RRL 2

Knowledge, attitude and practice of breast self-examination among nursing students in Lagos University
Teaching Hospital, Nigeria
http://www.interesjournals.org/er/june-2011-vol-.2-issue-6/knowledge-attitude-and-practice-of-breast-
self-examination-among-nursing-students-in-lagos-university-teaching-hospital-nigeria
Knowledge, attitude, and practice of breast self-examination among female nurses in Aminu Kano
teaching hospital, Kano, Nigeria
AA Yakubu1, MA Gadanya2, AA Sheshe1

1
Department of Surgery, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
2
Department of Community Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
Date of Web Publication 6-Sep-2014
Correspondence Address:
Dr. A A Yakubu
Department of Surgery, Aminu Kano Teaching Hospital, Bayero University, Kano
Nigeria
Source of Support: None, Conflict of Interest: None
Check
DOI: 10.4103/0331-8540.140344
Abstract
Background: The incidence of breast cancer is increasing and the presentation is often late in our
environment with poor prognosis. Breast self-examination (BSE) remains an important diagnostic tool
for the early detection of breast cancer in a resource-limited community. Nurses being in closer contact
with patients should be in the forefront in educating the general public on BSE. Objectives: This study
investigates the knowledge, attitude and practice of BSE among female nurses in Aminu Kano Teaching
Hospital (AKTH) with regard to the number that practice, method and the frequency of BSE. Materials
and Methods: The study is a descriptive cross-sectional study of female nurses employed in AKTH using
self-administered questionnaire. Respondents were selected by simple random sampling methods from
the register of nursing staff at AKTH. The data collected were on socio-demographic profile, knowledge,
attitude and practice of BSE. The relationships between these factors were studied. Results: All the
nurses studied are aware about BSE, with 91.2% practicing it. There is appallingly poor knowledge of its
timing, frequency and method. Only 45 (41.2%) of the respondents practice BSE monthly, and none of
the respondents can accurately describe the exact method of BSE. Conclusion: There is universal
awareness of the BSE among nurses, with dismal awareness of its purpose, method, timing, and
frequency among the female nursing staff studied. However, there is a lot of enthusiasm to encourage
others to do it. Therefore, nurses need to be also further trained and educated about the procedure.
Keywords: Breast self-examination, female nurses, Kano, knowledge
How to cite this article:

Yakubu A A, Gadanya M A, Sheshe A A. 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
How to cite this URL:

Yakubu A A, Gadanya M A, Sheshe A A. Knowledge, attitude, and practice of breast self-examination
among female nurses in Aminu Kano teaching hospital, Kano, Nigeria. Niger J Basic Clin Sci [serial
online] 2014 [cited 2018 Mar 7];11:85-8. Available
from: http://www.njbcs.net/text.asp?2014/11/2/85/140344
Introduction
The breast is the most common site of cancer in women; approximately one in nine women develops
the disease in her life time. [1] The incidence is raising and the presentation is often late in our
environment. [2] Early detection and appropriate treatment is the best chance for cure. In a resource-
limited community, an important method of early detection is breast self-examination (BSE). Among
women who practise breast self-examination (BSE), breast cancers may be detected when they are at an
earlier stage and are smaller than in women who do not practise BSE. [3],[4],[5],[6],[7],[8],[9],[10],[11],[12] However,
the efficacy of BSE for decreasing breast cancer mortality is unproven. [3] Early detection allows more
efficient, less aggressive and less mutilating treatment. [13] Breast self-examination is a simple,
affordable, non-invasive adjuvant screening method for the detection of early breast cancer in
women. [14]
Nurses, by the nature of their work play a unique role in educating the patients on the early detection of
breast cancer, risk factors and available screening methods and practices as they usually have the
closest contacts with female patients. [14] Additionally, the knowledge and practice of BSE will improve
early detection in themselves and the community. [14],[15]
Materials and Methods
This is a cross-sectional study of 102 female nurses employed in Aminu Kano Teaching Hospital, (AKTH)
carried out in December 2009. The respondents were selected by simple random sampling method from
staff payroll register in the finance unit of the hospital. Male nursing staffs were excluded. Informed
consent was obtained from all the participants who were involved in the study.
A self-administered pre-tested and structured questionnaire was administered. The questionnaire

elicited information on socio-demographic, working experience, workplace details, reasons, methods,
attitude towards BSE, and encouragement of others to perform BSE.
The generated data was analysed using Epi-Info version 3.2.2 by center for disease control (CDC)
software for analysis. Qualitative data were presented as frequencies, percentages or proportions,
whereas quantitative data were described using measures of central tendencies and those of dispersion
as appropriate. Chi-square (χ2 ) test statistical significance was used to examine association between
qualitative variables.
Results
Socio-demographic profile
At the time of data collection, there were a total of 563 nurses within the work force of AKTH; out of
which 102 were recruited for the study. The number of female nurses entered into the study was 102.
The mean age of the participants was 36.48 ± 3.4 years. The majority (51.0%) of the participants are
between the age ranges of 30-39 years. About a quarter of the respondents (24.5%) work in specialties
related to surgery. About half of the respondents (43.1%) have 1-10 years of work experience. All the
respondents were married [Table 1].
Table 1: Socio - demographic profile of respondents
Click here to view

Knowledge of breast self-examination
All the 102 respondents (100%) are aware about BSE, with the source of their knowledge being:
Colleagues 27 (26.5%), media 13 (12.7%), friends 5 (4.9%), school 38 (37.3%), lectures 7 (6.9%) and other
sources 12 (11.8%). Most of the respondents (69%) are aware of the correct purpose of doing BSE.
However, none of the respondents provided accurate description of how BSE is done. Responses
provided by the respondents include "observing in front of the mirror" 3 (2.94%), "by palpation of
breast" 71 (69.6%) and "by pressing the nipple" 1 (0.98%). Only 14 (13.7%) of the respondents know that
BSE should be conducted around the 5 th day after menstrual cycle.
Attitude towards breast self-examination
All the 102 respondents (100%) unanimously agree that BSE is useful, with up to 86 (84.3%) of the
respondents saying that they encourage others to do BSE.
Practice of breast self-examination Only 45 (41.2%) of the respondents practice BSE monthly, all others
indicated less frequent or rarely more frequent BSE [Table 2].
Table 2: Depicts the distribution of BSE practice among respondents
Click here to view
Relationship between socio-demographic factors and knowledge and practice of breast self-
examination
The responders that work in surgery related specialty wards were found to be associated with higher
practice of BSE (P = 0.01). No association was found between practice of BSE and age (P = 0.1), years of
service (P = 0.51).
In relation to the correct timing of BSE, an association was found in responders that work in surgery
related specialty wards (P = 0.00), and years of service (P = 0.00) [Table 3].
Table 3: Relationship between the practice and timing of BSE and the
respondents' characteristics
Click here to view

