that militate against their practiceof early detection measures

 

1.4    Research Questions

The following research questions guided the study:

1. What is the knowledge level of female students about breast cancer, its causes/risk factors and detection measures?
2. How BCa can be prevented or managed as perceived by the female students?
3. What are the female students’ sources of knowledge on Bca?
4. What factors militate against female students’ practice of early detection measures?

 

1.5    Significance of the study

 

BCa has become the commonest cancer affecting women world-wide. The findings of  the study will inevitably benefit many persons and groups of people. These include: all female students; local and regional administration; Superiors General;  Medical  Advisory Councils; health institutions, staff and student nurses/midwives, as well as medical students at large.

Findings of this study will help provide information on how much knowledge of BCa  and appropriate health behaviours the female students exhibit, and generate valid data for  adequate assessment of the female students on the subject matter. The feedback  value  of the  study will help in making modifications where they are deficient. The implications of  the study will serve as a guide for self-monitoring of both the female students and prospective candidates into the sisterhood within the state and beyond. It will give insight into the attitude of some female students towards breast- self examination, and also reveal the reason/s why some detest examination of the breast by health providers.

The findings will equally help design acceptable health promotion/awareness programmes about BCa. Thus, informing in-service training programmes so that the incumbent and aspiring female students can learn and imbibe the skills in BSE  and  the  disposition to  avail oneself of the other detection  practices well in advance. The result  of the study therefore will guide the authority of the schools on how to develop, structure and organize workshop programmes on BCa in order to derive maximum benefit for the various categories of female students in the state. It will also sensitize  the  formators and formatees in all formation houses on the need to organize programmes in their day to day examination of their breasts..