|Year : 2017 | Volume
| Issue : 1 | Page : 26-33
Knowledge, practice and attitude of breast self, clinical breast and mammographic examinations amongst medical doctors in Bayelsa State
DO Allagoa1, SC Uwaezuoke2, EL Kotingo1
1 Department of Obstetrics and Gynaecology, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria
2 Department of Surgery, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria
|Date of Submission||30-Mar-2017|
|Date of Acceptance||30-Mar-2017|
|Date of Web Publication||19-Apr-2017|
D O Allagoa
Department of Obstetrics and Gynaecology, Federal Medical Centre, Yenagoa, Bayelsa State
Source of Support: None, Conflict of Interest: None
Background: Breast cancer is the most common cancer in women both in the developed and less developed world. Regular self, clinical and mammographic examination of the breast according to internationally acceptable guidelines can result in early detection of cancer in asymptomatic women thereby reducing morbidity and mortality related to the disease.
Aim: The aim of this study is to assess the knowledge, practice and attitude of breast examinations and breast cancer amongst medical doctors in Bayelsa State to achieve the desired reduction in mortality.
Methods: This is a descriptive cross-sectional study of Doctors in Federal Medical Centre, Yenagoa and Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State carried out between September 1, and October 1, 2015. A structured self-administered questionnaire was designed and used to collect information from 216 medical doctors. The data were processed using SPSS Windows version 20. Summary statistics, sample frequencies and crossed tabulations were then computed.
Results: Of the 176 respondents, none had a low level of knowledge; 58 (33.0%) showed moderate level of knowledge, whereas 118 (67.0%) showed a high level of knowledge. Only 55.7% of doctors had performed breast self-examination (BSE), 16.5% clinical breast examination (CBE) and 4% mammography. However, when it was coned-down to only female doctors, it was found that whereas 54 (85.7%) of our female respondents practiced BSE, only 15 (23.8%) had CBE, and only 2 (3.2%) had done screening mammography. Majority (92.6%) believed that breast cancer can be cured if detected early, with 100% opted to seeing a doctor.
Conclusion: Convincing majority of medical doctors in our study had excellent knowledge about BSE, CBE and mammography as screening modalities, respectively, for breast cancer. Attitude towards breast cancer treatment was also positive. However, their practice levels were quite poor.
Keywords: Attitude, breast cancer, breast examinations, knowledge, practice
|How to cite this article:|
Allagoa D O, Uwaezuoke S C, Kotingo E L. Knowledge, practice and attitude of breast self, clinical breast and mammographic examinations amongst medical doctors in Bayelsa State. Port Harcourt Med J 2017;11:26-33
|How to cite this URL:|
Allagoa D O, Uwaezuoke S C, Kotingo E L. Knowledge, practice and attitude of breast self, clinical breast and mammographic examinations amongst medical doctors in Bayelsa State. Port Harcourt Med J [serial online] 2017 [cited 2021 Apr 16];11:26-33. Available from: https://www.phmj.org/text.asp?2017/11/1/26/204712
| Introduction|| |
Breast cancer is the most common cancer in women both in the developed and less developed world. Globally, it is estimated that over 508 000 women died in 2011 due to breast cancer. Although breast cancer is thought to be a disease of the developed world, almost 50% of breast cancer cases and 58% of deaths occur in less developed countries.
Incidence rates vary greatly worldwide from 19.3/100,000 women in Eastern Africa to 89.7/100,000 women in Western Europe. In most of the developing regions, the incidence rates are below 40/100,000.
Breast cancer in African landmass was characterised by territorial or regional differences as the incidence was 27% of cancers in North African nations (Algeria and Egypt) in contrast with 15% in sub-Saharan Africa.
In Nigeria, it has been recorded as the most common cancer in the female  and a principal course of death in women. In the North-Western geopolitical zone of Nigeria, cancer of the breast was second to cancer of the cervix, while in the South-Western geopolitical zone of Nigeria, it was the most common cancer among women., In the North-Central geopolitical zone, breast cancer constituted 22.41% of new cancer cases enlisted in 5 years and accounted for 35.41% of all cancers in women.
Early detection and management of breast cancer have been linked to better outcome indices in Western Europe and North America. However, in Nigeria, most of the individuals affected present late, in advanced stages of cancer in which the treatment is best palliative.,, A cross-sectional study in Nigeria involving 1000 women indicates a poor knowledge and attitude among women concerning breast cancer. This is due partly to poor education or misinformation available to the general populace and the women in particular.