Discussion
Several studies have shown increasing incidence of carcinoma of the breast in our environment; the
presentation in vast majority is late. [2]Efforts must be made to curtail this disturbing trend through
continuous health education when contact is made by heath workers with the community. Among
health workers, the nurses are often in closer contact with the community, and it is therefore imperative
to update their knowledge to train them to carry out this role properly. As expected, all the 102
respondents (100%) are aware of BSE, which is higher than the value found in a similar study in Ebonyi
(92.9%) in 2007. [16] The slight difference in BSE awareness may be accounted for by increase awareness
of BSE overtime in Nigeria. Only about two-third of the respondents (69%) was aware of the correct
purpose of doing BSE. This indicated that even among those who claim knowledge about BSE, their
understanding is shallow since they do not know the purpose of it. Only about one-third of the
respondents 38 (37.3%) indicated their source of knowledge on BSE to have been from nursing school.
Most of the other respondents indicated other less formal methods with their attendant inaccuracies.
This is possibly what is reflected in the respondents' shallow knowledge of BSE. None of the respondents
provided accurate description of how BSE is done. Responses provided include "observing in front of the
mirror" in 3 (2.94%), "by palpation of breast" in 71 (69.6%) and "by pressing the nipple" in 1 (0.98%).
Only 14 (13.7%) of the respondents know that BSE should be conducted around the 5 th day after
menstrual cycle. This poor knowledge of timing and method of BSE will affect the usefulness of BSE
among those nurses that perform BSE and subsequently in accurate knowledge will be imparted to
patients and clients. This is similar to the finding in Ebonyi [16] were up to 87.0% of the nurses do not
perform BSE correctly.
All the 102 respondents (100%) unanimously agree that BSE is useful, with up to 86 (84.3%) of the
respondents saying that they encourage others to do BSE.
Up to 93 (91.2%) said they practice BSE. This observation is slightly different with the finding in
Aba [17] where only 84% of the nurses practice BSE.
Only 45 (41.2%) of the respondents practice BSE monthly, all others indicated less frequent or rarely
more frequent BSE. This frequency is within the range of 47.9% and 50% of respondents that practice
BSE monthly in other studies. [15],[17] These studies and the current report showed higher percentage of
monthly BSE than Ebonyi study, where only 28.0% of the nurses perform BSE monthly, similar to findings
by Jebbin and Adotey in Port-Harcourt, where BSE is practiced only occasionally, despite the majority
being aware and consider it worthwhile. [18] Similar study among health professionals at the Abia State
University Teaching Hospital, Aba found that 84% are aware of BSE, but the number that examine their
breast monthly was only 45 (47.9%). [17] Haji-Mahmoodi et al. reported that among female healthcare
workers in Iran, more than 70% of subjects had strong belief on its beneficial effects but only 6% of
them were performing BSE regularly. [19]
Several studies have shown that knowledge or awareness does not correlate with practice or effective
performance of the exercise. [4],[15]This may be related to the sources of information that is not well
articulated or is inadequate. [4],[14],[15],[18]
Only subjects in surgery-related specialty wards were found to high practice of BSE (P = 0.01) compared
to others. No association was found between practice of BSE and age (P = 0.1), years of service (P =
0.51). Furthermore, only responders working in surgery related specialty wards (P = 0.00) and the
number of service years (P = 0.00) were found to be associated with knowledge of the correct timing of
BSE. Abu Salem et al. found that 52% of their study subjects in Pakistan perform BSE. A significant
relationship was found between higher levels in work experience and BSE practice. Except for age, no
significant relation was found between the socio-demographic factors and BSE practice. [20] The
relationship of age to BSE was also established by several other reports. [15],[19],[21]
Working in surgical or its related specialty wards expose the nurses to cases of breast disorders and will
probably serve as a motivation for BSE. Additionally, those who work in surgical or its related specialties
in a teaching hospital are more likely to be in closer contact with surgeons and participate in ward
rounds, seminars and teaching programmes and are therefore better motivated and more aware of
timing of BSE. This is similar to a study of female nurses in Ebonyi State University Teaching Hospital,
Abakaliki that found 91 (92.9%) of the respondents have heard of BSE, mainly (64.3%) through seminars.
Only 28 (28.6%) practiced BSE monthly, 77 (87.0%) did not adopt the correct steps. [16] In a similar study
among the nurses in Jordan, 81.5% had knowledge about BSE. The most common sources of information
in the respondents were written materials (42.6%), nursing school education (38.6%) and health
professionals (37.6%). Of the respondents in the study, 69.3% knew the correct timing of BSE. [14]
Conclusion
BSE remains an important investigation tool for the early diagnosis of breast cancer in our environment
due to lack of facilities and screening programme. Nurses being the closest in contact with patients
among health workers need to be properly educated to efficiently carry out this procedure. There is
universal awareness about the BSE among nurses, with dismal awareness of its purpose, method,
timing, and frequency among the nurses studied. BSE and breast cancer education programmes should
be integrated into the curriculum or nursing schools and as part of hospitals continuing medical
education (CME) programmes.
References
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perform breast self-examination: Are they reliable sources of information? BMC Public Health
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18. Jebbin NJ, Adotey JM. Altitudes to, knowledge and practice of breast self-examination (BSE) in
Port-Harcourt. Niger J Med 2004;13:166-70.
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Knowledge, attitudes, and practice among female health care workers in Tehran, Iran. Breast
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http://www.njbcs.net/article.asp?issn=0331-
8540;year=2014;volume=11;issue=2;spage=85;epage=88;aulast=Yakubu
https://www.researchgate.net/publication/234063945_Knowledge_Attitude_and_Practice_of_Breast_S
elf-Examination_among_Female_Secondary_School_Students_in_Ilorin_Nigeria
https://www.researchgate.net/publication/315343053_BREAST_SELF-
EXAMINATION_BSE_KNOWLEDGE_ATTITUDE_AND_PRACTICE_AMONG_POST_RN_NURSING_STUDENTS
_IN_LAHORE
Original Article
Knowledge, Attitude And Practice Of Breast Self-Examination Among Female Medical Students In The
University Of Lagos
I NK, O OA, A RA, B RB, O AT
Keywords
attitude, breast cancer, breast self-examination, knowledge, practice
Citation
I NK, O OA, A RA, B RB, O AT. Knowledge, Attitude And Practice Of Breast Self-Examination Among
Female Medical Students In The University Of Lagos. The Internet Journal of Health. 2009 Volume 12
Number 1.
Abstract
Background: Breast cancer is the leading cause of cancer mortality in women worldwide. The incidence
of breast cancer is rising more rapidly in population groups that enjoyed a low incidence of the
disease.Objective: The purpose of this study was to investigate the knowledge, attitude and practice of
breast self-examination (BSE) among female medical students in University of Lagos.Method: The study
was designed as a cross sectional survey of female students in the college of medicine. The aim was to
assess level of their knowledge about breast cancer, attitude and their practice of BSE. A self-
administered questionnaire prepared by the author was employed. Consent was obtained and
assurance of confidentiality of responses was given to each respondent. Results: Majority of the
respondents, 40.7% were from the age group 21-22 drawn from first to sixth year medical
students.97.3% had heard of breast cancer and breast self-examination.54.8% of the respondents heard
of breast cancer from television/ radio. Most of the respondents, 85.8% knew how to perform breast
self-examination correctly. Only 65.4% of the respondents thought that breast self-examination was
necessary. 43.5% of the respondents said that the last time they performed breast self-examination less
than a year ago. Majority of the respondents, 69.6% preferred to perform breast self-examination in the
morning while 47.7% of the respondents preferred to carry out breast self-examination in front of the
mirror.Conclusion: There was a high level of awareness of breast cancer and breast self-examination
among the respondents. Their attitude towards breast cancer and breast self-examination was fair
though the practice was poor.
Introduction
Cancers in all forms are responsible for about 12 per cent of deaths throughout the world (Park, 2002).
Globally, breast cancer is the most common malignant neoplasm among women (Leszczynskaet al.,
2004; WHO, 2006). Breast cancer causes 376,000 deaths a year worldwide; about 900,000 women are
diagnosed every year with the disease (WHO, 1997).
Although the incidence of breast cancer in developing countries is relatively low (Koet al., 2003), about
50% of all cases of breast cancer are diagnosed in these countries (Haji-Mahmoodiet al., 2002; Sadler et
al., 2001). Based on a study during 1975–1990, Asia and Africa have experienced a more rapid rise in the
annual incidence rate of breast cancer than that of North America and Europe (Shiraziet al., 2006).
Although mammography remains the best single diagnostic tool in the detection of breast cancer it is
not routinely performed in Nigeria due to low level of awareness, ignorance, illiteracy, cost, high
technology equipment and ex¬pertise required. False negative for mammography is higher in the
younger age group, and this is likely to happen in Nigeria where cases below the age of 30 have been
widely reported (Anyanwu, 2000; Wu and Yu, 2003; Banjo, 2004).
There is also evidence that most of the early breast tumours are self-discovered and that the majority of
early self-discoveries are by breast self-examination (BSE) performers (Okobiaet al., 2006).
Cavdaret al (2007) reported that most female physi¬cians and nurses (65% and 70% respectively)
believed that BSE was unnecessary; therefore the need to evaluate breast cancer awareness, attitude
and practice among female students who are going to be our future health personnel.
Method
The study was designed as a cross sectional survey of female students in the college of medicine. The
aim was to assess level of their knowledge about breast cancer, attitude and their practice of breast self-
examination (BSE).
Participants
The study was conducted in June, 2010 at College of Medicine of the University of Lagos, Nigeria.
Consent was obtained and assurance of confidentiality of responses was given to each respondent.
A self-administered questionnaire prepared by the author was employed. Questions were partly drawn
using information on breast cancer from the literature. Additional questions were adapted, after
modification, from questionnaires used in similar studies conducted earlier in the country. The
questionnaire was in three parts. The first part was to elicit socio-demographic data on age, ethnicity,
and marital status of each participant. Questions relating to knowledge of breast cancer were asked in
the second part. Participants’ awareness of breast cancer and early detection methods were also
assessed in this section. The third part of the questionnaire assessed practice of BSE among participants.
Analysis
The data were evaluated by descriptive statistics and chi-square using Epi-info 2004 series. The
differences between the three vari¬ables were considered significant if the p-value was less than 0.05.
Results
The total number of questionnaires given out was five hundred (500) but four hundred and ninety-nine
were recovered. The respondents were drawn from first (17.8%), second (34.3%), third (23%), fourth
(3.5%), fifth (7.4%) and sixth (13.9%) year female medical students.
Figure 1
Table 1: Demographic profile of respondents
Table 1 above shows the demographic profile of the respondents. Majority of the respondents, 40.7%
were from the age group 21-22. Most of the respondents, 58.9% were Yoruba, 29.4% were Igbo, 2%
were Hausa and 9.7% were from other tribes. 95.4% of the respondents were single while 4.6% were
married.
Most of the respondents, 85.1% were Christians, 14.7% were Muslims while 0.2% were of other
religions. Only 8.8% had a family history of breast cancer, most of which was an aunt (53.6%).
Figure 2
Table 2: Respondent’s knowledge of breast cancer and breast self-examination
Table 2 above shows the level of breast cancer and breast self-examination awareness of the
respondents. Most of the respondents, 97.3% had heard of breast cancer and breast self-examination.
80.9% of the respondents knew it is common in our environment, 98.6% knew it can be detected early
and 98.2% knew that early detection increases chances of survival. 23% of the respondents heard of
breast cancer at home, 24.5% heard of it at school, 54.8% of the respondents heard of breast cancer
from television/ radio and 30.8% heard of it from newspapers.
Only 53.6% knew that both male and female are required to perform breast self-examination, with
54.5% of the respondents having the view that breast self-examination should start at less than 19 years
while 45.5% were of the opinion that it should start at over 19 years of age.
The respondents also felt that breast self-examination should be performed daily (23.8%), some weekly
(22.5%), some monthly (50.8%) and some yearly (2.9%). Most of the respondents, 85.8% knew how to
perform breast self-examination correctly.
Figure 3
Table 3: Attitude of respondents to breast self-examination

