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Awareness and Prevention of Breast Cancer Among Reproductive Women

Assessment of Level of Awareness and Prevention of Breast Cancer Among Reproductive Women (15-45years) Attending Federal Teaching Hospital Abakaliki

This chapter deals with the review of literature related to the study, the related literature to the study were discussed under the following headings;

  1. Conceptual framework
  2. Causes of breast cancer
  3. Clinical magnifications of breast cancer
  4. Stages of breast cancer
  5. Preventive measures of breast cancer
  6. Awareness of women about breast cancer
  7. Theory related to the study
  8. Empirical review of the study
  9. Summary of literature review

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 CONCEPTUAL FRAMEWORK

Causes of breast cancer

Breast cancer is a formidable health threat to all women population, which is a serious disease that impose a challenge and important investment in the health of future generations of women (Gursoy et al, 2009).

According to Brunner and Suddarth’s (2008), breast cancer has no specific cause but believed to be caused by the following predisposing risk factors namely;

  • Female gender
  • Increasing age
  • Personal history of breast cancer
  • Family history of breast cancer
  • Genetic mutation
  • Early menarche
  • Late menopause
  • Nulliparity
  • First child after 30years of age
  • Hormonal therapy
  • Exposure to ionizing radiation during adolescence and early adulthood
  • Obesity
  • Alcohol intake
  • High-fat diet

Gender and age of breast cancer

Being a woman is the most obvious risk factors for breast cancer, 99% of the cases occur in women and incidence is low in male. The increasing age is also associated with increasing risk of breast cancer, the risk greatest after 50years of age and low before 40years of age (Brunner and Suddarth’s, 2008).

Genetic mutation and family history of breast cancer

Recent studies have shown, that about 5% to 10% of breast cancer cases are hereditary as result of gene changes called mutations (Muhammad, 2007). The most common mutations are those of the BRCA-1 and BRCA-2 genes, are tumor suppressor gene that normally function to identify damage DNA and thereby restrain abnormal cell growth. Mutations in these genes are responsible for the majority of hereditary breast cancer (Brunner and Suddarth’s, 2008).

Personal history of breast cancer

A woman with cancer in one breast has a 3-4 fold increased risk of developing a new cancer in the other breast or in another part of the same breast (Watson, 2007)

Nulliparity and first birth at late age

The early menarche before 12years of age, nulliparity and first birth after 30years of age and late menopause after age 55years of age are major risk factors of breast cancer. The mechanism of these factors appear to involve repeated exposure to estrogen during menstrual cycles (Brunner and Suddarth’s, 2008).

Hormonal replacement therapy

It has become clear that long-term use of post-menopausal hormone therapy, particularly estrogen and progesterone combined increase risk of breast cancer (America Cancer, Society, 2010).

Alcohol and cigarette smoking

The recent studies have shown alcohol consumption increases the risk of breast cancer. Through the metabolism of alcohol into acetaldehyde by alcohol dehydrogenase. The elevated value of active acetaldehyde could lead to high risk of various cancers especially breast cancer (Ji Jia Zhu and Yin Qing Hu, 2010). The women smokers are at high risk of developing breast cancer (Watson, 2007).

Obesity and high fat diet

High fat might raise the value of circulating estrogen which can stimulate the growth of malignant cells in breast tissue. The obesity increased body mass index has associated with increased breast cancer risk (Brunner and Suddarth’s, 2008).

Clinical manifestation of breast cancer

According to Brunner and Suddarth’s (2008), early breast cancer is usually symptoms less, however, there are some symptoms develop as the breast cancer advances. The breast cancer symptoms include

  • Breast lump or mass
  • Breast lump is usually painless, firm to hard and irregular borders.
  • A change in the size in shape of the breast
  • Abnormal nipple discharge such as bloody or clear to yellow or green fluid, may look like purulent
  • Change in the colour or feel of the skin of the breast, nipple or areola such as dimpled, puckened or scaly, retraction, “orange peel appearance, redness, accentuated vein on breast surface.
  • Change in appearance or sensation of the nipple such as pulled in (retraction), enlargement or itching.
  • Breast pain, enlargement or discomfort on one side only.
  • Pain and tenderness

