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 Table of Contents  
Year : 2017  |  Volume : 4  |  Issue : 1  |  Page : 40-43

Breast cancer risk factors and signs: How much do Nigerian women know?

Department of Public and Environmental Health, School of Health Sciences, National Open University of , Lagos, Nigeria

Date of Submission17-Sep-2016
Date of Acceptance07-Feb-2017
Date of Web Publication29-Jun-2017

Correspondence Address:
Samuel O Azubuike
Department of Public and Environmental Health, Faculty of Health Sciences, National Open University of Nigeria, Plot 91, Cadastral Zone, Nnamdi Azikiwe Express Way, Jabi-Abuja
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJAMR.IJAMR_45_16

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How to cite this article:
Azubuike SO. Breast cancer risk factors and signs: How much do Nigerian women know?. Int J Adv Med Health Res 2017;4:40-3

How to cite this URL:
Azubuike SO. Breast cancer risk factors and signs: How much do Nigerian women know?. Int J Adv Med Health Res [serial online] 2017 [cited 2022 Jan 21];4:40-3. Available from: https://www.ijamhrjournal.org/text.asp?2017/4/1/40/209130

  Introduction Top

Rapid increase in breast cancer incidence is now occurring in many developing countries.[1] This has been attributed to change in reproductive behaviors, use of exogenous hormones, differences in weight, exercise, diet, and alcohol consumption.[2],[3] Breast cancer among African women has been marked by advanced stage distribution, partially explained by delayed presentation for medical evaluation.[4] Factors related to women's knowledge and beliefs about breast cancer and its management can contribute significantly to health-seeking behavior.[5]

Increasing exposure to breast cancer risk factors has been implicated in the rising incidence of breast cancer in Africa. Prevention strategies would, therefore, require an understanding of these risk factors by the vulnerable population. Study on knowledge of breast cancer risk factors among health workers in Nigeria has been previously conducted.[6] General knowledge of risk factors and symptoms among Nigerian women has also been reported.[7] However, there seems to be little or no report on the level of awareness associated with specific risk factors, signs, and symptoms associated with breast cancer incidence. These would be necessary to inform health education priorities.

It is against this backdrop, this re-analysis was aimed at reporting the level of awareness about specific breast cancer risk factors, signs, and symptoms among Nigerian women as well as to ascertain if such knowledge is related to practice as seen in our previous report.[7]

  Materials and Methods Top

This report is based on a cross-sectional study reported in an earlier publication.[7] It involved 336 women of reproductive age (19–49 years) attending Immunization Clinic in Benin City, Nigeria. The specified age group has been reported to be at the highest risk of breast cancer in Nigeria.[4],[8] The sample size estimation, subject selection, data collection procedure, and ethical approval have been previously described.[7]

  Results Top

The sociodemographic information has been previously described.[7]

[Table 1] shows that the leading risk factors known to the participants were alcohol intake (41.1%) and oral contraceptive use (39.6%). Lowest knowledge was expressed for age (14.6%) and menses before 12 years of age (12.8%). Age was indicated by only 49 (14.6%) women, family and previous history by 91 (27.1%) women. With the exception of alcohol intake, <40% had knowledge of other important specific breast cancer risk factors. The mean number of participants with knowledge of each of the risk factors was 78 (23.2%). Similarly, the highest level of awareness of breast cancer signs and symptoms was recorded for pain in the breast region, (57.4%), followed by nipple discharge (46.7) [Table 1]. Painless lump was acknowledged by 152 (45.2%) women, while pulling in of the nipple was the least acknowledged, by 109 (32.4%) women. With the exception of pain in the breast region, <50% of the participants knew about important signs/symptoms of breast cancer. Mean frequency for the knowledge of each of the specified signs and symptoms was 43.8%.
Table 1: Knowledge of breast cancer (risk factors, signs, and symptoms) (n=336)

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[Table 2] shows that the number of people with right practices was higher for nonconsumption of alcohol (80.4%), followed by regular checking of weight (42.9%). Nonuse of oral contraceptives was the least practiced. However, irregular practice was highest for “consideration of fat content of foods (19%), followed by nonconsumption of alcohol (13.4%).”
Table 2: Practices toward breast cancer risk factors

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[Table 3] indicates a significant association between the knowledge of obesity as a risk factor and regular checking of weight (P = 0.02), between knowledge of family history as a risk factor and practice of breast self-examination (BSE; P = 0.002), as well as between knowledge of previous treatment of breast cancer as a risk factor and practice of BSE (P = 0.001).
Table 3: Does awareness of risk factors relate to their practices and practice of early detection?