Table 3 above shows the respondents’ attitude to breast self-examination. 65.4% of the respondents
thought that breast self-examination was necessary while 83.1% of the respondents have carried out
breast self-examination. Of those that have carried out breast self-examination before, 87.4% did it to
examine their breasts regularly while 6.8% did it because they have a family history of breast cancer.
Of those that have never performed breast self-examination, 46.7% did not because they do not have
any symptom, 26.7% felt it was not important, 22.6% did not know how to do it, 20% felt they can never
have cancer, 10% of the respondents felt they were violating themselves by touching their breast and
did not believe in the efficacy of the test and 3.3% of the respondents were scared of being diagnosed
with breast cancer.
Figure 4
Table 4: Respondents’ practice of breast self-examination
Table 4 above shows the respondents’ practice of breast self-examination. Most of the respondents,
80.2% said they perform breast self-examination regularly. 56.1% of the respondents started performing
breast self-examination at less than 19 years while 43.9% started performing at over 19 years of age.
20.9% of the respondents said that the last time they performed breast self-examination was less than a
week ago, 28% last carried it out less than three to six months ago while 43.5% last carried theirs out
less than a year ago.
Majority of the respondents, 69.6% preferred to perform breast self-examination in the morning
followed by evening with 23.3%. 47.7% of the respondents also preferred to carry out breast self-
examination in front of the mirror, 36.5% preferred lying on the bed while 13.3% preferred performing it
in the bathroom.
Most of the respondents, 93.2% indicated interest in knowing more about breast self-examination.
Discussion
The age of the respondents ranged from 15 years to 26 years and above with the mean age group as 21
years. This age pattern is consistent with the present 9-3-4 educational system in Nigeria. The study was
appropriate in this age group as most of them were young adults who should find out more information
on breast cancer and breast self-examination before they reach the age of common occurrence of the
disease and as future doctors, would be able to educate and advice their patients effectively.
Most of the respondents surveyed had heard of breast cancer (97.3%) and 85.8% claimed they knew
how (BSE) is done; the level of breast cancer awareness of the respondents may have been due to their
area of study and level of education. In a similar study, it was found that the women who had tertiary
education were more knowledgeable about breast self-examination while those who had primary
education were the least knowledgeable (Balogun and Owoaje, 2005).
Their primary source of information was the television/radio. This finding is consistent with the study
conducted by the Family Planning Association of Hong Kong (1996) which revealed that the promotion
activities by the media, billboards and advertisements effectively exposed the public to breast cancer
information. Similar observation was reported in an Eastern state of Nigeria (Nwagbo and Akpala, 1996).
The least reported primary source of information on breast cancer in the study was the home of the
respondents (23%). This is one of the gaps existing in family life education as parents and care givers
have no time to discuss pertinent health issues with their children. It might also be due to the fact that
some of the parents have no information or knowledge on some of these topics and as such have little
or nothing to discuss (Saludeenet al., 2009).
A little more than half (65.4%) of the respondents believed that it is necessary to perform breast self-
examination. This showed that the level of concern about screening for breast cancer is still low among
the respondents considering their status as medical students and a lot much more would be expected
from them as future doctors.
83.1% of the respondents claimed to have carried out breast self-examination before; this demonstrates
that some attention is being given by the young adults in this study to check their breast for early onset
of lump and other symptoms of breast cancer, though not regularly as nearly half (43.5%) of the
respondents had not examined their breasts in nearly one year. This may partly be because of the
assumption that they are free from breast pathology. As a result of this ignorance, little emphasis may
be placed on regular BSE by such respondents (Kayodeet al., 2005).
Recommendation
There is need for further study to address the knowledge gaps on breast cancer and breast self-
examination so that positive attitudes can be developed by the young adults towards breast self-
examination, to assist in early breast cancer detection as well as reducing late breast cancer
presentation.
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http://ispub.com/IJH/12/1/8251
http://uob.edu.ly/assets/uploads/pagedownloads/1dfad-females-kap-conference-paris-final.doc2.pdf
Females' knowledge attitude and practices about breast selfexamination (BSE) and risk factors of breast
cancer at Benghazi- Libya
http://www.interesjournals.org/er/june-2011-vol-.2-issue-6/knowledge-attitude-and-practice-of-breast-
self-examination-among-nursing-students-in-lagos-university-teaching-hospital-nigeria
Knowledge, attitude and practice of breast self-examination among nursing students in Lagos
University Teaching Hospital, Nigeria
http://www.njbcs.net/temp/NigerJBasicClinSci11285-5864357_161723.pdf
Knowledge, attitude, and practice of breast self-examination among female nurses in Aminu Kano
teaching hospital, Kano, Nigeria
https://s3.amazonaws.com/academia.edu.documents/34821623/37._Knowledge_Attitude_and_Practic
e_of_Breast_Self_Examination_among_secondary_school_teachers.pdf?AWSAccessKeyId=AKIAIWOWY
YGZ2Y53UL3A&Expires=1520462185&Signature=0KFRi4UBu7FalPrA3b0JyCMOJiA%3D&response-
content-disposition=inline%3B%20filename%3DKnowledge_Attitude_and_Practice_of_Breas.pdf
KNOWLEDGE, ATTITUDE AND PRACTICE OF BREAST SELF EXAMINATION AMONG FEMALE SECONDARY
SCHOOL TEACHERS IN ILORIN, NIGERIA
Awareness of breast cancer and breast self-examination among female undergraduate students in a
higher teachers training college in Cameroon
Carlson-Babila Sama1,2,&, Bonaventure Dzekem2,3, Jules Kehbila2,4, Cyril Jabea Ekabe2,4, Brice Vofo2,5,
Naomi Liteba Abua2, Therence Nwana Dingana2,6, Fru Angwafo III7
1
Bambalang Sub-Divisional Hospital, Northwest Region, Cameroon, 2Galactic Corps Research Group
(GCRG), Cameroon and Faculty of Health Sciences, University of Buea, Cameroon, 3Clinical Research
Education, Networking and Consultancy (CRENC), Douala, Cameroon and Health Services Partner
Cameroon, 4Grace Community Health and Development Association (GRACHADA), Kumba,
Cameroon, 5Ntam Medicalised Health Centre, Kumba, Cameroon, 6Catholic General Hospital, Njinikom,
Northwest Region, Cameroon, 7Gynaeco-Obstetric and Paediatric Hospital and Department of Surgery,
University Teaching Hospital, Yaoundé, Cameroon
&
Corresponding author
Carlson-Babila Sama, Bambalang Sub-Divisional Hospital, Northwest Region, Cameroon
Abstract
Introduction: the incidence of breast cancer (BCa) in Cameroon is on the rise and accounts for a leading
cause of mortality. An understanding of the knowledge and practices on breast cancer and breast self-
examination (BSE) among teachers are important first steps which will guide the designing of
interventions aimed at raising awareness across the general population.
Methods: we conducted a cross-sectional study in April 2016 involving 345 consenting female
undergraduate students in the Higher Teachers Training College, Bambili, Cameroon. Data was collected
using a pretested self-administered questionnaire and analysed using descriptive methods.
Results: the mean age of the respondents was 22.5±3.2years and a vast majority (n = 304, 88.1%) had
heard about BCa primarily from the television/radio (n=196, 64.5%). Overall, less than a quarter (n=65,
21.4%) of respondents who had heard about BCa had sufficient knowledge on its risk factors and
signs/symptoms. A plurality (53.3%) thought BCa can be prevented via vaccination while over a third
(38.7%) opined that BCa can be treated spiritually. Less than half (47%) of respondents who had heard
about BCa had heard about BSE amongst which only 55 (38.5%) had ever practiced it.
Conclusion: though most students are aware of the existence of breast cancer, their overall knowledge
on its risk factors and clinical presentation is insufficient with a concomitant low practice of BSE. These
highlighted gaps warrants intensification of sensitization campaigns and educational programmes in
order to raise knowledge levels and enhance prevention strategies that would aid in reducing the
burden of breast cancer in Cameroon.
Introduction
Worldwide, breast cancer is the second most frequent cancer and the fifth cause of cancer-related
mortality [1]. It is the most common cancer to affect women and it is second only to lung cancer as the
principal cause of cancer-related deaths among women [1-3]. In low- and middle-income countries
(LMICs), it remains a significant public health challenge as incidence rates have been shown to increase
yearly by as much as 5% with over 1 million projected new cases annually by 2020 [2-5]. The emergence
of breast disease and subsequent development of cancer appears to be more aggressive in young
women compared to its progression in older women [6,7]. In 2008, the prevalence of breast cancer in
women ≥15 years in sub-Saharan Africa was estimated at 23.5 per 100,000 women and approximately
35,427 women died from the disease (crude mortality rate of 12.8 per 100.000 women) [8,9]. In
Cameroon, the incidence of breast cancer is higher than the worlds average; estimated at 2625 per
100,000 women with a resultant high mortality [3,5]. The high morbidity and mortality due to breast
cancer can be in-part reduced if the lesion is detected early enough [2]. In this regard, women need to
