TABLE OF CONTENTS PAGE
Title page i
Dedication ii
Certification iii
Approval iv
Acknowledgement v
List of tables viii
List of figures ix
Abstract x
CHAPTER ONE:
INTRODUCTION
Background to the study 1
Statement of the problem 5
Purpose and objectives of the study 6
Research questions
7
Significance of the study 7
Scope of the study 9
Operational definition of terms 9
CHAPTER TWO:
REVIEW OF RELATED LITERATURE
Conceptual review 10
Concept of breast cancer 10
Types of breast cancer 18
Staging and grading of breast cancer 19
Risk factors for breast cancer 22
Manifestations of breast cancer 43
Epidemiology of breast cancer 44
Breast cancer screening guide/early detection practices 53
Breast self examination: 54
Techniques for Performing BSE: 56
Factors affecting breast self examination 60
Clinical breast examination (CBE): 62
Mammography 62
Biopsies 65
Breast ultrasound 67
Concept of reverend Sisters 76
Theoretical review 81
Health belief model 81
Empirical review 86
Studies on knowledge of breast cancer and its early detection measures 96
Summary of reviewed literature 102
CHAPTER
THREE: RESEARCH METHODS
Research design 105
Area of study 105
Population of the study 106 Sample size 106
Sampling procedures 108
Instrument for data collection 108
Validity of instrument 108
Reliability of instrument 109
Ethical considerations 109
Procedure for data collection 110
Method of data analysis 110
CHAPTER FOUR: PRESENTATION OF RESULTS 108
Summary 125
CHAPTER
FIVE: DISCUSSION OF FINDINGS
Discussion of major findings 127
What the reverend sisters know as breast cancer 127
What the sisters attribute as risk factors/causes of breast cancer 128
Early warning signs of breast cancer identified by the respondents 129
Reverend sisters knowledge of early detection measures of BCa 130
Early detection measures the respondents know 131
Breast cancer preventive measures respondents know 132
Respondents’ sources of knowledge on breast cancer 133
How respondents do breast examination respondents 134
Factors identified by respondents as militating against their use of detection and preventive health behaviours 136
Conclusion 137
Implications to the study 138
Limitations of the study 139
Recommendations 140
Suggestion for further studies 141
Summary 141
REFERENCES 144
APPENDICES
Appendix A: Questionnaire 149
Appendix B: PPMCC calculation for reliability of instrument 153
Appendix C:Introduction letter from the Department 156
Appendix C: Ethical Approval letter 157
LIST OF TABLES
Table 1:Number and sample
distribution of Sisters from various congregations 107
Table 2: Socio- demographic characteristics of the respondents 112
Table 3: What breast cancer means to the respondents (n = 324) 113
Table 4: Breast cancer risk factors/causes identified
by the respondents 114
Table 5: Early warning signs of BCa identified by
respondents 116
Table 6: Breast cancer early detection practices
respondents know 118
Table 7: Breast cancer
preventive measures respondents know
119
Table 8: Respondents’ sources of information 120
Table 9: How the respondents do breast examination 121
Table 10: When respondents practice breast self-examination 122
Table 11: When respondents do clinical breast examination 123
Table 12: Factors identified by respondents as militating against their
use
of detective and preventive health behaviours 124
LIST OF FIGURES
Figure I: Conceptual model for the
study 86
Figure II:
Responses on whether women who had prolonged exposure
to ovarian hormone have high risk of developing breast cancer 115
Figure III: What breast examination means to the respondents 117
ABSTRACT
This study assessed the knowledge of breast cancer and
early detection measures of reverend sisters in Anambra State. Eight objectives
and eight research questions were raised to guide the study. Cross-sectional
descriptive survey design was used. A sample size of 324 respondents was drawn
from an estimated population of 794 sisters of the various congregations living
in communities located in Anambra State through stratified, proportionate and convenient
sampling techniques. Data were collected by administration of a 17-item
self-developed questionnaire through personal contacts by the researcher and 3 research assistants. Data were
analysed descriptively using
frequencies and percentages. Unpaired t-test was used to compare the responses
of the two groups of respondents. There
was significant difference in the knowledge of breast cancer preventive
measures among the respondents. Only 61 (18.8%) of the sisters described breast
cancer as uncontrolled multiplication of breast tissue. As many as 52 (16.0%) of the respondents had no idea
of what breast cancer means. Painless lump was identified by 141 (43.5%)
respondents as the early warning sign of breast cancer. There was no
significant difference in the awareness of early warning signs/symptoms of
breast cancer among the two groups (0.7438>p0.05) and what the two groups knew
as breast examination (0.8608>p0.05). Most popular breast cancer early
detection practices identified was breast self examination. More sisters in the
active group seem to be aware of this than the contemplatives. A good number of them had never done breast
self examination 50 (15.4%) and clinical breast examination 158 (48.8%). As
many as 148 (45.7%) respondents were not aware of where to obtain the services,
and 73 (22.5%) avoided the detection measures because of fear of lumps. Not
being aware of where to obtain the services was a factor to reckon with, while
at the same time, the sisters preferred to live in ignorance for fear of a lump
being detected. Congregations should establish policy guidelines aimed at
promoting adequate and urgent dissemination of all relevant information about breast
cancer; and, integrate breast cancer screening procedures into their curriculum.
There should be free access to screening services in the government health
institutions.