Risk factors that have been implicated in the development of breast cancer include female sex, increasing age, family history of first-degree relative with breast cancer, previous breast cancers or lumps with atypical hyperplasia, early menarche (12 years), multiparty, first childbirth after 30 years, late menopause (55 years).
The screening methods used in breast cancer include breast self-examination (BSE), clinical breast examination (CBE) and mammography. The CBE is usually, conducted by the medical doctor or nurse while the individual at certain periods in a month on the breast to exclude any abnormal changes. The screening mammography is a low-dose X-ray examination modality with high resolution that reveals changes in the breast that may be cancerous.
Regular self, clinical and mammographic examination of the breast according to internationally acceptable guidelines can result in early detection of cancer in asymptomatic women thereby reducing morbidity and mortality related to the disease.,, Although the American Cancer Society no longer recommends BSE due to no associated increase in survival rate, from studies in a developing country like Nigeria, it increases/aids breast awareness and can lead to the earlier presentation in breast changes.
Health-care professionals particularly medical doctors play a crucial role in ensuring that the general population has access to adequate and correct information and screening modalities available for breast cancer to achieve the desired reduction in mortality. A lot depends on the conviction and practice of these professionals because it impacts on how the community will receive the information that are passed on. Therefore, the aim of this study is to assess the knowledge, practice and attitude of breast examinations and breast cancer amongst medical doctors in Bayelsa State to achieve the desired reduction in mortality.
| Methods|| |
This is a descriptive cross-sectional study of medical doctors in Federal Medical Centre, Yenagoa and Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, carried out between September 1, and October 1, 2015.
Bayelsa State is a South-South state of Nigeria in the core of the Niger Delta, between Rivers state and Delta state. Federal Medical Centre, Yenagoa and Niger Delta University Teaching Hospital, Okolobiri, are the two tertiary institutions that provide all levels of health-care services to patients particularly from Bayelsa, Rivers and Delta states, including training and research.
This included medical doctors.
This included medical doctors in Federal Medical Centre, Yenagoa and Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State.
House officers, Corps members, Medical officers, Residents and Consultants were included while Nurses, Pharmacists, Medical Laboratory scientists, other supportive staff and Patients were excluded.
Sample size determination
A suitable sample size of doctors was selected within the target population. This sample size was derived as follows:
A prevalence rate of 15% by Parkin et al. was used. Precision (i.e., margin of sampling error) tolerated was set at 5%, at 95% confidence interval, using the formula for cross-sectional study.
n = pq/(e/1.96)2
Where n = sample size
p = prevalence rate = 15%
q = 100 − p =100 − 15 = 85%
e = margin of sampling error tolerated at 95% confidence interval = 5%
Hence, n = 15 × 85/(5/1.96)2
n = 196
Adjusting for attrition or noncompliance rate of 10%.
Hence, 10% attrition = 10/100 × 196 = 19.6.
Thus, the adjusted sample size = 196 + 19.6 = 215.6.
Working sample size ≈ 216 subjects.
This was a multi-stage random sampling in which a sample frame of the tertiary hospitals in Bayelsa State were obtained. There are two of such centers; Federal Medical Centre, Yenagoa and Niger Delta University Teaching Hospital, Okolobiri. Among these, Department of Obstetrics and Gynaecology, Surgery, Paediatrics, Internal Medicine, Accident and Emergency, general out-patient department and dentistry were selected by simple random sampling and the number of medical doctors to be sampled in each of these centres was predetermined. A stratified sampling by sex and rank was then done to select the number of males and females in each department to be studied. Finally, to avoid bias, academic fora like morning review and Continuing Medical Education were utilised. Questionnaires were self-administered and collected almost simultaneously.
A structured self-administered questionnaire was designed and used to collect information from doctors.
The data were processed using SPSS Windows version 20. Summary statistics, sample frequencies and crossed tabulations were then computed.
Consent and ethical approval
Permission to study was obtained from the Ethics and Research Committee of the Federal Medical Centre, Yenagoa. Verbal informed consent was obtained from each participant before inclusion in the study. The reason for the study and procedure for data collection was explained to the doctors before collection of data from them.
| Results|| |
[Table 1] shows the sociodemographic data of the respondents. There were more respondents in the 20–30 years (70 [39.8%]), and 31–40 years (89 [50.6%]) age groups. One hundred and thirteen (64.2%) were males while 63 (35.8%) were females. Over half (54.0%) were Ijaw followed by those of Ibo extraction (24.4%), 10 (5.7%). All were Christians and medical doctors. Eighty-seven (49.4%) were single while 89 (50.6%) were married.
