AWARENESS, PRACTICE, AND PERCEIVED BENEFIT OF BREAST CANCER

SCREENING AMONG WOMEN ATTENDING PRIMARY HEALTH CENTRE,

UJOELEN, EKPOMA, EDO STATE

ALU MOTUNROLA FOLASADE

CMS/FBM/NSG/16/30518

DEPARTMENT OF NURSING SCIENCES,

FACULTY OF BASIC MEDICAL SCIENCES,
COLLEGE OF MEDICINE,
AMBROSE ALLI UNIVERSITY,
EKPOMA

JANUARY, 2023

i
AWARENESS, PRACTICE, AND PERCEIVED BENEFIT OF BREAST CANCER

SCREENING AMONG WOMEN ATTENDING PRIMARY HEALTH CENTRE,

UJOELEN, EKPOMA, EDO STATE

ALU MOTUNROLA FOLASADE

CMS/FBM/NSG/16/30518

A RESEARCH WORK SUBMITTED TO THE DEPARTMENT OF NURSING

SCIENCE, FACULTY OF BASIC MEDICAL SCIENCES, COLLEGE OF
MEDICAL SCIENCES, AMBROSE ALLI UNIVERSITY, EKPOMA, EDOSTATE.
IN PARTIAL FULFILMENT OF THE REQUIREMENT OF NURSING AND
MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF REGISTERED
MIDWIFE CERTIFICATE

JANUARY, 2023

ii
 DECLARATION

I, ALU MOTUNROLA FOLASADE, hereby declare that this research was carried out by

me under the appropriate guidance of my supervisor and that I have not submitted this

same work to any college or journal for publication.

ALU MOTUNROLA FOLASADE

Matric Number: CMS/FBM/NSG/16/30518

____________________________________
Signature/Date.

iii
 CERTIFICATION

This is to certify that this research project by ALU MOTUNROLA FOLASADE with

matric Number: CMS/FBM/NSG/16/30518 has been examined and approved for the

award of Registered Nursing Certificate.

________________________ __________________
MRS. IDIANOSEN Date
SUPERVISOR

________________________ _________________
DR. (MRS.) AUGUSTINA CHIKAODILI ISABU Date
HEAD OF DEPARTMENT

…………………………………….... ………..……………
External Examiner Date

iv
 ABSTRACT

The study examined the awareness, practice, and perceived benefit of breast cancer
screening among women attending primary health centre, Ujoelen, Ekpoma, Edo State. The
study sought to assess the awareness, practice, and perceived benefit of breast cancer
screening among women attending primary health centre, ujoelen, Ekpoma, Edo State. This
study adopted a descriptive research design. The study was carried out in the Primary
Health Centre, Ujoelen in Edo State. The target population for this study comprised women
attending ante-natal and immunization clinics in the Primary Health Centre, Ujoelen for a
period of 1 months. A total of 290 respondents were sampled for this study using the simple
rand sampling techniques. Major findings of the study majority of the respondents have
heard about cancer 229(78.9%). The major source of information was antenatal clinic
114(39.4%) followed by immunization 82(28.3%). A higher proportion of the respondents
agreed that breast cancer can be prevented 172 (59.2%), while 114(40.8%) of them
disagreed. Majority of the respondents disagreed 196(67.6) that breast cancer cannot be
detected. Furthermore, majority of the respondents 257(88.7%) indicated that they have
heard about breast self-examination. From the results in table 4.3 which shows the
Perceived benefit towards screening measures for breast cancer, majority of them indicated
that breast self examination was too complicated 261(90.1%), 253(87.3%) indicated that
they were afraid of breast self-examination. 253(87.3%) indicated that they would
recommend breast self-examination to another person. Based on the result finding it was
recommended that breast awareness campaign should be carried out by the government and
non-governmental organizations (NGOs). Hospitals should organise programmes to teach
about breast self examination and issues about breast cancer as early as possible.

Keywords: Knowledge, awareness, practice and breast cancer

v
 DEDICATION

This project is dedicated to God almighty for his protection and guidance so far.

vi
 ACKNOWLEDGEMENT

My sincere appreciation to God almighty for his love, protection and care throughout my program

and how far he has helped me.

I also appreciate my Supervisor, Mrs. Idianosen for her counsel, supervision and mentorship,

guidance throughout this work. I appreciate you ma. Also say a big thank you to the Head of

Nursing department, Dr. (Mrs.) Augustina Chikaodili Isabu for her contributions towards the

success of this work. I’m grateful ma.

My sincere gratitude also goes to my Parents, Mr. and Mrs. Alu who have been a major support to

me throughout the duration of this program, I really appreciate you. Also my siblings for their

support, prayers and words of encouragement, thank you so much, also my very good friends Bose

and Kenny for their help and encouragement. Finally to the women who supported me by

participating in this study, thank you very much. God bless you all.

vii
 TABLE OF CONTENTS

COVER PAGE - - - - - - - - i
COVER PAGE i
TITLE PAGE ii
DECLARATION PAGE iii
CERTIFICATION PAGE iv
ABSTRACT v
DEDICATION vi
ACKNOWLEDGEMENT vii
TABLE OF CONTENTS viii
LIST OF TABLES x
LIST OF FIGURES xi
CHAPTER ONE
1.0 Introduction 1
1.1 Background to the Study 1
1.2 Statement of Problem 4
1.3 Objectives of the Study 5
1.4 Research Questions 6
1.5 Significance of the Study 6
1.6 Scope of the Study 7
1.7 Operational Definition of Terms 8
CHAPTER TWO
2.0 Literature Review 9
2.1 Conceptual Review 9
2.2 Theoretical Framework 34
2.3 Empirical Review 40
CHAPTER THREE
3.0 Methodology 43
3.1 Research Design 43
3.2 Research Settings 43
3.3 Target Population 44

viii
3.4 Sample Size Determination 44
3.5 Sampling Technique 44
3.6 Instruments for Data Collection 45
3.7 Validity of the Research Instrument 45
3.8 Reliability of Research Instrument 45
3.9 Method of Data Collection 45
3.10 Method of Data Analysis 46
3.11 Ethical Consideration 46

CHAPTER FOUR
4.0 Analysis of Results 47
4.1 Presentation of Results 47
4.2 Answering Research Questions 52
CHAPTER FIVE
5.0 Discussion of Findings 53
5.1 Discussion 53
5.2 Implications of findings to Nursing 56
5.3 Limitations of the Study
56
5.4 Summary 56
5.5 Conclusion 57
5.6 Recommendations 57
5.7 Suggestions for Further Studies 58
References 59
Appendix I (Questionnaire) 62
Appendix II (Ethical consideration) 63

ix
 CHAPTER ONE

INTRODUCTION

1.1 Background to the study

The breasts also known as mammary glands are accessory organs of the female

reproductive system. Breast tissues can also be associated with some abnormalities such as

inflammatory, benign and malignant conditions, but the most worrisome and deadly is

breast cancer. Variations in breast tissues occur during menstrual cycle, pregnancy and the

onset of menopause (American Cancer Society, 2007). Normal changes must be

distinguished from those that may signal disease. Breast cancer is the growth of malignant

tumor in the women’s breasts or an uncontrolled growth of breast cells. The causes of

breast cancer like any other part of the body are not known. Breast cancer, like any cancer

affecting the body, begins when any of the special genes called oncogenes found in every

normal cell are activated or excited by radiation, chemicals, viral infection or continual

irritation or friction (Lewis, 2005). These oncogenes then produce proteins that transform a

normal cell which does divides into cancerous cell that grows out of control. Breast cancer

is the most common in women after skin cancer and also the second most common cause

of death amongst women after lung cancer.

Although there is no single, specific cause of breast cancer but there are some risk factors

that may predispose one to developing breast cancer. The factors include increasing age

and personal history of breast cancer, genetic mutations, and hormonal factors e.g. early

1
menarche, late menopause and nulliparity, exposure to ionizing radiation during adolescent

and early adulthood, obesity and also high fat diet(Lewis, 2005).

Breast cancer is a global health issue and a leading cause of death among women globally

and it is responsible for about 12% of death throughout the world (Hosseni, Mahdavi &

Pilevarzadeh, 2015). Breast cancer is distinguished from other types of cancer by the fact

that it occurs in a visible organ and can be detected and treated at an early stage. This

observation demands that breast cancer control should be of increasing priority in health

care programme of developing countries like Nigeria (Haruna, Ahmadu, Teryila, Babji,

Nelson & Hamina, 2017).

