Nigerian Medical Journal

REVIEW ARTICLE
Year
: 2019  |  Volume : 60  |  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

Correspondence Address:
Ofonime Effiong Johnson
Department of Community Health, University of Uyo Teaching Hospital/University of Uyo, Uyo
Nigeria

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.



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;60:219-225


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 Jan 22 ];60:219-225
Available from: http://www.nigeriamedj.com/text.asp?2019/60/5/219/271770


Full Text

 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.[1] This shows an upward trend, as it was reported to make up 10.9% of all cancers in 2008.[2] 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.[2] Change in lifestyle has led to increasing incidence of breast cancer in Africa.[3] 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.[4]

The knowledge and health-seeking attitude for breast cancer management are low in Africa,[5] 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).[6] 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.[7] 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.[8] 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.[9] However, its practice is dependent on knowledge and attitude toward breast cancer and BSE among women.[10]

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.[11] BSE has a positive effect on the early detection of breast cancer.[7] 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.[12]

BSE is regarded as a valuable screening tool for breast cancer when used as an adjunct to CBE and mammography.[13] Furthermore, it can be utilized in enhancing breast cancer awareness among women.[8] BSE is recommended because it is inexpensive, private, painless, easy, and safe and requires no special equipment.[14] It has also been shown to improve breast health awareness and thus potentially allow for the early detection of breast anomalies.[15],[16] 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.[17]

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%).[18] Studies conducted in other regions of the world have also shown poor attitude toward BSE and poor practice, despite good knowledge.[19],[20]

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].{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.{Table 1}

 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.[14],[44]

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.[21],[30],[36],[38] 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.[32],[34]

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,[38] with the lowest levels, (1.3%) being reported among female university students in Egypt.[39] 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%).[22] 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.[24] 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,[33] while in Cameroon, another study reported that 35% of respondents regularly practiced BSE though 74.1% had heard about it.[15] In Nigeria, a study reported a 39.65% awareness of BSE, with 28.94% practice among this category of women.[23] This was low compared to the level of awareness among students and health workers in other studies in the same country.[21],[22] 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.[42]

The highest levels of awareness of BSE (100%) among the reviewed articles were reported among nurses and teachers in Nigeria,[24],[25] while the highest monthly practice level (78.3%) was reported in Nigeria among female laboratory scientists.[21] Similarly, the lowest level of BSE awareness (39.65%) was reported among women in Rivers State, Nigeria,[23] while the lowest level of monthly practice (1.3%) was reported among female university students in Egypt.[39]

The media was reported to be the major source of information on BSE in several of the reviewed studies.[37],[38],[40],[41] 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.[26],[27],[33] 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.[16],[26],[29],[32],[34] 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