be "breast aware" by being able to identify the risk factors and symptoms of breast cancer as well as risk
reduction strategies.
Though still clouded in controversy, breast self-examination (BSE) still has an important role to play in
the early detection of breast cancer in resource-constraint settings where routine clinical breast
examination and mammography may not be feasible. In such settings, BSE is recommended because it is
free, private, painless, easy, safe, and requires no specific equipment. It has also been shown to improve
breast health awareness and thus potentially allow for early detection of breast anomalies [10-13]. The
American Cancer Society also recommends that women from the age of 20 years onwards should be
educated on the benefits of performing BSE monthly [14]. It had been demonstrated that factors related
to women´s awareness, knowledge and perceptions about breast cancer may contribute significantly to
medical help-seeking behaviours [15-17]. Thus, considering the potential pivotal role played by teachers
in information dissemination, this study sought to assess the awareness, knowledge and perceptions of
breast cancer and practice of breast self-examination among female undergraduate students in a higher
institution of teaching as this will be essential in informing policy for targeted interventions through the
provision of guided educational training programs.
Methods
Study design, setting and participants: we conducted a descriptive cross-sectional study on the 11th of
April 2016 at the Higher Teachers Training College (HTTC) Bambili, University of Bamenda in the
Northwest Region of Cameroon. Bambili is a centre of attraction for a youthful multi-ethnic population
who either move there for studies or to explore the diverse economic activities triggered by the
presence of the university. The undergraduate program in HTTC is a three year course and annually, this
college graduates about 500 trained teachers. The target population was first cycle female
undergraduate students. To consider equal chances of participation, the students were informed about
a free and voluntary participation in a breast cancer survey 1 week earlier via oral message during
lecture hours. On the said day of the survey, students were consecutively approached in their respective
lecture halls for inclusion.
Study procedures and data collection: a structured and self-administered questionnaire was developed
by the researchers after an extensive review of literature [10-12,18]. The validity of its contents was
established through consultation with experts and was pretested on 41 first cycle students from HTTC
who were eventually restrained from participating in the final study. Other than concerns about some
ambiguous words which were simplified in the revised version, all pilot students reported they easily
understood the questionnaire. It had three sections: socio-demographic characteristics, knowledge
about breast cancer, and a section on BSE. Data collection facilitators (1 student per academic level)
underwent a 2-hour training one day prior to the census. Coding of questionnaires rather than using
names was done in order to ensure confidentiality. Consenting participants were handed printed copies
of the questionnaire and allowed time to fill their responses and return them anonymously to the
facilitators. The completeness of returned questionnaires was visually checked on a daily basis by the
principal investigators. The study was approved by the ethics committee of the regional delegation of
public health for the Northwest Region and all recruited students signed a consent form.
Scoring of knowledge: each of the questions on knowledge of risk factors and clinical presentation
(signs/symptoms) of breast cancer was equitably scored. Categorical responses (Yes/No/Don't know)
were applied for the question items. We assigned one point (1) to a correct answer and zero (0) for
don't know or an incorrect answer. The overall knowledge score was calculated by summing scores of all
knowledge questions (16 on risk factors and 12 on signs/symptoms) yielding a possible range of overall
scores from 0 to 28. Scores were divided into two categories: insufficient knowledge (< 50% of correct
answers) and sufficient knowledge (≥ 50% of correct answers).
Statistical analysis: data from the questionnaires were entered and analysed using statistical package
for the social sciences (SPSS Inc., Chicago, IL) version 20.0. We summarised continuous variables as
means and standard deviations (SD), and categorical variables as count and percentages.
Results
Socio-demographic characteristics : of the 420 questionnaires distributed, 391 (93.1%) were returned
amongst which 345 were properly filled, thus subjected to analysis. The participants were between 17
and 34 years (mean = 22.5 ± 3.2) of age. Half (49.9%) of them were in the age range 21-25 years. A vast
majority (90.7%) were Christians while almost two-thirds (64.6%) of the respondents were in their first
year of studies. Sixty-two (18%) were married (Table 1).
Awareness, knowledge and attitudes on breast cancer: of the 345 participants, 41 (11.9%) reported to
have never heard about breast cancer. Television/radio (n =196, 64.5%) and health personnel (n =190,
62.5%) were the main sources of knowledge for the 304 (88.1%) participants who had heard about
breast cancer (Figure 1). Further analysis will include only the 304 participants who knew what breast
cancer was. Of these, 18 (5.9%) had a family history of breast cancer and about one fifth (21.1%) of
these female students responded “No” to the question item “will you allow a male doctor to examine
your breast” Table 2summarizes the perceptions towards breast cancer among the 304 participants.
Exposure to radiation (n =179, 58.9%), hormone replacement therapy (n = 177, 58.2%), smoking (n =
177, 58.2%), alcohol consumption (n = 142, 46.7%) and high fat diet (n = 138, 45.4%) were the most
frequently indexed risk factors for breast cancer. Meanwhile, late menopause (n = 28, 9.2%), early age at
first menstruation (n = 25, 8.2%) and not having a child (n = 24, 7.9%) were the least recognized risk
factors. Witchcraft was implicated as a potential cause of breast cancer by a third (n =106, 34.9%) of the
respondents. The most common symptom of breast cancer identified was lump in the breast (n =248,
81.6%) while over 77% (n =235) of the respondents did not know that lump under the armpit could be a
sign of breast cancer.
The mean knowledge score on risk factors was 5.2 ± 2.7 (range: 0-14). Only 32 (10.5%) of respondents
had sufficient knowledge of risk factors of breast cancer. The mean score for knowledge on
signs/symptoms of breast cancer was 5.4 ± 3.1 ranging from 0 to 12. One hundred and eleven (36.5%)
had sufficient knowledge on the signs/symptoms of breast cancer. The overall knowledge score ranged
from 0-23 with a mean score of 10.7 ± 4.8. Overall, less than a quarter (n = 65, 21.4%) of participants
had sufficient knowledge on breast cancer. With respect to their attitudes if diagnosed with breast
cancer, almost half (n =145, 47.7%) said they will go to a prayer house, 58 (19.1%) will use traditional
medicine and only 105 (34.5%) will agree to perform mastectomy if necessary (Table 3). Of the 304
participants who had heard about breast cancer, 287 (94.4%) agreed that breast cancer could be
prevented amongst which breast examination was the commonest mode of prevention cited (n =237,
82.6%). Over half (n =153, 53.3%), 104 (36.2%) also thought breast cancer could be prevented by
vaccination and physical exercise respectively (Table 4). A minority (n =35, 11.5%) did not know that
breast cancer could be treated. Of those who knew (n =269, 88.5%), 248 (92.2%) and 104 (38.7%) said it
could be treated medically and spiritually respectively (Table 4).
Awareness and practice of breast self-examination: less than half (n =143, 47%) of those who knew
about breast cancer had heard about breast self-examination (BSE). Majority (n = 47, 32.9%) did not
know how often BSE should be performed while only a quarter (n =37, 25.9%) correctly stated that it
should be performed monthly (Table 5). As little as 10 (7%) participants knew that the appropriate time
to perform a BSE was few days after menstruation. Despite a substantial proportion (n =88, 61.5%) of
students who had never performed BSE, most (n =133, 93%) recognised the importance of BSE for their
health. Reasons for not performing BSE are summarised in Figure 2. Of the 95 participants that
responded to the question item on the appropriate age to commence BSE, only 3 (3.2%) correctly stated
that 20 years was the appropriate age to commence BSE.
Discussion
Our findings have shown considerable awareness about the existence of breast cancer, but insufficient
knowledge and misperceptions on its risk factors and causes as well as infrequent practice of breast self-
examination. In this study, 88.1% of participants had heard about breast cancer. This is higher than the
81.2% and 64% observed in a group of Malaysian [19] and Iranian [20] women respectively. It is however
much lower than the 100% among female medical students in Harar, Ethiopia [6], 98.7% among female
students in the University of Ibadan, Nigeria [21] and 95% among female university students in Ghana
[22]. The lower rate of awareness on the existence of breast cancer in our study with respect to these
studies may be due to the fact that breast cancer is part of a medical curriculum while it has been
adopted in the curricula in the other two universities in a bid to raise awareness. Though about 9 in 10
of our participants knew about breast cancer, our findings reveal a poor understanding and
misperceptions on its risk factors, signs/symptoms, prevention and treatment. More than two-thirds of
the respondents did not identify gender, increasing age, race/ethnicity, and positive family history, first
child at late age, early menarche, late menopause, positive personal history, and nulliparity as potential
risk factors of breast cancer. Knowledge gaps about risk factors has also been reported elsewhere