Medical advances have shown that one third of all cancers are preventable and a further

one third if diagnosed sufficiently early is potentially curable (Sama, et al., 2017). A good

knowledge of breast cancer preventive measure involves breast self-examination, which is

a risk–free and painless procedure conducted with the objectives of identifying breast

related disorders and cancerous condition (Ameer, et al., 2014). It is one of the three tests

the American Cancer Society (ACS) recommends in order to help detect breast cancer in

its earliest stages (Ibnawadh, Alawad, Alharbi, Alduawihi, Alkowiter & Alsalhy 2018). A

number of women perform this examination themselves as a screen test for breast cancer

by examining the breast and region around it for lumps, distortions and swellings that

might be an indication of breast related disorder or even breast cancer.

Having a good knowledge about breast cancer by women can help in the diagnosis of

breast cancer and detect changes in the breasts early, when they’re more likely to be treated

2
successfully. The purpose of breast-self-examination is to learn the topography of the

breast which will in turn allow one to notice changes in the future in order to detect breast

lumps or masses. Breast self-examination is carried out once monthly, between the 7th and

10th day of the menstrual cycle, will go a long way in detecting breast cancer at an early

stage of growth when there is low risk of spread, ensuring a better prognosis when treated

(Tasci & Usta, 2014).

Breast Cancer awareness and percieved benefit 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. 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 (Omoyeni, Oluwafeyikemi, Irinoye & Adenike, 2014).

A study on Knowledge, percieved benefit and practices towards breast cancer conducted

recorded low knowledge and percieved benefit among the women, especially in rural areas

(Mohamed, et al., 2013). The need for new studies has become necessary to ascertain

levels of improvement. This would be necessary in designing appropriate awareness

creation intervention strategies. Knowledge of the level of awareness and percieved benefit

among urban population would also give an indication of what may be expected in the

rural areas, since urban people are expected to have more access to information (Omoyeni,

3
Oluwafeyikemi, Irinoye & Adenike, 2014). Knowledge also plays an important role in

improvement of health seeking behavior and self care. Knowledge and practices of breast

self-examination have played an important role in early detection of breast cancer,

especially combined with regular physical exams and mammograms (Mary, 2015). It is

against this backdrop that this study has undertaken to study Breast Cancer knowledge,

percieved benefits and preventive practices and its hindrances among women in Benin

City.

1.2 Statement of problem

In 2015, 570,000 women died from breast cancer which is pproximately 15% of all cancer

deaths among women. While breast cancer rates are higher among women in more

developed regions, rates are increasing in nearly every region globally (Ranni, 2017). In

Nigeria, breast cancer is responsible for about 16% of all cancer related death (Gabriel et

al., 2016).

Several researchers have identified factors that interfere with breast cancer screening

practices including fear, perceived susceptibility, perceived barriers, forgetfulness, lack of

knowledge, and a poor percieved benefit towards preventive measures by women (Akuoko,

Armah, Sarpong, Quansah, Amankwaa, & Boateng, 2017; Sule, 2011; Hanson, Adejumo,

& van Wyk, 2017; Sama, Dzekem, & Kehbila, 2017). Women need to engage in health

education regarding breast cancer and must be knowledgeable about breast cancer

management and prevention and confident in the application Clinic of that knowledge to

patient education. Thus, considering the potential pivotal role played by women in

4
information dissemination health counseling and selfcare, this study sought to assess the

knowledge, percieved benefit and practice of preventive measures of breast cancer among

women attending antenatal clinic in Primary Health Centre, Ujoelen.

1.3 Objectives of the study

The main aim of the study is to assess the awareness, percieved benefit and practice of

preventive measures of breast cancer among women attending Antenatal and

immunization.

The specific objectives of the study are to:

1) Assess the level of awareness of breast cancer among women attending antenatal

and immunization clinic.

2) Assess if the women attending antenatal clinic and immunization practices breast

self-examination.

3) Determine if the women know the perceived benefits of breast cancer screening

1.4 Research questions

1) What is the level of awareness of breast cancer among women attending antenatal

and immunization clinic at Primary Health Centre, Ujoelen?

2) Do these women practices breast self examination as a preventive measures of

breast cancer?

3) Do these women have knowledge of perceived benefit of breast cancer screening?

5
1.5 Significance of the study

The study seek to raise awareness on the need and importance of a good awareness of

breast cancer as an important tool in the prevention and early detection of breast cancer.

The findings of this study was self-reflective on the women attending antenatal and

immunization clinic, as it will reveal any awareness gap as regarding breast cancer

screening. The results of this study are of great importance because it may assist health

professionals in planning health education for women attending clinics. Also, from these

research findings, health screening which include breast self-examination education could

be included as one of the annual activities in Primary Health Centre, Ujoelen. The findings

of this study will help improve the health of women through health education, good

nutrition and personal and environmental hygiene. It will help the women to improve on

skills of practices self breast examination and those measures to take in preventing

occurrence of breast cancer. And also the findings of this study will seek to add to the

existing body of awareness as regards breast self-examination and provide base line data to

monitor performance of relevant future interventions.

1.6 Scope of the study

The study was limited to the women attending antenatal and immunization clinics to assess

their awareness, percieved benefit and practice of preventive measures on breast cancer.

6
1.7 Operational definition of terms

- Breast: A pair of glandular tissues of the mammary gland situated at the anterior

surface both on the chest wall as one of the reproductive organ and for aesthetic

purpose especially in women.

- Breast cancer: A malignant disease characterized by uncontrolled growth and spread

of abnormal cells of the breast tissue.

- Awareness: Familiarity and understanding of the definition, risk factors, symptoms,

signs, complications, principles and importance of breast self-examination.

- Practice: The action taken by individual respondents to carry out breast self-

examination

- Women: A woman is an adult human female.

- Prevention: consist of the methods or activities that seek to reduce specific predictable

problems.

7
 CHAPTER TWO

LITERATURE REVIEW

This chapter presents all the reviewed literature used in the current study. The literature

was reviewed under the following headings:

- Conceptual review

- Theoretical review

- Empirical review

2.1 Conceptual review

Concept of Breast Cancer

Globally cancer is the top leading cause of death. It was estimated that 8.2 million people

died of cancer in 2012 and prevalence estimates for 2012 show that there were 32.6 million

people alive who had had a cancer diagnosed in the previous five years (Segni, Tadesse,

Amdemichael, Demissie, 2016). More than half of all cancers (56.8%) and cancer deaths

(64.9%) in 2012 occurred in less developed regions of the world (Segni, Tadesse,

Amdemichael, Demissie, 2016). Breast cancer is the most common malignancy in women

and comprises 18% of all female cancers. One million new cases worldwide are detected

every year and accounts for the most common cause of cancer death in women (Sujindra

and Elamurugan, 2015). In Nigeria, the incidence of breast cancer has been reported to be

52/100,000 (Jedy-Agba, Curado, Ogunbiyi, Oga, Fabowale, Igbinoba, & Adebamowo,

2012).

8
Early detection and diagnosis can greatly increase chances for successful treatment and

thus increasing awareness of the possible warning signs of the disease among the general

public is a necessity (Segni, et al., 2016). The three screening methods recommended for

breast cancer include breast self-examination (BSE), clinical breast examination (CBE) and

mammography (Ayodele et al., 2013). BSE is a cost-effective method of early detection of

cancer of the breast especially in resource poor countries. It provides an inexpensive

method for early detection of breast tumors, thus awareness and consistent practice could

protect women from severe morbidity and mortality due to breast cancer. Agbonifoh,

(2014), defined breast self-examination as “a procedure done by a woman by examining

her own breasts and their accessory structures for evidence of changes that could indicate a

malignant process”. BSE is usually performed one week to ten days after the first day of

the menstrual cycle, when the breasts are smallest and cyclic nodularity is least apparent.

BSE is encouraged during all phases of a woman’s

adultlife.AwomanwhoregularlyandcarefullyperformsBSEisbetterableto detect small

abnormalities than a woman who is unfamiliar with her breasts. Doing BSSE regularly is

one way for women to know how their breasts normally look and feel.