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.
2International Agency for Research on Cancer. GLOBOCAN 2008. Section of Cancer Information. Lyon, France: International Agency for Research on Cancer; 2010.
3Opoku SY, Benwell M, Yarney J. Knowledge, attitudes, beliefs, behaviour and breast cancer screening practices in Ghana, West Africa. Pan Afr Med J 2012;11:28.
4International Agency for Research on Cancer: GLOBOCAN 2018. Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2018. Available from: https://doi.org/10.3322/caac.21492. [Last accessed on 2019 Sep 04].
5Ströbele L, Kantelhardt EJ, Traoré Millogo TFD, Sarigda M, Wacker J, Grosse Frie K. Prevalence of breast-related symptoms, health care seeking behaviour and diagnostic needs among women in Burkina Faso. BMC Public Health 2018;18:447.
6Martei YM, Pace LE, Brock JE, Shulman LN. Breast cancer in low- and middle-income countries: Why we need pathology capability to solve this challenge. Clin Lab Med 2018;38:161-73.
7Tavafian SS, Hasani L, Aghamolaei T, Zare S, Gregory D. Prediction of breast self-examination in a sample of Iranian women: An application of the health belief model. BMC Womens Health 2009;9:37.
8Obaji N, Elom H, Agwu U, Nwigwe C, Ezeonu P, Umeora O. Awareness and practice of breast self-examination among market women in Abakaliki, South East Nigeria. Ann Med Health Sci Res 2013;3:7-12.
9Abate S, Yilma Z, Assefa M, Tigeneh W. Trends of breast cancer in Ethiopia. Int J Cancer Res Mol Mech 2016;2:1-5.
10Dündar PE, Ozmen D, Oztürk B, Haspolat G, Akyildiz F, Coban S, et al. The knowledge and attitudes of breast self-examination and mammography in a group of women in a rural area in Western Turkey. BMC Cancer 2006;6:43.
11Segni MT, Tadesse DM, Amdemichael R, Demissie HF. Breast self-examination: knowledge, attitude, and practice among female health science students at Adama science and technology university, Ethiopia. Gynecol Obstet (Sunnyvale) 2016;6:368.
12National Breast Cancer Coalition. Breast Self-Exam: Position Statement. National Breast Cancer Coalition; 2011. Available from: http://www.breastcancerdeadline2020.org. [Last accessed on 2019 Jan 20].
13Smith RA, Cokkinides V, Eyre HJ. American cancer society guidelines for the early detection of cancer, 2005. CA Cancer J Clin 2005;55:31-44.
14Sama CB, Dzekem B, Kehbila J, Ekabe CJ, Vofo B, Abua NL, et al. Awareness of breast cancer and breast self-examination among female undergraduate students in a higher teachers training college in Cameroon. Pan Afr Med J 2017;28:91.
15Suh MA, Atashili J, Fuh EA, Eta VA. Breast self-examination and breast cancer awareness in women in developing countries: A survey of women in Buea, Cameroon. BMC Res Notes 2012;5:627.
16Nde FP, Assob JC, Kwenti TE, Njunda AL, Tainenbe TR. Knowledge, attitude and practice of breast self-examination among female undergraduate students in the University of Buea. BMC Res Notes 2015;8:43.
17Black E, Richmond R. Improving early detection of breast cancer in Sub-Saharan Africa: Why mammography may not be the way forward. Global Health 2019;15:3.
18Kayode FO, Akande TM, Osagbemi GK. Knowledge, attitude and practice of breast self-examination among female secondary school students in Ilorin, Nigeria. Eur J Sci Res 2005;10:42-7.
19Akhtari-Zavare M, Ghanbari-Baghestan A, Latiff LA, Matinnia N, Hoseini M. Knowledge of breast cancer and breast self-examination practice among Iranian women in Hamedan, Iran. Asian Pac J Cancer Prev 2014;15:6531-4.
20Aker S, Öz H, Tunçel EK. Practice of breast cancer early diagnosis methods among women living in Samsun, and factors associated with this practice. J Breast Health 2015;11:115-22.
21Gwarzo UM, Sabitu K, Idris SH. Knowledge and practice of breast-self examination among female undergraduate students of Ahmadu Bello University Zaria, Northwestern Nigeria. Ann Afr Med 2009;8:55-8.
22Agboola AO, Deji-Agboola AM, Oritogun KS, Musa AA, Oyebadejo TY, Ayoade BA. Knowledge attitude and practice of breast self examination in female health workers in Olabisi Onabanjo university teaching hospital, Sagamu, Nigeria. Int Med J 2009;8:5-10.
23Bellgam HI, Buowari YD. Knowledge, attitude and practice of Breast Self-Examination among Nigerian women in Rivers State, Nigeria. Nigeria Health J 2012;12:6.