CHAPTER ONE
INTRODUCTION
Background to the study
Breast cancer (BCa) is a
malignant tumour that has developed from breast cells, which has no cure at
present. However, it can be managed with modern technological tools, and one’s
life can be prolonged. In the last four decades, with the introduction of
screening programmes that efficiently detect cervical cancer in its early
stage, BCa has been seen to overtake cervical cancer in incidence and has
become number one neoplasm among women (Okolie, 2012). BCa has therefore become
a worldwide major health problem. The vast majority of it occur invasively in
women (National Cancer Society [NCS], 2013). It accounts for 16% of all female
cancers, and 22% of it are invasive. In both men and women, it accounts for
18.2% of all cancer deaths (NCS, 2013).
Adebamowo and Ajayi (2006) corroborate the opinion of NCS and maintain
that BCa is the commonest cancer among women in the world and in Nigeria too.
Adebamowo and Ajayi (2006)
opine that it has become the commonest malignancy affecting Nigerian women.
Also, according to Smeltzer, Bare, Hinkle and Cheever (2010), among the ten
leading types of cancers by gender determined on the basis of estimated new
cases and deaths in the United States in 2004, BCa accounts for 32% and the
highest in female while prostate cancer accounts for 33% in males, which is the
highest among them. Some of its common threats to physical wellbeing according
to Adejumo and Adejumo (2009) include effects of treatments, recurrence and
metastasis, fatigue, arm and shoulder discomfort, as well as lymphedema.
Unfortunately,
Nigeria (which is the home country of the reverend sisters that are the focus
of this study) remains ill-equipped to deal with the complexities of cancer
detection and care as the testing and care facilities are still very few. The prevalence of BCa
within the country is 116 per 100,000, and 27,840 new cases were expected to
develop in 1999 (Adebamowo & Ajayi, 2006). In 2005,
between 7 and 10,000 new cases of BCa developed.
This
increasing incidence of BCa in Nigeria is in line with the situations in other
developing countries, and even those advanced countries that used to have a low
incidence now record high incidence. The relative frequencies of BCa among other female
cancers, from Cancer Registries in Nigeria were 35.3% in Ibadan, 28.2% in
Ife-Ijesha, 44.5% in Enugu, 17% in Eruwa, 37.5% in Lagos, 20.5% in Zaria and
29.8% in Calabar (Banjo, 2004 ). Similarly, in all the centres, except Calabar
and Eruwa, BCa rated first among other cancers.
Further reports showed that majority of cases
occurred in premenopausal women, and the mean age of occurrence ranged between
43–50 years across the regions. The youngest age recorded was 16 years, from
Lagos (Banjo, 2004). This trend was attributed to several factors such as: the
acceptance of fine needle aspiration as an accurate diagnostic evaluation, and
increased awareness about BCa and usefulness of breast self-examination
(Thomas, 2000).
Several
other factors are responsible for this increasing detection, but the most
important in the researcher’s view are: increased
access to diagnostic facilities;empowerment of women, which
is increasing women’s ability to make independent decisions
about their own health-care; increasing westernization of dietary products;and physical
activity; obstetric and gynaecological factors among others. Conventionally, breast
self-examination (BSE) is the easiest and simplest procedure for detecting
breast masses because a woman who knows the texture, contour, and feel of her
own breasts is far more likely to detect changes that may develop (ACS, 2007).
The above notwithstanding,
the American Cancer Society (2010) made the following recommendations: monthly
self breast examination (SBE) beginning at the age of 20, from the fifth day of
the menstrual cycle to one week following menstruation; clinical breast
examination every three (3) years, from age 20 to 40, then annually, beginning
at age 40; and mammogram, at age 40, and above annually. Adejumo and Adejumo
(2009) recommend that in addition to the above promotive health behaviours,
needle aspiration may be performed when ultrasound reveals a suspicious lesion. The researchers advanced that imaging
techniques offer new and emerging technologies that aid diagnosis of the
disease at its rudimentary stage.
Anecdotal knowledge and experience have
revealed that the knowledge of preventive and promotive health behaviours of
reverend sisters is highly militated against, probably owing to their
life-style, ignorance and fear on their part, and inability of the health team
to create adequate awareness. This, may lead to increase in the rate of high
sisters mortality, sequel to BCa, as evidenced by the number of deaths (7),
recorded by the congregations, which occurred in quick succession. Such deaths
would have been averted if the sisters were responsive to preventive health
behaviours of early BCa detection practices. Moreover, early detection of BCa
will lead to early intervention at an early phase of cancer progression,
resulting in improvement in years of survival for the clients/sisters.
There are two categories of reverend sisters,
the contemplatives and the active ones. The active reverend sisters are the
sisters that live in convents from where they interact and operate with the
outside world, committing themselves to some hours of private and community
prayers. The conservatives are popularly known as nuns who live in
monasteries and take vow of stability, in addition to the vows of chastity,
poverty and obedience. They live strict life of enclosure.
There is an urgent need to
assess the knowledge of BCa and its preventive health behaviours among the
different congregations for early detection and prompt intervention, so as to avert
deaths sequel to its occurrence. Okolie (2012) maintains that BCa is now a
manageable disease, and attributes this to early diagnosis and advances in
surgical techniques, chemotherapy and radiation, with the main thrust being,
early diagnosis. The reverend sisters therefore have a role to play in
diagnosis by performing monthly breast self examination (BSE), obtaining
routine screening, via mammography and seeing a health professional for regular
breast examinations, as well as going for ultrasound (though secondary), in
order that BCa could be detected early enough for prompt intervention/s, given
their nulliparous nature. The researcher’s concern is basically to find out
what reverend sisters in Anambra State know about BCa and what they do towards
its early detection.
Statement ofProblem
KNOWLEDGE OF BREAST CANCER AND EARLY DETECTION MEASURES AMONG REVEREND SISTERS IN ANAMBRA STATE