Breast Cancer Screening Practices

Early detection of breast cancer is crucial not only for the survivorship of a patient, but for

her quality of life while treating the cancer and thereafter. For many patients, early

detection could mean not having to experience aggressive chemotherapy. (Weiss M. 2008)

9
Also the high burden of breast cancer in women worldwide underscores the unmet

potential of biomarker for early detection. Early detection is the key to positive, long-

lasting outcomes, thus reducing the suffering and cost to society associated with the

disease.

According to Therese (2006) Breast cancer prevention practices has long been considered

by many to be an opportunity for women to self-detect breast masses that may develop

between screening sessions. The premise is that women who detect interval cancers and

present earlier than their scheduled screening are more likely to be diagnosed with an

earlier stage breast cancer. Using breast self-examination for screening has long had a

strong intuitive appeal for women and it has been advocated and widely promoted for

many years by various medical societies, breast cancer advocacy groups and the media as

an effective screening tool. Breast self-examination has been an integral part of breast

cancer screening recommendation for many years.

Mayo (2006) stated that breast cancer can be prevented by detection at an early treatable

stage. Many breast irregularities are found by women themselves yet women do not know

how to perform breast self-examination though a few do regularly. There is now a move in

the promotion of breast self-examination towards encouraging breast awareness. Breast

self-examination according to carol (2011) stated that taking a few minutes to do breast self

examination, a minimum of once every month can make a life time of difference. Nearly

70% of all breast cancers are found through self exams and with early detection the 5-year

survival rate is 98% (Carol, 2011).High incidence of breast cancer can be reduced through

10
early detection during breast self examination. There is evidence that women who correctly

keep a regular practice of breast self-examination monthly are more likely to detect lump in

the early stage of its development and early diagnosis has been reported to influence early

treatment and says yield better survival rate.

Breast cancer awareness according to Rachael (2002) says there is greater than 1-10

chances that a woman will develop breast cancer sometime in her life and over 1,000,000

women find lump in their breasts, some cancerous and most of them benign every year. A

simple breast self-examination could be one of the keys to early detection of abnormality

especially breast cancer.

The breast self-examination has limitations however and is not a substitute for regular

breast examination from a doctor or screening. Watson (2002) stated that women should be

aware that 90% of breast tumors are initially known by women themselves. A high

percentage of breast carcinoma is palpable and can be detected early at a size of about 1cm.

early detection of breast lump thus implore progress as the chances of metastasis is

decreased in the early stage of the disease.

The world of early detection of breast cancer is imperfect – there is not one test that will

detect all cancers early. This report robs women of one of the key tools in what is already a

limited arsenal for detection of this terrible disease in the general population –

mammography, a doctor’s examination and a woman’s own breast self examination. For

20% of women whose cancers are only found by physical examination not mammography

– an individual woman’s self-examination may be her main opportunity for early detection

11
with a potential survival benefit. “It also sends the wrong message to women about their

role in their own health care, especially today when so many women cannot afford

expensive doctor visits and medical testing” i.e. this tends to make most women rely solely

on breast self-examination thereby neglecting other screening tests such as mammograms

and a clinical breast examination from a doctor or other health professionals or personnel.

And also because mammograms aren’t fool proof, they are considered one part of a three

pronged breast cancer detection program for women, along with monthly breast self-

examination and a clinical exam conducted by a health care provider. 75% of breast cancer

patients have no family history of the disease, emphasizing how important it is for all

women to follow the generally accepted recommendations of a monthly breast self-

examination, annual screening mammogram and annual clinical exam by a health care

professional (Weiss, 2008).

Weiss (2008) also acawareness that there are clear limitations to what breast self-

examination can detect and at what stage, she also says, “There are also inherent

limitations to the value and quality of mammograms and clinical breast examinations.

What’s important is that women are encouraged to use all three tools to maximize the

chance of early detection.

A breast examination is a self-inspection of one’s breasts. During a breast

exam,theeyesandhandsareusedtoobservetheappearanceandfeelofthe breasts. Breast exams

allow one to become more familiar with her breasts. This may give one a greater awareness

of the condition of her breasts. Breast exams may help identify potential breast problems.

12
Breast examination once thought to be essential for early breast cancer detection, are now

considered optional. While other breast cancer screening tests have been proved to save

lives, there's no evidence that breast exams can do this. What's now stressed is breast

awareness being familiar with the normal consistency of breasts and the underlying tissue,

as well as inspecting breasts for new changes (Allen et al., 2010). There is no consensus on

the efficacy of BSE. Regarding the controversy on BSE, Allen et al. (2010) pointed out

that it is important to know that the sensitivity and specificity values of BSE are difficult to

determine. BSE has the disadvantage of increased number of healthcare visits and twice the

number of benign biopsy results leading to increased healthcare cost. Moreover, increased

biopsies lead to a higher risk of breast cancer.

According to the American Chemical Society (ACS)(2014), BSE does not reduce mortality

from breast cancer. BSE is only recommended for women who wish to use it since its

usefulness is questioned and it may lead to unnecessary biopsies. The ACS (2014) pointed

out that four out of every five breast biopsy specimens are benign. When women discover

abnormalities in their breasts, feelings of anxiety and depression are likely to increase

concerning what could possibly be a benign condition.

BSE as a diagnostic measure allows women to gain a sense of control over their health and

to become comfortable with their own breasts. It is a simple, non-invasive procedure that

can be performed by non-medically trained individuals (Allen et al., 2010).

According to the National Breast Cancer Foundation (NBCF), up to 70% of breast cancers

are found by women performing their own BSE. The American College of Obstetrics and

13
Gynecology (ACOG) recommends the use of BSE as a tool for breast cancer screening

since palpable lesions can be detected through BSE (Allen et al., 2010). The purpose of

breast assessment is to identify signs of breast disease and initiate early treatment. The

incidence of breast cancer in women is rising, but early detection and treatment have

resulted in increased survival rates (Weber & Kelly, 2014).

Ignatavicius and Workman (2013), maintain that nurses working with women should

educate them on the importance of familiarizing themselves with the appearance and feel

of their breasts. Any changes detected should be reported to the health care provider.

Premenopausal women should be educated about lumps that appear and disappear with the

menstrual cycle. Proper timing for BSE for premenopausal women to examine their breasts

should be one week after the menstrual period, when hormonal influence on breast tissue is

decreased, so fluid retention and tenderness are reduced. Women who are in menopause or

after a hysterectomy should be taught to pick a day each month to do BSE, since their

breast tissue is no longer influenced by hormonal fluctuations (Ignatavicius & Workman

2013).

Conducting Breast Cancer Screening Practices

For this screening tool to be effective, it is important for a woman to know what is normal

for her. The most effective way to accomplish this is through consistency. One must be

consistent in all factors that make up the self-breast examination. In the paragraphs to

follow, the basics of a self-breast examination and the key elements involved was

explained. These elements should be addressed and demonstrated to patients to ensure

14
comprehension. The nurse could offer a breast model for return demonstration by the

patient to ease any uncertainties.

Women should be provided education on the proper way to do a self-breast examination.

The first steps should include the ideal time of month to perform the examination. This

time should be approximately 2 days after the end of the menstrual cycle. In

postmenopausal women, it should be a time during the month that they will recall every

month. The self-breast examination begins by facing a mirror and examining the physical

appearance of the breasts. Ask questions such as, are the breasts symmetrical, is the color

consistent in both breasts, is the nipple dimpled, and is there any rash or abnormalities that

can be visualized. Raise arms one side at a time to examine the underarm region.

The next step in a thorough self-breast examination involves position. Performing your

monthly breast examination involves being in the same position each month. If performing

in a standing position, the shower is an example of this, place one hand behind your head.

Utilize the other hand to examine the breast. The technique and pattern that one chooses is

an individual preference. Three different techniques are utilized, the Circle motion, the Up

and Down motion, and the Wedge. The American Cancer Society recommends the Up and

Down motion.

The Circle technique requires the use of the finger pads, not finger tips, of the first three

fingers. Palpate the breast tissue, using three different types of pressure. First palpate light,

followed by medium pressure, and then complete the examination with firm pressure.

Palpate from the nipple area outward in a circular pattern. Make sure to palpate the entire

15
breast tissue, including into the underarm area. You are feeling for lumps, knots, or skin

thickening.