among the general population [19,23], university students in Angola [24], female medical students in
Saudi Arabia [25], nurses in Pakistan [26] and female teachers in Malaysia [27] and Kuwait [28]. With
regards to misperceptions, 17.8% and 34.9% of participants cited wearing of tight brassieres and
witchcraft respectively as risk factors of breast cancer. This is in line with a community survey in semi-
urban Cameroon [11], studies on rural women [29] and market women [16] in Ibadan, Nigeria and
female medical students in Ethiopia [6] that suggests women still attribute the occurrence of breast
cancer to a mystical origin. Among others, they considered it “a spiritual attack”, “God's curse”, and
“attack from the enemy”. This observation was not that different from reports in a more developed
setting; female teachers in Saudi Arabia attributed the occurrence of breast cancer to God and belief in
the evil eye [30] while 96.8% of Arab-speaking women in Qatar attributed its occurrence to fate/destiny
and less than one-fifth to Gods' punishment and bad luck [31]. As observed elsewhere [6,18,28,32] the
commonest symptom of breast cancer identified by our respondents was breast lump. However,
knowledge about other signs/symptoms was unsatisfactory. Thus, the need for further health education
on the risk factors and clinical presentation of breast cancer is desirable.
Most (94.4%) of our participants perceived that breast cancer could be prevented which is similar to the
95% reported by Suh et al [11]. Though breast examination was mentioned by the majority (82.6%) as a
preventive method, a plurality (53.3%) of them incorrectly mentioned vaccination against breast cancer
as a preventive method. Interestingly, 12.9% of these respondents also identified sucking of the breast
by a male partner as a method of preventing breast cancer. This idea may have emanated, in part, from
a recent social media circular within the study setting which suggested girls should make their breast
more available to a male partner as regular sucking will help in reducing their risk of developing breast
cancer. This calls for urgent actions by authorities to foster awareness on breast cancer in university
milieus as such an act has not been proven to prevent breast cancer, and may also promote sexual
immorality; thus increasing the risk of acquiring sexually transmitted infections including HIV/AIDS as
well as unwanted pregnancies. Though a small proportion, it however remains disturbing that 11.5% of
our respondents agreed that breast cancer cannot be treated. This observation concurs to that of
Oluwatosin et al [33] in the Akinyele locality in rural Nigeria where the women had even attributed a
local name for breast cancer; “jejere” which means “that which devours”. Oladimeji and colleagues [16]
also noted that 30% of women in their study considered breast cancer a fast killer. These may be an
indication that the myth suggesting that "breast cancer equals death" is still deeply rooted across
communities. These wrong assumptions may partly account for some of the reasons why patients
present late to hospitals with advanced disease states. Other than seldom mass campaigns for breast
health awareness and screening organized by the ministry of public health, there is no national
screening program for breast cancer in Cameroon. Introduction of such a program will greatly aid in
increasing awareness, eliminate mythical concerns as well as lead to early detection of breast anomalies,
hence better prognosis. In a 20-year retrospective analysis of the profiles of 531 breast cancer patients
followed up at the Yaoundé General Hospital, Cameroon, Ngowa and collaborators [34] noted that there
was a mean delay of 10.35 months with some taking up to 52 months between the apparition of the
first signs of breast cancer and presentation for first medical evaluation. As a consequence of this late
presentation, none of the patients presented with carcinoma in situ. More than half of them had
solicited traditional treatment and visited spiritual houses at first intention before their first medical
evaluation. Lack of awareness on breast cancer, ignorance, cultural beliefs and the fear of mastectomy
as a treatment modality in hospitals were major setbacks to early presentation. These observations
equally concurred to findings in this study with regards to the attitudes of our participants if they
developed breast cancer.
Early detection of breast cancer plays a pivotal role in reducing related mortalities. Until circumstances
are favourable for routine mammographic screening in resource-limited settings, emphasis should be
oriented towards encouraging women to regularly practice BSE. Freeman and collaborators [35] had
reiterated the need for young girls to be properly taught BSE as this will greatly influence their practice
as they grow older. Though controversies still exists over its effectiveness in reducing mortality [36], the
technique remains an important tool for early detection especially in low- and middle-income countries
where access to diagnostic and curative facilities may be problematic [4,10,12,37]. In this study, only
38.5% of the participants had ever performed a BSE. It is comparable to the 41% reported by Nde et al
[10] among female undergraduate students in the University of Buea, Cameroon, the 42.6% among
female undergraduate students in Kirkuk University, Iraq [38], the 37.3% among health extension
workers in Ethiopia [12] and 29% in Senegal [39]. Similarly, though close to three-quarters of female
undergraduate students in the Ahmadu Bello University, Zaria, Nigeria had heard about BSE, only about
one in five had ever practiced it [40]. Our findings suggests the need to increase awareness of BSE as a
screening tool as it renders women more “breast aware” and thus potentially allow for early detection
of breast cancer. In so doing, various breast-conserving procedures including lumpectomy,
segmentectomy, and quadrantectomy may be warranted in patients with early stage cancers rather
than the generally feared mastectomy. Raising awareness on the possibilities of breast reconstruction
surgery is also warranted as this may improve medical help seeking attitudes of sufferers.
Limitations: other than the lack of a statistical sample estimate, our findings are confined to a group of
young educated women which does not necessarily reflect the situation among women in rural areas,
thus a potential limitation. Furthermore, this study was conducted in a single department in the
university, thus, may not portray the full picture of awareness/perceptions of breast cancer and practice
of BSE among female students in the entire university and other state/private universities within the
country. Also, the students were not assessed on their ability to correctly perform BSE.
Conclusion
Female undergraduate students in the Higher Teachers Training College Bambili have insufficient
knowledge on breast cancer with poor practice of BSE. Massive health education campaigns designed to
enlighten not only female university students in this setting, but also the public at large on the potential
causes, risk factors, signs/symptoms, prevention and treatment of breast cancer should be promoted.
The unique role of mass media, particularly television/radio to reach a large audience at the same time
should be fully explored in order to provide comprehensive information about breast cancer. These
breast awareness campaigns should also seek to dispel spirituality and myths regarding the occurrence
of breast cancer. Taking into consideration the invaluable role that can be played by BSE in such a
resource-disadvantaged setting with a concomitant high burden of breast cancer, there is an urgent
need for focused strategies to implement and re-enforce existing cancer awareness and the potential
benefits breast self-examination.
What is known about this topic
 Generally, Cameroonian female students have poor knowledge on breast cancer and
infrequently practice breast-self-examination.
What this study adds
 Narrows awareness, knowledge levels and practice to a group of undergraduate teachers;
 Breast lump is the most commonly known symptom of breast cancer: important knowledge
deficits on signs/symptoms and treatment of breast cancer were noted;
 These students have poor attitudes, misperceptions and myths regarding breast cancer; many
will avert mastectomy, majority will seek spiritual/traditional healing.
Competing interests
The authors declare no competing interest.
Authors’ contributions
Carlson-Babila Sama, Bonaventure Dzekem, Naomi Liteba Abua and Fru Angwafo III contributed to study
conception, design, data collection and analysis and drafting of initial manuscript. J Jules Kehbila, Cyril
Jabea Ekabe and Therence Nwana Dingana provided keen reviews to the drafted manuscript. All authors
read and approved the final version prior to submission.
Tables and figures
Table 1: socio-demographic characteristics of the included 345 female undergraduates from HTTC,
University of Bamenda, Cameroon, April 2016
Table 2: frequency distribution of knowledge and misperceptions towards breast cancer in 304 female
undergraduates from HTTC, University of Bamenda, Cameroon, April 2016
Table 3: perceived attitudes regarding development of breast cancer of 304 female undergraduates
from HTTC, University of Bamenda, Cameroon, April 2016
Table 4: perceptions about prevention and treatment options of breast cancer among female
Table 5: knowledge, practice and perceived importance of breast self-examination among female
Figure 1: distribution of participants according to sources of knowledge about breast cancer
Figure 2: reasons for not performing breast-self examination
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http://www.panafrican-med-journal.com/content/article/28/91/full/
Awareness of breast cancer and breast self-examination among female undergraduate students in a
higher teachers training college in Cameroon
Cite this: The Pan African Medical Journal. 2017;28:91. doi:10.11604/pamj.2017.28.91.10986
Received: 19/10/2016 - Accepted: 16/09/2017 - Published: 29/09/2017

