|Year : 2019 | Volume
| Issue : 5 | Page : 219-225
Awareness and practice of breast self examination among women in different African countries: A 10-year review of literature
Ofonime Effiong Johnson
Department of Community Health, University of Uyo Teaching Hospital/University of Uyo, Uyo, Nigeria
|Date of Submission||13-Jun-2019|
|Date of Decision||03-Sep-2019|
|Date of Acceptance||06-Sep-2019|
|Date of Web Publication||26-Nov-2019|
Ofonime Effiong Johnson
Department of Community Health, University of Uyo Teaching Hospital/University of Uyo, Uyo
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Breast self examination (BSE) is an important screening technique in detecting breast abnormalities. This procedure enables women become familiar with their breasts, thus making it easier for them to detect any changes that may occur. Routine performance of BSE is recommended for females above 20 years. This review of literature was conducted to assess the awareness and practice of BSE among women in different countries in Africa. A total of 28 out of 80 articles were reviewed from 15 African countries based on relevance. Review identification was performed through the search of Google Scholar and PubMed/MEDLINE/PubMed Central databases. Search terms used were “BSE,” “awareness,” “practice,” and “Africa.” Reference lists of identified studies were also used to find more studies. Majority of the reviewed studies showed adequate awareness, mainly from the media, but poor practice of BSE among women in various countries in Africa. A major barrier identified was inadequate knowledge of BSE technique. Although awareness of BSE was relatively high in many of the reviewed studies, the practice was low. Educational intervention program should be carried out among women in various African countries, not only to raise awareness but also to educate on the skills required to carry out BSE effectively.
Keywords: Africa, awareness, breast self examination, females, practice
|How to cite this article:|
Johnson OE. Awareness and practice of breast self examination among women in different African countries: A 10-year review of literature. Niger Med J 2019;60:219-25
|How to cite this URL:|
Johnson OE. Awareness and practice of breast self examination among women in different African countries: A 10-year review of literature. Niger Med J [serial online] 2019 [cited 2020 Feb 17];60:219-25. Available from: http://www.nigeriamedj.com/text.asp?2019/60/5/219/271770
| Introduction|| |
Breast cancer is currently the most common cancer among women worldwide and the second most common cancer among both sexes, making up 12.3% of all cancers (excluding nonmelanoma skin cancer) and 23% of all female cancers. This shows an upward trend, as it was reported to make up 10.9% of all cancers in 2008. Although breast cancer is thought to be a disease of the developed world, nearly 50% of breast cancer cases and 58% of deaths occur in less-developed countries. Change in lifestyle has led to increasing incidence of breast cancer in Africa. The incidence of breast cancer in Africa in 2018 ranged from 27.9/100,000 in Central Africa to 48.9/100,000 in Northern Africa, with a corresponding mortality of 15.8%–18.4%, respectively.
The knowledge and health-seeking attitude for breast cancer management are low in Africa, such that majority of the affected patients present late to the hospital when little or nothing can be done in terms of treatment. It has been reported that most patients with breast cancer in developing countries present for the first time at advanced stages (III and IV). This is possibly due to lack of early detection of the disease. The diagnosis of breast cancer during the early stage has been linked to a reduction in mortality, morbidity, and cost of management of the illness. This indicates a need for increased community awareness of methods for the early detection of the disease. Early detection is usually done through screening, and screening methods include breast self examination (BSE), clinical breast examination (CBE), and mammography. Due to fewer number of experts and lack of advanced diagnostic techniques in developing countries, promoting regular BSE has been said to be the feasible screening option for early detection of breast cancer. However, its practice is dependent on knowledge and attitude toward breast cancer and BSE among women.
BSE involves visualization and palpation of the breast by oneself for lumps, shape, texture, size, and contour. The purpose of BSE is for a woman to be able to identify changes in the breasts should they exist. It is carried out once monthly between day 7 and 10 of the menstrual cycle. BSE has a positive effect on the early detection of breast cancer. About 80% of breast cancers not detected by mammography are detected by women themselves, though most often not as a part of a systematic regular self-examination, but as a part of daily activities such as showering and dressing.
BSE is regarded as a valuable screening tool for breast cancer when used as an adjunct to CBE and mammography. Furthermore, it can be utilized in enhancing breast cancer awareness among women. BSE is recommended because it is inexpensive, private, painless, easy, and safe and requires no special equipment. It has also been shown to improve breast health awareness and thus potentially allow for the early detection of breast anomalies., While screening programs with mammography have been effective in high-income countries, research has shown that other strategies such as BSE are equally important in reducing mortality from breast cancer, particularly in low-resource settings.