The Up and Down technique involves doing your breast examination by utilizing the first

three fingers of your hand and using the pads of your fingers to palpate all three types of

pressure from the outside of the breast tissue to most inner side of the tissue. Palpate up the

breast tissue and then back down until the entire breast tissue has been palpated. Complete

the examination by moving the pads of the fingers up and down the underarm region

continuing to utilize all three different types of pressure.

The Wedge technique involves using the pads of the first three fingers on your hand. Begin

the examination in the nipple region. Palpate from the nipple outward, imagining the breast

to be wedged in eight different sections. Walk the finger pads from the nipple to outmost

region of the breast and then back up the breast toward the nipple, completing a wedge

pattern. After the entire breast tissue is palpated using light, medium, and firm pressure,

begin to palpate the underarm area for any lumps, bumps, or thickening.

Once the breast examination is completed on one side, proceed to the other breast,

repeating all steps described previously. During the breast examination, it is important to

pay close attention to detail. Become familiar with the tissue in your breasts. The

familiarity will help detect any differences in the breast tissue in the following monthly

breast examinations. This step is crucial in early self-detection of breast cancer. Do not

forget to palpate the area from the breast tissue to the collar bone, including the upper chest

area.

16
Step 1: The woman stands in front of a mirror, pressing her hands firmly down on her hips.

This position helps to contract the chest wall muscles and enables visualization of any

breast changes. She was looking at the size, shape, color .and contour noting any dimpling,

puckering, or bulging of the skin, redness, soreness, rash, or swelling, inversion of the

nipple or breast skin.

Step 2: The woman raises her arms and looks for the same changes as mentioned above.

The woman must examine both underarms while sitting up or standing with her arms

slightly raised.

Step 3: While at the mirror, the woman looks for any discharge coming from the nipples;

for example, watery, milky or yellow fluid or blood.

Step 4: The woman lies down with her right arm behind her head. This position spreads

the breast tissue evenly over the chest wall, making it easier to feel. The woman uses the

three middle finger pads of her left hand to feel for any right breast lumps. The woman

needs to apply light pressure to feel the tissue closest to the skin; medium pressure to feel

deeper, and firm pressure to feel the tissue close to the chest and ribs. The woman

examines her left breast by putting her left arm behind her head and using her right-hand

finger pads to do the examination.

Step 5: Finally, the woman feels her breasts while she is standing or sitting. Most women

find that the easiest way to feel their breasts is when their skin is wet and slippery, so they

like to do this in the shower. The woman has to cover her entire breast, using the same

hand movements described in step 4. Finally, the woman feels her breasts while she is

17
standing or sitting. Breast self-examination (BSE) provides an inexpensive method for

early detection of breast tumors, thus awareness and consistent practice could protect

women from severe morbidity and mortality due to breast cancer. Agbonifoh (2014),

defined breast self-examination (BSE) as “a procedure done by a woman by examining her

breasts and their accessory structures for evidence of changes that could indicate a

malignant process”. BSE is usually performed one week to ten days after the first day of

the menstrual cycle, when the breasts are smallest and cyclic nodularity is least apparent.

BSE is encouraged during all phases of a woman’s

adultlife.AwomanwhoregularlyandcarefullyperformsBSEisbetterableto detect small

abnormalities than a woman who is unfamiliar with her breasts. Doing BSE regularly is

one way for women to know how their breasts normally look and feel.

Weber and Kelly (2014) refer to BSE as an option for women, starting in their 20s, to

familiarize themselves with the appearance of their breast tissue to be able to detect any

changes. Women who choose to do BSE should have their practice reviewed during their

physical examination by a health professional. BSE plays a minor role in finding breast

cancer. Some women feel comfortable doing BSE regularly monthly after their menses

whilst others are more comfortable looking and feeling their breasts whilst showering or

getting dressed (Weber & Kelly, 2014). Women who have had a breast lumpectomy,

augmentation, or breast reconstruction may also perform BSE. Some women may still

decide not to do BSE even with the awareness of its advantages and disadvantages.

Practice of Breast Self-Examination

18
A breast examination is a self-inspection of one’s breasts. During a breast exam, the eyes

and hands are used to observe the appearance and feel of the breasts. Breast exams allow

one to become more familiar with her breasts. This may give one a greater awareness of

the condition of his breasts. Breast exams may help identify potential breast problems.

Breast examination once thought to be essential for early breast cancer detection, are now

considered optional. While other breast cancer screening tests have been proved to save

lives, there's no evidence that breast exams can do this. What's now stressed is breast

awareness being familiar with the normal consistency of breasts and the underlying tissue,

as well as inspecting breasts for new changes (Allen et al., 2010).There is no consensus on

the efficacy of BSE. Regarding the controversy on BSE. Allen et al., (2010) point out that

it is important to know that the sensitivity and specificity values of BSE are difficult to

determine. BSE has the disadvantage of increased number of healthcare visits and twice the

number of benign biopsy results leading to increased healthcare cost. Moreover, increased

biopsies lead to a higher risk of breast cancer.

According to the ACS (2014), BSE does not reduce mortality from breast cancer. BSE is

only recommended for women who wish to use it since its usefulness is questioned and it

may lead to unnecessary biopsies. The ACS (2014) points out that four out of every five

breast biopsy specimens are benign. When women discover abnormalities in their breasts,

feelings of anxiety and depression are likely to increase concerning what could possibly be

a benign condition.

19
BSE as a diagnostic measure allows women to gain a sense of control over their health and

to become comfortable with their own breasts. It is a simple, non-invasive procedure that

can be performed by non-medically trained individuals (Allen et al., 2010). The American

College of Obstetrics and Gynecology (ACOG) recommends the use of BSE as a tool for

breast cancer screening since palpable lesions can be detected through BSE (Allen et al.,

2010). The purpose of breast assessment is to identify signs of breast disease and initiate

early treatment. The incidence of breast cancer in women is rising, but early detection and

treatment have resulted in increased survival rates (Weber & Kelly, 2014).

Ignatavicius and Workman (2013), maintain that nurses working with women should

educate them on the importance of familiarizing themselves with the appearance and feel

of their breasts. Any changes detected should be reported to the health care provider.

Women who are in menopause or after a hysterectomy should be taught to pick a day each

month to do BSE, since their breast tissue is no longer influenced by hormonal fluctuations

(Ignatavicius & Workman 2013).

Method of Conducting BSE

For this screening tool to be effective, it is important for a woman to know what is normal

for her. One must be consistent in all factors that make up the self-breast examination. In

the paragraphs to follow, the basics of a self-breast examination and the key elements

involved was explained. These elements should be addressed and demonstrated to patients

to ensure comprehension. The nurse could offer a breast model for return demonstration by

the patient to ease any uncertainties.

20
Women should be provided education on the proper way to do a self-breast examination.

The first steps should include the ideal time of month to perform the examination. This

time should be approximately 2 days after the end of the menstrual cycle. In

postmenopausal women, it should be a time during the month that they will recall every

month. The self-breast examination begins by facing a mirror and examining the physical

appearance of the breasts. Ask questions such as, are the breasts symmetrical, is the color

consistent in both breasts, is the nipple dimpled, and is there any rash or abnormalities that

can be visualized. Raise arms one side at a time to examine the underarm region.

The next step in a thorough self-breast examination involves position. Performing your

monthly breast examination involves being in the same position each month. If performing

in a standing position, the shower is an example of this, place one hand behind your head.

Utilize the other hand to examine the breast. The technique and pattern that one chooses is

an individual preference.

Threedifferenttechniquesareutilized,theCirclemotion,theUpandDown motion, and the

Wedge. The American Cancer Society recommends the Up and Down motion.

The Circle technique requires the use of your finger pads, not finger tips, of the first three

fingers. Palpate the breast tissue, using three different types of pressure. First palpate light,

followed by medium pressure, and then complete the examination with firm pressure.

Palpate from the nipple area outward in a circular pattern. Make sure to palpate the entire

breast tissue, including into the underarm area. You are feeling for lumps, knots, or skin

thickening.

21
The Up and Down technique involves doing your breast examination by utilizing the first

three fingers of your hand and using the pads of your fingers to palpate all three types of

pressure from the outside of the breast tissue to most inner side of the tissue. Palpate up the

breast tissue and then back down until the entire breast tissue has been palpated. Complete

the examination by moving the pads of the fingers up and down the underarm region

continuing to utilize all three different types of pressure.

