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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 31  |  Issue : 5  |  Page : 585-590

Breast cancer knowledge and screening practices among female nurses in a tertiary hospital in North Central, Nigeria


1 Department of Surgery, Federal Medical Centre, Bida, Nigeria
2 Department of Community Medicine, Federal Medical Centre, Bida, Nigeria
3 Department of Nursing, Federal Medical Centre, Bida, Nigeria
4 Department of Obstretric and Gynaecology, Federal Medical Centre, Bida, Nigeria

Date of Submission12-Jul-2022
Date of Decision26-Aug-2022
Date of Acceptance08-Sep-2022
Date of Web Publication29-Nov-2022

Correspondence Address:
Dr. Adekunle Adedapo Abiodun
Department of Surgery, Federal Medical Centre, PMB 14, Bida
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJM.NJM_80_22

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  Abstract 


Background: Breast cancer is a global burden and has become a major public health concern. Early diagnosis through screening is the best way to achieve cure, reduce morbidity and mortality from breast cancer. Many of the women in this environment have little or no knowledge about breast cancer and the attitude and orientation of health-care professional are important determinants of the use of breast screening program. Aim: The aim of the study was to evaluate the knowledge and practice of breast cancer screening among female nurses in the Bida, Niger state. Materials and Methods: This study was a cross-sectional conducted among female nurses in Federal Medical Centre, Bida, between May and August 2021. The questionnaire contained 20 questions on the knowledge of breast cancer. Each correct answer had a score of 1 and 0 for an incorrect answer or “don't know.” The overall score was calculated for each respondent by summing up the symptom and risk score. It was graded as 0–9 = Poor and 10–20 = Good. Data collected were analyzed by computer analysis using the SPSS version 25. Results: A total of 150 female nurses participated in the study with mean age of 41.7 ± 8.1 years. Overall assessment of the respondent's knowledge of breast cancer revealed that 112 (74.7%) of them had good knowledge and 38 (25.3%) had poor knowledge. Only 59 (38.3%) practice breast self-examination monthly. Concerning clinical breast examination, 22 (14.7%) of them have had their breast examined before by a health professional while 12 (8%) of the participants had done mammography before. Conclusion: Our findings highlight that the knowledge of breast cancer among female nurses was good but it has not really translated into practices of the preventive measures for early detection of breast cancer.

Keywords: Breast cancer, knowledge, practice


How to cite this article:
Abiodun AA, Abiodun JA, Eletta AE, Gomna A, Adekanye AO, Okunoye-M Y, Abdullahi B S, Okinbaloye SA, Abdulrahman T, Yusuf A, Rotimi B. Breast cancer knowledge and screening practices among female nurses in a tertiary hospital in North Central, Nigeria. Niger J Med 2022;31:585-90

How to cite this URL:
Abiodun AA, Abiodun JA, Eletta AE, Gomna A, Adekanye AO, Okunoye-M Y, Abdullahi B S, Okinbaloye SA, Abdulrahman T, Yusuf A, Rotimi B. Breast cancer knowledge and screening practices among female nurses in a tertiary hospital in North Central, Nigeria. Niger J Med [serial online] 2022 [cited 2023 Jan 31];31:585-90. Available from: http://www.njmonline.org/text.asp?2022/31/5/585/362205




  Introduction Top


The estimated global burden of breast cancer is expected to cross 2 million by the year 2030.[1] Breast cancer is a major public health problem worldwide due to its high incidence-prevalence, the over-burdened implication on the health-care system and cost of medical care.[2] The mortality rate of breast cancer is higher among Sub-Saharan African women when compared to women in Western countries, even though the incidence is much higher in Western women.[3.4] Apart from the fact that African women are more prone to the aggressive form of breast cancer, the higher mortality rate (22.3/100,000) compared to developed countries like Northern American 12.5/100,000 can also be attributed to a lack of public awareness of the disease, absence of organised screening programs, delayed presentation, and lack of access to health care.[5],[6]

If breast cancer is discovered early, cure can be achieved. However, the only way to reduce mortality from breast cancer is early detection through screening.[7] For screening practice to improve, there is a need to improve the knowledge and create awareness of breast cancer among women. Breast cancer awareness is an effort geared toward improving knowledge and decrease the stigma of breast cancer through education on the symptoms, signs, risk factors, and treatment modality, hoping that the increased knowledge will lead to earlier detection of the disease.[8] For any woman to go early to the hospital to see a doctor, she must be able to recognize symptoms of breast cancer which can only come through knowledge and awareness of the disease.

The nurses who constitute a major part of health workers often give health talks in clinics and interact with patients and their relations; they can play a significant role in educating the patients about breast cancer and various screening methods.[9] For nurses and other health workers to be effective in promoting any health behavior, they must possess the appropriate and adequate knowledge, must have the right attitude and beliefs concerning the health behaviour being promoted.[7] If the knowledge of breast cancer is poor among those who should teach others, there will be difficulty in promoting these life-saving methods in the community. There is a need for the nurses to have good knowledge of breast cancer symptoms and signs, risk factors, and various screening practices. The result of this will guide us on how to incorporate them into the breast screening practice in the hospital and their various communities.