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[Figure 1] indicates that electronic media indicated by 215 (63.99%) participants was the greatest source of information followed by hospital indicated by 76 (22.62%) participants.
Figure 1: Source of breast cancer information

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  Discussion Top

We found that electronic media and hospital were the dominant sources of information. This has also been reported in previous studies.[9],[10] They certainly provide a good opportunity for dissemination of breast cancer information. People's preference to learn from their physicians had been reported.[11]

Knowledge of the leading risk factors known to the participants such as alcohol intake, and oral contraceptive use seemed not to agree with other previous studies consulted.[12],[13],[14],[15] There might be suggestions that some other health-related programs other than breast cancer awareness program might be the source of this knowledge. The need for specific breast cancer awareness program targeting a wide range of various risk factors associated with breast cancer is, therefore, necessary. Important risk factors such as age described in absolute terms as the greatest risk of developing breast cancer [16] was indicated by only 14.6%. Though this was higher than the 5% reported in Australia,[15] it was comparatively lower than reports from Britain and Malaysia.[12],[16]

Awareness of a family history of breast cancer was low compared to several other studies where it appeared as one of the leading or most cited risk factors.[12],[13],[15],[17] However, low knowledge of family history had been reported.[6] Knowledge of the roles of nonmodifiable risk factors such as age and family history could enable women appreciate their vulnerability and make informed choices to reduce exposure to modifiable risk factors. The inability of respondents to appreciate other complex risk factors such as menstruation after the age of 55, early onset of menses, and first child after the age of 30 have been noted in previous studies,[14],[18] although figures in those studies were comparatively higher. This further reflects poor level of awareness among the current participants.

On the knowledge of breast cancer signs/symptoms, the participants demonstrated higher awareness of the relevant signs/symptoms (mean frequency = 147 [43.8%]) compared to risk factors (mean = 78 [23.2%]). While knowledge of signs and symptoms is necessary, the result might suggest a better knowledge of secondary than primary level of prevention. Primary prevention here will require adequate knowledge of potential risk factors and adoption of attitudes that lead to reduced exposure to them, and thereby reducing vulnerability to the disease.

The most common presentation, which is painless lump, was ranked fourth in this study and was indicated by only 152 (45.2%) participants. While a higher figure, (81.6%) had been reported in a related study,[13] a lower figure (6.7%) had been reported in another study.[19] While this might be said to be fair compared to results of other studies,[8],[20],[21] it is still not encouraging in view of the fact that about 54.5% could not identify it. Since early manifestation of breast cancer usually appears as painless lump, knowledge of this sign seems to hold the key to early detection, especially in a region like Nigeria where mammography is unavailable. Pain in the breast region identified as a leading sign in this study has appeared together with painless lump as leading signs/symptoms in another study.[18] However, it was only recognized by a few in several other studies.[13],[21],[22] This tends to suggest that might give attention to breast cancer only when it produces pain. It had been suggested that breast pain typically results from benign conditions and not treated as an early sign of cancer.[23] Knowledge of lump under the armpit was low compared to a previous study where it was one of the leading recognizable signs.[22] Nipple discharge, which was rated second in this study had also appeared as one of the most frequently cited sign in other studies [12] in contrast to another study where it was cited by a few.[21] The differences might be due to differences in emphasis by health educators. The knowledge of breast cancer signs/symptoms in this study could be considered relatively fair compared to an Iranian study as well as other local studies.[8],[21],[20] This may be related to differences in time and urbanisation.

Concerning practices toward breast cancer risk factors, the highest practice level was found to be nonconsumption of alcohol, while the least was for nonuse of oral contraceptive. However, this good practice in relation to alcohol might not have resulted from knowledge of its implication in breast cancer incidence. This is in consideration of the fact that it was only 138 (41.1%) participants who had this knowledge. Association between knowledge and consumption of alcohol was not statistically significant (P = 0.058). For oral contraceptive, the number that knew it as a risk factor though low (39.6%) was high compared to the number that do not use it (17.7%). This tends to suggest that knowledge might not be related to practice. Association between the knowledge and nonuse of oral contraceptive was not statistically significant (P = 0.0532). It seems that their perception of its advantages was higher than their perception of the risk it poses. There was a strong association between knowledge of obesity as a risk factor and regular checking of weight (P = 0.02). This might be attributed to recent campaigns against obesity and promotion of weight-watching behavior. Such awareness might have created opportunity for knowledge of the dangers obesity poses in relation to cancer. Knowledge of high fatty diet as a risk factor, seemed to be related to its consideration in diet. However, association between the two was not statistically significant. Knowledge of the previous treatment of breast cancer as a risk factor and practice of BSE was statistically significant. Similar result was also obtained for knowledge of family history as a risk factor and practice of BSE where a significant association was found (P = 0.002). It seemed that previous and family experience of breast cancer increased their awareness of early detection. While there was evidence that knowledge of some of these risk factors might translate to right practices, it was also observed that some of the existing knowledge seemed not to be sufficiently adequate to bring about the desired attitudinal change toward prevention. In general, it seemed that most of the respondents were not yet sufficiently informed to improve their practices toward breast cancer prevention.