The Wedge technique involves using the pads of the first three fingers on your hand. Begin

the examination in the nipple region. Palpate from the nipple outward, imagining the breast

to be wedged in eight different sections. Walk the finger pads from the nipple to outmost

region of the breast and then back up the breast toward the nipple, completing a wedge

pattern. After the entire breast tissue is palpated using light, medium, and firm pressure,

begin to palpate the underarm area for any lumps, bumps, or thickening.

Once the breast examination is completed on one side, proceed to the other breast,

repeating all steps described previously. During the breast examination, it is important to

pay close attention to detail. Become familiar with the tissue in your breasts. The

familiarity will help detect any differences in the breast tissue in the following monthly

breast examinations. This step is crucial in early self-detection of breast cancer. Do not

forget to palpate the area from the breast tissue to the collar bone, including the upper chest

area.

Step 1: The woman stands in front of a mirror, pressing her hands firmly down on her hips.

This position helps to contract the chest wall muscles and enables visualization of any

22
breast changes. She was looking at the size, shape, color .and contour noting any dimpling,

puckering, or bulging of the skin, redness, soreness, rash, or swelling, inversion of the

nipple or breast skin.

Step 2: The woman raises her arms and looks for the same changes as mentioned above.

The woman must examine both underarms while sitting up or standing with her arms

slightly raised.

Step 3: While at the mirror, the woman looks for any discharge coming from the nipples;

for example, watery, milky or yellow fluid or blood.

Step 4: The woman lies down with her right arm behind her head. This position spreads

the breast tissue evenly over the chest wall, making it easier to feel. The woman uses the

three middle finger pads of her left hand to feel for any right breast lumps. The woman

needs to apply light pressure to feel the tissue closest to the skin; medium pressure to feel

deeper, and firm pressure to feel the tissue close to the chest and ribs. The woman

examines her left breast by putting her left arm behind her head and using her right-hand

finger pads to do the examination.

Step 5: Finally, the woman feels her breasts while she is standing or sitting. Most women

find that the easiest way to feel their breasts is when their skin is wet and slippery, so they

like to do this in the shower. The woman has to cover her entire breast, using the same

hand movements described in step 4. Finally, the woman feels her breasts while she is

standing or sitting.

23
2.2 Theoretical Framework

The theoretical framework adopted to guide this study is the Theory of Reasoned Action.

The Theory of Reasoned Action was developed by Martin Fishbein and Icek Ajzen in 1967

and was derived from previous research that began as the theory of percieved benefit and is

one of the three classic models of persuasion. The theory is also used in communication

discourse as a theory of understanding. The theory aims to explain the relationship between

percieved benefits and behaviors within human action. TRA is used to predict how

individuals washave based on their pre-existing percieved benefits and behavioral

intentions. An individual's decision to engage in a particular behavior is based on the

outcomes the individual expects will come as a result of performing the behavior.

The theory of reasoned action serves to understand an individual's voluntary behavior. The

ideas found within the theory of reasoned action have to do with an individual's basic

motivation to perform an action. TRA says that a person's intention to perform a behavior

is the main predictor of whether or not they actually perform that behavior.

According to the theory, intention to perform a certain behavior precedes the actual

behavior (Glanz, Rimer, Viswanath, 2015).This intention is known as behavioral intention

and comes as a result of a belief that performing the behavior will lead to a specific

outcome. Behavioral intention is important to the theory because these intentions "are

determined by percieved benefits to behaviors and subjective norms". The theory of

reasoned action suggests that stronger intentions lead to increased effort to perform the

behavior, which also increases the likelihood for the behavior to be performed.

24
 Adapted from Percieved benefits, Personality and Behavior by Azjen, (1998)

Assumptions of the theory

- Human beings are rational and make systematic use of information available to

them.

- People consider the implications of their actions before they decide to engage or not

engage in certain behaviors.

Constructs of the theory

- Behavior: It is the transmission of intention or perceived behavioral control into

action.

- Behavioral Intention: It is an indication of how hard people are willing to try and

of how much an effort they are planning to exert, in order to perform the behavior.

Influenced by three components: person’s percieved benefit toward performing the

25
 behavior, the perceived social pressure, called subjective norm and perceived

behavioral control.

- Percieved benefit: It is the first determinant of behavioral intention. It is the degree

to which the person has a favorable or unfavorable evaluation of the behavior in

question (Azjen, 1998).

- Subjective Norm: It is considered the second predictor of behavioral intention.

This is the influence of social pressure that is perceived by the individual

(normative beliefs) to perform or not perform a certain behavior (Azjen, 1998).

This weighted by the individual’s motivation to comply with those perceived

expectations (motivation to comply).

- Perceived Behavioral Control: Is the third antecedent of behavioral intention.

This construct is defined as the individual’s belief concerning how easy or difficult

performing the behavior was. It often reflects actual behavioral control (Azjen,

1998).

Application of the framework to the study

The theory of reasoned action is used in order to predict and understand healthy and

unhealthy behavior and the outcomes of behavior. It assumes that human beings are

rational and make systematic use of information given to them and hence people consider

the implications of their actions before they decide to engage or not engage in certain

behaviors.

26
If women are aware and awarenessable of the need and benefits of breast self-examination,

they was more willing to perform the act. The intention to carry out this behavior is

dependent on the subjective norms (including motivation and social pressure), thewomen’s

percieved benefit (which is based on the women’s awareness of the benefits of breast self-

examination) and the perceived behavioral control (i.e. the perceived easy or difficulty of

carrying out breast self-examination.

Breast self-examination is relatively easy to carry out as it may not require any special

awareness. Based on this if the women have a good understanding of the principles and

benefits of Breast self-examination, they was more motivated to carry-out the practice.

27
2.3 Empirical review

With data from South-Eastern Nigeria, Casmir, Anyalewechi, Onyeka, Agwu, and Regina

(2015) to determine the awareness and practice of breast self-examination among female

undergraduates in Owerri, findings revealed that female undergraduates had a poor

awareness of the right procedure and practice. Seven hundred and twelve (98.9%)

respondents reported they have heard of breast self-examination.

In a similar study of Addis, et al. (2017) to assess the practice and associated factors of

breast self-examination (BSE) among women in Debre Berhan University teaching

Hospital in Ethiopia. Findings from the study revealed that majority the study participants,

338 (84.5%), were between 20 and 24 years old with the mean age of 21.1 ± 1.65.wo

hundred fifty-six (64%) of the participants had heard about BSE and 30.25% had good

awareness about BSE. Mass media were the most common source of information.

Segni, Tadesse Amdemicheal, Demissie (2016) in a study to assess Awareness, Percieved

benefit and Practice of regular Breast self-examination amongst women who attend clinics

in Adama science and Technology University in 2014, findings from the study revealed

that the level of awareness was considerably low among women, only 8.7% of them had

good awareness towards breast self-examination.

Ayed, Eqtait, Harazneh, Fashafsheh and Awawdeh, (2015) in a descriptive cross sectional

conducted a study among women in Arab American university had shown that majority of

the respondents have poor awareness of breast self-examination 43.3%, while 41.2% were

with fair awareness. The majority of poor awareness level was among nursing mothers

28
while the good awareness was among fourth year then third year respectively (8.2% and

4.1%). The major source of information about BSE (57.6%)was mass media in the study.

Similarly, Robinson-Bassey and Festus, (2016) in a study aimed at determining the

awareness and percieved benefit of women towards breast cancer screening in the

University of Port Harcourt, Rivers State. Findings revealed that 69(49.3%) had good

awareness of breast cancer screening, 50(35.7%) had fair awareness while 21 (15.0%) had

poor awareness of breast cancer screening.

Regarding the percieved benefits towards breast self-examination, Robinson-Bassey and

Festus, (2016) in a their reported that 95(67.9%)hadpositivepercieved

benefittowardsbreastcancer screening while 45(32.1%) had negative percieved benefit

towards breast cancer screening. Similarly, Ayed, Eqtait, Harazneh, Fashafsheh and

Awawdeh, (2015) in their study reported 75.3%ofparticipantshadpositivepercieved

benefittowards BSE, and4.1% practice BSE always every month.