This study aimed to evaluate the knowledge and practice of breast cancer screening among female nurses in the Federal Medical Centre, Bida, Niger State.


  Materials and Methods Top


This study was cross-sectional conducted among female nurses in Federal Medical Centre, Bida between May and August 2021. Data were collected using a questionnaire designed online with Google forms. A 60 itemed, structured, pretested, self-administered questionnaire was used as the tool for data collection. The questionnaire was used to obtain the following; sociodemographic characteristics, knowledge of breast cancer symptoms and signs, breast cancer risk factors, awareness, knowledge, and practice of breast cancer screening. The questionnaire was transmitted electronically to female nurses in the center through WhatsApp messaging app. Female nurses who consented to the study completed the questionnaire using their mobile electronic devices and on submission, their responses were received real time through the Google account drive of the principal investigator. The questionnaire contained 20 questions on knowledge of breast cancer, of which 10 questions assessed their knowledge about symptoms and signs of breast cancer and the other 10 questions assessed their knowledge of breast cancer risk factors. Each correct answer was assigned a score of 1 while a score of 0 was given for an incorrect answer or “I don't know.” A total score for each respondent was computed by summing the number of correct answers.

Respondents' symptom and risk scores were summed up and Graded as '0–4 = poor and 5–10 = good, respectively. The overall knowledge score was then calculated for each respondent by summing up the symptom and risk scores. It was Graded as 0–9 = Poor and 10–20 = Good. Data collected were analyzed by computer analysis using the IBM SPSS Statistics for Windows 25.0. (IBM Corp., Armonk, NY, USA).

Approval was obtained from the health research ethics committee. Informed consent was obtained from all participants recruited into the study. Absolute confidentiality was observed.


  Results Top


A total of 150 female nurses participated in the study with a mean age of 41.7 ± 8.1 years. Most of them were above 40 years 98 (65.4%) with the highest respondent 76 (50.7%) were between the aged 41 and 50 years. Most of the respondents were married 132 (88%) and Nupe 58 (38.7%) by tribe, a higher proportion of respondents had Bachelor of Science as their highest level of education 76 (50.7%) [Table 1].
Table 1: The sociodemographic characteristics of respondents

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On the overall assessment of the respondent's knowledge of breast cancer, the study showed that 119 (79.3%) had good knowledge of the disease while 31 (20.7%) poor knowledge [Figure 1]. The overall mean knowledge score of breast cancer of the respondent was 12.6 ± 3.6. The mean knowledge score of symptoms/signs was 6.7 ± 1.9 while the mean knowledge score of risk factors was 5.9 ± 2.4. The result revealed that their knowledge of symptoms of breast cancer is better than risk factors (P < 0.001).
Figure 1: The knowledge score grade of respondents

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In respect to their sociodemographic characteristics and their knowledge of breast cancer, it was only their level of education that had a significant relationship (P < 0.01), those with a higher degree had better knowledge of breast cancer [Table 2].
Table 2: Relationship between sociodemographic and knowledge of breast cancer of the respondents

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Knowledge of breast self-examination

Majority of the respondents 148 (98.7%) have heard about breast self-examination (BSE) and 147 (96.7%) believed it was a useful tool for early detection of breast cancer. A large proportion of respondents believed that BSE should start at puberty 120 (71.3%) and most 109 (65.3%) thought BSE should be done by monthly. A significant number of respondents 85 (54.0%) thought BSE is best done a week after menstruation [Table 3].
Table 3: The knowledge of breast self-examination among respondents

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Knowledge of clinical breast examination

Majority of the respondents 141 (78.0%) have heard about clinical breast examination (CBE) and they knew CBE is a useful tool for the detection of breast cancer. A proportion of respondents 54 (36.0%) thought CBE should be done yearly while majority believed 70 (46.7%) CBE should be done using palpating hand. In response to who should perform CBE, 114 (76%) believed that it should be done by doctor, 31 (20.7%) by trained nurse and 2 (2%) by individuals [Table 4].
Table 4: The knowledge of clinical breast examination among respondents

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Knowledge of mammography

A great proportion of 139 (92.7%) respondents have heard about mammography and majority 139 (92.7%) affirmed that it is a useful tool for early detection of breast cancer. Only 60 (40%) of them thought mammography should start from 40 years and 65 (43.3%) affirmed it should be done yearly. Majority of them 86 (57.7%) were willing to pay <N 5000 for annual mammography [Table 5].
Table 5: The knowledge of mammography among respondents

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Practice of the screening methods

Concerning the BSE, majority of them practice it 143 (95.3%), however, only 59 (38.3%) practice it monthly. There were only 22 (14.7%) respondents who have done CBE before while only 14 (9.8%) of them had done it in the past three years. In addition, only 12 (8%) respondents who have done mammography before and 2 of them were below the age of 40 years [Table 6]. Only 7 (4.7%) of them had done it in the past three years. When their level of education which was found to be statistically significant with the knowledge of breast cancer was compared to the practice of BSE, it was found not to be statistically significant [P = 0.5 [Table 6]].
Table 6: Relationship between level of education, knowledge, and breast cancer screening practice

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  Discussion Top


With the growing burden of breast cancer worldwide, there is an important need for the health caregiver to also increase their knowledge of the disease to educate the timid population on how to prevent the disease and give standard care to those who have come down with the disease. This formed the basis for our study, to highlight how much of the knowledge of breast cancer the female nurses in our center have and how much they have been involved in the practice of breast cancer screening methods.