[Table 2] shows respondents knowledge on risk factors for breast cancer. Majority of the respondents considered female gender (96.0%), increasing age (84.7%), early onset of menstruation (77.8%), late menopause (73.3%), previous breast disease (86.4%), family history of breast cancer (97.7%), oral contraceptive usage (84.1%), nulliparity (77.9%) and smoking (83.5%) as risk factors for breast cancer. Also considered as risk factors were obesity (67.6%) and first baby after 30 years (59.7%). Most of the respondents did not consider breastfeeding (79.5%) and use of bras (61.4%) as risk factors.
[Table 3] shows respondents knowledge on the clinical presentation of breast cancer. Majority of the respondents indicated that breast cancer presents with lump in the breast (99.4%), bloody discharge (97.7%), ulceration (99.4%), skin of the breast looking like the back of an orange (98.3%) and it is the most common female cancer (73.3%). Nearly 33% indicated that breast cancer lump is usually painful while 64.2% indicated that it is usually not painful.
[Table 4] shows the knowledge on screening and management of breast cancer. Majority of the respondents stated that BSE (97.7%), CBE (97.7%) and mammography (97.7%) are methods of screening/early detection of breast cancer. One hundred and fifty-six (88.7%) stated that from 20 years individuals can start BSE. More of the respondents indicated that BSE is done monthly (62.5%), followed by those who indicated it is done weekly (21.6%). Fifty-five (31.3%) stated that BSE is done in premenopausal women a week before menses while 121 (68.8%) stated a week after menses. Fifty-five (31.3%) stated that BSE is done on a specific day in the month, 86 (48.9%) stated that it is not while 35 (19.9%) are not sure. More of the respondents (60.8%) stated that screening should be done on both men and women. Majority (92.6%) indicated that breast cancer could occur in men. One hundred and sixty (90.9%) stated that surgery is a treatment modality for breast cancer, 1 (0.6%) stated the use of cytotoxics, 1 (0.6%) stated the use of radiation, 2 (1.1%) stated native/herbal/alternative while 12 (6.8%) stated prayers as management modalities for breast cancer.
[Table 5] shows the practice of screening and method of treatment of breast cancer. Ninety-eight (55.7%) do BSE, while 78 (44.3%) do not. Of the 78 that do not do BSE, 59 (75.6%) stated that it is not done because it was not important while 12 (15.4%) stated that they are afraid of realising a lump. Of the 98 who performed BSE, 39 (39.8%) performed it 3 months earlier, 30 (30.6%) performed it the previous week and 26 (26.5%) performed it 1 year earlier. Majority (84.7%) stated that they use the opposite hand when performing BSE. Twenty-nine (16.5%) have had a CBE while 147 (83.5%) have not. Of the 29 who had CBE, 13 (44.8%) had it the previous week and 12 (41.4%) had it 3 months earlier. Seven (4.0%) respondents stated they have had a mammography while the majority (96.0%) stated they had not. Of the seven who had mammography, five (73%) had it once a year and two (27%) had it twice a year. Only 8 (4.5%) respondents indicated that they have had breast disease previously. All the respondents stated that if they detect a lump or breast cancer, they will see a doctor. Forty-seven (26.7%) stated that they would want a lumpectomy for breast cancer if diagnosed while 108 (61.4%) stated mastectomy. Majority (86.4%) stated that mastectomy does not cure breast cancer. Majority (92.6%) stated that breast cancer can be cured if detected early.
[Table 6] shows that majority (85.7%) of the female doctors indicated that they do BSE routinely. Majority (76.2%) stated that they do not do CBE routinely. Only two (3.2%) had done mammography previously.
[Figure 1] shows the distribution of knowledge on BSE among respondents: None had low level of knowledge, 58 (33.0%) showed moderate level of knowledge, whereas 118 (67.0%) showed a high level of knowledge.
|Figure 1: Distribution of knowledge on breast self-examination among respondents|
Click here to view
[Table 7] shows the relationship between cadre and knowledge on breast cancer. At P< 0.05, Chi-square = 0.576, difference (df) 1 and P = 0.448, there was no statistical significant relationship between cadre and knowledge on BSE.
|Table 7: Relationship between educational status and knowledge on breast self-examination|
Click here to view
| Discussion|| |
The sociodemographic distribution showed that majority (50.6%) of the respondents were within 31–40 years of age. Males (64.2%) were more than the females (35.8%). Ijaw was the most dominant tribe (54.0%) followed by Ibos (24.4%). All (100%) were Christians.