Nde, Assob, Kwenti, Njunda, & Tainenbe, (2015) in a study to assess the awareness,

percieved benefit and practice of breast self-examination among women in the teaching

hospital, University of Buea involving 166 women of ages 25-50 years (mean = 22.8), 88%

of the respondents as important, only 3% had performed BSE regularly. Furthermore, only

19.9% of the respondents have been to any health facility to have breast examination.

Overall, although a majority (63.3%) of the respondents had a some positive percieved

benefit towards BSE as an important method for early detection of breast cancer, just a

29
modest 9.6% were substantially aware of it. Lack of awareness on BSE was cited as the

main reason for not performing BSE.

Omoyeni, and Oluwafeyikemi (2014) in a cross-sectional study carried out among women

in Egypt, showed that 56.4% of women performed BSE in their life time but only 18.8% of

respondents practiced BSE on a monthly basis and 68.0% of those who practiced BSE

were married. 79.3% women reported that they did not practice BSE because they

perceived they did not have a breast problem, and 68.9% of them were not convinced that

BSE is important. 53.4% of the women reported that they did not know how to practice

BSE. Only 17.2% reported that they did not practice BSE because they are lazy.

Casmir, Anyalewechi, Onyeka, Agwu, and Regina (2015) in their study revealed that

majority of the respondents have heard of BSE (98.9%), but only 76.7 percent of such

respondents reported they practice breast self-examination. Further investigation indicated

that only 32.5 percent could correctly have described the procedure.

Birhane, Alemayehu, Anawte, Gebremariyam, Daniel, Addis, et al., (2017) in their study

revealed that few of the participants (28.3%) had performed BSE. Lack of awareness on

how to perform BSE was cited as the main reason for not practicing BSE. Knowing how to

perform, when to perform, and position to perform BSE and having a perception that BSE

is important and useful to detect breast cancer were significant predictors of practices of

BSE.

Yakubu, Gadanya, Sheshe (2014) in a study to investigates the awareness, percieved

benefit and practice of BSE among women in Aminu Kano Teaching Hospital (AKTH)

30
with regard to the number that practice, method and the frequency of BSE, a descriptive

cross-sectional study, findings revealed that all the women studied are aware of BSE, with

91.2% practicing it. There is appallingly poor awareness of its timing, frequency and

method. Only 45 (41.2%) of the respondents practiced BSE monthly, and none of the

respondents can accurately describe the exact method of BSE.

Umbreen, Jabeen and Riaz (2017), in their study revealed that women do not practice

breast self-examination though awareness was high. 34.6% subjects said they have

performed breast self-examination before and 65.4% not performed breast self-

examination. On the performance of breast self-examination, 12.8% performed less than a

week prior to the study, 19.2% less than three to six months and 2.6% less than one year.

On the time of breast self-examination practice, 29.6% performed in morning, 2.6%

performed in afternoon and 21.8% performed in evening.

31
 CHAPTER THREE

METHODOLOGY

This chapter presents all methodologies employed by the researcher during the course of

the study, which includes:

Research Design

Research Settings

Target Population

Sample Size and Sampling Technique

Instrument of Data Collection

Validity and Reliability Of Research Instrument

Method of Data Collection

Method of Data Analysis

Ethical Considerations.

3.1 Research design

This study adopted a descriptive research design. Descriptive design was chosen because it

is effective in seeking the views of people about particular issues that concerns the study.

3.2 Research settings

The area used for the study is Ujoelen primary Health Centre, Ujoelen, Ekpoma. The

primary health centre is comprised of 3 nurses, 3 community health extension workers, and

9 attendants. It is located in Ujoelen community of Ekpoma town in Esan west Local

Government Area, Edo state. Ekpoma is the administrative headquarter of Esan West Local

32
Government Area and it is subdivided into seven (7) clans/kingdoms; Ekpoma, idoa,

Ogwa, urohi, Ukhun, Egoro and Ujiogba. Ekpoma comprises several communities amongst

which are Ujoelen, Ujoelen, Iruekpen, Ujemen, Uhiele, Ikhirolo, Emaudo, Eguare,

Ebhoakhuala, Illeh, Ihumudumu, Idumebo, Akahia etc.

Ekpoma is a developing town with several markets, schools (primary, secondary and

tertiary institutions), banks, churches, hotels, and hospitals including the Ambrose Alli

University (AAU). The language of the people in Ekpoma is Esan and they are majorly

farmers.

Ujoelen community is located at about the centre of Ekpoma and is a well-known

community in Ekpoma. The neighbouring communities to Ujoelen are Ujoelen, Eguare,

Ujoelen and Emaudo.

3.3 Target population

The target population for this study comprised women attending ante-natal and

immunization clinics in the Primary Health Centre, Ujoelen for a period of 1 months. There

are over 1,058women who attend clinical in the Primary Health centre.

3.4 Sample size determination

The sample size for this study was determined using Taro Yamane’s Formula (Yamane,

1973).

N
n=
1+ N ( e 2 )

Where, n = minimum sample size

33
 N = Total population

e = constant (0.05)

1, 058 1 , 058
n= = =290.3
1+1,058 ( 0.05 )
2 3.645

Hence a sample of 290women was used for the study.

3.5 Sampling technique

A simple random sampling was used in selecting the participants for the study. The women

was selected from ANC and immunization clinics so as to ensure proportional

representation. All women who satisfied the inclusion criteria was given unique name tags

and put in a basket. Tags was picked at random, women whose tags are picked was used

for the study.

Inclusion criteria. women who attend ANC and Immunization clinics.

Exclusion criteria. Other women apart from those attending antenatal and immunization

clinics.

3.6 Instruments for data collection

Data was collected using a structured self-report questionnaire. The questionnaire was

based on the literature, experience of the researcher and objectives set for the study. The

questionnaire was divided into a demographic section (A) making 5 items; Section (B)

referring to the Awareness about breast cancer with 10 items; and Section (C) referring to

the practice of breast self-examination with 3items, making a total of 18items. The

questionnaire consisted of predominantly closed ended questions.

34
3.7 Validity of the research instrument

The validity of the research instrument was established through face and content validity

technique this was achieved through consultation with the supervisor who corrected the

questionnaire this made it more appropriate for the study.

3.8 Reliability of research instrument

Test–retest was adopted in to ascertain the reliability of the instrument. Twenty-nine (29)

copies of the questionnaire was pilot tested and re-administered after two weeks. Data

collected was coded and analyzed using the Pearson’s Product Moment Correlational

Coefficient formula. An index value of 0.731 was accepted as reliable.

3.9 Method of data collection

The questionnaires were distributed and collected by the researcher and any other trained

assistants. The questionnaires was checked and any resulting data errors was corrected

before data analysis.

3.10 Method of data analysis

Data was analysed using descriptive statistics and presented using tables and charts using

SPSS computer application.

3.11 Ethical consideration

Ethical approval was obtained from the Health Research and Ethics Committee, Primary

Health Centre, Ujoelen. Prior to data collection written consent was obtained from the

management of the Primary Health Centre, Ujoelen. Principles to be considered in this

35
study will include autonomy or respect of persons, right to protection from discomfort and

harm, right to fair treatment and right to confidentiality and privacy. Written informed

consent was issued to the participants before the administration of the questionnaire after

proper education about the significance of the research. Privacy and confidentiality of the

respondents was of uttermost concern.

36
 CHAPTER FOUR

RESULTS

4.1 Presentation of Results

Section A: Sociodemographic data

Table 4.1: Distribution of the sociodemographic characteristics of the respondents

Characteristics Frequency Percentage

(%)
Age
Mean 32.8years
Marital status
Single 4 8.0
Married 286 92.0
Divorced/separated - -
Widowed - -
Total 290 100
Religion
Christianity 135 88.0
Islam 153 11.3
African traditional religion 2 0.7
Total 290 100
Level of education
Non-literate 14 4.7
Primary 25 8.7
Secondary 217 74.6
Tertiary 35 12.0
Total 290 100
Occupation
Housewife 23 8.0
Farmer 44 15.3
Trader 141 48.7
Civil servant 81 28.0
Total 290 100
Family history of breast cancer/Relation with breast cancer
Aunt 23 8.0
Cousin 15 5.3
Grand mother 21 7.3
Uncle 37 0 0.0
Mother 17 6.0
None 213 73.3
Total 290 100
From the result in table 4.1, the mean age of the respondents was 32.8years. Majority of

the respondents were married 286(92.0%), only 4 (8%) were single. 135(88%) were

Christians, 153(11.3) were practicing Islam. Majority of the respondent had secondary

education 217(74.6%). Majority of them were traders 141(48.7%).