Knowledge deficit among health-care professionals has been identified as a potential barrier to breast cancer prevention and early detection, given their leading role and contribution in spreading the knowledge and awareness of screening methods, particularly in primary care settings across the world.[10],[11],[12] Previous studies have shown that nurses who have adequate knowledge about breast cancer can make a meaningful contribution toward the early detection of breast cancer.[13],[14] This present study showed that nurses in the center have very good knowledge of breast cancer. This was similar to previous studies conducted among nurses in Nigeria.[15],[16]

This is not unexpected because the subject of breast cancer would have been part of their curriculum in nursing school and also in practice; they must have seen and be involved in the management of patients with breast cancer. Nurses' knowledge about breast cancer may be a useful tool in increasing the awareness and knowledge of breast cancer among women in the hospital setting and community. They can also be sources of disseminating information about breast cancer in the wards, outpatient clinics, at home, social and religious gatherings.

From this study, they were all aware of breast cancer 100% and majority of them were aware of BSE (98.7%), CBE (92.7%), and mammography (92.7%).

Breast self-examination

The value of BSE has been a subject of debate as there is no consensus that it is a useful breast cancer screening.[17] In developing countries where accessibility, affordability, and availability of sophisticated diagnostic screening methods are difficult to access in terms of cost and availability, BSE still remains the most readily available methods of screening.[18] Majority of the respondents believed that it is a useful diagnostic tool for screening of breast cancer.

Majority of the female health professionals including nurses do not know the age BSE should start. Most of them think BSE should start at puberty rather than at the age year of 20 years recommended by the American Cancer Society Guideline.[19],[20] Their belief may due to the significant change that occurs in female breast at puberty. From this study, only 12.7% knew BSE should start at the age of 20 years while a significant proportion (71.3%) of nurses believed it should start at puberty. This has also been observed in other studies.[21] Even though the majority of them claimed to practice BSE, only 35.3% of them practice it monthly. This finding was similar to what has been previously documented in literature about the monthly practice of self-breast examination among female nurses which remain low.[15],[22],[23] This study showed that knowledge is not always synonymous to practice.

Clinical breast examination

One of the recommended options of the American Cancer Society Guideline in breast cancer screening is CBE in low socioeconomic status where mammography is not easily accessible in terms of cost and availability.[18] CBE should be done every three years for women in their twenties and thirties, and every year for women at the age of 40 years and over.[19] From this study, there was high awareness of CBE as useful screening tool for breast cancer. This was an improvement when compared with the result that was obtained in 2008 in Lagos where only 41% of the nurses who participated in the study knew that CBE as screening method.[16] The time gap between the study may account for the significance as knowledge is increase daily and the dissemination is spreading fast. However, Bello et al. in a study on awareness of nurses on CBE as a screening tool reported an awareness rate of 93.2% among nurses which is slightly higher than that of our study. His study showed that only 26% of the participants have had their breast examined by a health professional in the past one year.[24]

Mammography

Majority of the respondents agreed that mammography is a useful diagnostic tool for breast cancer but only 17% of those who are eligible for mammography had actually had a mammography done. This follows a similar pattern to what is generally seen among health professional including nurses in Nigeria.[15],[24],[25] This is contrary to what is obtainable in the western world. From the Europe database on screening mammography among women between 50 and 69 years, majority of the women have had mammogram done at least once in their lifetime. Among the countries studied, France has the highest proportion of their women (92.9%), followed by Spain (92.3%), Austria and Germany (90%), Belgium (89.5%), and Hungary (86.9%).[26] This great compliance may be due to an organized screening program which is absent in our country.

From the study, 40 (43%) of the respondents claimed that not availability mammography in the center was the reason why mammogram has not been done. Some of the reasons for low practice of mammography were due to lack of awareness, absence of national screening programs, and lack of facilities for mammography.[22]


  Conclusion Top


Our study highlight that nurses were fully aware of breast cancer and have good knowledge of the disease. However, the knowledge of breast cancer they possess had not really translated into practices of the preventive measures for early detection of breast cancer. It is thus recommended that health agencies in the country implement national breast cancer screening campaigns/programs to improve the uptake of screening practices. Furthermore, the government should improve access to mammography by ensuring all secondary and tertiary facilities are equipped with functional mammography machines.

Acknowledgment

We would like to thank the Department of Nursing Services, Federal Medical Centre, Bida.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Full text]  
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