Breast Self-examination: Knowledge, Attitude, and Practice among Female Health Science Students at
Adama Science and Technology University, Ethiopia
https://www.omicsonline.org/open-access/breast-selfexamination-knowledge-attitude-and-practice-
among-female-health-science-students-at-adama-science-and-technology-univer-2161-0932-
1000368.php?aid=70946
Knowledge and Beliefs of Breast Self-Examination and Breast Cancer among Market Women in Ibadan,
South West, Nigeria
 Kelechi Elizabeth Oladimeji ,
 Joyce M. Tsoka-Gwegweni ,
 Franklin C. Igbodekwe,
 Mary Twomey,
 Christopher Akolo,
 Hadiza Sabuwa Balarabe,
 Olayinka Atilola,
 Oluwole Jegede,
 Olanrewaju Oladimeji
 Published: November 25, 2015
 https://doi.org/10.1371/journal.pone.0140904
Abstract
Background
In most resource constrained settings like Nigeria, breast self-examination self-breast examination (BSE)
is culturally acceptable, religious friendly and attracts no cost. Women's knowledge and beliefs about
breast cancer and its management may contribute significantly to medical help-seeking behaviours. This
study aimed to assess knowledge and beliefs of BSE among market women.
Methods
A descriptive cross-sectional study was conducted among 603 market women in Ibadan, Nigeria. Data
was collected using semi-structured interviews and analyzed using descriptive and analytic statistical
methods.
Results
The mean age of the respondents was 34.6±9.3 years with 40% of the women aged between 30-
39years. The proportion of married women was 339 (68.5%) with 425 (70.8%) respondents reporting
that they do not know how to perform BSE. However, 372 (61.7%) women strongly agreed that BSE is a
method of screening for breast cancer. Highest proportion 219 (36.3%) reported that the best time for a
woman to perform BSE was ‘anytime’. Most of the respondents believed breast cancer is a dangerous
disease that kills fast and requires a lot of money for treatment.
Conclusion
More efforts are needed in creating awareness and advocacy campaigns in the grassroots in order to
detect early breast cancer and enhance prevention strategies that would reduce the burden of breast
cancer in Nigeria.
Figures
Citation: Oladimeji KE, Tsoka-Gwegweni JM, Igbodekwe FC, Twomey M, Akolo C, Balarabe HS, et al.
(2015) Knowledge and Beliefs of Breast Self-Examination and Breast Cancer among Market Women in
Ibadan, South West, Nigeria. PLoS ONE 10(11): e0140904.
https://doi.org/10.1371/journal.pone.0140904
Editor: Seema Singh, University of South Alabama Mitchell Cancer Institute, UNITED STATES
Received: March 2, 2015; Accepted: October 1, 2015; Published: November 25, 2015
Copyright: © 2015 Oladimeji et al. This is an open access article distributed under the terms of
the Creative Commons Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are credited
Data Availability: Due to ethical restrictions related to patient privacy, data will be available by
contacting Ms Kelechi Elizabeth Oladimeji via oladimejikelechi@yahoo.com; keoladimeji@cchrad.org.
Funding: This study was supported by Center for Community Health Care, Research and Development,
Nigeria (CCHARD), www.cchrad.org. Ms. Kelechi Elizabeth Oladimeji is currently a Public Health
doctorate Scholar in College of Health Science, Howard College Campus, University of KwaZulu-Natal,
Durban, South Africa. Kelechi is also a co-lead at the Center for Community Health Care, Research and
Development, Nigeria (cchrad.org). The funders had no role in study design, data collection and analysis,
decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Breast cancer is a global health concern and a leading cause of morbidity and mortality among all the
cancers that affect women [1]. In 2008, it was estimated that the prevalence of breast cancer in women
aged 15 years and over in Sub-Saharan Africa is 23.5 per 100,000 women [2]. Breast cancer has been
identified as a major public health problem in both developed and developing nations because of its
high incidence-prevalence, the over-burdened health system and direct medical expenditure [3]. Global
statistics shows that the annual incidence of breast cancer is increasing and this is occurring more
rapidly in countries with a low incidence rate of breast cancer [4–5]. Findings from Elima Jedy-Agba et al.
in 2012 [6] documented that the incidence of breast cancer in Nigeria has risen significantly with
incidence in 2009–2010 at 54.3 per 100 000, thereby representing a hundred percent increase in the last
decade. Some cases have been reported among women aged below 30 years in Nigeria [7]. This is
supported by the literature showing a rise in breast cancer incidence rates in Sub-Saharan Africa [8].
The high incidence of breast cancer necessitates the need for early detection because this would
increase the treatment options available to affected women and thereby improve survival rates [9].
Some studies have shown that in most of the developing nations and resource constraint settings,
breast cancer is diagnosed in advanced stages of the disease when compared with developed nations
and thus has a poor outcome and high fatality rate [1, 10–17].
Screening for early detection and diagnosis of diseases and health conditions is an important public
health principle [18]. Breast self-examination (BSE) is a check-up that a woman does by herself at home
to look for changes or problems affecting the breast tissue. BSE is still recommended as a general
approach to increasing breast health awareness and thus potentially allow for early detection of any
anomalies because it is free, painless and easy to practice [19]. The American Cancer Society [20] also
recommends that women, starting from the age of 20 years should be educated on the pros and cons of
performing a monthly BSE. For women to present early to hospital they need to be "breast aware"; they
must be able to recognize symptoms of breast cancer [21].
There are reports suggesting that factors related to women's knowledge and beliefs about breast cancer
and its management may contribute significantly to medical help-seeking behaviours [21–22]. Recent
studies in Senegal, Angola and Nigeria [23–29] revealed a low level of awareness and knowledge on
breast cancer risk factors and its early warning signs. Lack of understanding of the risk factors associated
with breast cancer discourages people from seeking early intervention or even to admit that symptoms
they may be experiencing are related to breast cancer. As such there is need for a study to assess
knowledge and beliefs about breast examination BSE and risk factors among women in our
communities. This study therefore aimed to assess the knowledge and beliefs of breast self-examination
and breast cancer among market women in densely populated markets in Ibadan, Oyo State, Nigeria.
Methods
Ethics
Ethical approval was given by the Oyo state, Ministry of Health Ethics Committee in August, 2012.
Participant information was anonymized and de-identified prior to analysis. Informed consent was
obtained from the participants aged 15 and above. The named ethics committees approved the consent
procedure in addition to the study protocol.
A cross-sectional study was conducted between July to October 2012, in order to assess knowledge and
beliefs on BSE among women selling in a few major markets in Ibadan, Oyo State, Nigeria. Major
markets were purposefully selected and subsequently consented participants were interviewed from
each of the market. Ibadan is the largest indigenous city south of the Sahara and is the capital of Oyo
state, Nigeria. It has a population of about 2.6 million people [30]. The study population comprised of
603 women selling at Oja-Oba, Agbeni, Bode, Oje and other markets in Ibadan. These markets are the
major markets in Ibadan. These women constitute eighty-percent of all traders selling in the selected
markets. They sold mainly food items such as meat, pepper, vegetables, provisions, raw rice and other
food stuffs.
Sample size calculation
1. Estimate of the expected proportion (p) of knowledge of breast self-examination among market
women = 0.5
2. Desired level of absolute precision (d) = 0.05
3. Estimated design effect (DEFF) = 1.5
1. 4. Assuming 4% will declining to participate in the study
Minimum sample size = 576.24 + 23.05 = 599 participants
Data was collected using interviewer administered semi structured questionnaires on socio-
demographic characteristics, knowledge, attitude and belief of participants after obtaining written
informed consent. Data was entered and analysed using statistical package for social sciences (SPSS)