38
Table 4.2: Distribution of awareness about breast cancer and its causes

Variable Frequency (n=290) Percentage (%)

Have you heard of breast cancer?
Yes 229 78.9
No 61 21.1
Total 290 100
Source of information, tick as appropriate
Antenatal Clinic 114 39.4
Immunization Clinic 82 28.2
Newspaper 57 19.7
Television 37 12.7
Total 290 100
In your opinion can breast cancer be prevented?
Yes 172 59.2
No 114 40.8
Total 290 100
Can breast cancer be detected early?
Yes 94 32.4
No 196 67.6
Total 290 100
Can early detection of breast cancer improve chances of survival?
Yes 257 88.7
No 33 11.3
Total 290 100
Have you heard of breast self-examination?
Yes 257 88.7
No 33 11.3
Total 290 100
Do you know the steps involved in carrying out breast self-examination?
Yes 257 88.7
No 33 11.3
Total 290 100
Who should perform breast self-examination?
Males 8 2.8
Females 249 85.9
Both males and 33
11.3
females
Total 290 100
At what age should breast self-examination begin?
>19 [ ] 93 32

39
 <19 [ ] 131 45
Any age[ ] 44 15
I don't know [ ] 23 8
Total 290 100
How often should breast self-examination be performed?
Daily 74 25.4
Weekly 98 33.8
Monthly 86 29.6
Yearly 33 11.3
Total 290 100
What is the appropriate time for performing breast self-examination?
Before menstruation 57 19.7
During menstruation 53 18.3
Some days after 65 22.5
menstruation
No particular time to 114 39.4
perform BSE
Total 290 100

From the results in table 4.2, majority of the respondents have heard about cancer

229(78.9%). The major source of information was antenatal clinic 114(39.4%) followed by

immunization 82(28.3%). A higher proportion of the respondents agreed that breast cancer

can be prevented 172 (59.2%), while 114(40.8%) of them disagreed. Majority of the

respondents disagreed 196(67.6) that breast cancer cannot be detected. Furthermore,

majority of the respondents 257(88.7%) indicated that they have heard about breast self-

examination.

40
 Section C: Practice of breast self-examination
Table 4.3: Frequency and percentage distribution of practice of the respondents
towards screening measures for breast cancer
Variable Frequency (n=290) Percentage (%)
Have you ever performed breast self-examination?
Yes 257 88.7
No 33 11.3
Total 290 100
How often do you do breast self-examination?
Daily 33 11.3
Weekly 98 33.8
Fortnightly 86 29.6
Monthly 74 25.4
Total 290 100
When was the last time you performed it?
2 months ago 74 25.4
A month ago 82 28.2
A week ago 86 29.6
Cannot remember when 49 16.9
Total 290 100

From table 4.4 which presented the respondents practice of breast self-examination,

majority of them indicated that they have carried out breast self-examination. 98(33.8%)

indicated that they carried out their self-examination weekly. While 86(29.6%) indicated

that they did their breast examination a week ago.

41
42
Table 4.4: frequency and percentage distribution of the Perceived Benefit of Breast

Cancer Screen

Variable Frequency (n=290) Percentage (%)

Reduce Breast Cancer Mortality
Yes 229 78.9
No 61 21.1
Total 290 100
More conservative treatment
Yes 257 88.7
No 33 11.3
Total 290 100
Positive Psychological control
Yes 196 67.6
No 94 32.4
Total 290 100

From the results in table 4.3, majority of the respondents understand that breast cancer

screening minimizes breast cancer mortality 229(78.9%). A higher proportion of the

respondents agreed that breast cancer screening can allow for more conservative treatment

257 (88.7%), while 33(11.3%) of them differed. Majority of the respondents agreed that

breast cancer screening can help for positive psychological 196(67.6) that breast cancer

screening can help positive psychological control.

43
Answers to the Research Questions

Research Question One: What is the level of awareness of breast cancer among

women attending antenatal and immunization clinic at Primary Health Centre,

Ujoelen?

Majority of the respondents have heard about cancer 229(78.9%). The major source of

information was antenatal clinic 114(39.4%) followed by immunization 82(28.3%). A

higher proportion of the respondents agreed that breast cancer can be prevented 172

(59.2%), while 114(40.8%) of them disagreed. Majority of the respondents disagreed

196(67.6) that breast cancer cannot be detected. Furthermore, majority of the respondents

257(88.7%) indicated that they have heard about breast self-examination.

Research Question Two: Do these women practices breast self examination as a

preventive measures of breast cancer?

From table 4.4 which presented the respondents practice of breast self-examination,

majority of them indicated that they have carried out breast self-examination. 98(33.8%)

indicated that they carried out their self-examination weekly. While 86(29.6%) indicated

that they did their breast examination a week ago

Research Question Three: Do these women have knowledge of perceived benefit of

breast cancer screening

The respondents have a good perceived benefit of breast cancer screening as shown in table

4.3, majority of the respondents understand that breast cancer screening minimizes breast
44
cancer mortality 229(78.9%). A higher proportion of the respondents agreed that breast

cancer screening can allow for more conservative treatment 257 (88.7%), while 33(11.3%)

of them differed. Majority of the respondents agreed that breast cancer screening can help

for positive psychological 196(67.6) that breast cancer screening can help positive

psychological control.

45
 CHAPTER FIVE

DISCUSSION

5.1 Key Findings

Majority of the respondents have heard about cancer 229(78.9%). The major source of

information was antenatal clinic 114(39.4%) followed by immunization 82(28.3%). A

higher proportion of the respondents agreed that breast cancer can be prevented 172

(59.2%), while 114(40.8%) of them disagreed. Majority of the respondents disagreed

196(67.6) that breast cancer cannot be detected. Furthermore, majority of the respondents

257(88.7%) indicated that they have heard about breast self-examination. Majority of them

indicated that they have carried out breast self-examination. 98(33.8%) indicated that they

carried out their self-examination weekly. While 86(29.6%) indicated that they did their

breast examination a week ago. The respondents have a good perceived benefit of breast

cancer screening as shown in table 4.3, majority of the respondents understand that breast

cancer screening minimizes breast cancer mortality 229(78.9%). A higher proportion of the

respondents agreed that breast cancer screening can allow for more conservative treatment

257 (88.7%), while 33(11.3%) of them differed. Majority of the respondents agreed that

breast cancer screening can help for positive psychological 196(67.6) that breast cancer

screening can help positive psychological control.

5.2 Alignment of Findings with Findings from Previous Studies

46
Breast cancer is the most common cancer in women worldwide, for this reason women's

awareness of breast self-examination is crucial. The need to evaluate the awareness and

awareness of breast self examination among female nursing students who are going to be

future health personnel is necessary and recommended (Cavdar, 2007). The results from this

study is in line with advice from experts who indicated that women should begin breast self

examination as early as age 20 (Smith et al., 2008). Similarly in Nigeria, the mean age at

presentation of breast cancer was below 25 years as evidenced by Salaudeen, Akande &

Musa (2009) and hence the targeted group for the study. There is therefore a need for

concern about prevention of breast cancer in this age group. Majority of the respondents

were Esan, this is keeping with the fact that the study community (Ambrose Alli University)

is in Esan land. Most respondents were Christians, this is also in tandem with the

predominant religion in the community. Majority of the respondents were single (79.0%)

because they are young adults. Also majority of the respondents did not have family history

of breast cancer (90.0%), others had significant family history of breast cancer linked to

first degree relatives e.g. aunt (2.0%), cousin (3.0%), grandmother (3.0%) and mother

(2.0%). It was commendable that the level of awareness concerning breast cancer and breast

self-examination was high as majority of the respondents are aware of breast cancer (97.0%)

and also breast self-examination (91.0%). The awareness of breast cancer and breast self-

examination among the respondents could be attributed to the level of education of the

respondents, who are in tertiary institutions and are opportune to obtain information from

various sources. The major source of information was from health professionals (59.0%) and

47
this is due to the fact that the respondents had opportunity and access to health professionals

while in school and due to the career choice of the respondents (Nursing) while in the

hospital for clinical experience. The home (family) was the least source of information about

breast cancer and breast self examination. This is one of the gaps existing in family life

education as parents and care givers have no time to discuss pertinent health issues with their

children. It may also be due to the fact that some of the parents have no information or

awareness on some of these topics and as such have little or nothing to discuss. Similar

findings were reported in studies conducted in other regions of Nigeria where 97% and 92%

of the respondents were aware of breast cancer as a disease entity and breast self

examination (Ekanem et al., 1990; Oyeka et al., 1997). This study is also in agreement with

reports from Enugu and Lagos both in Nigeria where 92% of the respondents are aware of

the procedure (Nwagbo et al., 1996; Odeyemi et al., 2002). The figure reported from a study

in Port-Harcourt, Nigeria was less where 89.4% of those studied had heard about it (Uche,

1998). However 9.0% of the respondents said they have not done breast self examination

before and this finding is not in agreement with the study of Maqsood et al., (2009) which

revealed poor practise regarding breast self examination by women in Pakistan where the

majority (63.1%) did not feel any need to perform breast self examination.. Of the 91.0% of

respondents that have carried out breast self-examinations only 3.0% have family history of

breast cancer.

