CHAPTER ONE

INTRODUCTION

1.1. BACKGROUND OF THE STUDY

Breast cancer (BC) is the most commonly diagnosed cancer in women in both high and low resource setting (Bray F et al, 2004). Although widely recognized as a significant public Health concern in developed Nations. BC is also becoming an increasing urgent issue in low and middle income countries (LMICs). Both incidence and mortality increase over the passed decades and a majority of death resulting from breast cancer now occur in developing nations. In South Africa, breast cancer incidence has doubled in the past 20 years and now account for >20% of female cancers (American Cancer society, 2016).

Despite rapidly increasing incidence rates, early detection and treatment remain extremely limited in LMICs, and these countries face significantly higher mortality rates than high income countries. The average 5 years survival in Africa is half of that in the United State (50% Vs 98.6%) and the age-standardize mortality rate for breast in south Africa is 16.5 in 100.000 as compared with 14.1 in 100.000 in the United State. (Coughlin SS et al, 2009).

Breast cancer is a global problem and 1.7 million new cases are diagnosed per year. Approximately 60% of deaths due to breast cancer occur in developing countries (DCs) (Bray F et al, 2012), whereas, in the United States (US), an estimated 249.260 new cases of breast cancer are diagnosed each year and mortality rate due to this diseases id decreasing (Miller KD et al, 2016). In contrast, breast cancer  in DCs represents one-half of all breast cancer cases and 62% of the death (Siegel RL et al, 2016). In Brazil, it is expected that the incidence of breast cancer will be one-fourth that of United States but this increase incidence is associated with an increase in breast cancer associated mortality (Chaternoud L et al, 2010).

In the US, 70% of women undergo mammography. This percentage is higher in white women (72.1%) and women with a higher level of education (80.1%). In high income countries like US, approximately 232 340 women will be diagnosed and 39620 will die of breast cancer in 2013 (Siegel R et al, 2013).

In Countries with budgetary limits, the percentage of cancer diagnosis in the presence of a palpable mass and adherence strategies base on self-breast examination are being discussed (Sayami P et al, 2009).

The prognosis for BC is considered good. The survival rate is on the order of 73% in developed countries and 57% in developing countries. In the US, 5-years survival rate is 89.7% (Parkin DM et al, 2002). Although the incidence of breast cancer is lower in developing countries, the mortality /incidence ratio is higher (Bray et al 2005). Due to economic and logical constraints, a limited organized network is aimed at early diagnosis of BC in developing countries. Mammographic screening is not a reality, which is reflected in the high number of patients diagnosed at an advanced stage. It is difficult to evaluate the health system of BCs, and it is also difficult to evaluate their improvement.

Cancer of the breast in women is a major health burden worldwide. It is the most common cause of cancer death among women in both high resource and low resource settings, and is responsible for one million of estimated 10 million neoplasm diagnosed worldwide each year in both sexes. (Ferlay J, Bray et al, 2001).

It is also the primary cause of death among women globally, responsible for about 375000 deaths in the year 2000. (Parkin DM et al, 2001).

1.2. STATEMENT OF THE PROBLEM

Despite advances in medicine, BC is diagnosed in the advanced stages in countries with limited resources because early detection, diagnosis and treatment are not efficiently promoted. To evaluate the complexity of the health care system, in relation to BC, the breast Health Global Initiative (BHGI) has sought to categorise the organizational levels of countries in relation to BC, specifically, at the basic levels, breast self-examination is encourage, whereas, diagnostic ultrasound and mammography with opportunistic breast screening are at the maximum level, the population undergoes organized screening for breast cancer. (Anderson Bo e al, 2006).

Breast cancer is the most frequent cancer among women, impacting over 1.5 million women each year, and also causes the greatest number of cancer – related deaths among women. In 2015, 570 000 women died from breast cancer that is approximately 15% of all cancer deaths among women in developed regions, rates are increasing in nearly every region globally WHO. (2015). In order to improve breast out comes and survival, early detection is critical. There are two early detection strategies for breast cancer; early diagnosis and screening.

According to WHO, (2009) 1/3 of BC death could be decreased if detected early and treated. In the world wide context, this means nearly 400 000 lives could be saved every year. Between the late 1980s to 2004, BC mortality rate fell by 50% in the 20-40 age group, by 60%, in the 65-69 age group and 26% in women aged 70 and above (Reibstein, 2010).

Breast cancer is also the leading cause of death in less developed countries. This is partly because a shift in lifestyle is causing an increase in incidence and partly causing clinical advances to combat the disease are not reaching women living in these regions. ( David Forman, 2010).

In Africa, in a study carried out in central Africa, the findings shows that breast cancer is common and mostly affecting women. Epidemiological trends are more or less common to those in developing countries with a predominance of invasive ductal carcinoma. Also in developing countries, it is the first leading cause of death among women with 324 000 deaths which represent 14.3% of all deaths (Antoine M et al, 2011).

However, according to WHO report in 2012, the incidence of breast cancer is 31.5/100,000 in Cameroon, in Egypt, 24.2/100000, in Ghana, 22.8%, 100,000, in Burkina Faso, 19.8/100.000 and 15.9/100.000 in Guinea (Ferlay J et al, 2013), with Cameroon being the highest. In a study carried out in Yaounde-Cameroon, the frequency of different cancer in selected areas, the epidemiology of breast cancer is relatively unknown, but there an estimated 15.000 cases diagnosed annually and a prevalence of 25000 throughout the country. Breast cancer is being increasingly recognized as a public Health problem in Cameroon (Enow Orock Ge, 2012).

Furthermore, during the investigator’s period of practical experience in Mbingo Baptist Hospital theatre, the investigator noticed about 21 cases of mastectomies in women within three months. She became disturbed and went further to checked on the number of mastectomies and breast mass excision done in 2016 and the first eight months of 2017. The investigator came out with the following statistics: 96 cases of mastectomy and 65 case of breast mass excision in 2016. Eighty one (81) cases and 53 cases for mastectomy and breast mass excision respectively in the first eight months of 2017. It is with this regard that she decided to carry out a research, to find out, whether women have the knowledge about breast cancer, and if they have, what preventive measure are employed to curb its occurrence.

1.3. STUDY QUESTION

What knowledge do women of the Azire Health Area of age 18-55 years have about breast cancer and what preventive measures are employed to curb its occurrence?

1.4. STUDY OBJECTIVES

1.4.1. General objectives

To assess the knowledge and practices of women age 18-55 years in the prevention of breast cancer.

1.4.2. Specific objective

1. To assess the respondents’ knowledge about breast cancer and its prevention
2. To assess the practical measures taken toward the early detection and prevention of breast cancer.
3. To determine the problems encountered in the practice of the preventive measures against breast cancer.
4. To ascertain the additional knowledge, they need from health care providers in the prevention of breast cancer.

1.5. STUDY HYPOTHESIS

Women who are knowledgeable about breast cancer and practice measure toward it prevention and or early detection, stands a better chance of not developing breast cancer than those who do not.