In this study, 67% (118) of the medical doctors had good knowledge of the risk factors of breast cancer while 33% had fair knowledge while none had poor knowledge. The risk factors of female sex, family history of breast cancer were positively identified in 96% and other common factors included previous breast disease (86.4%), oral contraceptives (84.1%), smoking (83.5%), nulliparity (77.9%). First childbirth after 30 years was the least identified (59.7%). A Moroccan study by Ghanem et al. related that all participants identified family history of breast cancer, late age of menopause, multiparity, early menarche, history of previous breast lumps and use of oral contraceptive as risk factors to breast cancer. Our findings were also supported by Bekker et al. who demonstrated in their study that more than half of general practitioners in the United Kingdom were able to correctly identify risk factors assessed. Similarly, Ibrahim and Odusanya  in Nigeria showed that 95.6% of doctors identified increasing age as risk factor and 80% identified contraceptive use. Their least recognised factors were nulliparity (73.3%) and first childbirth of advanced age (57.8%).
However, according to Cockburn et al. in Australia, the general practitioner knowledge was limited concerning aspects of breast cancer risks. We are also aware that Doctors knowledge of risk factors in a study by Akhigbe and Omuemu were relatively lower.
The American Cancer Society recommends CBE at least every 3 years from 20 to 39 years and from 40 years onwards annually. They also recommend annual mammography screening from 40 years. Routine BSE is not recommended but not discouraged., In 2009, the United States Preventive Services Task Force recommended mammography of 1–2 years to a biennial screening interval in women between 50 and 74 years of age and that in women aged 40–49 years, routine mammography screening be individualised. They concluded that there was insufficient evidence to assess additional benefits and harm of CBE beyond screening mammography in women 40 years and above they recommended against BSE. The recommendations pose a challenge to the surgeon practicing in developing countries particularly in Nigeria where Okobia and Osime 2001, documented that a larger proportion of cases occur in women below the age of 50 years  In a study by Udoye et al. of histologically diagnosed breast cancers in Bayelsa State it was found that the peak age incidence was 30–40 years of age followed closely by the 5th decade. This coupled with ignorance, poverty and unavailability that screening guidelines will if applied will only catch a small number of cases early in our environment.
Even though convincing majority (97.7%) of medical doctors in our study had excellent knowledge about BSE, CBE and mammography as screening modalities respectively for breast cancer, their practice levels were quite poor. Only 55.7% of doctors had done BSE, 16.5% CBE and 4% mammography. These were gotten from both male and female doctors in the study. However, when it was coned-down to only female doctors, it was found that whereas 54 (85.7%) of our female respondents practiced BSE, only 15 (23.8%) had had CBE and only 2 (3.2%) had done screening mammography. Akhigbe and Omuemu  recorded 81.4% of their female doctors practice BSE. Ibrahim and Odusanya  noted 93.3% practice BSE monthly, 31.1% of doctors having had CBE within the last 1 year and 6.7% having had mammography. They also noted 24.8% of nurses and 19% of other health professionals have had a CBE. Furthermore, Oluwole in a Nigeria community found that only 30% of female health workers have ever had a CBE. This goes to say that doctors and perhaps other health workers may not be “practicing what they preach to their clients.” This may have a bearing on patient's awareness and then uptake of screening modalities in our locality. It was also supported by Okobia et al. who found out in their study that only 34.9% practiced BSE, 9.1% only had CBE, and none had mammography done on them. Studies have shown that knowledge and attitude of health-care providers towards breast cancer are important in the adoption of the screening modalities by women in their environment. In a survey of female secondary school teachers in Ilorin Nigeria; however, 95.6% were aware of BSE but only about (4.6%) had heard about it from health personnel. BSE and CBE still remain workable modalities in combating the late presentation of breast cancer in this scenario.
Possible reasons advocated by our respondents concerning their poor practice of CBE and mammography included screening modalities not being necessary, the fear of realising a lump in their breast. It is quite possible that female doctors might also be uncomfortable with having their colleagues carry out breast examination on them. Furthermore, the relative unavailability and high cost of the screening mammographic examination may have dissuaded the female respondents from having it done.
There was positive attitude towards breast cancer treatment in our study. 92.6% believed that breast cancer can be cured if detected early, with 100% opted to seeing a doctor. 61% agreed to mastectomy as the preferred method for treating breast cancer, while 90.9% chose surgery as the most effective method. This compares favourably with findings of Ibrahim and Odusanya, Ghanem et al. in Morocco and Saeedi et al. in Riyadh Saudi Arabia. Of note is the 1.1% who agreed that native herbal alternative is a treatment option, while 6.8% took prayers as a treatment option for breast cancer.