Majority of the respondents 96.0% are aware that early detection of breast cancer increase

survive rate only 4.0% of the respondent are not aware. This does not correspond with the

48
study done by (Uche, 1999) which states that “50% did not know that cancer was curable

when detected early (Uche, 1999)”. From this study, it was shown that majority of the

respondent (97.0%) perform breast self examination and this finding is not in agreement

with the study of Ashton, Karnilowicz & Fooks, (2001) which shows that, only 18 per cent

to 36 per cent of women actually perform Breast Self Examination (Ashton, Karnilowicz &

Fooks, 2001). Of the 97% that perform breast self examination, 43 (43.0%) of the

respondents practice breast self examination every month, 8 (8.0%) of the respondents

practice breast self examination once every six month, 3 (3.0%) of the respondents practice

it once every year, 28 (28.0%) practice breast self examination anytime they feel like, while

9 (9.0%) practice breast self examination seven days after menstruation each month. From

this research, it indicates that the practice of breast self examination was poor because for

the majority (43.0%) that practiced, the time interval was too long for one examination to

another. This shows that efforts are needed to encourage the practice of breast self

examination among female nursing students in Ambrose Alli University.

Summary

The study examined the awareness and percieved benefit of women towards breast cancer.

The study sought to assess the level of awareness of breast cancer among women attending

antenatal and immunization clinic. And determine the percieved benefits of the women

towards breast cancer. Assess if the women attending antenatal clinic and immunization in

49
practices of breast self-examination. This study adopted a descriptive research design. The

study was carried out in the Primary Health Centre, Ujoelen in Edo State. The target

population for this study comprised women attending ante-natal and immunization clinics in

the Primary Health Centre, Ujoelen for a period of 1 months. A total of 290 respondents

were sampled for this study. Major findings of the study majority of the respondents have

heard about cancer 229(78.9%). The major source of information was antenatal clinic

114(39.4%) followed by immunization 82(28.3%). A higher proportion of the respondents

agreed that breast cancer can be prevented 172 (59.2%), while 114(40.8%) of them

disagreed. Majority of the respondents disagreed 196(67.6) that breast cancer cannot be

detected. Furthermore, majority of the respondents 257(88.7%) indicated that they have

heard about breast self-examination. From the results in table 4.3 which shows the Percieved

benefit towards screening measures for breast cancer, majority of them indicated that breast

self examination was too complicated 261(90.1%), 253(87.3%) indicated that they were

afraid of breast self-examination. 253(87.3%) indicated that they would recommend breast

self-examination to another person. Based on the result finding it was recommended that

breast awareness campaign should be carried out by the government and non-governmental

organizations (NGOs). Hospitals should organise programmes to teach about breast self

examination and issues about breast cancer as early as possible.

50
Conclusion

Breast cancer which is the second leading cause of cancer death in the worldwide with

majority of the cases occurring in the developing countries is an abnormal growth of cells

which begins in breast tissue. Breast cancer is curable if detected early (WHO, 2010).

The low survival rates in less developed countries may be explained mainly by lack of early

detection, lack of adequate diagnosis and treatment facilities which results in high proportion

of women presenting with late stage disease.

Women can be made 'breast-aware' with cheap and non invasive early detection measures

such as breast self examination (BSE) which may in turn lead to early diagnosis of breast

cancer. Breast self-examination offers women a chance to learn what is normal for them so

that they can recognize any changes immediately.

Furthermore, as recommended by the American Cancer Society (2007) breast self

examination should be started as early as 20's. This will help to reduce the incident of new

breast cancer cases worldwide. The younger the age at which females are exposed to

information and awareness of breast self-examination, the higher the chances of adherence

to breast self examination in the future. Adequate breast cancer awareness and screening

practices can prevent late presentation of breast cancer in a developing country like Nigeria.

Recommendation

51
 Breast awareness campaign should be carried out by the government and non-

governmental organizations (NGOs), on the importance of breast self examination.

 Hospitals and schools (especially higher institutions) should organise programmes to

teach about breast self examination and issues about breast cancer as early as possible this

will go a long way to encourage positive behaviour towards breast self examination, and can

also lead to seeking regular professional breast examinations/screenings later in life.

 Emphasis should be laid on breast self examination in undergraduate and

postgraduate courses, especially for nurses, as they are mostly involved in patient education.

52
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57
 QUESTIONNAIRE
DEPARTMENT OF NURSING SCIENCES
AMBROSE ALLI UNIVERSITY
EKPOMA, EDO STATE
Dear Respondent
This study is being carried out by an undergraduate student in the Department of Nursing,
College of Medicine, Ambrose Alli University, Ekpoma, Edo State, as part of the
requirement for the completion of a project on the topic. Kindly and sincerely provide
answers to the questions in the spaces provided. Every information provided is highly
confidential and strictly for academic purpose. No names are required.
PART A
Tick the appropriate response to the questions provided
1. DEMOGRAPHIC PROFILE OF RESPONDENTS
Age:
o 15-24
o 25-34
o 35-44
o 45 and above
Marital status:
o Single
o Married
Religion:
o Christianity
o Islam
o Others

Section B Responses on Awareness, Practice and Perceived Benefit of Breast cancer

screening
Variable Response
Have you heard of breast cancer?
Source of information, tick as appropriate

58
 Antenatal Clinic
Immunization Clinic
Newspaper
Television
In your opinion can breast cancer be prevented?
Yes
No
Can breast cancer be detected early?
Yes
No
Can early detection of breast cancer improve chances of survival?
Yes
No
Have you heard of breast self-examination?
Yes
No
Do you know the steps involved in carrying out breast self-examination?
Yes
No
Who should perform breast self-examination?
Males
Females
Both males and
females
At what age should breast self-examination begin?
>19 [ ]
<19 [ ]
Any age[ ]
I don't know [ ]
How often should breast self-examination be performed?
Daily
Weekly
Monthly
Yearly
What is the appropriate time for performing breast self-examination?

59
 Before menstruation
During menstruation
Some days after
menstruation
No particular time to
perform BSE

Variable Response
Have you ever performed breast self-examination?
Yes
No
How often do you do breast self-examination?
Daily
Weekly
Fortnightly
Monthly
When was the last time you performed it?
2 months ago
A month ago
A week ago
Cannot remember when

Variable Response
Reduce Breast Cancer Mortality
Yes 229
No 61

60
More conservative treatment
Yes 257
No 33
Positive Psychological control
Yes 196
No 94

61
REF: AAU/FBM/NSG/48/Vol.II/802 DATE: June 2, 2022

NAME OF STUDENTS: ALU MOTUNROLA FOLASADE

MATRIC NUMBER: CMS/FBM/NSG/16/30518
This is to inform you that the above named is a final year student of the Department of
Nursing science of our University. She is seeking for ethical clearance from your office to
enable her carry out research on the project topic entitled: “AWARENESS, PRACTICE,
AND PERCEIVED BENEFIT OF BREAST CANCER SCREENING AMONG WOMEN
ATTENDING PRIMARY HEALTH CENTRE, UJOELEN, EKPOMA, EDO STATE”. This
is a requirement for all final year students of the Department.

62