24Yakubu AA, Gadanya MA, Sheshe AA. Knowledge attitude and practice of breast self examination among female nurses in Aminu Kano teaching hospital, Kano Nigeria. Niger J Basic Clin Sci 2014;11:85-8.
25Tobin EA, Okeowo PO. Breast self examination among secondary school teachers in South-South, Nigeria: A survey of perception and practice. J Public Health Epidermiol 2014;6:169-73.
26Amoran OE, Toyobo OO. Predictors of breast self-examination as cancer prevention practice among women of reproductive age-group in a rural town in Nigeria. Niger Med J 2015;56:185-9.
27Ogunbode AM, Fatiregun AA, Ogunbode OO. Breast self-examination practices in Nigerian women attending a tertiary outpatient clinic. Indian J Cancer 2015;52:520-4.
28Gueye SM, Bawa KD, Ba MG, Mendes V, Toure CT, Moreau JC, et al. Breast cancer screening in Dakar: Knowledge and practice of breast self examination among a female population in Senegal. Rev Med Bru×2009;30:77-82.
29Kudzawu E, Agbokey F, Ahorlu CS. A Cross sectional study of the knowledge and practice of self breast examination among market women at the Makola shopping mall, Accra, Ghana. Adv Breast Cancer Res 2016;05:111-20. [Doi: 10.423/abcr. 201.53013].
30Fondjo LA, Afriyie OO, Sayki SA, Waife AA, Amankwaa B, Acheampong E, et al. Comparative assessment of knowledge, attitudes and practice of breast self-examination among female secondary and tertiary school students in Ghana. Int J Breast Cancer 2018;2018:7502047.
31Morse EP, Maegga B, Joseph G, Miesfeldt S. Breast cancer knowledge, beliefs, and screening practices among women seeking care at district hospitals in Dar Es Salaam, Tanzania. Breast Cancer (Auckl) 2014;8:73-9.
32Birhane K, Alemayehu M, Anawte B, Gebremariyam G, Daniel R, Addis S, et al. Practices of breast self-examination and associated factors among female Debre Berhan University students. Int J Breast Cancer 2017;2017:8026297.
33Abay M, Tuke G, Zewdie E, Abraha TH, Grum T, Brhane E. Breast self-examination practice and associated factors among women aged 20-70 years attending public health institutions of Adwa town, North Ethiopia. BMC Res Notes 2018;11:622.
34Kifle MM, Kidane EA, Gebregzabher KN, Teweldeberhan AM, Sielue FN, Kidane KS, et al. Knowledge and practice of self breast examination among female college students in Eritrea. Am J Health Res 2016;4:104-8.
35Ndikubwimana J, Nyandi JB, Mukanyangezi MF, Kadima JN. Breast cancer and Breast self examination: Awareness and practice among secondary school girls on Nyarungenge district, Rwanda. Int J Trop Dis Health 2016;12:1-9.
36Obaikol R, Galunkande M, Fualal J. Knowledge and practice of breast self-examination among female students in a sub-Saharan African University. East Cent Afr J Surg 2010;15:22-7.
37Ramson LM. Knowledge, attitude and practice of breast self examination for early detection of breast cancer among women in Roan community in Luanshya, Copper Belt Province, Zambia. Asian Pac J Health Sci 2017;4:74-82.
38Idris SA, Hamza AA, Hafiz MM, Ali ME. Knowledge and practice of breast self examination among final year female medical students in Sudan. Int J Public Health Res 2013;1:6-10.
39Boulos DN, Ghali RR. Awareness of breast cancer among female students at Ain Shams University, Egypt. Glob J Health Sci 2013;6:154-61.
40Bayumi E. Breast self-examination (BSE): Knowledge and practice among female faculty of physical education in Assuit, South Egypt. J Med Physiol Biophys 2016;25:1-8.
41Conde P, Kava AC, El Fakir S, Tachfouti N, Nejjari C, Diakite DO, et al. Attitude and practice of BSE in women in Morocco. J Glob Oncol 2018;4:Supplement 2, 201s-201s.
42Ramathuba DU, Ratshirumbi CT, Mashamba TM. Knowledge, attitudes and practices toward breast cancer screening in a rural South African community. Curationis 2015;38.doi:10.4102/curationis.v38i1.1172.
43Tieng'O JG, Pengpid S, Skaal L, Peltzer K. Knowledge attitude and practice of breast cancer examination among women attending a health facility in Gaborone, Botswana. Gend Behav 2011;9:3513-27.
44Sani AM, Naab F. Relationship between age and breast self-examination among Nigerian women. J Nurs Health Sci 2014;3:34-9.