version 20. Descriptive and Chi-square statistics was employed in analysing the data.
Results
Socio-demographic profile of participants
A total of 603 market women were recruited. Table 1 shows the socio demographic profile of the
respondents. There was a fair distribution of the women recruited at the various markets.The mean age
of the respondents was 34.6±9.3 years. The highest proportion was aged between 30–39 years. The
majority of the participants were married 497/603 (82.4%).
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Table 1. Socio-demographic profile of study participants (n = 603).
https://doi.org/10.1371/journal.pone.0140904.t001
Knowledge about how to perform BSE
More than three-quarters of the participants responded to knowledge on how to perform BSE.The
majority of participants 425 (70.8%) reported that they did not know how to perform BSE, while only
29.2% reported that they do.
Knowledge about how to perform BSE was slightly higher in participants who came from Oja-oba-
market (37.6%) followed by those from Agbeni, Bode and other markets with level of knowledge all
above 25% except in participants from Oje market. Very few participants were recruited in the ages
below 20, and 50 years or above. Therefore the latter will not be considered further in this discussion,
only ages 20–49 years will be reported. The percentage of participants who reported that they knew
how to perform BSE increased with age in participants up to 49 years; with age group 40–49 years
(40.4%) being the highest, followed by 30–39 years (32.0%) then 20–29 years. Married participants had
a higher knowledge of how to perform BSE than single participants. Knowledge of BSE was correlated
with educational level (Table 2), and there were 8.0% of the women with no formal education who
reported they did not know while about close to 7% of the study women who had post-secondary
education reported to have knowledge. There was a statistically significant relationship between
educational level and knowledge on how to perform BSE (p<0.0001),(Table 2).
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Table 2. Knowledge about how to perform BSE by socio-demographics of study responders.
SBE: self-breast examination
Knowledge about when to perform BSE
In total 271 participants responded to the question of when is the right time to perform BSE. Only 8.1%
of these knew correctly that ‘mid-cycle’ was the right time to perform BSE.The highest proportion 219
(80.8%), reported incorrectly that the right time for a woman to perform BSE was ‘anytime’. Although
below 10%, a large number of women who knew when to perform BSE came from Oja-oba market
(8.3%) compared to the other three markets. However, these differences were not statistically
significant. Knowledge about when to perform BSE decreased with increasing age showing a slightly
higher level of knowledge in the 20–29 year olds than in the 30–39 and 40–49 year age groups(p<0.00).
Compared to married, a double percentage of single women knew when to perform BSE. The level of
knowledge about when to perform BSE was higher among post-secondary education (15.1%) while
among other groups it was less than 10%. These differences were not statistically significant (Table 3).
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Table 3. Knowledge about when to perform BSE by socio-demographics of study responders.
About two-third (61.7%) of the study population strongly agreed that BSE is a screening method for
breast cancer. About 28.5% agreed that fear of detecting breast cancer would make them not practice
BSE, while more than 50% strongly disagreed with this statement. The majority of the women strongly
disagreed that SBE should be done ‘only if you feel abnormal around your breast’. There was similar
responses of participants who strongly agreed or disagreed about postures for SBE (Table 4).When
asked about their beliefs on breast cancer, there were varying responses (Fig 1). Many of the
respondents had a fair knowledge on the effects of the burden of breast cancer and that the hospital
was the place they would refer someone for diagnosis and treatment options (Fig 2).
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Fig 1. Venn diagram showing beliefs of market women about breast cancer.
https://doi.org/10.1371/journal.pone.0140904.g001
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Fig 2. Graph showing the likely referring points of care by the market women.
https://doi.org/10.1371/journal.pone.0140904.g002
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Table 4. Distribution of the study respondents according to their knowledge, attitude and beliefs
about breast self-examination (n = 603).
Discussion
The present confirm findings from studies conducted in Nigeria over the past years, on BSE and breast
cancer among women in the south-east [31], south [29, 32], south-west [33–35] and north [36] of the
country. All these studies showed that knowledge on BSE as a screening method for breast cancer and
on the right time to carry out BSE was very poor. The only contrast in the present study is that
knowledge about postures involved in preforming BSE was good.
Important knowledge deficits can have a detrimental impact on the education of women on screening
practices and attitudes of women in the adoption of early detection practices [21]. A correlation may
exist between level of education and breast cancer knowledge [37] educational level and marital status
as predictors of (CBE) and (BSE) [28,38]. Two studies in Nigeria indicated that education and
employment in professional jobs significantly influenced knowledge of breast cancer [21,39]. Our study
revealed significant differences between the respondents’ market area, age up to 49 years, marital
status and educational level and their knowledge on SBE.
Assessment of the participants’ knowledge, attitude and beliefs showed that majority of the
respondents reported that the right time to perform self-breast examination was ‘anytime’ and majority
also disagreed that BSE should be done only when they feel abnormal around the breast. Some of the
respondents reported that they would not practice BSE because they are afraid of detecting any
evidence suggestive of breast cancer. In addition, findings from the study reveal that most of the study
population have heard of breast cancer as a disease and self-breast examination as a screening method
but there is still inadequate knowledge and understanding of the disease and its screening method.
These findings are similar to the study among market women in Abakaliki (south-east Nigeria) by [33],
women in south-west Nigeria by [28,33–34], women in Federal Capital Territory of Nigeria by Banning
and Ahmed [40].
There is a great need for more awareness campaigns, advocacy to improve the knowledge of self-breast
examination directed towards women of low socio-economic status and people at the grassroots levels
in the country. This will ensure early detection and intervention to prevent mortality due to breast
cancer.
We conclude that knowledge about how and the time to perform BSE among Nigerian women working
in the markets in Ibadan, south west Nigeria is very poor, particularly among women who are single,
young with a low level of education after controlling for confounders. Similarly, few participants had
strong negative beliefs towards breast cancer. Any interventions aimed at improving the knowledge
about BSE and breast cancer screening should target these groups. Such interventions should be
evaluated to ensure their success in improving women’s health.
The quantitative nature of our study limits the extent to which the information reflects the nuanced
views of respondents. A qualitative interview would have allowed a deeper understanding of the
perspectives of the respondents.
Supporting Information
S1_Questionnaire.pdf
figshare
download
S1 Questionnaire. BSE_SEMI_STRUCTURE QUESTIONNAIRE
https://doi.org/10.1371/journal.pone.0140904.s001
(PDF)
Acknowledgments
We acknowledge the efforts of the research assistants and all those market women who gave consent to
participate despite their busy time for buying and selling.
Author Contributions
Conceived and designed the experiments: KEO OO FCI. Performed the experiments: KEO OO FCI JMT MT
CA HSB OA OJ. Analyzed the data: KEO OO JMT OA OJ. Contributed reagents/materials/analysis tools:
KEO OO FCI JMT MT CA HSB OA. Wrote the paper: KEO OO FCI JMT MT CA HSB OA OJ.
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Knowledge, attitude and practice of breast self-examination among nursing students in Lagos University