The limitation of the present study lies in the fact that measurement was done subjectively and answers obtained were subject to recall bias. However, we believe that the result is reliable enough to inform a tentative decision for intervention and for further investigation.

  Conclusion Top

This study found a generally poor knowledge of breast cancer issues among participants which was worse for breast cancer risk factors than for signs and symptoms. The knowledge of key elements that could facilitate timely prevention and early diagnosis was very low. In some cases where good knowledge was recorded, it could not be attributed to breast cancer consciousness.

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Conflicts of interest

There are no conflicts of interest.

  References Top

IARC. World Cancer Report 2008. Lyon: IARC; 2008.  Back to cited text no. 1
Allen NE, Beral V, Casabonne D, Kan SW, Reeves GK, Brown A, et al. Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst 2009;101:296-305.  Back to cited text no. 2
Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: Collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet 2002;360:187-95.  Back to cited text no. 3
Fregene A, Newman LA. Breast cancer in sub-Saharan Africa: How does it relate to breast cancer in African-American women? Cancer 2005;103:1540-50.  Back to cited text no. 4
Odusanya OO, Tayo OO. Breast cancer knowledge, attitudes and practice among nurses in Lagos, Nigeria. Acta Oncol 2001;40:844-8.  Back to cited text no. 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.  Back to cited text no. 6
Azubuike S, Okwuokei S. Knowledge, attitude and practices of women towards breast cancer in Benin City, Nigeria. Ann Med Health Sci Res 2013;3:155-60.  Back to cited text no. 7
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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.  Back to cited text no. 8
Dündar 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.  Back to cited text no. 9
Jebbin NJ, Adotey JM. Attitudes to, knowledge and practice of breast self-examination (BSE) in Port Harcourt. Niger J Med 2004;13:166-70.  Back to cited text no. 10
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Grunfeld EA, Ramirez AJ, Hunter MS, Richards MA. Women's knowledge and beliefs regarding breast cancer. Br J Cancer 2002;86:1373-8.  Back to cited text no. 12
Osime OC, Okojie O, Aigbekaen ET, Aigbekaen IJ. Knowledge attitude and practice about breast cancer among civil servants in Benin City, Nigeria. Ann Afr Med 2008;7:192-7.  Back to cited text no. 13
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Pöhls UG, Renner SP, Fasching PA, Lux MP, Kreis H, Ackermann S, et al. Awareness of breast cancer incidence and risk factors among healthy women. Eur J Cancer Prev 2004;13:249-56.  Back to cited text no. 14
Paul C, Barratt A, Redman S, Cockburn J, Lowe J. Knowledge and perceptions about breast cancer incidence, fatality and risk among Australian women. Aust N Z J Public Health 1999;23:396-400.  Back to cited text no. 15
National Cancer Institute. Breast Cancer risk in American Women. Available from: http//www.cancer.gov/types/breast/risk-fact-sheet. [Last accessed 2017 Apr 17; Lasr updated on 2012 Sep 24].  Back to cited text no. 16
Elsie KM, Gonzaga MA, Francis B, Michael KG, Rebecca N, Rosemary BK, et al. Current knowledge, attitudes and practices of women on breast cancer and mammography at Mulago Hospital. Pan Afr Med J 2010;5:9.  Back to cited text no. 17
Hadi MA, Hassali MA, Shafie AA, Awaisu A. Evaluation of breast cancer awareness among female university students in Malaysia. Pharm Pract (Granada) 2010;8:29-34.  Back to cited text no. 18
Pham CT, McPhee SJ. Knowledge, attitudes, and practices of breast and cervical cancer screening among Vietnamese women. J Cancer Educ 1992;7:305-10.  Back to cited text no. 19
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Montazeri A, Vahdaninia M, Harirchi I, Harirchi AM, Sajadian A, Khaleghi F, et al. Breast cancer in Iran: Need for greater women awareness of warning signs and effective screening methods. Asia Pac Fam Med 2008;7:6.  Back to cited text no. 21
Schettino MR, Hernández-Valero MA, Moguel R, Hajek RA, Jones LA. Assessing breast cancer knowledge, beliefs, and misconceptions among Latinas in Houston, Texas. J Cancer Educ 2006;21 1 Suppl: S42-6.  Back to cited text no. 22
American Cancer Society. Cancer Facts and Figures. Atlanta: America Cancer Society; 2011.  Back to cited text no. 23


  [Figure 1]

  [Table 1], [Table 2], [Table 3]

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