Stages of breast cancer

Brunner and Suddarth’s (2008), the stages of breast cancer are the process the physicians use to assess cancer are the process the physicians use to assess the size and location of a patients cancer. The information obtained is required for the determing the optimal form of treatment. However, like other cancer breast cancer also have stages from 0 to stage IV. According to Brunner and Suddarth’s (2008), breast cancer is divided into O to stage IV according to the size and nature of spread (metastasis) they include stage O (carcinoma insitu): Carcinoma insitu is early stage of breast cancer, however, in this stage cancer has not invade into the normal breast tissue and is contained in either of the breast duct (ductal carcinoma insitu) or breast lobes (lobule carcinoma insitu). This type of cancer is not invasive and is not able to travel to the lymph nodes or other parts of the body.

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Stage 1: According to Brunner and Suddarth’s (2008), in this stage the tumor is larger than the stage 1 that means 2-5cm in diameter and it has not spread to distant parts of the body but it may or may not be spread to axillary lymph nodes.

Stage II (a): According to Brunner and Suddarth’s (2008), tumor size is >5cm in diameter but has not spread to axillary lymph nodes.

Stage III (b): According to Brunner and Suddarth’s (2008), tumor size is <2cm in diameter but has spread to less than 4 axillary lymph nodes.

Stage III: According to Brunner and Suddarth’s (2008), this stage cancer spread to axillary lymph nodes.

Stage IV (a): Tumor size is >5cm and spread to axillary lymph nodes.

Stage III (b): Tumor size is <2cm in diameter but the cancer has spread to axillary lymph nodes above the collar bones.

Stage IV: Tumor spread distant part of the body like bones, liver and kidney.

Prevention of breast cancer

Primary prevention

Muhammad (2007), the aim of primary prevention is to eliminate or modify established risk factors for developing breast cancer. However, some of these risk factors are genetically environmental and behavioural. It is usually impossible or difficult to alter or modify genetically and environmental risk factors like age, positive family history trace or ethnicity. But there are some behavioural risk factors like using hormonal replacement therapy and consumption of alcohol that can be altered. It is obvious that knowledge and awareness about the breast cancer can impact directly upon behavior leading to modify breast cancer risk.

Secondary prevention

Secondary prevention comprises the diagnosis and treatment of early cancer. It is proved that detection of breast cancer in an early stage has a potential value. Early detection could mean earlier diagnosis of symptomatic breast cancer as well as the detection of occult breast cancer through mammograph screening in an asymptomatic women. In 2007, the global summit consensus conference, recommended a step wise process for building the foundation for achieving earlier detection and their recommendations underlined the importance to promote the empowerment of women to seek and obtain health care; to create infrastructure of diagnosis and treatment of breast cancer and to promote early detection through breast cancer education and awareness. Their   also recommended that if recourse become available, early detection effort should be expanded to include mammography screening. However, programs for early detection have little value of if the existing health care services cannot provide proper breast cancer treatment, breast cancer treatment must be available, promptly accessible and affordable.

Awareness of women about breast cancer

Breast awareness is included that encouraging women to pay attention to their bodies and their own breast such as learning the appearance of breasts and recognizing any irregular changes (NLS, national Health Service, 2010). The basic knowledge associated with breast cancer awareness is looking and feeling of breast as well as routine self-examination (Ji Jia Zhu et al, 2010).

However, in a study by Gasalberti (2009), a low rate for breast self examination has been associated with not knowing how to perform, lack of awareness about breast cancer, lack of confidence in breast self-examination skill and time, fear of finding cancerous lumps and worrying about suffering illness as well as perceiving the performance as unpleasant  and embarrassing. In order to increase the women’s awareness of breast cancer and breast self examination, a helping relationship that includes social support from various sources was important (Park et al, 2007).

Funke (2008), pointed out that the long term in teaching breast self examination and breast cancer awareness in seminar had profound effects on women in carrying out this performance regularly and correctly without influence of age or education.