Teaching Hospital, Nigeria

AA Yakubu1, MA Gadanya2, AA Sheshe1

Date of Web Publication 6-Sep-2014

Source of Support: None, Conflict of Interest: None

Keywords: Breast self-examination, female nurses, Kano, knowledge

How to cite this article:

How to cite this URL:

Materials and Methods

A self-administered pre-tested and structured questionnaire was administered. The questionnaire

Table 1: Socio - demographic profile of respondents

Click here to view

Attitude towards breast self-examination

Table 2: Depicts the distribution of BSE practice among respondents

Click here to view

Click here to view

7. Gould-Martin K, Paganini-Hill A, Casagrande C, Mack T, Ross RK. Behavioural and biological

19. Haji-Mahmoodi M, Montazeri A, Jarvandi S, Ebrahimi M, Haghigat S. Breast self-examination:

I NK, O OA, A RA, B RB, O AT

attitude, breast cancer, breast self-examination, knowledge, practice

Table 1: Demographic profile of respondents

Table 2: Respondent’s knowledge of breast cancer and breast self-examination

Table 3: Attitude of respondents to breast self-examination

Table 4: Respondents’ practice of breast self-examination

What is known about this topic

What this study adds

 Narrows awareness, knowledge levels and practice to a group of undergraduate teachers;

The authors declare no competing interest.

Figure 1: distribution of participants according to sources of knowledge about breast cancer

Figure 2: reasons for not performing breast-self examination

4. Anderson B, Shyyan R, Eniu A, Smith R, Yip C, Bese N. Breast cancer in limited-resource

16. Oladimeji K, Tsoka-Gwegweni J, Igbodekwe F, Twomey M, Akolo C, Balarabe H. Knowledge and

25. Nemenqani D, Abdelmaqsoud S, Al-Malki A, Oraija A, Al-Otaibi E. Knowledge, attitude and

28. Alharbi N, Alshammari M, Almutairi B, Makboul G, El-Shazly M. Knowledge, awareness, and

Cite this: The Pan African Medical Journal. 2017;28:91. doi:10.11604/pamj.2017.28.91.10986

Received: 19/10/2016 - Accepted: 16/09/2017 - Published: 29/09/2017

 Kelechi Elizabeth Oladimeji ,

 Hadiza Sabuwa Balarabe,

 Published: November 25, 2015

2. Desired level of absolute precision (d) = 0.05

3. Estimated design effect (DEFF) = 1.5

1. 4. Assuming 4% will declining to participate in the study

Minimum sample size = 576.24 + 23.05 = 599 participants

Socio-demographic profile of participants

Table 1. Socio-demographic profile of study participants (n = 603).

Knowledge about how to perform BSE

Table 2. Knowledge about how to perform BSE by socio-demographics of study responders.

SBE: self-breast examination

Knowledge about when to perform BSE

Table 3. Knowledge about when to perform BSE by socio-demographics of study responders.

SBE: self-breast examination

SBE: self-breast examination

S1 Questionnaire. BSE_SEMI_STRUCTURE QUESTIONNAIRE

16. 16.Sadjadi A, Nouraie M, Ghorbani A, Alimohammadian M, Malekzadeh R. Epidemiology of

30. 30.National Population Commission census. 2006.

Knowledge and practice of breast self-examination among sample of women in Shatra/Dhi-Qar/Iraq

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