The study was limited to doctors, hence may not be generally applied to other health workers. Furthermore, the female doctors were few and the results from them may not be a true reflection of their knowledge, practice and attitude of female doctors in general.
| Conclusion|| |
Convincing majority of doctors in our study had excellent knowledge about BSE, CBE and mammography as screening modalities, respectively, for breast cancer. Attitude towards breast cancer treatment was also positive. However, their practice levels were quite poor.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.
Parkin DM, Ferlay J, Hamdi-Cherif M, Sitas F, Thomas JO, Wabinga H, et al.
Cancer in Africa: Epidemiology and Prevention. IARC Scientific Publications No. 153. Lyon: IARC Press, 2003.
Kene TS, Odigie VI, Yusufu LM, Yusuf BO, Shehu SM, Kase JT. Pattern of presentation and survival of breast cancer in a teaching hospital in North Western Nigeria. Oman Med J 2010;25:104-7.
Afolayan EA. Cancer in North Western region of Nigeria – An update analysis of Zaria cancer registry data. West Niger J Med Sci 2008;1:37-43.
Ogunbiyi JO, Fabowale AO, Ladipo AA. Cancer Incidence and Top Ten Cancers in Eleven Local Government Areas in Ibadan, Nigeria and Its Environs, 2004-2008. Ibadan Cancer Registry Technical Report; 2010.
Adesunkanmi AR, Lawal OO, Adelusola KA, Durosimi MA. The severity, outcome and challenges of breast cancer in Nigeria. Breast 2006;15:399-409.
Okobia MN, Bunker CH, Okonofua FE, Osime U. Knowledge, attitude and practice of Nigerian women towards breast cancer: A cross-sectional study. World J Surg Oncol 2006;4:11.
Iglehart JD, Smith BL. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston Textbook of Surgery. 18th
ed. Philadelphia, PA: Saunders Elsevier, 2008; 851-97.
Anderson BO, Braun S, Lim S, Smith RA, Taplin S, Thomas DB; Global Summit Early Detection Panel. Early detection of breast cancer in countries with limited resources. Breast J 2003;9(Suppl 2):S51-9.
Smith RA, Cokkinides V, Eyre HJ. American Cancer Society Guidelines for the early detection of cancer, 2005. CA Cancer J Clin 2005;55:31-44.
Ghanem S, Glaoui M, Elkhoyaali S, Mesmoudi M, Boutayeb S, Errihani H. Knowledge of risk factors, beliefs and practices of female healthcare professionals towards breast cancer, Morocco. Pan Afr Med J 2011;10:21.
Bekker H, Morrison L, Marteau TM. Breast screening: GPs' beliefs, attitudes and practices. Fam Pract 1999;16:60-5.
Ibrahim NA, Odusanya OO. Knowledge of risk factors, beliefs and practices of female healthcare professionals towards breast cancer in a tertiary institution in Lagos, Nigeria. BMC Cancer 2009;9:76.
Cockburn J, Irwig L, Turnbull D, Simpson JM, Mock P, Tattersall M. Encouraging attendance at screening mammography: Knowledge, attitudes and intentions of general practitioners. Med J Aust 1989;151:391-6.
Akhigbe AO, Omuemu VO. Knowledge, attitudes and practice of breast cancer screening among female health workers in a Nigerian urban city. BMC Cancer 2009;9:203.
Smith RA, Duffy SW, Tabár L. Breast cancer screening: The evolving evidence. Oncology (Williston Park). 2012;26:471-5, 479-81, 485-6.
Okobia MN, Osime U. Clinicopathological study of carcinoma of the breast in Benin city. Afr J Reprod Health 2001;5:56-62.
Udoye EP, Uwaezuoke SC, Fente BG. Breast cancer burden in Bayelsa state Nigeria: A histopathological profile. Int J Curr Res 2015;7:12894-7.
Oluwole OC. Awareness, knowledge and practice of breast self examination amongst female health workers in a Nigerian community. Sudan J Med Sci 2008;3:99-104.
Coleman EA, Lord J, Heard J, Coon S, Cantrell M, Mohrmann C, et al.
The Delta project: Increasing breast cancer screening among rural minority and older women by targeting rural healthcare providers. Oncol Nurs Forum 2003;30:669-77.
Kayode FO, Akande TM, Osagbemi GK. Knowledge, attitude and practice of breast self-examination among female secondary school teachers in Ilorin Nigeria. Eur J Sci Res 2005;10:42-7.
Saeedi MY, Al Amri F, Ibrahim AK, Kassim K. Knowledge, attitude and practices of breast cancer screening among female general practitioners in Riyadh, Saudi Arabia. Cancer Res J 2014;2:108-13.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]