However, young breast cancer patients have a lower rate of survival than old breast cancer patients due to being diagnosed at advanced stage and the young women should pay more attention to breast awareness (Funke, 2008).

According to Muhammed (2007), education and awareness alone may contribute in a favorable shift in the stage of breast cancer at presentation and that the important aspect of awareness is the dissemination of knowledge about that breast cancer is curable if diagnosed early survival rat is good. Aburoma et al, (2010), stated that breast self examination along with clinical breast examinations and mammography have been recognized as screening modalities and beneficial components that raise  awareness of breast health in all women of child bearing age. Therefore, breast self examination is still commonly recommended by many health care workers as a non-invasion screening test for early diagnosis of breast cancer (Aburoma et al, 2010).

Breast self examination

Breast self examination is one of the primary methods for early detection of breast cancer (Ji Jia Zhu et al, 2010). According to Muhammed (2007), breast self examination is a simple and cost effective method of breast cancer screening. However, this breast self examination is formalized practice that a woman is taught to examine her own breast regularly (usually monthly after 20years). During the breast self examination, a woman systematically inspect, and palpate each breast using contralateral hand with her ipsilateral arm raised above her head, she perform the examination by both lying and standing position. According to him it is better to examine the breast in front of mirror so that she can inspect any sort of symmetry or dimpling. The breast self examination is done in an attempt to find out breast cancer earlier and reduce mortality.

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Several studies based on breast cancer patients retrospective self-reporting on their breast self examination have shown a positive relation with early detection of breast cancer and that most of the early breast cancer is self discovered.

On the other hand evidence from recent studies has raised the question of teaching breast self examination however, breast self examination may have great value in terms of awareness and motivating women to see a health care provider when they find a lump. Therefore, the earlier response to symptom may reduce the cancer stage of diagnosis. In addition, breast self examination may be an effective primary tool in breast health education.

Clinical breast examination

Clinical breast examination is a standardized procedure whereby a health care provider examine a women’s breast, chest wall, and axillae. The examination consist of

(1) Usual inspection of the breast while the women in upright position and her arms relaxes and then raised above her head

(2) Palpation of the axillae and (supraclavicular fossae when the woman in the upright position and

(3) Palpation of the breast while the woman both in upright and supine position.

The examiner inspects the breast usually for symmetry, skin of the breast, areola, and nipple for oedema, erythema, pulcerma, dimpling or ulceration, all of which can be evidence of underlying masses. The provider palpate the regional axillary nodes and enlarged hard, matted or fixed nodes can indicate cancer.

Clinical breast examination training is necessary as a key contributor to prompt diagnosis of symptomatic disease. In addition, it is likely to be used in areas where mammography examination is unavaialable.

Mammography

Mammography is the gold standard for early detection of breast cancer but there are two limitation of mammographic screening. One is cost and another is its technical complexity. As a result mammography is not recommended for countries with limited resources one criticism against mammography is false positive results which might lead to range of adverse consequences among women without breast cancer. That’s why implementation of mammographic screening also demands strong quality assurance (center’s for disease control and prevention, 2010).

Mammography acts as a major method in the field of breast cancer screening.

Theory related to the study

The theory applicable to the research work is situation awareness theory.

Situation awareness, according to Stella and Harden (2005), involves being aware of what is happening around you to understand how information, events and your own actions impact your goals and objectives both now and in the near future. However, having inadequate situation awareness has been identified as one of the primary factors in accidents attributed to human error (Sorathia, 2008), the most common theoretical framework of situation awareness is provided by Endsley, (2004). Endsley’s model illustrates three stages or steps of situation awareness formation. The stages include

  • Stage I – perception phase
  • Stage II – comprehension phase
  • Stage III – projection phase

Application of the theory to the research work

Stage I- perception phase: This phase is where one begins to have feelings about the status, attributes, and dynamics of relevant elements in the environment. Here, the individual begins to detect, monitor and recognize important occurrences in his environment. In this study, this stage is when the individual detects, recognizes and feels the need for awareness of breast cancer, mainly practice of breast self examination, which is important or relevant element for prevention of breast cancer. This is also the stage where a woman gets information and become aware about breast cancer and the various methods of early detection of breast cancer.