A study carried out among female secondary school teachers in Ilorin, Nigeria, West Africa found that awareness of BSE was high (95.6%), though its practice was relatively low (54.8%). Studies conducted in other regions of the world have also shown poor attitude toward BSE and poor practice, despite good knowledge.,
With the increasing morbidity and mortality from breast cancer in Africa, there is a need to explore the awareness and practice of BSE in different countries in Africa. The objective of this literature review was to assess the awareness and practice of BSE in African countries within a 10-year period.
| Methodology|| |
A comprehensive and systematic search was carried out using PubMed/MEDLINE/PubMed Central, and Google Scholar. Search terms were “BSE” AND “awareness” AND “practice” AND “Africa” and African countries such as Nigeria and other countries. Reference lists of included studies were also scanned to identify additional relevant articles. For inclusion criteria, the reviewed articles had to be full paper articles published in the English language from January 2009 to January 2019, directly focusing on awareness and practice of BSE. Articles from all parts of Africa were included in the review. A total of 80 articles on BSE among women in African countries were initially assessed. Thirty articles did not have direct relevance to the focus of the review and were removed. Twenty-two articles were also subsequently excluded on grounds of duplication of information from the same countries or unavailability of the full texts. Twenty-eight full-text articles from 15 African countries were finally reviewed [Figure 1].
| Results|| |
Based on the inclusion criteria, a total of 28 descriptive surveys were retrieved, and the data extracted are summarized in [Table 1]a, [Table 1]b, [Table 1]c, [Table 1]d. The review covered 15 countries in West, Central, East, North, and South Africa. A total of 7 (25.0%) of the studies were conducted in Nigeria, 3 (10.7%) in Ethiopia, Ghana, and Cameroon, and 2 (7.2%) in Egypt, respectively. Ten other studies (35.7%) were also included in the review from each of the following countries: South Africa, Botswana, Uganda, Tanzania, Senegal, Eritrea, Rwanda, Sudan, Morocco, and Zambia. Majority of the reviewed studies showed adequate awareness, mainly from the media, but poor practice of BSE among women in various countries in Africa. A major barrier identified was inadequate knowledge of BSE technique.
| Discussion|| |
Prevention remains a fundamental factor in the fight against breast cancer. Screening and early detection play important roles in the treatment and prognosis of breast cancer. BSE is a screening method that can be performed by women themselves. It is inexpensive and accessible and is, therefore, a good screening method for resource-poor settings, where mammography is not readily available.,
This review showed that though many of the studies reported a relatively high level of awareness of BSE in different countries in Africa, adequate practice was generally low. The review cut across different occupational groups in different countries in Africa.
Several studies assessed the awareness and practice of BSE among female students. Awareness was reported to be high in Nigeria, Ghana, Uganda, and Sudan.,,, In contrast to this, reviewed articles in Ethiopia and Eritrea showed relatively lower levels of awareness, as only 64.0% and 48.9% of students were aware of BSE, respectively.,
Practice levels of BSE across countries were reported to be generally poor. The highest level of regular BSE practice among students, (66.7%) was reported among medical students in Sudan, with the lowest levels, (1.3%) being reported among female university students in Egypt. Stressing the benefits of BSE may help in improving the practice of this simple procedure.
Health workers in some of the reviewed articles had adequate knowledge of BSE. Agboola et al. reported that more doctors had correct knowledge of BSE, followed by medical laboratory scientists and then nurses. However, only a third of the nurses practiced BSE, while more laboratory scientists (78.3%) practiced BSE than doctors (68.2%). Another study reported that all nurses in Aminu Kano University Teaching Hospital, Nigeria, were aware of BSE; however, only about two-fifths of them practiced BSE regularly. Female health workers, especially nurses who have longer contact time with clients, in addition to carrying out BSE on themselves, are expected to educate and encourage clients on practice of BSE.
The practice of BSE in the general populace varied among women in different countries. A study in Ethiopia reported a very low level of practice among the general populace, with only 6.25% doing BSE regularly, while in Cameroon, another study reported that 35% of respondents regularly practiced BSE though 74.1% had heard about it. In Nigeria, a study reported a 39.65% awareness of BSE, with 28.94% practice among this category of women. This was low compared to the level of awareness among students and health workers in other studies in the same country., In South Africa, only 2% of the studied rural women recognized BSE as a screening method for breast cancer, even though more than a third knew how to do BSE correctly.
The highest levels of awareness of BSE (100%) among the reviewed articles were reported among nurses and teachers in Nigeria,, while the highest monthly practice level (78.3%) was reported in Nigeria among female laboratory scientists. Similarly, the lowest level of BSE awareness (39.65%) was reported among women in Rivers State, Nigeria, while the lowest level of monthly practice (1.3%) was reported among female university students in Egypt.
The media was reported to be the major source of information on BSE in several of the reviewed studies.,,, Some reviewed studies reported that increasing age, tertiary education, previous breast disease, and family history of breast disease were associated with higher knowledge and practice of BSE.,, This suggests that having perceived susceptibility to breast disease increased the likelihood of practice of BSE. The most common barrier to practice of BSE reported by many of the studies in this review was lack of knowledge of BSE technique.,,,, Efforts must be put in place to overcome this barrier through intensive health education programs, preferably involving the media.
| Conclusion|| |
The overall picture from this literature review shows that the level of awareness about BSE among women from studies in different African countries is relatively high; however, the level of practice is low, even among health workers in some of the studies. Since a major reason stated for low practice was lack of knowledge and skill on how to perform BSE, in addition to awareness programs, educational interventions which teach the step-by-step practice of BSE is necessary to increase the practice of BSE in Africa.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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