Stage II- comprehension phase: This is the stage where the woman recognizes, interprets and evaluates the information she received in stage I, and integrates the information to understand how it will impact on her goals and objectives. The women in the stage has recognized she stand to prevent breast cancer by regular practice of breast self examination on her own convenient time to enable her detect any breast problem early for prompt treatment.

Stage III- projection phase: This is the highest level of situation awareness and involves the ability to project the future action of the relevant elements in the environment. This stage is simply characterized by the woman’s acceptance of breast cancer awareness and practice of breast self examination and to recognize risk factors of breast cancer and avoid them.

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EMPIRICAL REVIEW OF THE STUDY

Irurhe et al (2010), conducted a study on knowledge and awareness of breast cancer in 200 female secondary school students in Nigeria and the result showed that 71% knew that breast can affect single breast while 29% had no idea. 74% were aware that it can affect both breast while 26% were not aware. 54.5% knew that early detected breast cancer is manageable while 45.5% did not know 51.5% believed that breast cancer may treated by surgery while 45.5% had no idea. 51% of the student knew that untreated cancer can spread to other part of the body while 49% had no idea. The result on breast self examination only 58.5% had heard of it while 38.5% never heard of it before.

Ji Jia Zhu and Yin Qing Hu (2010), carried out a study on awareness of reducing risks of breast cancer in 60 women in Finland and China. The study showed that finnish women 70% lead about the breast cancer while Chinese women 67% heard about the breast cancer. 8% finnish women and 92% Chinese women would like to do it. but I don’t know about it, one-fourth (15) of same women said that I know about it but I do not have time. Chinese women 100% said that I don’t know why I should do it while 0% finnish women chose the same option. 50% finnish women and 11% Chinese women said that it is not for my age group. 8% finnish women and 92% Chinese said I do not have enough information about it. 100% Chinese women and 0% finnish women chose the reason that I know about it, but I do not have time.

Mehrnoosh et al, (2010), conducted a cross sectional study on 262 among undergraduate female student at university putra Malaysia (UPM) to assess their knowledge on breast cancer and practice of breast self examination. They found that 36.7% of students who performed breast self examination while 63.3% of female who not performed breast self examination 57.5% were practice breast self examination occasionally. 82.7% of students knew that there is an association between family history and breast cancer while 16% and 16.9% of respondents knew about the relationship between uses of oral contraceptive pills, early menarche with breast cancer. 64.1% knew that nipple that turns in is not normal while 23.2% knew that there is an association on between nipple itches and breast cancer. 84% knew the name of different position for doing a breast self examination while 55.7% of student know about the appropriate age to initiate breast self examination and 32.1% of respondents know the optimal time for doing a breast self examination before menopause.

SUMMARY OF THE LITERATURE REVIEW

In summary, breast cancer is a formidable health threat to all women population and this is a serious disease that impose a challenge and an important investment in the health of future generation. The causes of breast cancer includes female gender, increasing age, personal history of breast cancer, family history of breast cancer, genetic mutations, early menarche, late menopause, nulliparity, first birth after 30years of age, hormonal therapy (oral contraceptive, exposure to ionizing radiation, obesity, alcohol intake, high-fat diet. The stages of breast cancer from stages to stage IV. The prevention of breast cancer that be primary and secondary, women’s awareness of breast cancer includes breast self-examination, clinical breast examination and mammogram. The theory related to the study is situation awareness theory. The empirical review of the study, this show that other studies conducted by their researchers revealed that the women of child hearing age have low awareness on breast cancer and there is increase in the prevalence of breast cancer. The researcher’s studies also showed that the subject have low knowledge concerning the factors that causes breast cancer and method used for early detection of breast cancer such as clinical breast examination by doctor,  breast self examination and mammogram this because of their educational background and sources of information regarding breast cancer.

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